An Inside look at Obstetrical Violence

Wednesday, March 31, 2021

An Inside look at Obstetrical Violence

(Derived from a podcast conversation with Tranquility By HeHe team members HeHe Stewart and Caitlin LeBeau in Episode 136 of The Birth Lounge Podcast, find it here!)

Have you ever heard the term “obstetrical violence” and wondered what it meant? Or maybe you envisioned this blatant act of disrespect or an assault of sorts. These are both examples of obstetrical violence, but there is another side to it, too. A sneaky side. We're going to share a few instances of medical manipulation in the birth room. Not always aggressive, not violent. And that is a tactic- they are trying to get you to do what they want. Which is so hard to say because we are conditioned to trust our doctors, we want to trust our doctors.

This isn’t about batting heads- this is about questioning, looking into research/evidence, looking into policies so you know if they are being influenced/pressured. Have that open communication if you can. You can say, 'That's not, evidence-based, I'm really only interested in evidence-based research and policy. If the hospital policy prevents you from giving me like the most current stuff, I would just appreciate you giving me that heads up. I understand you can't suggest that, but I would love if you would just let me know the last year that the policies of the hospital have been revisited.'

This should feel like a two sided convo. You can push back a little. they should be able to give you answers- and if they don’t you need to do that research on your own before game time.

Bait and Switch

But a bait and switch- which basically means, you earned my trust and then you tricked me. So heartbreaking because during the pregnancy, they were amazing. This one that we last had where the mom was overdue and went into an appointment and they basically had told her, 'You know, we're going to have to do an induction because your baby has passed 40 weeks and 2 days'. Which we know average first time mothers deliver most typically between 40-41 weeks.

So they went home, they did the research. They decided to try a natural induction method instead over the weekend first. After the weekend, they gave their doctor provider a call and the doctor said, 'Oh, we don't have any beds until Tuesday in the evening.'

What is that? If I NEEDED an induction four days ago and now I'm comfortable coming in for a medical induction, but your pushing it a day and plus? How does that make sense? I just can't handle being told that you need to have your baby without having gotten out of that window of where we know a first time baby is likely to be born around 40 plus 5. And then you have providers calling it a late baby or an overdue baby. And that is instilling fear in these parents, especially when you're at the end of pregnancy.

'This is a long labor...'

We had a birth recently that was going well at about 16 hours- we had just hit the mark where her provider said the baby could 'come at anytime'. Then shift change at the hospital happened. The nurse we we working with literally said to us, 'Be careful with the doctor coming on call.' How horrifying that a nurse felt compelled to warn us about the doctor that was coming into our space.

The doctor on-call comes in, says, 'Let's get you prep for a C-section.' This was the first time we were seeing the doctors face. They hadn't introduced themselves. Also, and most importantly, this is the first time we're hearing these words. You haven't even checked in with us on what is happening, what our birth goals are, how long, how long we've been in labor. It had been 16 hours. What happened? The fear that that doctor brought in the room and then said, 'Your labor is so long. I don't think this is going to happen for you, kiddo.' I feel nauseous thinking about those words. That is so rude and disrespectful.

16 hours is a long time, but is it a long time in birth? Not really, not at all. It's not even the average amount of time for a first time mother. But then you have a doctor coming in a doctor who sees this every day say, 'This labor has really taken a long time'. And birthing people start to question themselves.

If there isn’t an immediate emergency, you should be able to think things through. Catch that manipulation when it's happening and push back on it. Ask the questions that you should. Your doctors aren't always going to tell you everything unless you ask. It's all in your approach of how you say this. Don't try and catch them tripping up in a lie, simply say something like, Oh, I was thinking X, Y, and Z, because the research I had seen showed X, Y, and Z' or 'I was actually wondering if X, Y, and Z would be an option. I know you didn't mention it. But I was wondering if we could explore that or I have some questions if I might be able to use that or not'. Your approach is not you against them. That's not what this is meant to suggest.


But what can you do?

Your job is to take this preparation, evidence based knowledge, this idea of shared decision making and put it in your toolbox. Make sure it feels aligned with you. Make sure that it's evidence-based and then go for it. Take the time and come up with a couple of questions that you have. Even one question can spiral into a conversation or your doctor giving you more information. This information could shape the path of your birth.

You can go in being the calmest person ever to the hospital, and then you go in and you hear these medical providers talking nonsense around you, or just hyping you up in the wrong ways. You just completely forget about what was happening 10 seconds before that. You're just focused on what your nurses and doctors are doing or saying. Even them using bad language around you and not being mindful of the words they are using. It doesn't have to be intentional. Just be aware of this when you go into the hospital. It can be startling and alarming. 

You can also use this as an opportunity to remind your medical team to take conversations outside or to ask them not to have conversations over/around you. Sometimes all your doctors or nurses need is a reminder that they are negatively impacting the birthing persons space with their words. You can also ask for a new nurse or doctor when you feel like they are negatively impacting your birth.

If a doctor does comes barging in and says, 'Let's go, you know, time for a c-section'. You can say, 'We haven't decided right now if we want a C-section. We would actually like a few minutes'. And you know, if it's an emergency, they will be very upfront with you and let you know that there isn't a few minutes to spare. It's rarely an emergency C-section, but we don't have a word for non-emergency sections. We have scheduled C-sections and then we have emergency C-sections. We don't have any sort of like unplanned terminology. This was just unplanned. We gave it a try and it didn't work.

Birth as a Business

So if we want to look at this as a business, birth is a business. If you haven't seen that documentary, you1000% should. It is called 'The Business of Being Born'. It's will open your eyes to how much birthing people can be cash cows for hospitals. We can go from bringing in like a little bit of income to like being a major source of income depending on choices and pressures put on birthing people.

And you have to think for the typical hospital labor you're looking at less than $10,000. For a C-section, you're looking at $30,000 to $55,000. That's how we go from being a small stream of income to a main source of income for a hospital.

