Questionnaire for Birth Professionals

Questionnaire for birth professionals (self awareness)

Ask yourself the question and then write down the answer(s) that pop into your head. Don’t figure it out. There are no right or wrong answers. What pops into your head may open up some awareness of your subconscious fear of birth.

1. With regard to having babies, what my mother said is_______________________________
2. With regard to having babies, what my father said is_________________________________
3. With regard to having babies, what I learned in school is _____________________________
4. With regard to my clients, what I have done that doesn’t meet my standards is ____________________________________________________________________
5. With regard to my birth practice, what I would be willing to forgive myself for is _____________________________________________________________________
6. With regard to pregnancy/birth, my biggest fear is________________________________________________________
7. How I feel when I’m standing in the lobby of a hospital is ______________________________
8. What I know about my own birth is_______________________________________________
9. If I could go back to the womb and re-create my own birth experience, I would: (write out all the elements of your fantasy ideal birth)
10. If I had beautiful, ecstatic births happening in my practice, who might be wrong? Who might be upset?
11. Some ways that I could be nicer to myself are _________________________________________

Birth without borders

I’ve been on a bit of a rant lately about “Keep those damn hats off babies”, “Take off those wet sports bras”, “Get everyone skin-to-skin, dark, private” and I get told that “We have to choose our battles”, “It’s important to meet people where they are and not overwhelm them with picky details”, and other variations of advice to STOP IT!

These things are HUUUUUGE to me. I only want to speak into the ears of those who want perfect births. I had a perfect birth. What is a perfect birth? It’s a birth that you look back on when your child is 30 years old and you wouldn’t change a single thing about it. . . every smell, touch, taste, word spoken and beam of light goes to the grave with you as a top of the mountain of life experience. It’s an experience that makes up for so much of the day to day b.s. that is part of living in a human body. It helps to salve the losses and the heartaches and gives you a glimpse of the bliss that’s possible when all the stars align on a really, really good day. That’s what I want for every birthing woman. When I saw this little video clip (I think it’s from Russia), it made my heart sing as I prayed that no one would enter the frame and interfere with this woman’s bliss (no one does). Unfortunately the sound is missing but I love it that someone turns off the lights so baby could transition to this bright world in a slow way. I also love it that the toddler comes in with questioning eyes to see what the heck is happening in his world and looks to the Dad with questioning eyes and is reassured that “Yes, this is different but it’s all good, sweetie.” I just made that up but I love my own version of things. Enjoy.

Group B Strep: what you need to know

We are told that the concern about Strep B involves two groups at high risk of infection:
1. Premature infants under 37 weeks gestation
2. Any infant in utero with membranes released longer than 18 hours

Contractions are a possible indicator of infection, but this situation is a concern in weeks 0-36. After 36 weeks, Braxton Hicks are normal and a good sign of a healthy toned uterus getting ready to push a baby out.

A culture that shows Strep B in the vagina is not necessarily illness related. Just as we commonly have Strep A in our throats on a swab and have no sore throat symptoms (no strep throat), from one day to the next we can all culture positive for Strep B without any symptoms or danger to our unborn babies. This is why many practitioners refuse to test for it and simply wait to test until such time as the above two “at-risk infant scenarios” show up. One day a woman might test positive and the next be negative. To treat with antibiotics before labour would NOT be recommended. Why?
The woman’s body could build up a resistance to the antibiotics and so could her baby’s body. Then if either got a more serious infection after the birth, the antibiotics might be ineffective.

Taking antibiotics can also lead to thrush, vaginal yeast and severe colic in the months after birth. There is some indication that antibiotic use can lead to Vitamin K deficiencies in the baby.

I would advise pregnant women to do as many things as possible to minimize their risk of ANY infections and maximize their immune systems. Some safe suggestions:

1. Boost vitamin C in your diet—e.g., eat 2 grapefruit per day. Other good sources of Vitamin C are red peppers, oranges, kiwi fruit.

orange, grapefruit, kiwi

Boost Your Vitamin C

2. Drink a cup of echinacea tea or take 2 capsules of echinacea every day.

3. Get extra sleep before midnight. Slow down your schedule.

4. Take 1 tsp colloidal silver per day. Take it between meals. Hold the liquid in your mouth a few minutes before swallowing. Colloidal silver can be purchased in most health food stores. It is silver suspended in water. It is antibiotic in nature and safe in pregnancy if you limit the daily intake to 3 tsps or less. Do not take more because there is a danger of turning your skin permanently blue by overdosing.

