Interesting read from the Doctor. Some good thoughts and ideas here!



https://wkstafford.wordpress.com/2011/10/26/my-birth-plan/

My Birth Plan

I have been delivering babies now for 25 years.  Birth plans have been around for that whole time, but they are certainly presented by couples to their doctors more frequently today than they used to be.  The increase in birth plan development is a consequence of couples trying to influence what happens in a hospital where one frequently becomes swept along by events out of their control.
I certainly do not mind being presented with a birth plan and using it to review a couple’s expectations and preferences.  However, in my opinion, it is far more important that one find an accoucheur (birth attendant) whose default style is in line with your birth plan, than trying to get someone to change their style to match your preferences.  In light of this I decided to write down my birth plan from the perspective of the professional who is being entrusted with caring for an expectant couple.  Here are my goals and preferences:

1. Give the couple the type of birth that THEY want to experience.  While most overt birth plans are produced from those who are looking for a natural birth experience.  Not everyone is looking for this.  I have some moms who want no medications at all and I have some who want an epidural placed in the parking lot.  Whatever the preferences, I will do my best to accommodate them.
2. Explain all interventions and get the mother’s permission, before doing them.  One of the biggest complaints I hear about unpleasant birth experiences is that things were done to them without them knowing what was happening.  While it is easy for a doctor to go into automatic mode, I do my best to not let that happen.
3. Alleviate fear.  One of my frequent statements about pregnancy is that it is the permanent state of paranoia.  Couples are often plagued by the “what ifs”  and modern obstetrics often adds to this with the constant pursuit of worst case scenarios.  While it is certainly true that bad events can occur during pregnancy, thankfully this is the exception and not the rule.  My job is to be alert for  problems without turning every visit into a worry generating experience and to reassure moms when there is no reason to worry.
4. Avoid Inductions.  I hate inductions.  Sometimes, inductions cannot be avoided, but even then I still hate them and really try not to do them.  No one knows what actually triggers labor, but one thing I do know is that forcing a uterus not yet ready to labor to labor is asking for trouble.
5. Encourage mothers to stay out of bed and in motion.  The best way to reduce discomfort and to move labor along is to stay out of bed and move about and frequently change position.  One can also use birthing balls, whirlpool tubs, showers, hypnobabies.  Doulas are welcomed as part of the birthing team and a great help in keeping the labor moving along in a productive manner.
6. Prefer no epidural.  If women want to have an epidural, they may, but my preference is no epidural as this allows for the most physiologic beneficial labor possible.
7. Keep the stirrups stowed.  When someone is ready to have their baby, the nurse’s automatically reach for the stirrups.  I tell them to put them away.  In my opinion, the stirrups serve no useful purpose and they impede a mother’s ability to find the most comfortable position in which to give birth.  I deliver women in whatever position they are most comfortable and have delivered ladies on their side, hands and knees, leaning over bed, standing, squatting, whatever works.
8. No episiotomy.  I avoid episiotomies.  (Hint:  when a doctor says they only cut an episiotomy when it is needed, they probably cut episiotomies on most of their deliveries)
9. Put baby on mother’s chest as soon as baby is born.  The baby goes from me to the mom, not the nurse.
10. Delay cord clamping.  I cannot say, that this is something that I fully understand, but it is frequently requested so I have incorporated it into my routine.
11. View Cesarean section as a negative outcome.  Again sometimes cesarean sections are unavoidable, but I never view them as equivalent to vaginal birth for delivering a baby.  Whenever, I have a pregnancy ending with a cesarean section I review the various aspects of the pregnancy and labor to see if I could have done something different to have ended with a vaginal birth instead of a cesarean section.
12. Maintain a relaxed environment.  Sometimes things can get pretty tense in the birthing suite, but it is my job as the team leader to keep things relaxed and low key.  I have no use for all of the drapes and masks.  I do  not even wear scrub suits (though my wife wishes I would).  This is how I got my nickname “Dr. Polo Shirt.”  I work at calling everyone involved in the birth by their name and try to treat them the way I would want to be treated.  
13. Care for the baby I deliver.  I really like it when I get to take care of the baby that I have delivered.  This is one of the services that is unique to family physicians who do obstetrics. Keeping the pediatric care with the same doctor who one has gotten to know throughout the pregnancy provides a level of comfort not available with most other care providers.

A Doula for Death?