I don't want you to feel fearful of this. I want you to do your own research. There are things that are good for you to know. There are a ton of things that you can read, listen to, or watch to educate yourself on the business side of birth, which is important to know as a consumer, because it actually does impact you. It impacts their bottom line, but it impacts you your body and your life after this. It's not meant to be scary. It actually gives you a lot of power if you'll dive into it in the correct way.


Don’t forget to check out our newest adventure The Birth Lounge, listen in to The Birth Lounge Podcast, and follow us on Instagram at @tranquilitybyhehe and @the.birth.lounge!

Food First Nutrition with Ryan Kipping

Wednesday, March 24, 2021

Food First Nutrition with Ryan Kipping


Today Ryann Kipping, a Registered Dietitian Nutritionist, Certified Lactation Educator, and Author of The Feel-Good Pregnancy Cookbook is here to break down how to get the majority of your crucial vitamins and minerals from food first! So many foods can be solutions to problems that pop up in pregnancy--constipation, nausea, heartburn. Ryann is sharing how to find the perfect prenatal, how to spot 3rd party testing, and how to identify trustworthy brands!

Diet culture is crazy right now. It's hard enough to eat when you aren't pregnant to figure out what to eat when you aren't pregnant. Then when you throw a pregnancy in the mix there's like so much confusion. There's so many do's and don'ts floating around. One source says something and another source says something completely different. That is why I'm here- to clear that confusion and make you feel confident. Not only that, but just so you have informed decisions, because like I always say, I'm not trying to steer you one way or the other. I'm just trying to give you the science and give you the information. So you can make the best choice for you and your pregnancy, because with all these diets floating around out there, ultimately nutrition should be individualized. You shouldn't be following the exact same diet as your neighbor, right? We are all so unique and we all have different health backgrounds and nutrition concerns.

So at the end of the day, it's definitely going to be individualized to you. With that being said, of course, during pregnancy, there are nutrients that are super important and things we do want to focus on. So to start us off, I think that one nutrient that most people immediately think of when they think of pregnancy is folate or folic acid, which are commonly used interchangeably. We're talking about the same nutrient. They're just different forms of that nutrient.

Folate vs. Folic Acid

So folate is the kind that's naturally found in food and folic acid is the synthetic form. So folic acid is generally the more common type found in supplements. It's also the kind that food is fortified with. So whenever you see these like flour/grain based products that are fortified - it is with folic acid. So that means it wasn't naturally there. They companies and organizations actually took folic acid and put it in that food.

I like to give a little background here, because the reason they did that was that there was a lot of neural babies being born with neural tube defects. Folate is the nutrient that helps close the neural tube. So it's super important for baby's brain and spinal cord development. So they companies decided to fortify the foods that people eat the most with folic acid and we'll fix this issue- and they did. So we saw a major decline in neural tube defects, which was great. But to me, I'm thinking, is it smart to be promoting the increased intake of processed refined grains essentially? And I'm not saying we can not eat those things. Just to pull back a little bit. I'm not saying we can't include those. We just want to include them within moderation. So all that being said, my focus and my recommendation is to put the majority of our focus on natural sources of foliage.

So that's the folate that's naturally there in dark leafy, green vegetables, avocados, asparagus, citrus, fruits, nuts, seeds, eggs. There's a lot of ways you can get natural folate. So that's the kind I say, we spend the majority of our time focusing on and that's also the kind we should look for in supplements too. We want to pick a supplement that has folate versus folic acid because that's what the body prefers and it's absorbed better in the body.

Choline

So another nutrient we want to talk about is choline. Choline has been compared to folate and it's important, although it is a new, relatively new nutrient in the science world. So not many people talk about it and not many providers even know that it's so important. They haven't seen the research out there, especially, doctors that went to school in like the sixties before it was like even discovered, right?

So choline has been compared in pregnancy to folate. It's important in brain and spinal cord development. It's mostly found in eggs, specifically in the yolks. So I always like to say, make sure you eat the yolk whenever you're eating eggs, because a majority of the nutrients are in the yolk.

Iron

Iron is obviously super important too. I think iron is the second nutrient people think of when we think of what nutrients are important for pregnancy, because your risk of iron deficiency is extremely likely because your blood volume is continuing to increase as you get bigger and bigger. As baby grows bigger and bigger- iron is super important for overall development of baby. Also, just for you to have energy, because pregnancy is so hard and you experience fatigue a lot in the first trimester. And I mean, throughout the whole pregnancy, but iron is a nutrient that's super important to make sure you're maintaining your energy levels. Super important, if you are feeling super fatigued to get your iron levels tested. Cause that's definitely a red flag.

Testing is so important because not everyone needs iron supplements, sometimes providers will just put blanket recommendation out there. They'll just like list off nutrients. When in reality it should be individualized to you. And if you don't need to supplement with iron, you shouldn't. It can cause stomach issues and constipation and things like that. So if you don't need to supplement with iron, if your levels are looking good, then we don't need to put you through that. So test, if you can. If your iron levels are looking good then I would honestly recommend finding a prenatal without iron because for lot of people, it does cause constipation and things like that.

There's different forms of iron, too. So if you are someone who does need iron try different forms of iron. Try food first, I'm totally a food first dietician. So the best way to increase your iron levels is by through food. So definitely work on increasing high iron foods. There's heme iron and there's non-heme iron. Heme iron is the kind that's better absorbed by our bodies and that's the kind that's found in animal products. So that's kind of where we want to put our majority focus is getting iron from animal products. Ideally from red meat, chicken, those kinds of things. You can include plant sources too, those aren't going to be like the best to increase your levels. Spinach is one of the best sources of iron from plants. Pumpkin seeds are great too. My final tip is to pair them with some source of vitamin C, especially with the non-heme sources because vitamin C will enhance iron absorption.