5. Plan ahead for extra warmth after the birth for both the mother and baby. Hot water bottles, heating pads, hot packs, big towels dried in a hot dryer during the pushing phase all help keep the mamatoto extra toasty after birth and reduce stress. Have a friend or family member assigned to be in charge of the mother/baby warmth team. Colostrum is the best antibiotic treatment the baby could ever get.

6. Other good prevention tips: Keep vaginal exams to a minimum — 0 is best. Do not allow membrane stripping to start the birth (a.k.a. membrane sweeping). Do not permit artificial rupture of the membranes. Do not allow children of other families to visit the new baby for the first three weeks. Keep the older kids healthy so they are not sneezing and coughing on the new baby.

I often think we must have had a lot of women who were Strep B positive in the 1000 plus births I have attended. We do not test unless we have long rupture of membranes and/or a preemie. Once the baby is born, we keep all women warm and baby skin-to-skin with the cord intact and, of course, all our mothers breastfeed. I have never had a baby sick with Strep B in thirty years. Unfortunately, the use of high dose antibiotics on so many pregnant women has resulted in an increase in infant deaths due to E Coli. *Group B strep/antibiotics

Prevent the diagnosis of positive for GBS: If your care provider wants you to go for GBS testing to comply with their protocols, read this article by a Certified Nurse Midwife about the use of garlic in the vagina to knock out bacteria. Do this regimen prior to testing.
http://www.midwiferytoday.com/articles/garlic.asp

Be sure to check out Lisa Barrett’s blogpost (and the comments) about the Cochrane Review regarding GBS and Antibiotics at http://www.homebirth.net.au/2009/07/gbs-cochrane-report.html
*References:
(1.) E. M. Levine et al., “Intrapartum Antibiotic Prophylaxis Increases the Incidence of Gram Negative Neonatal Sepsis,” Infectious Disease Obstetric Gynecology 7, no. 4 (1999): 210-213.
(2.) C. V. Towers and G. G. Briggs, “Antepartum Use of Antibiotics and Early-Onset Neonatal Sepsis: The Next Four Years,” American Journal of Obstetric Gynecology 187, no. 2 (2002): 495-500.
(3.) C. V. Towers et al., “Potential Consequences of Widespread Antepartal Use of Ampicillin,” American Journal of Obstetric Gynecology 179, no. 4 (1998): 879-883.
(4.) R. S. McDuffie Jr. et al., “Adverse Perinatal Outcome and Resistant Enterobacteriaceae after Antibiotic Usage for Premature Rupture of Membranes and Group B Streptococcus Carriage,” Obstetric Gynecology 82, no. 4, pt. 1 (1993): 487-489.
(5.) T. B. Hyde ct al., “Trends in Incidence and Antimicrobial Resistance of Early-Onset Sepsis: Population-Based Surveillance in San Francisco and Atlanta,” Pediatrics 110, no. 4 (2002): 690-695.
(6.) M. L. Bland et al., “Antibiotic Resistance Patterns of Group B Streptococci in Late Third Trimester Rectovaginal Cultures,” American Journal of Obstetric Gynecology 184. no, 6 (2001): 1125-1126.
(7.) M. Dabrowska-Szponar and J. Galinski. “Drug Resistance of Group 9 Streptococci,” Pol Merkuriusz Lek 10, no. 60(2001): 442-444.
(8.) R. K. Edwards et al., “Intrapartum Antibiotic Prophylaxis 2: Positive Predictive Value Antenatal Group B Streptococci Cultures and Antibiotic Susceptibility of Clinical Isolates,” Obstetric Gynecology 100, no. 3 (2002): 540-544.
(9.) S. D. Manning et al., “Correlates of Antibiotic-Resistant Group B Streptococcus Isolated from Pregnant Women,” Obstetric Gynecology 101, no. 1 (2003): 74-79
(10.)Cochrane Database: Jan. 2013 “Maternal colonization with group B streptococcus (GBS) during pregnancy increases the risk of neonatal infection by vertical transmission. Administration of intrapartum antibiotic prophylaxis (IAP) during labor has been associated with a reduction in early onset GBS disease (EOGBSD). However, treating all colonized women during labor exposes a large number of women and infants to possible adverse effects without benefit.”
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007467.pub3/abstract

