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Friday, 31 January 2014 10:06

Fetal Monitoring - Is it Really Safer?

Beep. Beep. Beep. You are in labor, lying in bed attached to an electronic fetal heart monitor (EFM).  A medical professional enters the room and immediately walks over to this machine, and with no eye contact he or she unfolds the long strands of paper to read a foreign language that no one explained to you.  Nervously you peer down at your fingers as if you are getting graded. Beep. Beep. With that he or she responds,  “Okay, looking good. I will be back to check on you in a couple hours.”  Beep. Wait a minute. Did the professional check on you or the machine? That is where lines blur. Babies all over the world are being continuously monitored without clear evidence of the benefit.

EFM was enthusiastically introduced into the medical system during the 1960s and took off in the 1980s with hopes that continuously detecting a baby’s heart rate would ensure safety and lower the risk of perinatal death.  Ina May Gaskin explains that this, in turn, increased the rate of cesarean section because doctors had not expected that “the lowered fetal heart rates during uterine contractions that could be picked up for the first time with the continuous monitor...were absolutely normal” (116).  Many heart rate tracings are identified as abnormal when the baby is in no distress. Continuous EFM is highly sensitive and has the ability to identify fetuses that are distressed, but also has low specificity, or the ability to identify those that are not in distress. The EFM “therefore has a high false positive rate” (Walsh 60). 

Walsh conducted a systematic review involving 12 studies and 37,000 women comparing continuous EFM to intermittent auscultation (listening by hand with a fetoscope periodically after a contraction). This review found (58):

  • No differences between the two in perinatal death, Apgar scores, NICU admissions, or cerebral hypoxia (or lack of oxygen to the brain).
  • EFM halved neonatal seizures, but also resulted in a significant increase in cesarean sections and assisted vaginal births.

Evidence shows that intermittent listening with a fetoscope is just as reliable as EFM, and in most cases takes away much of the fear involved in birth resulting in fewer cesareans.  So why is this method still in practice? Continuously monitoring a woman in labor requires less human contact. One nurse is able to “monitor” several patients at a time from a local station. Doctors are able to monitor an entire unit. This in turn lowers costs and shows evidence, via the long strands of paper, that the baby was watched throughout labor if a courtroom was ever involved.

Beep. Beep. Beep. Imagine that you are back in that hospital room. Let’s say that your female nurse walks in and begins to document your baby’s heart rate. This time instead of looking down, look into her eyes and ask her to turn down that noise. Maybe even ask if she will turn the machine away from your line of vision so that it is no longer your concern, just hers.  Then ask her the best ways to move around. Most likely she will respond with compassion and understanding.

As a labor and delivery nurse I do this for all of my patients. I always offer to educate them regarding what we are monitoring, why we are monitoring and the policies that go along with that. Then I ask permission to tilt the machine away so that it is no longer a concern. Sometimes the mother and I even cover the machine with a blanket! I then show her how to move around the room while still being monitored, and encourage her to get out of bed if she does not have an epidural. 

Technology has a way of creating the illusion that we are progressing. This is not always true and there are data to prove it.  Hospital staff and even parents tend to depend on these machines, creating a mind-body split. Sometimes the monitor becomes more important than the internal experience. Don’t let that happen to you – keep yourself empowered and ask questions. The ancient ways of birthing through continuous human contact are still relevant and vital to health and safety for mothers and newborns.

For more information on this topic, pregnancy, or to read birth stories visit: http://birthwithbalance.com

Gaskin, Ina May. Birth Matters a Midwife’s Manifesta. New York City. Seven Stories Press. 2011. Print. 

Walsh, Denis. Evidence and Skills for Normal Labour and Birth a Guide for Midwives. New York City. Routledge. 2012. Print

 

Sunday, 14 April 2013 11:28

New Mother Book Review

"Filled with great advice for expectant moms, New Mother makes the perfect gift for any pregnant woman.