How much should we be eating to know we're getting enough from food?

So I say food first because ideally we want to strive to meet our nutrient needs through food. Then use supplements as an insurance policy that we're getting everything that we need. So a prenatal vitamin is not going to provide everything you need. It just doesn't. And it won't. So you have to think about your food. There are certain times in life that I think it's necessary to supplement and pregnancy is one of those times because your needs are heightened.?Your needs are higher for nutrients than they will likely ever be in your life during pregnancy and breastfeeding. Your needs are so high, so it can be challenging to meet those nutrient needs, especially if you're like a smaller person and you don't eat that many calories.

So if you are eating around 1600 calories, you won't be able to meet your nutrient needs because you're just simply not eating enough food. So in that case you definitely need to be taking a well-rounded prenatal vitamin. I have worked with people that don't want to take anything that they don't want to supplement with anything. I say maybe we can just take a few like individual nutrients to make sure you're good to go, but yeah, if you don't want to supplement- you're going to have to be really on top of your planning.

You're just going to have to be able to run through the nutrients in your head and look at your days and plan them out. You can't just like wing it and go by the fly. I think we should all do a little bit of planning, even if we are taking a prenatal vitamin, but pregnancy is hard too, right? There's so many ups and downs. There's morning sickness, heartburn, fatigue. There's so many things that you're going to go through that make it challenging to stay on top of your nutrition. We just want to make sure we're doing the best we can.

How Do we Know What Prenatal to Pick?

So I always say, I wish that people spent the amount of time and money on their nutrition and food and planning versus the time they spend on finding supplements and spending money on supplements, because truly the food you eat is way more important.

So just to preface it with that, however, we do want to find a supplement that is quality and that is going to work. The number one thing to look for is if the brand is third-party tested. So essentially that means they've paid a third party to take their supplement, run it through tests, to make sure that it is free of certain harmful things. That what they're saying is in there, if they're saying so much of a certain vitamin in there, that that is actually true.

It's pretty apparent if this is something that they have done. They usually have stickers that will say, 'third-party tested' on the bottle. If you're doing online research, usually it's clear on their website. That's definitely a good way to know if they're a quality supplement brand.

You definitely want to do your due diligence. People are always asking, which one do you recommend? Which one do you recommend? And I never bulk recommend one, because that really doesn't make any sense. It should be individualized. There's so many factors that come into play, but of course always third-party testing.

Nausea and Prenatals

If you think it's your prenatal vitamin that's causing the nausea, I would definitely say changing your prenatal vitamin and trying another. You can also try taking it with food, because that can absolutely help. There are also gummy or powdered versions of prenatal vitamins. If you have one that's a large pill, you can absolutely cut it and break it up to see if that helps too.

So there's just a lot of options when it comes to that. Again, considering what is in your prenatal- iron could be causing some nausea too. So do you need iron? We can look at that. And then nutrients that specifically help with nausea. Magnesium and vitamin B6 can definitely help. I'm going to bring up the point that we do want to try food first. We want to try more natural options. So we want to try increasing our food intake of high magnesium foods, high B6 foods. We want to try ginger, ginger tea or anything like that smells like lemon, eucalyptus, or lavender. If none of those things are working, we can talk about supplements. Your doctor might also want to talk about medications like Zofran and things like that for nausea.

There are so many options out there to help you manage morning sickness and nausea. So try everything. And you never know what might work. A lot of times too, women will say the only thing they can tolerate is carbs. You want to be able to eat something. Some calories is better than nothing at all. But I usually say is try to follow them up after with some source of protein. So, if you can eat a piece of plain toast and then maybe 30 minutes later, have some nuts, a piece of chicken, or have a piece of cheese. Something that has protein and fats in it. So you're getting some other nutrients that will be better to manage your blood sugar, all of those types of things.

Constipation in Pregnancy

As far as constipation goes, the two things we want to focus on are fiber and fluid. So increasing fiber foods, like cooked vegetables. Vegetables in general, but cooked is usually more advantageous because women often experience bloating and gas in pregnancy. So cooking vegetables can help with that. Fruits and vegetables are really high in fiber. Apples, brussel sprouts, lentils, chia seeds. Chia seeds are unique in that they can actually help with diarrhea and with constipation. You do want to make sure anytime you're increasing your fiber, you also increase fluids because it could make you more constipated.

What about Heartburn in Pregnancy?

One of the best things I say is walking after a meal, I know that's not super food related, but walking gets your digestion going. So the worst thing you can do after a meal is lie down. So don't lay down on the couch after a meal, because you're only like helping gravity pull that acid back up your esophagus. So at the least you want to sit up straight on the couch and work on your posture to make sure digestion is moving. But best case scenario, you go for like a 10 to 20 minute walk after you eat.

So you can eat small frequent meals throughout the day can really help your body is having a hard time, digesting it all. Trigger foods is another and super important tip. A lot of people have that one or two food, food groups, or specific foods that will trigger it. A lot of times it's tomatoes because they're super acidic. So it's important to find what your trigger food is. Sometimes dairy will help, but some people say that dairy makes their heartburn worse. So again, it's individualized and you just kind of have to figure out what helps your heartburn and what are your triggers. That way you can avoid that food or minimize it.

Healthy Fats

Fats are super important and fats do not correlate to the fat on your body. So I think that that's definitely something we want to bust as a myth. Your baby's brain is like 60% fat and it's being made from scratch. So you definitely need healthy fats. And then to that point as well, your need for fat soluble vitamins increases during pregnancy. So you have to eat fat for your body to absorb those vitamins. So it's super important that you have healthy fats in your diet.

