Safety in Childbirth

Preventing Group B Strep Colonization in Pregnancy
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Preventing Group B Strep Colonization in Pregnancy

For clients of Gentle Delivery, you know that routine Group B Strep testing is offered to every expectant mom in accordance with the ACOG standards of care. While the pros and cons of testing and subsequent treatment plans are discussed in detail elsewhere, the purpose of this post is to help you to minimize your risk of developing Group B Strep colonization during pregnancy, thus promoting better health for you and baby (and increasing your chances of obtaining a negative test result!).

If you are interested in researching Group B Strep info, I’d strongly encourage you to read Aviva Romm’s article: Group B Strep in Pregnancy: What’s a Mom to do? You’ll find clear explanations of GBS, risks and benefits of antibiotic treatment, and tips on promoting health. This post by Wellness Mama also includes further links for study along with Katie’s suggestions for avoiding GBS colonization with natural methods: How I Avoided GBS Naturally  And finally, this article provides a few other options to consider while making decisions on prevention and treatment: Decrease Your Chances of GBS

As a practicing CPM in a state that does not offer licensure, I am currently unable to offer IV antibiotic treatment to GBS+ clients. This increases my desire to do all I can to help support a mom’s immune system and decrease the possibility of a GBS+ test result, as it greatly simplifies the care protocols and necessary decision making for clients and their families!

So here are the primary suggestions for making your vaginal flora inhospitable to Group B Strep:

  • High Quality Probiotics (if not started early on in pregnancy, then beginning at 28-32 weeks orally, adding vaginal support at 32-34 weeks)

“Many species of Lactobacillus have been shown to be beneficial to the vaginal flora; Lactobacillus reuteri and Lactobacillus rhamnosis are species known to be especially helpful for supporting healthy vaginal (and bladder) flora, while these and others, including L crispatus and L. salivarius strains, have been shown to to inhibit the growth of vaginal pathogens including Gardnerella vaginalis and Candida albicans, and also reducing the frequency of bladder infections in addition to vaginal infection.

In one study, 110 pregnant women at 35-37 weeks of gestation who were diagnosed by GBS culture as being GBS positive for both vaginal and rectal GBS colonization were randomly assigned to be orally treated with two placebo capsules or two probiotic capsules (containing L. rhamnosus and L. reuteri ) before bedtime until delivery. All women were tested for vaginal and rectal GBS colonization again by GBS culture on admission for delivery. Of the 99 who completed the study (49 in the probiotic group and 50 in the placebo group), the GBS colonization results changed from positive to negative in 21 women in the probiotic group (42.9%) and in nine women in the placebo group (18.0%) during this period. The researchers concluded that an oral probiotic containing L. rhamnosus and L. reuteri could reduce the vaginal and rectal GBS colonization rate in pregnant women.

In another study involving 57 healthy pregnant women, L. salivarus was taken daily by the 25 GBS positive women in the group from weeks 26 to 38 of pregnancy. At the end of the trial (week 38), 72% and 68% of the women were GBS-negative in the rectal and vaginal samples, respectively. The researchers concluded that this seemed to be an efficient method to reduce the number of GBS-positive women during pregnancy, decreasing the number of women receiving antibiotic treatment during labor and birth.”  (copied from Aviva Romm’s article here)

In light of these studies, and knowing that probiotics are vitally important to the health of both mom and infant for a variety of reasons, supplementing regularly with probiotics during pregnancy can be beneficial in more ways than one. For GBS specific support, it’s recommended that you begin supplementing orally at 28-32 weeks (though earlier is even better!), and then increasing your oral dosage and consider using a probiotic vaginally for at least 2-4 weeks before your Group B Strep test (and then continue the oral support through the rest of your pregnancy).

As you shop for probiotics, pay attention to the different strains it includes, as not all probiotics are created equal, and they will be most effective against GBS strains if it includes L. Rhamnosus, L. Reuteri and L. Salivarus.

Some brand suggestions that other midwives have given me are:

  • Diet Support
    • Eating a diet high in fermented foods/drinks (kefir, sauerkraut, kombucha, yogurt, etc.) help to promote a healthy gut flora.
    • Eliminating sugar and simple carbs are also effective in promoting beneficial gut flora.
    • Add 1-2 tbl of coconut oil into your daily diet for it’s antibiotic properties, specifically in the few weeks prior to testing.
    • Apple Cider Vinegar consumed daily or in capsule form may be helpful.
  • Vitamin C
    • Consuming 1000-2000mg of high quality vitamin C daily (in divided does) can help to increase your body’s immune response, which makes it more difficult for unhealthy microorganisms to grow. You can begin this regimen around 30 weeks.
  • Garlic/Allicin (active component of garlic)
    • Garlic has been used as an antimicrobial agent for generations, and for good reason. However, high doses of garlic can cause blood thinning, so I don’t recommend staying on high doses of garlic or allicin after obtaining your GBS test. But it is a treatment to consider to reduce the possibility of GBS colonization before getting tested. Currently there is a midwife practice conducting a study where participants are instructed to use Allicin Gel 2x daily for 12-14 days along with ingesting 180mg of Allicin capsules 2x daily for 12-14 days prior to testing. The basis for this study is from a preliminary study done in 2009 where Allicin was shown to reduce the possibility of early rupture of membranes and chorioamnionitis, both of which can be complications of GBS infection. Other methods of using garlic include: taking garlic capsules daily, consume raw garlic daily, and/or insert a raw garlic clove vaginally at night before going to bed.

            While we still have a lot to learn about Group B Strep (how exactly it is transmitted, best ways to treat it, and how to prevent it from the beginning), and while there still seem to be a few moms who naturally carry Group B Strep bacteria in their vaginal tract no matter what they try to do about it (antibiotic or otherwise!), one of the benefits of utilizing these suggestions is that they promote health for mom and baby regardless of the GBS presence (or lack thereof). While obtaining a negative Group B Strep test does eliminate a certain amount of worry, risk and decisions, the benefit to your body of increasing the good bacteria and gut flora through healthy foods, probiotic supplementation and other factors may provide long-term benefits that you will see later on. I’d highly encourage every pregnant mom to consider these suggestions, and wish each of you a healthy and safe pregnancy and birth!

            I’d also love to hear: did you try any of these prevention methods? How did it affect you and your GBS status? Did you test positive in one pregnancy and then negative in another? What was most beneficial for you?

Questions to Ask When Interviewing a Potential Midwife
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Questions to Ask When Interviewing a Potential Midwife

Baby Tirzah helping Mommy do office work!

Are you looking into the possibility of working with a midwife, and trying to decide if it’s the right choice for you? If you’re blessed to live in an area with several options, it can be a great idea to take the time to “interview” each one, and see which one feels like the best fit for you and your family. Most midwives (myself included) offer free consultations that can give you a chance to sit down and ask your questions in person, and this can be a great opportunity to explore whether or not you and this care provider will be a “good fit”.