UPDATE: Cochrane Library, June 10, 2014
Intrapartum antibiotics for known maternal Group B streptococcal colonization
Women, men and children of all ages can be colonized with Group B streptococcus (GBS) bacteria without having any symptoms. Group B streptococcus are particularly found in the gastrointestinal tract, vagina and urethra. This is the situation in both developed and developing countries. About one in 2000 newborn babies have GBS bacterial infections, usually evident as respiratory disease, general sepsis, or meningitis within the first week. The baby contracts the infection from the mother during labor. Giving the mother an antibiotic directly into a vein during labor causes bacterial counts to fall rapidly, which suggests possible benefits but pregnant women need to be screened. Many countries have guidelines on screening for GBS in pregnancy and treatment with antibiotics. Some risk factors for an affected baby are preterm and low birthweight; prolonged labor; prolonged rupture of the membranes (more than 12 hours); severe changes in fetal heart rate during the first stage of labor; and gestational diabetes. Very few of the women in labor who are GBS positive give birth to babies who are infected with GBS and antibiotics can have harmful effects such as severe maternal allergic reactions, increase in drug-resistant organisms and exposure of newborn infants to resistant bacteria, and postnatal maternal and neonatal yeast infections.

This review finds that giving antibiotics is not supported by conclusive evidence. The review identified four trials involving 852 GBS positive women. Three trials, which were more than 20 years old, compared ampicillin or penicillin to no treatment and found no clear differences in newborn deaths although the occurrence of early GBS infection in the newborn was reduced with antibiotics. The antibiotics ampicillin and penicillin were no different from each other in one trial with 352 GBS positive women. All cases of perinatal GBS infections are unlikely to be prevented even if an effective vaccine is developed.
Source: http://summaries.cochrane.org/CD007467/intrapartum-antibiotics-for-known-maternal-group-b-streptococcal-colonization

UPDATE April 2016: From the (30th Anniversary Special) copy of Midwifery Today Magazine. Quote: “Unlike the US, the UK does not recommend universal screening because, while GBS disease is the most common cause of infection in full-term newborns, it is statistically still quite rare.(Wickham discusses these numbers in depth.) The Royal College of Obstetricians and Gynecologists (RCOG) firmly states that it will not support routine screening for GBS “until it is clear that antenatal screening for GBS carriage does more good than harm and that the benefits are cost effective” –two factors that have yet to be affirmed in any research done to date.” End Quote

This was part of a book review in Midwifery Today Magazine, Spring 2016 for “Group B Strep Explained” by Sarah Wickham, Midwife, 2014, paperback, pub’d by AIMS

Hold that hat!

Image

Someone on Facebook is doing a survey of what birth workers think about putting knit toques on newborn heads.

We have to ask ourselves about the way this hat thing got going. Babies were not doing well after being born to medicated women and immediate cord clamping. The baby who has started off at such a deficit will lose body heat and be in very rough shape. Helping keep in heat by a hat might be a matter of life and death in this instance where the body is so weakened.

Contrast that to a baby born spontaneously and placed on his mother’s body. . . both of them wrapped together in a warmed blanket skin to skin. The cord is intact, the placenta continues its work of transferring just the right amount of blood back and forth to the baby while he/she adjusts to life in an air environment in a leisurely fashion.

Then, the baby and the mother lock in a gaze; the mother recognizing that this is her own; she buries her nose in the wet head and drinks in the smell of her young; she locks the imprint of that child’s whole being into her vision and she would not ever confuse her baby with someone else’s. Later, she chooses the clothing SHE wants her child to wear; she dresses and grooms her own baby. . . she is in charge and has been born as the mother. No one and no article of clothing has come between her and her total impressions of that baby. Through skin, mouth, nose, eyes and heart she has claimed the baby as her own and the bond is strong.

eliskintoskin

Bringing medical birth practices to a natural birth is a sign that we lost so much knowledge in the dark years when homebirth/midwifery was wiped out. Now, we can look again at these things and lay them aside as foolish for well women and their infants.

http://www.normalfed.com/starting/hat/ Article by a Lactation Consultant

What’s a Poor Midwife To Do?