So very specifically in oils like cooking oils, we want to do our best to avoid processed vegetable oils. Instead use like avocado oil, extra virgin olive oil, real butter, coconut oil is fine. Also nuts and seeds, avocados, olives, the fats that are naturally found in meats, fatty types of fish. Definitely lots of healthy fat options. We also don't need to limit our fat in dairy. I actually recommend full fat dairy during pregnancy.

If you're lactose intolerant and you can't eat dairy at all, that's okay. Dairy is a huge source of calcium, but there's plenty other foods that have calcium. You just have to kind of be a little more cognizant of like where your calcium is coming from.

Most milk alternatives can all generally fit in your prenatal diet. You just want to be aware of what nutrients you're missing and where you're getting those nutrients. Because most of those milks don't have protein like cow's milk does. So those aren't going to be a source of protein for you. They aren't going to be a source of B vitamins like cows milk is they aren't going to be a source of B12. So if you are choosing like a plant-based milk, we do want to try to pick one that is fortified with some nutrients. Dairy can be a source of vitamin D one of the only sources of vitamin D, because vitamin D is so hard to get from food. So that's another nutrient to think about. Dairy as a major source of iodine. So there are definitely nutrients you want to kind of think about if you are not including dairy in your diet at all.

Looking for more? You can find Ryan at https://www.theprenatalnutritionist.com/.  She has also created The Prenatal Nutrition Library, which gives you clear answers to guide you through a healthy, feel-good pregnancy using food first.  She has also shared her Recommended Grocery List! You definitely want to check out Ryann's resources if you are trying to conceive, pregnant, or even postpartum as you try to balance your nutritional needs! 

The Beginning of Home Birth with Kaitlyn Fusco

Wednesday, March 17, 2021

The Beginning of Home Birth with Kaitlyn Fusco


Today, we are chatting with Katelyn Fusco, Host of Happy Home Birth Podcast. We are covering home birth and how birth has transformed over the years. Katelyn is sharing who is right for home birth and the top home birth myths. We are also diving into stickier topics like the business side of birth and how legislation can impact women’s health. We shine a spotlight on consent and continuity of care as well. I'll hand it over now for Katelyn's thoughts!

We are so ingrained now, especially in the United States, to think that birth is a medical event that just has to take place in the hospital. I mean, that's just in our minds. I know growing up, that's how it was for me. My mom had all three of her children as C-sections. So when I was growing up, I thought, 'Okay, well, I'll have C-sections for my babies. Birth is surgery the end'. I don't think I'm alone in that whether, you know, you were born from a cesarean section or however you got here, it's very likely that you grew up thinking that birth was a medical event. It's kind of crazy because we haven't even had hospitals for that long. So the fact that birth has transitioned from something that was just a it's kind of like the extraordinary normal, you know, like birth is extraordinary, but it is normal. It's transitioned from that to something that we have to have like flashing lights and warning signs.

Let's go ahead and start back. I mean, biblically look in Genesis, midwives are mentioned in Genesis. Like this is from the very beginning we have been giving birth and women have been supporting other women in birth. So this is not new. Midwifery is not some new age woo-woo thing. This is literally from the beginning. So I love to start there. I also like to talk about the fact that when in the past we were giving birth, it was not so isolated. So now, even if you have a doula, even if you have your partner with you, you are going into a hospital typically where you're giving birth. And it is a teeny, teeny, tiny little group, maybe, maybe a threesome. You, your partner, your doula- it's a small group that we're giving birth with. Back before the hospital and before this became the norm birth was a community event. We were growing up seeing women give birth hundreds of times before we gave birth. Seeing, 'Oh, wow, this, this works. Of course, this is what we do'. Moms, sisters, aunts- were at the birth together- we were all there and we were all supporting the person giving birth. So birth wasn't this crazy shocking thing and we knew our bodies were made to do this. We knew that we were created, we were designed to be able to give birth.

That doesn't mean that every single time it goes perfectly, of course birth is wild. It is a wild event, but it is something that is not supposed to be just deeply in our bones that we're fearful of. I think that that is the biggest issue is there's just become this shift, especially in the United States. If you compare our maternity system to other places, you know, it is so different. Home birth is, is highly more common in other countries. The way that The American Medical Association formed, it was a business. One of the things that they did was instead of working with midwives, it was, 'These people are not educated. We are educated'. So they realized that they could trash these midwives who had decades and centuries of knowledge passed down one to the other one to the other, you know, these amazing established communities. There were smear campaigns and they talk about this in the 'Business of Being Born', which is a great documentary. I actually spoke to a midwife, my friend Janell, about this and about how there were actually transcripts in Varney's midwifery book from the AMA where they were talking about how they were going to convince the public, that midwives were not quality even though they knew and acknowledged that their outcomes were worse than those of midwife attended births.

How did we get from a primarily home birth to hospital?

It started off where doctors had become prevalent as a career, but birth was left untouched there for a minute because that was, that was woman's work. Then they realized, 'Wait, hold on a second- we could make money out of this'. So that is what happened. It did start at home. Doctors did begin attending births at home, but the shift to the hospital was massive. It revolutionized everything, because it turned into, 'Why would you have your baby in your home? It's dirty, it's unclean. It's unsterile.' It began like, 'Oh, I'm going to be fancy. I'm going to go to the hospital to have my baby.' Then it filtered down throughout society and became the norm. like, Oh, well, you go to the hospital.

It was not like the hospital today, like women were going into the hospital, but their partners were not with them. They were going into these back rooms. We don't know what happened. The partner has no idea what's going on. They would use like sheepskin wraps around their arms so that when they were held down with all of these drugs, they wouldn't leave marks. The drugs that they were giving them actually didn't help with pain management at all. It was knocking them out. They're basically in and out of consciousness this entire time. Do you think it's easy to have a baby that way? It is not my friend. It's just disturbing to think how behind the times they were with their practices, as opposed to what was going on in the community beforehand, when using midwives, you know? The hospital was seen as the safe option, but in reality, if you looked at what was going on it was the last place you would want to be.