While I think it’s a good idea to look into your options for ANY medical provider, it can be especially important when thinking about a homebirth. Your midwife will be coming into your space, and you want both yourself and your husband to feel completely comfortable with this person, which facilitates clear & open communication, thus providing you with the best care possible. So besides some specific questions (which we’ll get to below!), also think about the intuitive side of how you connect and communicate throughout the interview. Another important component in this interview is dad’s perspective, so whenever possible please have him attend this initial consult, as this can give him the opportunity to ask questions he might have, and help establish a good working relationship from the beginning.

There are many posts out there that cover long lists of questions, but I want to get you started by giving you a few basic questions, which might bring up more as you go along. It’s a good idea, too, to do your own research before you meet with a perspective midwife. For instance, does she have a Facebook page or website? Are there reviews you can read by previous clients? Is there information listed about the types of services she offers, or things that set her apart from other options in your area? What type of credentialing/training does she have? Do the philosophies expressed on her website correspond with what you are looking for? Do what you can to find out as much as possible before meeting up, as this will enable you to get the most information out of your time together, and may raise specific questions that you might have missed otherwise. It will also keep you from wasting time that you could be spending looking into other options!

So let’s get started:

  1. What kind of training did you go through to become a midwife?

Some midwives have attended midwifery school, others have been trained strictly through apprenticeships. Some midwives have credentials that indicate a certain level of training, and require a stated number of continuing education hours to be maintained. There are midwives who have gone through rigorous school programs and have delivered few babies outside of the hospital, and others who have done minimal studies and have only delivered babies at home. This question is not meant to dictate which type of training and educational experience is best, but rather to help you think through whether the training this midwife has received is adequate for your own comfort and safety concerns and desired birth location.

  1. How would you describe your style during labor & delivery? Hands-on or hands-off?

Depending on your preferences, this may help you determine if you can work together well. If you know you want someone very involved, or you want to be left alone as much as possible, the midwife’s answer may shed some light on how her style could affect your labor. Some midwives are very good at adapting to their client’s wishes, and some have their own set way they want to see things happen.

  1. What do you provide or include in your services, and what will be my responsibility?

Depending upon your state, local regulations and/or your community options, a midwife’s care package may include the ability to obtain lab work and/or ultrasounds or refer you to providers for these items, or you may be responsible to figure these things out for yourself. Some midwives include a “birth kit” as part of their package, while others ask clients to purchase this separately. A birth pool is included in some midwives care bundle, while others provide options for rental. Some midwives are able to give your baby vitamin K or provide mom with RhoGam if needed, while others need you to get these items from your pediatrician if you want them. Most midwives are able to file the needed paperwork to obtain a birth certificate and social security number, while there are a few who need you to do this legwork. Asking clear questions and getting an idea of what is and isn’t included will hopefully eliminate unmet expectations and surprise expenses as you continue through your pregnancy!

4. What tests & procedures do you routinely offer, and am I given the freedom to decline when I prefer?

It’s great when your midwife is willing to discuss the pros and cons of different tests and procedures, and allows you to make a true informed choice on each of these. Depending on the political environment, local standards of care, protocols, etc the midwife may have more or less freedom in these areas, or she may have personal preferences as to certain tests.

  1. What are some of your recommended resources for pregnancy and for birth preparation?         

This question may give you some insight into the birth philosophies the midwife has, as well as indicate how in-touch she may be with more up-to-date resources and educational material. Some books and resources are old classics, but there is also a wealth of more recent publications that can help you to be prepared. Are her health suggestions in line with your perspective and preferences? Does she require certain books to be read or DVD’s to be watched? Does she provide some resources for clients, or are you expected to purchase certain materials? Does she encourage a parenting style or lifestyle that you may be uncomfortable with, or that you find helpful?

  1. What is her client load typically, and what happens if two mamas are in labor at the same time?

While this doesn’t happen often, it does occasionally, and it’s a good thing to discuss. This question will reveal what sort of back-up plan the midwife does or doesn’t have, and will give you some indication with how well she works with the midwifery community around her. It also helps you to think about the “what-if’s”, since birth can’t always be controlled like we wish!

  1. What do you see as your role during labor, and would you encourage me to hire a doula?

It’s great if a prospective midwife can be honest about the support she can provide. Some midwives operate with a large team or a small client load that allows them to spend more time coaching and supporting a mom throughout labor. Most midwives are glad to support in whatever way they can once you’re in active labor, but they need to conserve their resources so that they have the energy and alertness they need for the time of birth, which means that if you really want hours of support early on, you’d probably be best served by considering a doula. This question can help you determine what the midwife’s expectations are for when she would come to you, and what sort of support you can expect, and will help you to define the role she would see herself filling at your labor.

  1. What are some of the reasons I would be risked out of care?

This gives you an idea of the midwives range of comfort, and whether she takes a more cautious or more relaxed approach. Each approach has it’s place, but you need an approach that makes you feel most comfortable and safe. It’s also good to remember that each midwife should only operate within a realm that they truly feel is providing safe care, so this is not a “good vs. bad” topic, rather a way to understand and communicate. Is this midwife comfortable with breech delivery? With a mom that goes past 42 weeks? With a baby that decides to come before 37 weeks? Continuing if gestational diabetes develops?

  1. What happens if I need to transfer care for some reason?

Does the midwife typically accompany clients to the hospital, or send them in by themselves? Does she have a doctor she works with, or a preferred hospital? Why or why not?

  1. How do you handle emergencies, and which ones have you encountered the most often?

This question will give you some insight into the midwife’s perspective: does she rely only on herbal remedies? Does she carry medications? Is she trained in NRP? Does she take a proactive approach to prevention? Does she see many emergencies? The answer may vary according to your area, too, as some incidents of complications can depend upon the clientele and area the midwife works in.

I hope this list can help you as you think through what is most important to cover as you interview your potential midwife! If you find it helpful, or if you have other questions you think should be added, I’d love to hear from you. Feel free to comment below, and be sure to share this list with others that might be looking into hiring a midwife for their maternity care!

answering questions after a birth…
Natural Induction Protocol: When Labor Needs to Happen
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Natural Induction Protocol: When Labor Needs to Happen

IMG_3165

Introduction: To begin this post, let me start by saying that for most healthy moms and babies, there is NO need to interfere and induce (“bring about or succeed in persuading something to happen”) labor. If you have done your homework, you know that induction can bring about a cascade of interventions that can ultimately result in a different outcome than you may be hoping for. I also want to make sure that you realize the importance of discussing even the possibility of “natural induction” with your care provider, as this person will have valuable information to consider in your particular situation.