This question came in to my blog in response to my archived post on the use of Castor Oil. Since it is a subject I seem to deal with daily, I’ve answered it where everyone can join in the discussion. Gloria

QUESTION

Hi Gloria! I am a student midwife, and in my state, women must be transferred to an OB if they have not given birth by 42 weeks. The local midwives (my preceptors) use castor oil as a last resort induction method. They don’t like doing it, from what they tell me, but they feel that, if after nothing else works (walking, sex, black and blue cohosh), it would be better to try castor oil and breaking the woman’s water, than to have a perfectly healthy woman transferred to the hospital.

What is your opinion on this? If you were faced with a similar situation (I should mention that midwifery licensing is strict in Florida, and midwives may lose their license if they do not follow the “rules”), what would you recommend? I do not plan on practicing here in Florida when I graduate from midwifery school, but I’d like to pass along some information to the midwives that I work with. Florida Student

RESPONSE

I am faced with a similar situation in my province. We have registered, government paid midwives who have to play nice with the doctors in order to have hospital privileges, a government salary, and publicly funded malpractise insurance. They have the same complaint “We hate to induce naturally but it’s better than what they are going to get in hospital. . . .” We also have the same mess here in B.C. as the rest of North America. Those membrane stripping, castor oil, acupuncture, herbal inductions don’t work because the woman isn’t ready to have the baby and, then, she gets on the prostaglandin/pitocin intervention-cascade train and the midwife feels so bad. . . but, hey, what could she do?

Canadian midwife with client

Canadian midwife with client

Every day, I thank my lucky stars that they used me as an example to the government of what a “renegade” midwife was. Midwives in my province could only become a professional body if they proved there was a “danger to the public” by NOT having a profession. I got to be the designated “danger” because I had proven for years that I would not lie down with the doctors and side with them against my clients. Obviously, the midwives organization would never have given me a license, even if I applied, so I didn’t have to bother applying. A few of my friends did and they were bankrupted and humiliated by the “professional” body. As soon as the government registrations were issued, we saw these inductions start. So many women in my community have been fooled by this cruel trick.

When the local midwives first obtained registration, there was a lot of righteous conversation about “evidence based” midwifery. The large multi centre trial about 41 week inductions conducted by Mary Hannah of Toronto (1) was pointed to by midwives to frighten women into being induced at 41 weeks. We had never seen this in our province prior to regulation. We had twenty years of experience as lay midwives with many post dates women and had not seen any problems but that experience was set aside in favour of the “evidence base”. Even though the midwifery empirical knowledge did not support Ms Hannah’s conclusions and even though the midwives were extremely conflicted and frustrated by the results of their labour inductions, they still obeyed the medical “evidence”. Then, the “evidence” was shown to be without merit. In 2002, Hall and Menticoglou published a paper in the British Journal of Obstetrics and Gynecology proving that Hannah’s study was wrong (2). Has that meant that midwives in my province are now encouraging women to relax up to and past 42 weeks gestation? Oh no, because now the doctors have kept on with their aggressive policies of inducing everyone at 41 weeks and, evidence- be- damned, they’ll make the midwives do the same thing. Science is trumped by community “standard of care” which basically means “we’ll all follow like sheep and hope the wolf doesn’t catch us”. Now, I don’t hear too much rhetoric about “evidence based practice” among local midwives. There is still a lot of lamenting about “how bad they feel” but the inductions continue unabated. Of course, the midwives don’t feel even 1/100th as bad as the woman who has had major abdominal surgery thanks to their aggressive policies.