This morning I read an article about death doulas. I had it open on my computer for days before I actually read the article. The idea seemed a bit macabre. Although, I have helped families when their baby was born still. I have taken a Still Birth Day Workshop and plan to take the full 8 week course in January 2016, but seeing those words was a bit off putting.

However, once I read the whole article, it all made sense and resonates so well with me. Just as I wait on the transformation of pregnancy and life earthside (birth), I can also support and love in the transition from life to eternal life (death) in the prenatal and perinatal times.

I am forever grateful for the close friends, and Hospice volunteers, who sat with us as Ledya, at 6 years old, made her journey from life on earth to life eternal.

TENS, what is it?

Transcutaneous Electronic Nerve Stimulation, or TENS is being used in birth. They are most often used for back pain which doesn't respond well to other pain relief modalities. 

In Europe they are popular, but are becoming more so in the USA and the birth 
world. Quite intriguing to me, so in June, I shall take a class to learn all about TENS. Maybe I will have a new tool in my doula bag for my fall births!!

Have you used a TENS in birth or for other pain that doesn't respond well to the usual painkillers? What was your experience? Would you like to have a TENS available at your birth?

You haven't given birth!?

Yes, it's true. I have not had a natural birth. I have not had a vaginal birth. Neither have I had an induction,  or forceps or vacuum birth. But, I do have 5 children.

I have had a caesarean section, a medical  or surgical birth. Or, as I prefer, I have had a caesarean birth. Three times actually. And, for full disclosure, I have 2 children by adoption. And about 100 foster babies, toddlers and children.

The Oxford English Dictionary describes birth this way: "The emergence of a baby from the body of its mother; the start of life as a separate being". No matter which exact route is taken, it is birth.

There were clear medical needs for my surgeries and I do not feel guilty, or ashamed, or even less of a woman because I have never had a vaginal birth. My children's lives were at risk and my Dr's saved their lives and on one occasion, saved mine too. So, you see, my births were not without trepidation and chaos.

My first son was born thirty years ago, before there were routine ultrasounds. I had laboured many hours and wasn't progressing, so an epidural was suggested so that I could rest and perhaps once my body relaxed I would dilate. Well I certainly dilate quickly from barely 4 to a good 7. My water was broken to help speed the process, and, it also told us our son was in distress - there was meconium staining! AND, he was breech! As I was only 7cms, we leisurely made our way to the OR.  Baby boy was fine, nursed well and we enjoy his company to this day.

With baby number 2 I used the same practise, but saw their midwife. Again it was a long labour and we tried all kinds of positions to get baby to descend without compressing his cord.  After 16 hours I was tiring, his heart rate kept dipping and taking longer and longer to return. Ultimately, the heart rate stayed down. I was whisked off for emergency surgery. I didn't have an epidural and because it was so emergent they didn't go slowly through the layers of my tissues, they cut right through my (full) bladder, which had adhered to my healing uterus 18 mths earlier. I will let you imagine the repair and healing there! However, I must admit, I was able to put a good spin on the required 7 days in the hospital, because, we had a three year old foster child and our own 18mth old, so I was happy to take all the rest I could get before going home to love on 3 little boys!

Baby number 3, well, in all honesty I had been in labour close to 24 hours two times before, so just said "unzip me" !

I was very happy to read the article recently posted about the new Dillard parents about  no shame in c section births . Sometimes we have caesarean births because there is a grave medical necessity, sometimes it is pressure applied by those we employed to assist us in birth. Either way, there is no shame. You may feel sad, depressed and perhaps have been traumatised, it is ok to grieve the loss of your dream birth. Do please reach out to professionals or trusted family members if your feel that you are hampered by your birth memories, or perhaps have PPD (postpartum depression).

There is no reason for shame! No reason for guilt, no reason to see myself as less of a woman because I didn't have a vaginal birth. I birthed 3 children. They are healthy and now they are giving me grandchildren....so far, born vaginally and one was born at home!

Swim noodles, shelf liner and clear tape!

Last week I spent my days being a commuter. I joined the myriad folks who drive north on the 95 to  work. Let me just say I have a much greater respect for my husband and have a much better understanding for those days when he comes home beyond exhausted.













Anyway, I learned about car seat safety, which is a much bigger topic than I ever imagined.