With those disclaimers, I want to also mention that there are situations that arise where it is in the best interest of mom and/or baby to get labor started sooner rather than later. These factors can include increasing blood pressure, presence of concerning signs of liver stress, prodromal labor (mom getting exhausted from nights of contractions), nearing 42 weeks of pregnancy, PROM without labor, and more. There are also moms who, due to being high risk or under an OBGYN who has strict protocols, want a more “natural” alternative to encouraging baby’s eviction over the traditional route of Pitocin or other medical induction methods, and the higher risk of interventions that accompanies these inductions. For moms who fall under these categories, I want to share with you a protocol that I have been following that has had great success with those needing an option of induction at home or without medication.

One of the biggest keys to making a “natural induction” successful is preparation. You can’t decide today that you need to have a baby and have it work nearly as well as preparing ahead of time as signs arise. For more information on general preparation (which can help make a needed induction that much more successful), check out my post HERE. For this post, I’m going to detail specific suggestions for induction. Each of the things I’ll mention below can help your body prepare for labor, and may even encourage things to happen without needing to get more aggressive. I use these methods in this way: if there are reasons to encourage labor (such as knowing you have a hospital induction date scheduled, or are post-dates and need to deliver by a certain date), we start this protocol about 4-5 days before we absolutely need to get baby out. Also keep in mind that the more ready your body is, the more likely natural resources will work. To me, that is a reassuring aspect of using natural methods to encourage labor, as if your body is not ready, it will NOT work. And if it doesn’t work, you’ll need to be patient for awhile longer, which is so very different that using Pitocin, for instance, where it is turned up in increasing increments forcing the body into labor, and creating contractions that are much stronger than what the body can naturally produce on it’s own. Experiencing contractions here and there and having a higher Bishop’s score definitely increase your chances of these suggestions working.

Now on to the method (and remember throughout these days that frequent sex and vaginal insertion of evening primrose oil gel caps at night can also help!):

The “Midwives Brew” is a vast improvement over the old method I used in my early days as a midwife. Up until recently, when faced with the need to induce, we used the castor oil recipe that was basically 2 oz. of castor oil mixed with EmergenC (or some drink/shake) which was repeated 2-3 times with a dose every 1-1 ½ hours, for a total of 6oz of castor oil consumption. Do you know how nasty that is?!? And it causes massive diarrhea, which is a miserable way to start labor! But the midwives brew doesn’t work the same way. You can research it further online, but it includes just enough castor oil to cause contractions, but the theory is that the oil binds with the almost butter to keep it from making you miserable. I also feel like the minimal amount of castor oil in this recipe also makes it safer from any concerns of causing the baby to pass meconium in utero, which is another positive aspect. The crazy thing is that this recipe really does work if your body is ready for labor, and it actually has an 85% success rate (see the link above for more info).

  • Day 1: MasterGland by Nature’s Sunshine taken in the following dosage: 2 capsules every half hour for 3 hours followed by 2 capsules every hour for 3-4 hours. Discontinue if you get a headache. This is an induction preparation method mentioned in Shonda Parker’s book “Naturally Healthy Pregnancy” with a quote from the book here.
  • Day 2: Labor-Prep Capsules (such as these by Traditional Midwife @ Sunstone Formulas, though there are other similar brands available online) taken 2-4 capsules every hour for 6 hours.
  • Day 3: Sip on Mama Natural’s Labor Day Tea throughout the day, and consider having a membrane sweep (sometimes referred to as stripping membranes) from your care provider.
  • Day 4: Either repeat the previous cycle beginning with Day 1, or proceed with the Midwife’s Brew (recipe and information below).

Midwives Brew:

  • 10 oz Apricot juice (Goya brand Apricot Nectar found in the Mexican section of the grocery store works well)
  • 8 oz. Lemon Verbena Tea (hard to find, but you can use 4 bags of Bigelow “I Love Lemon” tea steeped in 8 oz of hot water for 10-15 min. Alternatively, some midwives use 3-4 drops of Lemon Verbena essential oil such as this one.)
  • 2 Tbl. Almond butter
  • 2-3 Tbl. Castor oil

Blend ingredients together in blender until well combined. Some prefer this over ice, but I’ll be honest that when I tried it, it was easier for me to get it down at room temperature.

The ingredients I have used for this recipe.

My suggestion is that you try to get some rest, eat a good breakfast, and then drink this mix around lunch time when your stomach is somewhat empty. A completely empty stomach can make it hard to handle, but if you’re too full you won’t be able to get it down either. It honestly isn’t as bad as it sounds, though it is a strange combination of flavors! After you’ve drank it, then eat whatever sounds good, and consider taking a good walk (avoid laying down for a bit until it’s settled).

Once you’ve taken this concoction, though, please be prepared! When this stuff works, it works much more gently than Pitocin, but it can cause efficient contractions…when I took it, my midwife missed my birth, and I almost didn’t make it home (a story for another day!). So learn from my experience, and don’t wait too long to get to the hospital or get your midwife on the way once contractions are consistent. Many of the moms I’ve seen take it end up with about 3-5 hour labors, though I’m not making any promises. Just wanting to not have anyone caught off guard!

So there you go! If you’ve used this method and it worked for you, I’d love to hear about it! Be sure to share this post with someone who might want to know that there are other (and much safer!) options out there than a medical induction, as this may help prevent them from heading down the cascade of interventions with their delivery!

Proactive Preparation Tips: Helping You Achieve a Successful Vaginal Birth
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Proactive Preparation Tips: Helping You Achieve a Successful Vaginal Birth

Proactive Preparation

Proactive Preparation Tips: Helping You Achieve a Successful Vaginal Birth

If you’ve read much about preparing for birth, you probably have realized that there tends to be two different “extremes” when it comes to how much or how little you do to prepare your body for the marathon of birth. On the one hand, there are those who feel strongly that you need to “trust your body” to do what it was made to do, and that the addition of herbs and other proactive methods give moms a sense that their body is broken and unable to work on it’s own. The other hand tends to view the whole process of labor and birth as an “accident waiting to happen”, and rushes to medicalize every situation (for example, routinely inducing labor at 41 weeks just because it’s a week past your due date).

My personal opinion (and take this as my opinion-as with anything, you must do your own research and make your own decisions about these suggestions!), is that there should be a balance between these two extremes. I feel strongly that a women’s body was designed to grow, nourish, carry and deliver a baby, and that you can have confidence that this a totally normal and natural process (and not a medical emergency!). But just like any other capabilities your body may have, these abilities can be supported, enhanced and enabled to do their job more efficiently, smoothly and successfully. With that mindset, I’m going to share with you some suggestions on how to support and prepare your body in order to provide you with a greater possibility of achieving a low-risk, normal, natural vaginal birth.

Some of the biggest factors that arise that prevent moms from their desired birth outcome include: pain in pregnancy that prevent them from moving well at the end of pregnancy, going so far past your due date that your care provider feels like an induction is necessary, a long early phase of labor that prevents mom from getting adequate rest and results in exhaustion (which often ends in transport from home and/or an epidural to provide needed relaxation), and a long pushing period that sometimes ends in surgical or assisted delivery. While there are varying factors in all of these situations that can all be prevented, there are MANY things you can do to reduce your risk of these situations occurring, if you just know what to be aware of and how to help your body to prepare!