Understanding Your Home Birth Options

So many people have no idea that home birth is an option. Hw can you have informed consent when you don't know all of the options? When it comes to home birth, it's not talked about a lot. 1% of the population gives birth at home right now in the United States. 1% that's, that's teeny. But my thought, and the reason that I created the Happy Home Birth Podcast is it would be a lot higher if people knew that it was an option and that it was safe.

That's where we need to be going. No home birth is not for everybody. Home birth is for low risk mothers. The majority of people do fall into that category over 90%. So 90% of people would be safe to have a home birth. That doesn't mean that they would be comfortable. That doesn't mean that I'm saying, well, you, if you're low risk, you just should, but that the safety factor is there. The great news is that midwives, you know, if, if you're choosing to use a midwife, they are trained in low-risk birth. There they are so competent at assessing what is and is not low risk. If you ever crossed that threshold of safety they will go ahead and transfer your care over. This would be the appropriate time to transfer care.

Also, it's important to note that though, there are different types of midwives and they do practice in different ways. Typically there is an overseeing type of provider that will also be able to check off and say like, 'Yes, you are low risk. You are qualified for a home birth.'

But your house is so...germy.

As the research with the micro-biome has just taken off in the last few years. We are realizing that theory of all germs being bad and scary and dangerous, it's just not accurate. The other neat thing that's going on with the micro-biome is that we're learning a lot of people have always assumed the placenta, the amniotic sac is sterile, but it is not. We are finding there is bacteria already there. So when the baby's not in this sterile vacuum, they're already being exposed to your microbes, to the microorganisms inside of your body. So they are already attuned to the environment. So it's kind of cool to think about the fact that, 'Okay, we are giving birth in the place that we created the baby- the place that we have grown and nurtured this life- we're giving birth to that new life in this atmosphere.' Is that not actually the safest place t be? We're not exposing them to something new, we're exposing them to the friendly things that they've already grown accustomed to.

Let's talk about the business of being born. What do pregnant people need to know to be informed?

The first thing I think is the most surface and the easiest for us to wrap our minds around. So 99% of people are giving birth in the hospital? A large percentage. It's busy, OBGYNs are busy. So the first issue is that the way that this system has been created. You go in for your prenatal care and the majority of your appointment is not with your doctor. The majority of your appointment is sitting in the waiting room. Is there a lot of education going on between you and your provider? Not often.

The other question is, is how often are you seeing the same person? How often are we having continuity of care? We don't know who the heck is going to show up when we're having our baby. So there's overcrowding of practices. There are so many patients coming in. There are so many doctors to take care of all of those patients. And of course they want to grow a business. They want to be able to add more doctors to generate more money. So these practices are getting larger, larger, larger.

There's no time for connection. It's not even that it's this evil situation or intentionally evil. It's that it's just a busy place. So we're going to get in, we're going to do what we got to do and we're going to get out.

The second issue that we could discuss is the fact that these obstetricians are well-versed in surgery, right? That's what they went to school for. However, do we need to be looking for pathology in every single birth? No, we don't because like I said, 90% of us are low risk. And then of those 10%, how many actually need a c-section? It's a very small percentage of the 10%. Which is not what we're seeing across the country.

We're putting these people who are trained to see pathology and who are trained in surgery in a situation where they're not really needed. It doesn't make sense that their job is to care for all pregnancies. And, if you look at other places, that's not how they divvy up the responsibilities. Midwives are taking care of the majority of low risk clients.

We've got another situation to consider: How are we looking at birth? Are we looking at it as a normal event? Or are we looking at it as a pathology?

When it comes to laws, most doctors, have a three year period where somebody could sue them. When it comes to OBGYNs it's 21 years. because they can look back and say, 'Oh, well, they're having this issue that's related back to birth.' So obstetricians are legally in a tough place. They can get in a lot of trouble. And so it's a lot of money to cover them insurance wise. They really want to prove that they did every single thing that they could do to get that baby out safely. So if there is even the slightest of like, 'Oh, well the heart rate went down for just a dip- take her to surgery.' Let's do, do, do to prove that we did everything, everything that we could to make sure that this baby came out safely the end. What that leads to, is it way more intervention than is actually necessary.

We add these three pieces up and it's kind of scary if we're not super confident in our care provider. If we don't feel that we are completely aligned with them and that they totally understand where we are and see our pregnancy as an individual and unique pregnancy.

I think that it's so easy for us to say, 'Oh yeah, OBs are the worst. Doctors are just awful.' And that's of course that's not true. It's just like any other profession, we've got great ones. We've got ones that are in it for the right reasons. And then we've got trash. Some humans just don't care as much. That's the reality. It's important for us to remember that. These people, these people are people and they are doing their best even if it is misguided.

The other issue that I didn't touch on is the fact that the information that they are working on is outdated. It takes so long for information to be trickled down to practice. So ACOG might come out with a statement about episiotomies. It'll take 25 years for a episiotomies to not be done. It takes that long for things to go down into practice. These doctors are so busy. They went to medical school 25 years ago. They learned the stuff in medical school. And now they're in the trenches. Their head is down. They're working on these massive patient loads. They're in the hospital, they're in their clinic. It's busy. Do they have time to sit down and read like the evidence based birth website all the time? No. So we are there, they're practicing on with, with standards that are just outdated.

That's one of the most frustrating parts to me. If you are going to be dealing with people's lives and the lives of their babies, you just have to care, there's no other way around it. You're going to have to find the time you said you would. You promised. You took an oath to take care of people- to give them the best care. And that's truly how I feel. I hold myself, my doulas and, my team to that same standard. We're not medical professionals. And I get that. They are 1000% busier than we are, but you promised as an OB to take care of people and you've got to do that. It's one of the priorities.