The information author Allie Chee provides allows for women to be in charge of their birth and postpartum time. Instead of just letting things happen, Chee informs us on how to plan for a desirable birth experience and teaches the reader that this really is something that you must be proactive about." 

-MIDWIFERY TODAY

 

• Do you want a natural childbirth?

• Have you considered home birth?

• Do you believe that your postpartum can and
should be magical?


NEW MOTHER: Using a Doula, Midwife, Postpartum Doula, Maid, Cook or Nanny to Support Healing, Bonding and Growth

 


NEW MOTHER, Book Summary

Reclaim the magic in motherhood!
It is possible to have it all: a more natural birthing experience; relaxing, bonding family time postpartum; time to care for yourself; time to take care of your home; and the ability to choose whatever vision you hold for your experience of childbirth and motherhood.

That’s not what we’ve been told, taught, or empowered to do... until now.
There’s more to pregnancy, childbirth, and postpartum than what is usually discussed in literature and doctors’ offices: the next problem, pain, or procedure! New Mother offers a clear vision for reclaiming the beauty and sacred nature of pregnancy and parenthood.

Author Allie Chee, at age 42 and after two miscarriages, wanted a home birth, a traditional 40-day postpartum healing and bonding time, and to breastfeed and co-sleep for two years. That’s not for everyone, but indeed almost everyone would want a more natural, loving childbirth experience at home or in the hospital than the standard, mechanical childbirth template common today—and this book helps you plan for just that…a more natural, loving childbirth experience!

Throughout the work, vignettes of the author’s and other mothers’ experiences are included that will resonate with parents, keep them laughing, and encourage them to rewrite the story of their lives.

 

"If you are pregnant or are a new mother you cannot afford not to heed
the advice given by Allie Chee in her book, New Mother, if you want to experience the true joy and fulfillment of new motherhood.
A very practical book written with humor and wisdom."

-DR. MAO SHING NI, Ph.D., D.O.M., Dipl. ABAAHP

__________________________________________


More info & reviews: New Mother Blog – Reviews

On Facebook www.facebook.com/AllieChee

Buy New Mother on:
Amazon
Barnes & Noble 

Published in Product Reviews

Ask any questions that are relevant

  • Is she certified?
  • When did she become certified or why is she not?
  • How many births has she attended?
  • How many clients does she usually take in a month (any more than 5 clients in a month is a red flag)?
  • How much will she charge, does she have a sliding scale, what is the payment schedule?
  • Does the payment change if she is unable to attend or if  you end up needing a c-section? If it doesn't work out can you get a refund or find someone else who might work for you?
  • Does she have other services available like belly casting, placenta encapsulation, photography, breastfeeding services, babysitting, or postpartum services?
  • Does she have a back up, can you meet them?
  •  

Get to know your doula on a personal level

  • Is she married, if so how long?
  • Does she have children, how many, how does she feel about her birth experience?
  • Why did she become a doula?
  • What is her overall philosopy on birth?
  • Did she breastfeed, how long, how does she feel about it?

Build a relationship

You should have at least 2 prenatal appointments with your doula. During these appointments you'll probably go over things she'll do to help you along during labor and if complications arise. Also during these times you should begin to get comfortable with her touching you in case massage, hair stroking, or counter pressure are used to comfort you during labor so you can let her know what you do and do not like beforehand and to build the comfortableness with her. If you would like she may have relaxation techniques to practice too which would be helpful so you know you can completely relax in front of her. Personally, I found an included belly casting session really helped me open up and get comfortable with my doula. 

If at any point you are not comfortable with your doula: First determine if the issue can be resolved and try to fix it. If you think it is something that  will affect your ability to remain comfortable with your doula for future appointments and/or during labor, birth, or postpartum then you should talk to her respectively and tell her you just can't do it; She may know someone else available that you may be comfortable with. 

If you are a doula or want to become a doula: The steps also apply to you but from a different standing point. Try to give your client as much information as possible so that the family can feel comfortable with you; like a friend rather than business. Reassure partners that you aren't there to take their place, but rather to help them help the mother or step in when they need a break. Beware them that you can not speak for them, you are not a medical professional, and can not give medical advice; You are simply there to support the family and help comfort the mother. 