  • Movement, Alignment and Positioning:

One key factor that makes a difference in your pregnancy comfort level, baby’s ability to descend efficiently, and your overall length of pregnancy/labor is the position of your baby in relation to your pelvis. I highly recommend you find a good chiropractor in your area (for those who are local you can find some recommendations when you click on the “Local Resources” tab) who is certified in Webster technique and works with pregnant moms, and get regular adjustments specifically throughout the last 6 weeks of pregnancy. If your pelvis and muscles are out of alignment, they can keep baby from being able to descend into a position that is optimal for triggering the start of labor, and the ability of the baby to navigate the birth canal, which can then cause labor to stall and/or make it more challenging for you during the pushing phase.

For the best explanation of position and how this can affect labor (and what you can do about it!), I highly recommend that you take the time to watch the Parent Class taught by Gail Tully at Spinning Babies. Once you’ve watched it, check out the Spinning Babies website for more tips and suggestions on optimizing your baby’s position. And finally, if you are getting near your due date (or are past your due date and are waiting for baby!), taking time to complete a few rounds of the Miles Circuit exercises has been shown to improve baby’s position and encourage labor to happen.

  • Exercise:

As they say, you don’t decide to run a marathon and then complete it tomorrow! I think it’s wise to go into labor with a similar mindset as one would in preparing for a long-distance athletic event. Regular exercises that help to strengthen your legs, open your pelvis (think deep squats and lunges) and build your stamina can play a role in encouraging baby to come in good time, helping to improve your ability to handle the rigors of labor and provide you with a much better recovery. Even if you’re only able to include ten minutes of purposeful exercise a day, it will give you great benefits. Here’s one to get you started: 10 Minute Pregnancy Workout. Long, brisk walks and swimming are also great exercises to consider including in yoaur routine.

  • Herbal Supplements:
    • Red Raspberry Leaf Tea has amazing health benefits, besides helping to prepare and tone your uterus making contractions more efficient. I have more information on this great tea in my post over here, and you can begin drinking one cup a day during the 2nd trimester, increasing to 3+ cups per day as you near your due date.
    • Birth Preparation Formula: I have personally had great success taking an herbal supplement during the last 5-6 weeks of my pregnancies that is specifically geared towards preparing your uterus and cervix for labor. Yes, I take it in addition to Red Raspberry Leaf tea. If you have a history of preterm birth, you would want to wait to start this until 36 weeks, and on the flip side, if you tend to go way past your due date, you could begin taking it at 34 weeks up until delivery. The moms that I have had take this tend to have shorter labors, earlier deliveries, and minimal postpartum bleeding (myself included!). There are several different brands available, though I tend to think the tincture forms work the best. My all-time favorite is the  Gentle Birth Formula. You will need 4 to 6oz in order to take it daily for 5-6 weeks, and it’s best to not consume the tincture in the late afternoon/evening, as it can cause contractions that may prevent you from sleeping!
    • Evening Primrose Oil or Borage Oil: The high GLA content in either of these oils can help to soften and prepare your cervix for labor, which can assist the body in working more efficiently once labor actually begins. You want a “mega” gel-cap with 1000mg or more per capsule, and this can be taken orally every day for the last trimester, and then also inserted vaginally at bedtime during the last few weeks of pregnancy.
  • Abdominal Support:

Some moms just need some extra support for their abdominal muscles, especially if they have had a few babies, or if their babies tend to be large. The muscles that support the uterus and help it to contract efficiently can become stretched (think of a rubberband that has been completely stretched out, and doesn’t quite return to “normal”), and are unable to “hug” baby enough to get a consistent labor pattern started, or even get baby low enough to obtain a good position to begin with! One way to work with this is to consider regularly providing your uterus with support, in particularly during the last 6-8 weeks of pregnancy. You can purchase a maternity support belt (Belly Bandit has some great, albeit expensive options), but many women find that using a rebozo or long scarf/piece of scarf works great, such as is illustrated in this post here  and another option here. The goal is to pull the uterus slightly up and towards you, mimicking the way your muscles naturally pull, with provides a firm, consistent support (which also relieves pressure from your back!).

  • Eating Dates!

The benefit of consuming dates during the last weeks of pregnancy has only recently been discovered. The suggested protocol is to eat 4-6 dates daily beginning around 36 weeks until you deliver. To find out more, you can check out the details of a recent study at Evidence Based Birth and see what Mama Natural has to say here.

With the exception of eating dates (this is newer option I’ve discovered!), I have personally tried all of the above suggestions for my own five pregnancies and births, and have seen many women successfully use these recommendations throughout my midwifery practice over the past 11+ years. I wish I would have known about many of these earlier in my practice, as I think it would have prevented more transfers and unnecessarily lengthy labors. Another side benefit to following these suggestions is that your body is that much more prepared and ready should an induction actually be medically indicated. While I rarely have reason to need to get labor started, when there is this need and the body is ready for labor, then there are many more options available that have a high likelihood of actually working (in case you’re wondering, one method many midwives use is the Midwife’s Brew, but you should never attempt this without discussing the details, risk vs. benefit, etc. with your care provider!). And if you end up needing a hospitalized induction, the above suggestions will also increase the chances that you end up with a successful induction and normal vaginal birth.

Understanding Gestational Diabetes (and your testing options)
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Understanding Gestational Diabetes (and your testing options)

GDM

I recently worked on updating the information I give to clients on Gestational Diabetese screening during pregnancy. Compared to 12 years ago when I was first delving into midwifery studies, there is so much more helpful information out there about this subject! For this month’s blog post, I decided to share my updated “informed consent” handout (this is something that each client recieives in order to help them make a truly informed choice regarding their screening options), as well as some links that may be helpful for those who are wanting to research this topic further.

Informed Consent Regarding Glucose Testing and Screening for

Gestational Diabetes

What is Gestational Diabetes?

John Hopkins Medicine describes Gestational Diabetes as follows: Gestational diabetes mellitus (GDM)  is a condition in which a hormone made by the placenta prevents the body from using insulin effectively. Glucose builds up in the blood instead of being absorbed by the cells.

Unlike type 1 diabetes, gestational diabetes is not caused by a lack of insulin, but by other hormones produced during pregnancy that can make insulin less effective, a condition referred to as insulin resistance. Gestational diabetic symptoms disappear following delivery. Approximately 3 to 8 percent of all pregnant women in the United States are diagnosed with gestational diabetes.

Although the cause of GDM is not known, there are some theories as to why the condition occurs: The placenta supplies a growing fetus with nutrients and water, and also produces a variety of hormones to maintain the pregnancy. Some of these hormones (estrogen, cortisol, and human placental lactogen) can have a blocking effect on insulin. This is called contra-insulin effect, which usually begins about 20 to 24 weeks into the pregnancy.