We are consumers of this broken system. We have to start saying, 'Listen, I'm not going to accept this.' That's a lot easier said than done, but I will give a great recommendation- 'Shared Decision Making: Bring Birth Back Into The Hands Of Mothers' by Dr. Brad Bootstaylor. He talks about the fact that you've got to hold your care provider accountable. To be upfront about the the things that you are looking for in your care provider. So you can see if you are an ideal fit. Now, the important thing for us to remember is, like I said, a lot of these practices have how many providers? We need to make sure that all of these providers are fitting. If they're not, then we're saying, 'Okay, I'm going to go look for someone else who closely aligns with me.'

A lot of times I think that we just go with what's easiest. We need to be very serious about this. This is the birth of our child and this is our birth into motherhood. This is a day that will be remembered forever. So we need to have the right people supporting us. We need to be asking them questions on all of the things that are important to us and make sure we're getting the straight answers.

And then of course, from, from my perspective, we need to be considering other care providers. We need to be considering care providers who are trained in physiological childbirth like midwives. They're trained in the fact that birth is an, a beautiful ordinary, extraordinary event.

So really considering if a midwife is an option for you. When you go to see your OB, how often, like how long do you talk to your OB? When you go to see a midwife, I'm just letting you know, your appointments are usually 30 minutes to an hour and only a brief period of that time. It is so holistically focused on you and the baby and all of this hands on care and attention during the prenatal period so that they can be hands off during the birth. The more positive birthing experiences that we have and that we share with others and tell them of their experiences, the more people are going to feel empowered to do the exact same thing. And that's how a revolution has started.

How do you know if you're right for home birth and then also, how do you go about finding a midwife?

We do know that 90% of moms are low risk. So if you do not have anything that's labeled high risk, you are more than likely a great candidate for home birth. As for hiring a midwife, I would recommend going to https://mana.org/.You can get a breakdown of your state and what the regulations are, what is, and is not considered legal from a care provider standpoint. Then you can start to search for your midwife.

BOOKS MENTIONED:

Dr. Brad Bootstaylor —book: Shared Decision Making


PODCAST MENTIONED:


Ep 59: "But What if Something Goes Wrong?"- How Midwives Handle Emergencies at Hom‪e‬




When Checking in Hinders the Process

Wednesday, March 10, 2021

When Checking in Hinders the Process

Today I'm going to be talking about when checking in, actually hinders the process. Now specifically, I'll be talking about birth today, but I think you're going to find this makes sense in other places of your life too. So specifically when, when hindering the birth process, I want you to think about physiological, from a natural standpoint, from an undisturbed undisrupted standpoint. So if we were to allow your body and your baby to do its own thing.

Cervical Checks

So the first place that I often see checking in disrupting our natural processes is that vaginal checks in the later part of pregnancy. So it used to be routine. And I mean, it still is routine in a lot of places to do vaginal checks starting at 37 weeks. However, the science is actually pretty clear that there's no benefit to having cervical exams before 40 or 41 weeks. Now this all goes back to your due date, right? And we know that first time babies are more likely going to be born between 40 weeks 5 days and 41 weeks and 2 days. I think the stats are something crazy like 80 or 90% of first-time babies are born in this time. That entire chunk of time is AFTER your estimated due date.

Why is that important? There actually are a few risks for vaginal checks in later pregnancy. Many providers will pose these vaginal checks to patients as if they are mandatory. And that's just simply not true and they're not evidence-based. Obviously every single time you go in there, you are going increase your risk of infection. So every time we do a vaginal check, both in pregnancy and during labor, we are introducing bacteria and there's a risk of infection. It also increases your risk of rupture in your membranes early. Now this particular study showed 6% of pregnancies had premature rupture of membranes, which simply means that your membranes rupture before your contractions begin. So with no check 6%, but with checks with weekly checks, starting at 37 weeks, you'll eat, it was a threefold increase up to 18%. It tripled your risk of having premature rupture of membranes. Crazy.

This is especially important for birthing people who tested positive for GBS, because the minute that your membranes rupture, you will need to head to the hospital to have IV antibiotics administered for the GBS.

So if your doctor is saying things like 'We want to know', 'we need to know where your baby is', or 'I wouldn't want your baby to come early and us not know it' - then they are either really misinformed and not practicing evidence-based medicine, or they're using this as a scare tactic. Honestly, neither one is okay. So we, we have to be limit the vaginal checks at the end, because there are no benefits, but there are actual risks. Now, one thing I do want to mention is that if you're curious and that's impacting you negatively as in you have anxiety, because you don't know, and you would be less anxious if you knew that is a valid reason to get a cervical exam. However, if we're doing it out of curiosity and it's just a check in, typically that's not a good reason to do that only because of the risk you are taking on. But that is a personal choice. You will be able to weigh what matters to you- what risks are worth it and what benefits are worth it. Right.

Electronic Fetal Monitoring

Number two is somewhere along the same lines- electronic fetal monitoring. I want to go into the different types because there are types that don't hinder the process and that is what you could be requesting. So the first thing we need to understand is there are two types of fetal monitoring.

We have electronic fetal monitoring which involved computer monitoring where you're hooked up with cords. There are two types of electronic monitoring. We have continuous monitoring and this is going to have you hooked up to computers and monitors and wires. Here you'll be limited in your mobility limited in your ability of what you can and can't do under continuous monitoring. You also have the wireless mobile option. You'll be able to move about the room freely and some of the mobile options are even water resistant. Not all mobile options are water resistant, so this is a great question for your provider about your birth hospital.

Also under electronic, you have intermittent fetal monitoring. Where you hook up to the monitors every so often - maybe once an hour, once every two hours, whatever feels good to you and your provider. Great question again for a prenatal visit with your provider.