I’ll post a link here to the B.C. Government Vital Statistics chart (click on Item 11) which shows that, prior to regulating midwives in 1998, there was an up and down pattern to cesarean rates and the rates remained below 25%. For the last reported year (2011) the rate was over 30%. This means that, since midwifery regulated on January 1, 1998 the cesarean rate has risen and the pattern has been a steadily upward climb. The cesarean rate is the score card of what is happening in obstetrics in any given jurisdiction. We’re obviously not doing so well here in B.C. When the registered midwives were soliciting the government for a professional designation, one of the cornerstones of their bid was that they would save the government money by preventing cesareans.

Cesarean Rates in British Columbia Before and After Midwifery Regulation

Cesarean Rates in British Columbia Before and After Midwifery Regulation

So, in answer to your questions: a)What is your opinion on this? I think it is disgusting that midwives are so cowardly and turn perfectly healthy pregnant women into wounded mothers. And (2) If you were faced with a similar situation (I should mention that midwifery licensing is strict in Florida, and midwives may lose their license if they do not follow the “rules”), what would you recommend? I will not be faced with a similar situation because I would not join an organization where I was made to go against my conscience, my common sense and my promise to my clients. If I was in such an organization and realized that I could not do my work with integrity, I would not be complaining about these ridiculous “protocols” I’d be changing them or resigning in protest.

(1) Hannah ME et al. Postterm pregnancy: putting the merits of a policy of induction of labor into perspective. Birth 1996;23(1):13-9.
(2) Menticoglou SM and Hall PF. Routine induction of labour at 41 weeks gestation:
nonsensus consensus. BJOG 2002;109:485-91.

related post: Castor Oil Inductions
This post was updated on Sept 5, 2014 to reflect B.C. Vital Statistics to 2011
Updated Dec 30, 2014 to include link to “Nonsensus Consensus”

The "Slow Birth" Movement

Somehow, we all got hooked into thinking that “quick was better” when it came to birth. When women tell their birth stories, it seems to be a point of pride to be able to say “I gave birth in 5 hours”, “I barely made it to the hospital”, “even with my first, it was so fast”. We hear these stories and may envy the women thinking that they performed in a fast, efficient manner and we view them as having a coveted talent.

I’ve been observing women giving birth for thirty years and I have given birth three times. From my experience, I don’t think that quick is necessarily a good thing when having a baby. Often fast births afford the woman no time to get her breath and regain her strength. Some women describe their fast births as feeling like they have been whipped around in a blender. In a rapid birth, the woman’s body sometimes displays the symptoms of transition after the birth of the baby (shaking, feeling hot/cold, vomiting). When a baby comes slower, there’s a building up of the intensity of the sensations so that the woman can adjust herself to the process that’s happening and, even though most women would like to shave a few hours off the whole thing, nevertheless, they know they can cope and that they will get to the finish line of birth. When the baby comes slower, the woman often dozes between her pushing sensations and seems to derive a great deal of energy from those short snatches of sleep even though they are interrupted often. The hormones of birth seem to allow the woman to operate in a different domain of sleep, energy and strength. I’m fond of telling women who are tired and discouraged at transition “You’re going to get a big burst of energy when you get the reflex to push” or “you’ll get an energy rush when you feel the baby’s head at your perineum”.

This trust in the process and knowledge that energy can ebb but then be regained in the birth process seems to be greatly lacking in today’s Western obstetrics. Slowing down or taking a long time to dilate is simply viewed as a problem and it’s a problem to be fixed by hurrying the woman’s body along. There’s no such thing as a resting phase, going in and out of the process, or simply a looooonnnnngggggg, slow birth process. This is not allowed and it’s viewed as pathological.
It hasn’t always been that way.

Waiting for the baby

Waiting for the baby

In his book “The Farmer and the Obstetrician”, Michel Odent does a comparison of big agri-business to modern hospital obstetrics. When we see the environmental disaster that large scale agri-corporations have produced and we know that the hospital obstetric system has produced a North America wide cesarean rate of 30% and rising, it’s clear there’s been a severe skewing of priorities and principles. We have to re-order our thinking about farming in order to survive: local organic farms, 100 mile diet, moratoriums on genetically modified crops, co-op gardens, raw diets—all these things have grown in the past few years as the few who knew they were important have held onto the knowledge (and the seeds) for the ones of us who were slow to catch on to the urgency.