As the placenta grows, more of these hormones are produced, and the risk of insulin resistance becomes greater. Normally, the pancreas is able to make additional insulin to overcome insulin resistance, but when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results.

For more information on understanding Gestational Diabetes and Insulin Resistance during pregnancy, I highly recommend checking into these websites: EvidenceBasedBirth.com and LilyNicholsRDN.com, and by reading Real Food for Pregnancy by Lily Nichols (available through my office lending library).

Risks Associated with GDM for mother and baby:

Ÿ Increased risk of developing Pre-eclampsia

Ÿ Increased risk of developing Type 2 Diabetes

Ÿ Maternal injury

Ÿ Increased risk of Cesarean section

Ÿ Shoulder dystocia

Ÿ Macrosomia (infant weight over 8lb 13 oz)

Ÿ Neonatal hypoglycemia

Ÿ Neonatal jaundice

Ÿ Stillbirth

Ÿ NICU stay

Ÿ Birth injury

Predisposing Risk Factors can include:

Ÿ Pre-pregnancy BMI >25

Ÿ Family history of diabetes

Ÿ GDM in previous pregnancy

Ÿ Polycystic Ovarian Syndrome (PCOS)

Ÿ Chronic hypertension

Ÿ Maternal age over 25

Ÿ Ethnicity (African-American, Native American, Hispanic, South & East Asian, Pacific Islander)

ŸPrevious macrosomic infant

Ÿ History of Cardiovascular disease

ŸPoor nutrition

Potential Signs and Symptoms of GDM:

Not all mothers will have any symptoms, but these are indicators of the possible presence of GDM:

Ÿ Polyuria (excessive urinary output)

Ÿ Polydipsia (extreme thirst)

Ÿ Weakness

Ÿ Poor healing/susceptibility to infections

Ÿ Size large for dates

Ÿ Recurrent glucose in urine

Ÿ Recurrent yeast infections

Ÿ Ketones in urine

Ÿ Excessive weight gain

Ÿ Polyhydramnios (excessive amniotic fluid)

Ÿ Polyphagia (excessive hunger)

What are my testing options?

The American College of Obstetricians (ACOG) recommends universal screening for every mom between 24-28 weeks for pregnancy. Women with a history of GDM or have high-risk factors are encouraged to screen as early as possible in pregnancy, and typically Glucola is used as the glucose load. Due to the preservatives, dyes and other ingredients found in Glucola, other glucose options are offered, such as a dye-free glucose drink, or the option of consuming 28 jelly beans per the article published by American Journal of Obstetrics and Gynecology. If opting for either of these tests, it is recommended to eat an average of 150 grams of carbohydrates daily for three days before testing. The standard testing procedure is as follows:

  • 1 hour Oral Glucose Challenge test: This involves drawing blood for blood sugar testing one hour after consuming a 50g glucose load (non fasting). Blood sugar levels should be under 140mg/dl. If the blood sugar levels are higher than this, then a 3 hour test is recommended to confirm or rule out a diagnosis of GDM.
  • 3 hour Oral Glucose Tolerance Test (GTT): This four-step test is performed after fasting for at least 12 hours, and includes drinking a 100g glucose drink. Blood is drawn fasting, and then again at 1, 2 and 3 hours after drinking the glucola. If two or more levels are out of range, the mother is diagnosed with GDM. Consultation with a physician is recommended, and transfer of care may become necessary should diet changes be insufficient to keep sugar levels within target ranges.

During recent years, more physicians are becoming comfortable with an alternative to the above traditional protocol as described here by Rebecca Dekker at Evidence Based Birth (near the end of the article):

Home blood sugar monitoring: “Another alternative could be for people to monitor their blood sugar levels at home and discuss the results with their care provider. This is another controversial way to screen for GDM. We didn’t find any studies on GDM screening that compared home blood sugar monitoring versus a standard oral glucose drink.

However, we hear of some people using this method. Basically, they are following a similar path that people do when they’ve been actually diagnosed with GDM. Usually, after a GDM diagnosis, mothers monitor their blood sugar levels four times a day, once after fasting (first thing in the morning) and again after each meal (AGOG, 2018).

The ADA and ACOG recommend that fasting blood sugar levels should be <95 mg/dL, and post-meal blood sugar levels should be <140 mg/dL at 1-hour. Other recommendations for healthy blood sugar level targets during pregnancy are even lower. For example, the California Diabetes and Pregnancy Program (CDAPP) Sweet Success recommends fasting/premeal levels at <90 mg/dL and post-meal levels at <130 (Shields and Tsay, 2015).

Monitoring your blood sugar levels at home might be an option for someone who cannot take a glucose test because of the side effects, or prefers not to drink the glucose solution. However, home blood sugar monitoring is demanding and has some drawbacks. Mothers may have to purchase their own testing kits, and they have to remember to set alarms and carry their testing supplies with them throughout the day. Some people would consider it a major downside that blood sugar monitoring requires constant finger sticks, although others may not mind. Since home blood sugar monitoring is usually done after GDM diagnosis, there is no clear-cut standard for screening/diagnosing gestational diabetes based on home blood sugar checks. It’s important to discuss any results with a care provider to determine if testing can be stopped, if home monitoring should be continued, or if consistent high values mean that treatment for GDM is needed. Also, with this method, it is important that mothers follow their normal diet while testing, to get a “real-life” picture of their blood sugar results over time.”

While this testing method has gained acceptance in some medical communities, it is important to note that it has not been officially documented as a standard for diagnosing GDM. However, research is ongoing, and this method does provide you with an accurate day-by-day picture of how your body is responding to your normal diet. For clients who choose to do home glucose testing (whether in addition to or in place of the Glucose Challenge Test), I am happy to provide you with a glucometer, supplies and a chart that you can use to track your glucose readings for two weeks.

What if I have Gestational Diabetes?

Many women are able to control GDM through regular exercise and dietary changes. For clients who test positive for GMD, I will ask you to read Lily Nichol’s books Real Food for Gestational Diabetes and Real Food for Pregnancy, and we will discuss a plan for your care, including necessary diet changes and logging, home glucose monitoring, and exercise routines. If additional insulin is needed to control sugar levels, this will result in a transfer of care, as insulin-dependence significantly raises risk factors making a homebirth not a safe option for mother and baby.

Conclusion: Informed Consent

I highly recommend checking out these websites for more information on Gestational Diabetes Screening:

I also would encourage you, regardless of your choice to screen for GDM, to spend time reading Lily’s Nichol’s books (mentioned above) and implementing her dietary suggestions for pregnancy. Excellent information is available at her website: LilyNicholsRDM.com

As an expectant mom, it is your responsibility to choose first whether to screen for Gestational Diabetes, and if so, which method of screening to utilize. This document is intended to begin the conversation and aid you in researching what is best for your health and the health of your baby, and I welcome your further discussion and questions at any time.

In your Client Information Folder you will find a document entitled “Consent & Waivers for Common Procedures”, on which is listed screening for Gestational Diabetes. Please indicate your choice on this form, after you have spent time reading the risks and benefits of screening and the type of screening.