Before you can learn about car seats for children you have to know all about the seat belts that are in each car. They are different for each manufacturer and always changing! Plus the cars from several years ago clearly have older styles to restraints. It's a huge category.  Retractable, ALR, ELR, sewn, sliding, buckle, latch plate. And on it goes... 67% of the time, if the driver isn't buckled, neither will the child be buckled and safe (National Occupant Protection Use Survey Controlled Intersection Survey 2011). Appropriate car seat or booster seat safety reduces risk of injury by up to 82% (AAA 2012)Vehicle crashes are leading cause of death for children (NHTSA 2012)

Then there are airbags to be considered....and they are coming in more and more places, even in the seat belts themselves!

Finally we can think about the car seats. There are new ones coming out all the time, often just a minor change from a previous model, but a change nonetheless. More initials, FF only, RF convertible, FF harness, BPB, LATCH. But, if you only use the lower anchors you are not really using the LATCH system. The LATCH system has a weight limit too, then what do you do to secure the child in the car? And, what about the winter...its cold and babies and children need a warm fluffy coat, right? Wrong, no coats on in the car.


Forward facing, a huge question which can be answered by the fact that we would all be safer if we travelled backwards! So, leave your children rear facing as long as they fit the convertible car seat makers height and weight limits. Most babies grow out of the infant carrier before a year old..

Plus, what happens when the car seat and the seat of the car, just do not mesh well together? That's were the swim noodles, shelf liner and clear tape come in, but there are very specific ways to use them that are accepted as safe by care seat and car manufacturers.

Once we got the answers to these and many other things we were allowed out into the community to actually participate in a car seat point. Fairfax County PD has these every 3 months or so. Locally, there are none. On occasion the Sheriff's office will be invited to an event.

So, if you have a child who is less than 4'9', 80 pounds and/or 8 years old, contact me and we can make sure s/he are safe, together,   fredericksburg.doula@gmail.com This is a free service as part of the Good Samaritan Law.

What questions should we be asking?

Mar 16, 2015

In life people are often told what to do, when to do it, how to do it and even when to stop. This is true whether you are a parent, a boss, a leader, a mentor or even a guide. We must do our job, by making sure someone else completes their job well.

Sometimes, we just need to do what we are asked or told to do.

In life though, there are plenty of occasions when it would be wise to ask a person  what they would like to do or eat or where they would like to go and how they would like to get there. Just because there are a myriad treatments for a sick person doen't mean it is appropriate or even what that person wants to do with their life. My daughter 6 year old Leyda, died at home because we felt that as a child, inparticular, she should be cozy and comfy...not surrounded by machines and equipment.  There were no organs to donate, so in cooperation with all her specialists, we stayed at home. 

During the birth process, we should be asking moms what they would like to do. Events may take a slightly different path than previously planned. We should be asking how mom would like to proceed, over and above the birth plan (that was prepared with rose colored glasses perhaps). We should stop long enough to let mom think and talk through the options. Even ask the medical staff leave the room. Thus, mom can continue to feel in control and a respected part of the team as the staff return and she states her wishes and/or agreement. Which may well be to wait a little bit to see how things look in an hour!

Actually, Mom is the Captain of the Team!

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Watermelon to the rescue!

Mar 12, 2015

As I was perusing my FB page this morning a mention was made of morning sickness, which can last all day and all pregnancy for some. When it is particularly bad, nothing stays down and IV fluids are required. Then it is call HG or Hyperemesis Gravidarum. There are many tips for treating it, ginger ale, crackers - before you even get out of bed and throughout the day, eat small meals, BioBands, acupuncture and the list goes on. Rarely does a food work  because it can't stay down. Medications are needed and frequent trips to get IV fluids.

Today I heard about watermelon being wonderful for nausea. Despite the fact that it is 92% water it is also loaded with good nutrition in the form of lycopene (more than tomatoes!), it is high in Vit C, A, B6, potassium and magnesium. Watermelon can be crushed and made into frozen pops, too! Perhaps once some meds are in place, watermelon would be a good food to try.

Here are a couple of sites to read further 

http://www.livestrong.com/article/491546-eating-watermelon-while-pregnant/

https://woolworthsbabyandtoddlerclub.com.au/pregnancy/pregnancy-health-and-nutrition/why-you-should-eat-watermelon-during-pregnancy/

And don't forget to carry a nausea kit: In case you're seized by a bout of nausea in an unexpected place, keep an emergency kit handy: plastic bags, wet wipes, napkins, water for rinsing your mouth, a toothbrush and toothpaste, and breath mints. And remember: This too shall pass.

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