Published in Jessica's Blog

I discovered I had a prolapsed bladder just 2 weeks after giving birth to my fourth child. I could feel a fleshy bulge caused by my bladder slipping down and putting pressure on my front vaginal wall. I was devastated. I felt broken, scared and alone.

I wondered if I would ever be able to bear children again. I began looking for information and found sites like www.wholewoman.com. It was there that I learned how common pelvic organ prolapses (POP) are (we are not alone!) and that they CAN be managed with lifestyle changes. That was 4 years ago.

Since then, I’ve given birth two more times with little or no effect on my prolapse (despite an OBGYN’s insistence that it would only get worse if I continued childbearing). I have learned so much in the last four years about pelvic organ support and health.

I have come out of a place of fear into a place of thankfulness and here are my top 10 reasons why I’m thankful for my POP:
 

 

 

  1. I think twice about raising my voice with my children! Yelling can actually aggravate POP so it is helpful to try and remain soft-spoken as much as possible.
     
  2. I have a greater need to avoid stress and foster peace in my life! Stress also aggravates POP so making an effort to live a peaceful life goes a long way in managing prolapse.
     
  3. I focus more on healthy eating! Because bowel trouble (especially constipation) is really terrible for POP, it is so important to eat foods high in fiber, as well as nutritious foods that promote optimal health.
     
  4. I lead a more active lifestyle! I can’t say that with 6 kids I am always faithful at exercising but I am certainly more active and I do exercise more than I ever did before. Avoiding exercises that strain your pelvic support system such as pilates and some yoga positions is key!
  5. I wear more feminine clothing! Tight clothes can really aggravate your POP so wearing loose fitting and flowing garments such as skirts and dresses contributes to keeping your prolapse in check! And it helps you feel feminine and beautiful too!
     
  6. I make better birthing choices. It’s true you can continue to bear children even with POP! My midwife is always mindful of protecting my prolapse as much as possible during childbirth. We avoid interventions. I usually try to give birth on my hands and knees so my bladder is out of the way. At my last birth, the placenta was a little stubborn and my midwife was careful not to coax it out to avoid damaging my prolapse. I was very appreciative of her support.
     
  7. My teens help out with household chores (especially ones that require heavy lifting!). I try to avoid lifting heavy things as it really can aggravate POP. I have learned not to carry around an overflowing basket of laundry or heavy garbage bags. My teens have learned to become more helpful and I have had to learn to delegate!
     
  8. I have a cuddle chair! At first, I was really sad about having to avoid lifting my heavy toddler. But, I eventually got creative and designated a chair where we would cuddle together whenever a toddler-sized-crisis arose. It actually became a really special spot for us to bond and spend time together!
     
  9. I take care of my bladder! With a bladder that sits a little low, there is always the potential for bacteria to accumulate in stagnant urine. This can lead to painful cystitis and urinary tract infections! I have learned to pay attention to my fluid intake (I drink lots of water!). I also take cranberry capsules daily to help flush out bacteria and I often pee standing over the toilet, while leaning forward to tip my bladder so it empties fully. It works wonders!
     
  10. I have learned that I can lead a normal life, even continue to bear children, with a little bit of wisdom, and smart lifestyle practices! Most days, my prolapse does quite well and doesn’t affect me at all. I’m thankful for women who have shared their stories and wisdom so that I could learn from them! So many women are affected by POP (some stats say 1 out of 2 women will experience a form of POP in their lifetime) and yet we are so afraid to talk about it.
     

If you have discovered you have a pelvic organ prolapse (bladder, uterus or bowel), take heart! There is hope! You can learn to manage POP and live a full life! Christine Kent has wonderful information over at wholewoman.com! The face of POP isn’t just the post-menopausal woman. Childbearing women can also experience POP. If this is you, take a deep breath, find information and live life fully!

Published in Julie-Anne's Blog

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