Did you find this information helpful? I’d love to hear about your experience with GDM and your testing/treatment options! If you’re wanting to research this topic further, here’s some links to other helpful posts, many written by moms sharing how they made a decision regarding GDM screening for their pregnancies (note, many of these posts are personal opinons shared for your consideration, though they may not include documented studies or be supported by general medical literature):

If you have more to add, or resources to share, feel free to comment below! 

Resources and Info on COVID-19: Links, Practice Changes, Recommendations & More
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Resources and Info on COVID-19: Links, Practice Changes, Recommendations & More

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With the COVID-19 crisis in full swing, it can be hard to know where to go for good information. As a midwife wanting to give my clients the best, up-to-date, evidenced based care as possible, I have found it extremely challenging to navigate all the information being thrown around as everyone scrambles to learn what they can about this new virus. Even information from reputable sources can contradict each other, leaving one’s head spinning, and making you unsure of what measures should be taken to protect your clients and your loved ones from any unnecessary exposure, while also caring for the emotional and physical needs of expectant moms! I’m sure you’re probably in a similar boat, so I’m wanting to make available some information sources for you as you try to understand how the current crisis may or may not affect you, your baby, your care, and your birth.

Here are some links that I have found helpful:

Aviva Romm Series on Covid-19 Info

WHO info for Pregnant and Nursing Mothers

National Association of Certified Professional Midwives: Covid-19

WHO Info-graphs

While information is changing on a day-to-day basis, I am currently implementing the following changes to my practice in order to minimize risk for my current clients, and enable safe midwifery care to continue in my community:

  • I am available to answer any questions clients might have via email or phone/text at any time.
  • Pushing prenatal visits further apart to minimize person-to-person contact.
  • Practicing social distancing and limited exposure for myself and my family, and not seeing any clients if myself or one of my family members are sick.
  • I will be performing April prenatal visits in client’s homes to reduce the risk of transmission or exposure. My current client load is light as I am just coming off of maternity leave, so this feels like the best option as I look into ways to make my home office space more practical for office visits due to the stringent recommended disinfectant protocols.
  • I am not taking on new (non-repeat) and/or long distance clients during April. I hope to resume new client consults and prenatals in May, but will base this on information as it becomes available, as well as on how able I am to handle the extra time needed to maintain the possible new protocols, etc. Having to unexpectedly homeschool two children this month, as well as juggling the demands of a nursing infant (and trying to understand what risk there could be to her health) all combine to make my days extra full right now, without adding in the hours of research needed to stay on top of current medical news!
  • If you are just beginning to look into the option of homebirth due to concerns with exposure at the hospital, I would suggest you begin by reading these two links:

I am also asking clients to follow these guidelines:

  • Please reschedule your visit if you or one of your family members are experiencing any of the typical Corona symptoms, including:
    • Fever
    • Coughing
    • Shortness of breath
    • And remember that Covid-19 care is outside of the scope of practice for your midwife to advise you on, so please contact the proper medical authorities if you suspect you may have contracted it!
  • Try to limit your exposure to illness by practicing safe social distancing from ill persons, and practicing good hygiene and hand washing.
  • Due to the unknown severity of respiratory complications for both mom and infant, a home birth will be out of the question if you test positive for COVID-19 over the time you are in labor.
  • Realize that there may be some changes in birth practices as more information and studies become available, so feel free to reach out with any questions, and stay tuned as I continue to research and keep you up to date on current research and practice guidelines/changes. Some of these changes may include restrictions on children attending prenatal appointments, amount of people in attendance at your birth, etc. As time goes by, I hope to have more concrete information to guide our practice protocols for the safety of everyone.

I would also strongly encourage all expectant moms to do what you can to boost your body’s (and your family’s!) natural ability to fight any virus (there are other illnesses out there you don’t want to catch, as well!). I don’t think we need to just sit back and hope we don’t get sick-you can be proactive in assisting your body in being able to resist and fight illness right now. There are some great resources available that help you to consider how healthy eating (low sugar, lots of whole foods) combined with adding some immune-boosting supplements (such as high-quality vitamin C, regular vitamin D, probiotics and others) and regular exercise can help you and your family to stay healthy and strong. Here are some resources to get you started in thinking about the possibilities:

Advice from a Pediatrician

Aviva Romm on Natural Remedies

If you’re interested on hearing additional perspective on the crisis from a well-known, more “naturally minded” pediatrician, then you may appreciate Dr. Sear’s podcast series: Coronavirus Update: Are We Doing it Right? Pt. 1

And finally, some practical ways to help you handle the extra challenges from social distancing right now, tips on reducing anxiety, and helps in understanding more about the virus: COPE Updates on Covid-19

If you have found a source to be especially helpful as you navigate the news surrounding Covid-19, I’d love to hear about it. And if you are in a different area, I’d love to hear how your midwife/care provider is implementing changes to their practices. Blessings to all of you expectant mamas navigating this new territory during this time in your life-I know it’s a challenge, and I am committed to continuing to provide you with personal, safe, gentle midwifery care!

 

Miscarriage Questions: 10 Year Anniversary Interview Part 3
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Miscarriage Questions: 10 Year Anniversary Interview Part 3

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Interview Pt 3: Miscarriage

This month I’m continuing to answer questions that were submitted by readers for Gentle Delivery’s 10th anniversary “ask the midwife” series (feel free to check out Part One and Part Two if you haven’t read them yet!) There were several questions asking about miscarriage and how that affects future care, and I’ve decided to make that the focus for this month. Sadly, miscarriage is a reality for many moms, and I’ve had more moms than usual experience miscarriage throughout this past year. Hopefully some of these suggestions and this information can be a blessing to those of you walking through this valley, or those of you wondering what happens next…

What is your approach when a client has a miscarriage? What do you say or do to help her through the process, and if she gets pregnant again later, does your prenatal care for her and the baby look different in any way?

This is one of the “flipsides” of midwifery practice…it’s not always dealing with excitement and new babies. Oftentimes miscarriage occurs “out of the blue”, and usually there is no obvious explanation, even though we usually wish we knew why, or what happened.

Typically, a client will have just been in touch to let me know that they are excited to set up a time to talk about homebirth (or resume care if they were a previous client), and then they let me know that they are having some spotting. Spotting in and of itself can indicate an impending miscarriage, or it can be indicative of an irritated cervix, or it can be sign of a “subchorionic hematoma” (which usually results in spotting/bleeding without harming the baby, and resolves on its own). Quite honestly, if a miscarriage is going to occur, there really isn’t much that you can do, as oftentimes if it is indeed going to progress into a miscarriage then the baby has already died by the point you are experiencing spotting. But the unknown is not easy, as you want to KNOW what is going on. Our options at this point include doing labwork to see where the progesterone and Hcg levels are by now and going in to an OBGYN or an ER for an ultrasound (usually this is a vaginal ultrasound in order to get the best look at the uterus in early pregnancy). If the mom is 5 or 6 weeks or more, they should be able to visualize the baby, and be able to tell if the heart is beating, and labwork can reveal whether the pregnancy hormones are continuing to increase as they should. If mom prefers to wait, then there are some herbs that can be taken, and some moms choose to also use progesterone cream to help support the body until we know for sure what is going on.