Now, all hospitals should also have Dopplers available, but that doesn't always mean that your provider is going to be trained in it. Dopplers have incredible benefits. So never hesitate to ask, to get someone in there that can use a Doppler if you have a strong preference. Dopplers are more comfortable to you. It really allows you for more personal space. You can be in the water. It allows you to labor in and all sorts of positions. Everyone in the room can still hear the baby's heart rate too.

The second type of monitoring is hands on monitoring. We also have hands-on monitoring options. This can be done by a Doppler, which is going to be a little battery pack with a monitor on the end of it. It's going to be wireless and allow you to stay mobile. You do also have a fetal stethoscope which can be used to monitor the baby as needed.

Electronic Fetal Monitoring was brought into labor rooms in the 1970s, despite the fact that there was no research or evidence to show that it was safe or effective. So why did we do it? Well, we did it because we thought we could save more lives. However, what studies have actually shown is that it increases your risk of a C-section without providing the benefits that we first thought it would. We thought we would see lower infant mortality, but those are actually on the rise. We thought we would see better APGAR scores, but we haven't seen better scores there either.

Hands on listening is evidence-based and produces better outcomes for birthing people and babies. So again, I want to bring up that any provider that cannot provide you with hands-on listening at your request, it's worth requesting a different provider if you have a preference. It has the potential to change the outcome of your labor. It's important for you as the consumer to understand that there are some things that your provider is not going to be able to offer you without you suggesting or asking for it. This is going to be one of those things.

We need to understand that a lot of hospital policies do suggest and require that their providers suggest to you continuous fetal monitoring. So you're going to have to request alternative options. You do have some science on your side. The American College of Obstetrics and Gynecology has endorsed hands-on listening as an appropriate and safe alternative to electronic fetal monitoring since 2009. In the UK, The National Institute for Health and Care Excellence actually recommends doing hands-on listening with all low risk pregnancies and not to even offer electronic fetal monitoring.

'Don't Push'

The third thing that I want to talk about is when you have the urge to bear down and someone tells you to stop. We can actually disrupt the natural process of birth, because what you're feeling when you have that urge to push is the fetal ejection reflex. You want your body to help you eject your baby with this natural process that your body already has- the fetal ejection reflex.

This is something I teach with our clients- how to recognize it, allow it to activate itself, and how to work with it in order to push your baby out. When we are able to teach clients how to work with this reflex, with our 'secret sauce to pushing', we consistently have women who push for less than one hour with zero tearing. Also, it's so powerful to know that if you, as a birthing person, really understand your body and the natural processes that your body gives you to help you to support you in birth, and make this labor and delivery easier. How much more powerful you are in birth as a birthing person? That for me, oh my gosh, I love it.

If someone is telling you not to push you, you don't have to necessarily listen to that. There is science on your side, proving that if that's what your instincts are telling you, you can go with that and you should go with that. Even if there is not research and your instincts are telling you something, you should go with that. But regardless if you're a very logistical person and you like the data and the hard numbers, I can appreciate that. Listen to episode 135, it breaks down how, if you have a cervical lip or you're not 10 centimeters, that pushing can actually a alleviate some pain and help that cervix go ahead and dilate the rest of the way. It also kicks in your fetal ejection reflux. This generally shortens the time of not only the second stage of labor, which is active labor, but also the pushing time. Check it out. You guys episode 135.


Boundaries

My final one - is boundaries. Ugh, who wants to talk about boundaries? Nobody ever, but we got to do it. So here we go. The end of pregnancy, when people are constantly checking in with you, your friends, your family, your coworkers, your neighbors, your laundry people, your mail man, the barista at Starbucks, your doorman. Everybody's going to be asking you if the baby is here or not.

Keep in mind, people ask because people love you and they care about you and they want to love on your baby. I hear you that it can be so annoying, overwhelming, and also just a big reminder that your baby was supposed to be here, but they are not.

(Side note. That goes back to you having a healthy, realistic expectation of what a due date is. If your due date is here, you know that you really need to add five to nine days so that if you're a first time parent based on the stats. You really don't want to set yourself up for additional stress or anxiety around the due date unnecessarily.)

You get to decide who gets what updates and how often. You can go with a narrower group of family and friends with who you update with what. You don't have to feel pressure to keep up with it all. This can be a super hard one. Keeping boundaries and not feeling the pressure or guilt. It's a little bit easier with coronavirus. That's a very easy excuse to keep people at arms length, which has been helpful for a lot of people. A double-edged sword, because it's also extra lonely as if new Parenthood wasn't isolating enough. However, it has also provided us the space that we need to keep people at bay and protect our mental health.

And remember: you are about to this sweetest, hardest, and probably most valuable transition of your whole entire life. I am so honored to share this information with you. To help educate you to advocate for your ideal pregnancy, birth, and postpartum.

Links:

  • - Secret Sauce to Pushing Course: JOIN HERE!
  • - Longer Labor Times with Directed Pushing: Here
  • - Early Pushing Urge: Here
  • - Dilation and the Cervical Lip: Here
  • - Pushing: Leave it to the Experts: Here
Don’t forget to check out our newest adventure The Birth Lounge, listen in to The Birth Lounge Podcast, and follow us on Instagram at @tranquilitybyhehe and @the.birth.lounge!

Your Responsibility in Labor

Wednesday, March 3, 2021

Your Responsibility in Labor

I am bringing you my takeaway from recent births today on the blog. All of them had a layer of nature that we could not control, which is something I talk about all the time. You can control 90% of labor and birth, but that other 10% is nature. That's life, right? Those are the pieces that no matter how hard we try as humans or even medical professionals, we'll never be able to control nature. Nature will always kind of reign above us, because it's nature. We are the smaller beings when we think about nature and humans, humans actually depend on nature. Nature does not depend on humans. Nature will always have this way of playing its hand in birth. So your responsibility with that 10% is not to give up on it. Your responsibility is to know what could happen within that 10% of birth. To understand what your options are at each of those places.