Instead of talking about “fast food” that seemed so sensible a while back, we’re talking about slow food. Food that takes time, patience, work and integrity to grow, sow and cook. Some are even talking about “slow money” to fund “slow food”, the kind of financing that doesn’t look for a quick return and a scheme but rather looks to the quality of neighborhoods, children, the air we breathe and the long term future.

For those of us who know there’s something terribly wrong with the state of obstetrics in North America, we must call for a return to SLOW BIRTHING. Birth which understands that some women will wait for several days after releasing their membranes and have no pathology. Slow birth means returning to a time when induction of birth was reserved for very seriously ill women and undertaken with great trepidation. Midwifery would be patient beyond all known limits . . . practitioners only steering the birth process in the most rare cases. We would return to a time when practitioners used to say such expressions as:

“Every birth is different, every woman is different and every baby is different.”
“Don’t let the sun set twice on a woman who is in active labor (past 4 centimeters dilation).”
“Don’t practice “meddlesome midwifery”.”
“A good obstetrician does not pick unripe fruit.”
“A good practitioner has two good hands and knows how to sit on them.”

These are all things I heard when I first started attending births 30 years ago and, now, I never hear them. We must get back to those times when the cesarean rate was below 15% or we will perish. As a society, we cannot withstand the damage that is being done to large numbers of women, babies and their extended families. The idea that we can “turn hospital beds” in order to make maximum use of the dollar cost of that bed is insane when it comes to giving birth.
The notion that a woman can be induced with all the pursuant cascade of interventions simply for the convenience of scheduling staff or room availability is a crime. We must wake up and recognize that giving birth to a baby is one of the most powerful transformative events in a woman’s life. This process is so important to the family and the rest of society that all efforts must be made to have it flow normally. Our priority must be the well being of the newborn baby and the conditions that are favorable to a long, satisfying breastfeeding experience. What we are doing right now with inductions, surgeries and the mass use of narcotics in childbirth is as harmful to the planet as fish farms and DDT. The small band of people who have kept the notion of SLOW BIRTH alive so that society at large can get back to what we know is the holistic way to treat new mothers and babies must be listened to and appropriate action taken. Childbirth is not a frill, it’s not an expendable experience, it’s a fundamental lynch pin in forming the family and, without it, we are doomed to being a sick society.

Insider’s Tip on How to Have a Great VBAC

The following is a post I sent to the ICAN (International Cesarean Awareness
Network) list. It is very, very important information for ALL birthing women
and can make all the difference in a VBAC birth. Read it carefully, copy it,
send it to your clients. One of the ICAN women replies to my post at the
end:

Subject: ICAN: Tip for birth

I wanted to write to those of you who are pregnant to tell you something
that has been running through my mind all day about how you can be
successful with your VBAC births. Many births begin in the night…. woman
will get up to pee, feel her membranes release and then an hour later begin
having sensations fifteen minutes apart. Because we think of birth as a
family/couple experience, most women will wake up their husbands to tell
them something’s starting and then, probably because we all hope we’ll be
the 1 in 10,000 women who don’t experience any pain, we start getting the
birth supplies organized, fill up the water tub, etc. I have seen so many
births that take days and days of prodromal (under 3 cms. dilation)
sensations and they usually begin this way. The couple distracts themselves
in that early critical time when the pituitary gland is beginning to put out
oxytocin to dilate the cervix. Turning on the light, causes inhibition of
the oxytocin release. Many couples don’t call their midwives until they have
sensations coming 5 minutes apart at 7:00 a.m. but they’ve been up since
midnight timing every one of the early sensations. If they had called their
midwife at midnight she would have said “Turn off the light and let your
husband sleep as much as possible through the night. You, stay dark and
quiet. Take a bath with a candle if it helps and call me back when you think
I should come over.”

Secret beginning of birth

Secret beginning of birth

That first night can make all the difference and yet so many couples act
like it’s a party and don’t realize they are sabotaging their births right
at the beginning. Staying up all night in the early part does two things–it
throws off the body clock that controls sleep and waking and confuses the
brain AND it inhibits the release of the very hormone you need to dilate
effectively. You know that it can take days to recover after a night of
partying or after working a graveyard shift. Don’t start your birth with
that kind of stress on your hormone system.