If the ultrasound or labwork shows that miscarriage is inevitable, then I try to offer support and encouragement while the mom walks through the next several days. In most cases, mom is able to pass the baby on her own, and we stay in touch via phone or email. Spotting usually progresses into bleeding, and cramps accompany the bleeding as the cervix dilates enough to pass everything, which typically happens within a week of the initial spotting. In the event that it takes a longer amount of time, then we can use herbs to help encourage things to move along, we closely monitor for infection, and occasionally we need to transfer to an OBGYN for further care.

Once a miscarriage has taken place, I really encourage moms to take it easy, and make sure that they give their body time to heal both physically and emotionally. Oftentimes a mom can be left feeling very tired and anemic, as the body usually loses a significant amount of blood, and the intensity of labor can leave her worn out. There is also the emotional side of processing the loss, and this combined with the hormonal swings that go along with pregnancy followed by delivery can create quite a roller coaster of emotions to work with, and mom needs to know that this is normal and okay…and that her body is grieving and adjusting, which takes time!

The good news is that a previous miscarriage in and of itself does not negatively affect care for a future pregnancy. As I mentioned before, we usually don’t know what the root cause was, but there are many moms who go on to carry a healthy pregnancy following a miscarriage. Sometimes it can help a mom to relax more if she has more frequent monitoring during the early weeks of pregnancy after a miscarriage, and I am glad to do progesterone and Hcg testing to make sure that these levels are increasing like they should during the initial weeks. Oftentimes these moms also want to get an ultrasound performed earlier, in order to know that everything is looking good and that baby is growing like he should. Other than these factors, there isn’t much different for prenatal care, unless a mom has had several miscarriages in a row.

If a mom has had several repeat miscarriages, I highly recommend consulting with a NaPro Fertility Specialist (these providers concentrate on helping to achieve and maintain correct hormonal balance in order to prepare a mom’s body for and help in maintaining pregnancy). Many moms have inadequate progesterone levels, and having a specialist helping to monitor levels and provide prescription strength progesterone when needed can be a tremendous blessing, and prevent the trauma of further losses.

In closing, here are some suggestions if you are walking through a miscarriage:

  • Drink red raspberry leaf tea frequently in order to help balance your hormones and increase your iron as you recover (although stop drinking if you become pregnant again, until you reach the second trimester).
  • Take Evening Primrose Oil to help regulate hormones and support the body.
  • Consider taking an herbal-based iron supplement for several weeks to help restore your iron levels.
  • Take time to rest, don’t push yourself too hard, drink a lot of fluid, and take time to reflect on the short life you were given to carry, and allow yourself time to recuperate and heal before trying to resume your normal responsibilities.
  • Check out these sites that have further tips: Healing After Miscarriage and Healing Naturally.

And if you are preparing for pregnancy following a miscarriage, here are some ways to support your body:

  • Take folate (not synthetic folic acid!) and methylated B vitamins regularly.
  • Start taking a high-quality plant-based (not synthetic!) prenatal vitamin to build your body’s supply of needed vitamins and minerals.
  • Look into the benefits of using a quality, natural based over-the-counter progesterone cream to help promote healthy progesterone levels.
  • Consider having some herbal tincture on hand (such as C & B formula from Mountain Meadow Herbs) that you could take at the first sign of any cramping or spotting-this tincture helps to calm the uterus.
  • Check out this blog post for more practical tips: Preventing Miscarriage

In closing, would you have any suggestions you would add? If you have experienced a miscarriage, what was the best information and advice you were given? Any suggestions for moms hoping to get pregnant soon after going through a loss? I’d love to hear your answers if you would be willing to share!

 

Preparing for Cold Season: Pregnancy-safe Remedies to Stock in Your Medicine Cabinet
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Preparing for Cold Season: Pregnancy-safe Remedies to Stock in Your Medicine Cabinet

img_4329As we head into the fall and winter months, I thought it might be a good time to mention a few of my favorite pregnancy-safe cold and flu remedies. During pregnancy, the extra demands on  your body combined with a suppressed immune system make for a greater chance of picking up an unwanted virus. But there are things you can do to help boost your body’s immune system, and to be ready to battle off a cold at the first sign or symptom!

One question I get asked often is whether or not there are medicines you can take safely during pregnancy, especially to help with fever or cold symptoms. As a general rule, you want to avoid ibuprofen (found in Advil or Motrin), but acetaminophen (Tylenol) is okay for occasional use, as long as you stay away from the cold combinations marked as “multi-symptom” (these are too strong for pregnancy). But I would strongly suggest that you really do reserve any type of medications as only an emergency remedy (like needing relief so you can be at the family wedding, for instance!), as there are still conflicting results in the medical literature, and you certainly want to be extremely careful about what you putting into your system during such a crucial time in your baby’s growth and development.

But did you know there are some really good natural ways to fight off a cold? Here are some great remedies…and let me note here that I am in no way affiliated with any of these particular brands or companies-in other words, I’m not being paid to pass this information on to you!

  • Extra Vitamin C: I like to keep a high-potency Vitamin C (such as the Ester C picture) in the cabinet for the times when I feel a cold coming on. Taking several thousand miligrams a day for a couple of days will help give your immune system a needed boost!
  • Emergen-C: these little packets that you mix into water to create a fizzy drink can really give you some extra energy during those days you feel tired and down from being sick. Full of extra B vitamins, other vitamins and needed minerals, these are great to keep around for emergencies.
  • Infant Immune Booster from Mountain Meadow Herbs is a combination of Elderberry and Echineacea in a glycerin base, and is safe for use during pregnancy, as well as being safe to give your little ones.
  • Immune Boost for Pregnancy by Wishgarden Herbs is a gentle combination of specific herbs that help to boost your immune system while still being pregnancy-safe.
  • Garlic-lots and lots of garlic! Garlic is a great way to fight off a cold, and you can take it by capsule, or eat it straight. This is one remedy, though, where everyone will know what you’re doing. 🙂
  • Elderberry Syrup: you can purchase this on Vitacost.com (my favorite place to purchase supplements that are reasonably priced!), and take it regularly whenever you feel the need.
  • And finally, when you (or your little one!) are struggling with a cough, here is my favorite natural cough syrup: Olba Natural Cough Syrup. I was delighted to find this one, and I can tell you that it really does work! Sweetened with honey and full of herbs, it is a great addition to your medicine cabinet.

So, here’s wishing you a healthy fall…and hoping these suggestions can be a help if you find yourself down with a cold or needing an extra immune boost. What are your favorite natural and/or pregnancy safe remedies for illness? I’d love to hear about it! Thanks for taking a minute to share this post with your friends!