When you find yourself in some of those situations, because remember it's inevitable, nature will always reveal its hand in labor. You want to feel in control and prepared. You need to do the work to educate yourself on your options, on the research, on your provider/hospital. We can help you do that work, as doulas and through The Birth Lounge Membership, but YOU have to take responsibility. You have to help carry through that preparation. So that since when. you do find yourself in a situation, you know how to respond and react.

The final piece of your responsibility in this is actually speaking up and advocating for yourself. Here's the deal: Your providers definitely have the space. There is room in birth for them to be in total control. This is oftentimes what we see in something called 'active management', where we try and actively control birth and control what happens in birth. And usually it's done under the guise of 'trying to prevent something bad from happening'. But really, if we look at birth and labor, birth is a natural thing. Birth is a very natural event. So what we actually see is when we intervene as humans, as medical professionals, as providers, we see our numbers kind of decrease in certain things. Our C-section rate is increasing. Meaning we are decreasing the number of vaginal births and vaginal births is obviously obviously the preferred birth method, because it's so much easier for the body to heal from.

Now don't get me wrong. I am SO grateful we have C-sections for those times we do need a C-section. But again, if we go back to the research (Check out Ep. 107 of The Birth Lounge Podcast!), I talk about the astronomical rate of C-sections in the US. I also cover what you, as a birthing person, can do to reduce your C-section. I chat with Dr. Neil Shaw, who is really pioneering the science on how do we use C-sections appropriately and save lives, but drastically reduced the number of unnecessary C-sections because it truly does have a soured aftermath for so many birthing people. It increases your risk of chronic pain, increases your risk of pelvic floor dysfunction, increases your risk of abdominal dysfunction, and increases your risk of infection. There's so many complications that are added on once we introduced the idea of a C-section. Your power here, your responsibility here is actually speaking up in labor. There is room for your doctor to be in control, but only if you allow them to be in control.

So let's play something out. Let's say your doctor comes in and says, 'You know what? I'm suggesting a C-section.' and it's the first time that you've heard this. And they say, 'I really think you need a C-section this is not going to happen for you'. And you're like, 'Wow, this seems kind of all of a sudden and I have questions about it. Can we have a few minutes?' And you ask for a few minutes and they come back in and they go, 'All right, let's get you prepped up for a C-section'. This is not consensual care. That is not informed consent. That's not shared decision-making. That is your provider being in control. There needs to be consideration for your birth goals, your thoughts, your questions.

I've seen this exact situation way more times than you would even believe. And there are two very distinct outcomes and the power in that totally lies in your hands. So in this moment, when you're having this immense pressure from your provider to make a decision that you're not even sure you want to make. The first place to start is to ask questions. You're gonna want to say, 'We're not sure that we want a C-section right now, we have a few questions that we would like to discuss with you'. What this does is it takes the control from your provider's hands and it stops the ball from rolling in the direction of a C-section and puts the control in your hands of asking questions until you're ready for the ball to roll. And at that point, you get to choose what path you go down.

It's hard in labor to not feel overwhelmed. It can be very hard to advocate for yourself. This is why it's extremely important to have the education and the preparation, but also to have someone there with you that can advocate for you, whether this be your partner, whether you join The Birth Lounge, whether you hire us for virtual services, or you hire us/a local doula to be present at your birth. Someone that you trust needs to be in that room. Someone who is not afraid to speak up, but can also speak to medical professionals in an educated and polite way so that you're more likely to get a provider to be open to your suggestions.

Now, I want to be extremely clear here. It is not up to your provider what happens to you. It is up to you, you get to make the decisions for your body and your baby. Of course, your medical professional is someone that you've hired. You're paying them for a service. You chose to have your baby with this practice. Or maybe even this particular doctor - so don't lose sight of that. But every now and then people do find themselves in what we call a 'bait and switch', meaning that all of your pregnancy went great. You were feeling supported and then all of a sudden, now that you're in labor, a switch has seemed to flip and your provider is not as supportive as they told you they were going to be. When you're 24 hours into labor, this bait and switch can be really hard when you find yourself in it, but you still have the power and you still have the responsibility to speak up.

You can speak up. Having discussions with your doctor and saying, 'I hear you. And I'd like to discuss my options, but I'm not sure X, Y, or Z is the right answer for me right now. I still have questions.' You can even say, 'I would like to take 20 minutes to discuss with just me and my partner. Please.' You can request a new nurse or a new doctor at any point in your labor. Please remember that nobody gets to do anything to you that you don't consent to, but it's your responsibility to set that tone, to hold that boundary, to ensure that no one does anything to your body without asking you.

That means if someone simply taps the inside of your leg in order to put in a catheter, which I have seen done before, the nurse did not even tell this patient what she was doing. You can take the control back here to say, 'Oh, I'm sorry, are you tapping my leg? Do you need to, do you need to do something?' You can be more direct and ask straight out, 'What is that? And what are you trying to do?' The control here is in your questions. The control here is understanding exactly what is being done to you before it is done to you. This is called shared decision-making. This is something that your provider should actively be engaging with you all throughout your labor. If you find that things are being done to you and they're not being explained, and consent is not being gotten, and discussion is not being had before these procedures are done- you have to do is take a pause and ask the questions. What are they doing? Why are they doing it? And are there any alternatives you might want to inquire about?

Remember that it's your responsibility as a birthing person to understand normal birth variations, common practices, and what your options are at each of those twists and turns. When you do encounter them, you can control 90% of labor. The rest of that 10% is totally up to nature. 100% out of our control. But, what we can do is be prepared to be able to respond and react no matter what comes your way in labor. This is exactly what I teach you in The Birth Lounge. If you are reading this the week it is posted- you are in luck! Our doors are open for Spring members through the first week of March! Join us here!

Also, don't miss out on our free training: How to Avoid a C-section!

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