When you begin to have sensations, I urge you to ignore it as long as you
possibly can. Don’t tell anyone. Have a “secret sensation time” with your
unborn baby and get in as dark a space as you can. Minimize what is
happening with your husband, family and the birth attendants. What would you
rather have–a big, long dramatic birth story to tell everyone or a really
smooth birth? You do have a say over your hormone activity. Help your
pituitary gland secrete oxytocin to open your cervix by being in a dark,
quiet room with your eyes closed. Gloria Lemay, Vancouver

Pam wrote:

“I really loved what Gloria had to say here. For me, it’s all about what
went wrong at my first birth (stayed up all night timing
contractions…stupid, stupid, stupid, and was totally wiped out by morning),
and could have been improved at the second, when I lacked a place to stay
dark and quiet. I printed it out for my husband to read, and am putting it in my
file of important things to remember when labor starts, within the next
couple of weeks.”

Helping your client avoid a Gestational Diabetes diagnosis

There is controversy in obstetrics about the diagnosis of gestational diabetes and the testing that is done to ascertain which women are at greatest risk. Dr. Michel Odent has written an article GESTATIONAL DIABETES: A DIAGNOSIS STILL LOOKING FOR A DISEASE? which can be viewed online at http://www.gentlebirth.org/archives/gdmodent.html

Pregnant woman testing blood sugar levels

Pregnant woman testing blood sugar levels

.

Until all the controversy is resolved and a more scientific test can be offered, we are stuck with the glucose tolerance test at 28 weeks gestational age. The mother can look at the list of who is at greatest risk and decide to decline the test if her risk is low.

Women at risk:
– maternal age over 25
– – obese woman prior to pregnancy
– – previous birth of baby weighing over 10# at birth
– – previous unexplained stillbirth at term
– – family history of diabetes (esp. close relatives who became diabetic at a young age
i.e. juvenile onset diabetes)
–previous history of recurrent miscarriages
–extremes of heaviness or thinness
–history of alcohol abuse
–history of anorexia or bulimia

This risk factor screening will only pick up 50% of women who are GD. Therefore, we would be wise to treat everybody “as if” they are GD because the diet and lifestyle changes are good for everyone (preventive health care).

If your client has any of the above factors, urge her to follow a GD diet and exercise program as early as possible and then, if she does take the 28 week test, she will usually sail through it with flying colors.

This doesn’t mean that she can start eating junk food though. I tell my clients that ice cream and chocolate are toxic to unborn babies–there is way too much fat, salt, sugar and caffeine in these products for a baby in utero to cope with.

Whole, organic foods, fresh water, and love are the ingredients to grow a healthy baby.

How can we best serve the health interests of mother and baby?

If you meet your client prior to the 28 week test, you can let her know that she can improve her chances of passing the test by eating healthy, unrefined food for the week preceding the test and exercising every day (a 20 minute brisk walk that elevates her heart rate). You can explain to her that some healthy women who just ate badly (lots of sweet desserts and junk food) prior to the 28 week test have tested positive for risk of GD and then had to undergo the more unpleasant fasting 3 hour blood tests.

If you meet your client after she has been diagnosed as GDM (gestational diabetic mother), I would encourage you to attend with your client at the diabetic clinic where a nurse will give her counseling and nutrition advice. Usually, the woman will be asked to maintain a food diary and daily ‘exercise after meals’ regimen. She will be shown how to test her own blood and may be asked to count the number of times her baby kicks in a 12 hour period.

The philosophy behind the diet is that the GDM needs to control her blood sugar levels at an even rate (also known as staying in the Zone–not getting stuffed or starved) and can do so by “grazing” on small amounts of wholesome food, eaten often.

What foods should your clients avoid?
*sugar (white or brown)
*honey, molasses, syrup, jams, jellies, marmalade
*chocolate, candy
*puddings, Jell-O, fruit yogurts
*desserts—cakes, pies, pastries, iced cookies, etc.
*soft drinks, tonic water
*sweetened condensed milk
*sweet sauces—oyster sauce, teriyaki, plum, sweet & sour, ketchup

Caffeine has been shown to make the body more resistant to the effects of insulin so tea, coffee and all soda pop should be avoided.