News & Updates from Gentle Delivery!
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News & Updates from Gentle Delivery!

There have been lots of things happening around here this spring, and I thought it would be good to give you all some updates on exciting new developments at Gentle Delivery Childbirth Services. Here’s a brief summary of assorted news items…take a minute to check out what is going on!

  • Addition of Pulse Oximetry Screenings for Critical Congenital Heart Defects (CCHD):

My new Pulse Oximeter just arrived in the mail last week, and I’m excited to be offering at-home CCHD screenings in keeping with PA legislation. These screenings have been mandatory in hospitals since Act 94 was passed in 2014, and this year midwives are being asked to join in reporting these screening results. This is a simple, non-invasive test that I will perform at the home postpartum visit within 24-48 hrs of your baby’s birth. To find out more about the testing, click here.

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Matthias helping me try out the new pulse oximeter!

  • New Apprentice for 2016!

As some of you know, I’ve been working on confirming a regular assistant/student, and I’m glad to be able to introduce you to Lynelle Martin. You can find out more about her by clicking on the “Current Assistants/Students” page, and those of you with babies due this year will be meeting her as she helps out with prenatals once a month and attends home visits.  She recently finished her Neonatal Resuscitation Certification, giving clients the added benefit of two CPR and NRP certified attendants at births.

  • Midwifery Today Conference:

I’m looking forward to writing up a more detailed report about some of the things I learned as I attended a day of the Midwifery Today Conference in Harrisburg, Pa. I enjoyed lively conversation with Lynelle and Rose Marie (another midwife I want to introduce you all to at a later time!) on the drive down, and was encouraged as I visited with many other midwives from all over the country-including Kathy, the midwife who delivered several of my siblings and was instrumental in getting me started in this field. Midwifery conferences tend to attract an extremely diverse group of midwives (ranging from Amish to Hippie and everything in-between!), and there are so many things to learn from each one. The added benefit is more CEU’s that I am required to get each year in order to keep my certification.

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Lynelle, Myself and Rose Marie after a long day at the conference!

  • YourWaterBirth.com Account Set Up:

I now have an account with Your Water Birth, a business offering affordable waterbirth and homebirth supplies, and if you are a client you can contact me for a code that will give you a 10% discount on your order! While there is a very affordable option in State College for those wishing to rent a birth pool, this company offers a great deal for those wishing to purchase their own pool and supplies. Check them out!

  • Travel Dates for Winter 2017

Just giving you all a heads up that my family will be taking a 3 week trip to the Midwest from Jan-Feb 2017 in order for my husband to teach at a Bible School for young people. We’re excited about the opportunity, and I will be glad to give you referral information if you are looking for a midwife over that time. For those who like to plan ahead, here’s your chance! <smile>

  • Advertising Cards Available:

I recently printed up some post-card sized advertising cards that contain contact information, a testimonial and information about the CPM certification. These will be on display at the area kids’ consignment sale at the end of April, but if you would like some yourself to pass out to friends, family and/or local home-birth-supportive businesses, I’d be happy to provide you with a stack!

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  • New Babies:

And lastly, no update is complete without a few pictures of sweet spring babies! Blessings as you enjoy the lovely spring weather that is here at last!

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Nothing like a peaceful newborn!

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so sweet and tiny

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Ready to call it a night and tuck everyone into bed!

So, you’re interested in a VBAC….
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So, you’re interested in a VBAC….

DSC_0632cThis is a subject that I get asked about frequently. There are many mamas out there, who, for a variety of reasons, are looking into their options concerning a pregnancy and birth after a previous cesarean section. The first question usually centers around whether or not I will take on a VBAC client…so let’s start with that, and then look into some ways to make achieving a VBAC a reality.

When it comes to considering a VBAC mom as a possible homebirth candidate, it’s helpful to have an idea of why the c-section was performed in the first place. You have the legal right to your medical records, so ask for them! Sometimes they don’t shed light on the subject, but frequently you’ll have a clue as to what actually happened, which may not have been clearly explained to you at the time. Was it due to a surprise breech? Was baby’s head in a bad position (such as posterior or asynclitic)? Did your water break, putting you on the clock, and labor didn’t start in time? Was it a case of “failure to progress”, where labor didn’t proceed, or you got “stuck” and then were tired? Or perhaps baby’s heart tones dropped, making it a fast emergency? Whatever the case, understanding what all took place helps to paint the picture, and give me an idea of what hurdles you might face in this next birth. And it might help you in knowing what to prepare for-for instance, if your c-section was due to a bad position of the baby, then we’ll be much more proactive at integrating exercises to help with optimal positioning. There are very few situations which risk a mom out of the option of a homebirth, but getting a clear picture of what happened before helps us to determine your eligibility. And perhaps you would feel more comfortable pursuing your first VBAC in the hospital setting…either way, these next suggestions can be beneficial and productive in helping you prepare for your birth!

I like to tell VBAC moms the same thing I tell first time mamas…preparing for birth is like preparing for a marathon. You don’t just decide to run a marathon today and achieve it tomorrow. It takes WORK to prepare your body for it! Most mamas planning a VBAC have not yet had a baby vaginally, so in that respect, we focus on preparation in the same way we do for a first birth. Not to make things sound negative, but it’s good to be prepared for the long haul-and prepare your body to be able to cope with it. Eating a healthy diet and consistent exercise both contribute to this. Regular walks, workouts, squats, etc. can all help to build up your stamina for labor and pushing. I’d also suggest seeing a chiropractor, especially during the last trimester, which can help to ensure good alignment of your pelvis and good positioning for baby. I highly recommend checking into Gail Tully’s website: spinningbabies.com, as well as following her suggestions in her DVD entitled “Daily Essentials”.

Besides getting your body ready, you need to prepare mentally and emotionally…and this includes educating yourself about the particular risks and concerns that affect VBAC mothers and babies, as well as talking with others who have gone through similar experiences. This support can be invaluable in helping you to work through your past disappointments and set realistic expectations. Some excellent resources that I encourage all VBAC moms to consider are:

  • VBAC Facts by Jen Kamel (She teaches an amazing class based on research surrounding VBAC safety. You can attend a live seminar, or take a webinar at your convenience.)
  • Read books on the subject:

C-Section by Mark Zawkowski, MD,  Natural Childbirth After Cesarean: A Practical Guide by Karis Crawford

  • Look into the “International Cesarean Awareness Network” (ICAN) and glean from their website…there are chapters throughout the US that meet regularly, where you can talk with other moms and learn from their experiences.
  • Join a facebook support group for VBAC mamas, and ask questions and hear about how other mamas achieve their VBAC.
  • Read evidencebasedbirth.com, and consider taking the class they offer online regarding “Failure to Progress”.

 

This information is hopefully enough to get you started with resources…blessings as you pursue your quest for a beautiful, natural and safe birth!