Fruit sugar should only be consumed in small portions. ½ a banana, 10 grapes, a small apple are the serving sizes. Milk products are also high in sugar and should be used in moderation according to the advice of a diabetic nutritionist.

    Update: June 16, 2015

Nice compilation of articles about Gestational Diabetes by an Australian doula http://www.themoderndoula.com.au/g-is-for-gestational-diabetes/

WOMEN WHO JUST WON’T GO

Some women just won’t go to the hospital to have their babies. Even though their doctors have warned them, even though their husbands won’t let them, even though they don’t have any supplies, they just won’t go to the hospital. This small group is never studied by researchers. What clock ticks inside of them that all cultural taboos cannot reset. . . what steely resolve has them navigate the logistics so that they give birth to a baby in the place that they feel safest despite lack of agreement?
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My friend, Dee, lives in small town, B.C. She had had two hospital births and was not impressed by what she experienced in the local institution. She let her husband know that she wouldn’t be going back there again. He agreed as long as they could find a midwife.

There was a British midwife living in their town but she did not attend home births so, as far as her husband was concerned, Dee’s home birth couldn’t happen.

She started having sensations at suppertime, she didn’t say a word. She ate her meal, cleaned up the kitchen, and excused herself to go to bed. Her husband was watching T.V. About 10:30 p.m. she called out to him “Do you want to come and meet your new daughter?”

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Caroline had had a home birth for her son. She was a single mother and she had a fainting spell after that first birth that required a transport to hospital. When her baby son was a few months old, she met and married a wealthy businessman. She became pregnant and her new husband was not at all comfortable with a home birth but he made sure they had a great doctor and hired me to be her prenatal teacher and birth coach.

The day she had the baby was sunny and cold. She called me and we went out for a long walk. Her sensations were picking up and so we returned home. Her husband had to go to City Hall for a meeting. She smiled at him and said, “Go ahead, we won’t be going to the hospital for a while. I’m going to have a shower.” I had no idea the baby was on the way out. She stepped out of the shower 20 minutes later with the baby’s head crowning. I quickly phoned her husband and told him to come right home but he missed the birth by 15 minutes. He was very happy to meet his new son and, after that, they just stayed home when their two daughters were entering the world.
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Louise wanted to have a homebirth but she was pretty sure her husband, a flight attendant, wouldn’t go for the idea. It was their first baby.

I encouraged her to set up a meeting with me and I did my best to “sell” him on the idea of a home birth. He sat in the meeting with his arms crossed firmly across his chest. When I finished talking he said “Thank you for your time, we won’t be having a baby at home.” I thought that was the end of the idea for both of them.

The day she started having birth sensations, he had an overseas flight. She let him go without saying a word. She gave birth by herself in her apartment and phoned an ambulance about a half an hour after to come and get her. (she needed help to clamp and cut the cord). When her husband came home, there she was in the hospital with a newborn daughter. I don’t know if she ever told him that she gave birth at home. She only told me the story about a week later. i was amazed.
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Camille had her first baby in France. The obstetrician told her at the first visit that the baby would die in pregnancy. The baby was born in the hospital 9 months later and was just fine. She wasn’t too impressed with French doctors.

She gave birth to her second child in Toronto, Ontario. The nurse at the hospital came in to check her and said “You’re fully dilated, you should push now.” Camille was furious. Who was this nurse to tell her when to push? She wasn’t too impressed with Canadian nurses.

She decided to have her third baby at home in Hamilton, Ontario. It was a cold stormy night. Her older two children were staying with a friend, her husband was on the road doing sales work, and Camille settled in to have her baby alone. She had done a lot of reading in preparation although material was scant in those days before the internet.

The baby was born on the linoleum floor of her bedroom. Camille’s only regret is that she didn’t realize she could leave the cord alone for a longer period of time. She tied and cut the cord, birthed the placenta, cleaned up the floor, went to the kitchen and made herself a cup of coffee and settled back into bed to enjoy her baby girl.

The reason I heard this story is that Camille’s daughter that was born on the bedroom floor became my client for a homebirth 30 years later! I was so excited to meet her Mom, Camille, after I heard about her births.
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I love these stories of women taking charge of their own births.