Delayed Cord Clamping - What Are We Waiting For?

Before the 1950's it wasn’t uncommon for obstetricians to wait at least five minutes before clamping and cutting. It was just after the 60's that delayed cord clamping was thought to have no benefit and the timing of the cord was shortened. Today, the majority of obstetricians cut the cord in the first 15 seconds of the baby’s birth. Many providers have been taught that this is the way it should be done, and more importantly they were taught that it could be detrimental to the mother or baby if they waited longer - despite any evidence to back up those concerns. As new research has come out over the past several years, there has been much resistance. Part of this is due to the fact that cutting the cord immediately allows for a faster delivery of the placenta (and subsequently they get out of the delivery
room faster too), and partly because it’s hard to undo years of negative misconceptions (i.e. the baby will be more likely to become jaundiced, the baby might get polycythemia, and/or receive too much blood).

Things are changing, and more and more research is coming out, and it’s getting harder for providers to ignore the evidence and not provide delayed cord clamping in normal birth situations.  We are starting to see guidelines being set due to the overwhelming evidence that the benefits of delaying cord clamping outweigh any potential risks.  In fact, those who are still hesitant to start implementing this practice are being asked to show their burden of proof to the contrary.  So who are these organizations out there are changing their guidelines?  

The World Health Organization:  WHO has has endorsed delayed cord clamping of at least 1-3 minutes for the past several years. 

The Neonatal resuscitation program (which is developed and maintained by the American Academy of Pediatrics and is the gold standard in all US hospitals for providers who care for babies immediately after birth):  In June of 2016, the Neonatal Resuscitation Program revised and updated their guidelines. “Evidence suggests that cord clamping should be delayed for at least 30 to 60 seconds for most vigorous term and preterm newborns.”

Finally, ACOG had to back up the guideline and issue new practices:  In December of 2016, ACOG (The American College of Obstetricians and Gynecologists), released it’s recommendations that all doctors and midwives delay the cord clamping for a minimum of 30-60 seconds for all healthy newborns.

In the United States we think of this as a new practice, but some countries have been doing this much longer. For example, in the UK, the National Institute for Health and Care Excellence (NICE) changed its guidelines back in 2012. They stated that doctors and midwives should not routinely clamp the cord ‘earlier than one minute from the birth of the baby’, and instead should wait one to five minutes - and longer if the mother requests it. (Studies showed that 53% of surveyed providers in the UK routinely delay cord clamping/cutting already in 2009).
Here in the DFW metroplex, almost all midwives (including those who work in hospitals), and many OB’s support delayed cord clamping. We get change by asking, and helping providers understand “myth-conceptions”. We have not only seen change, but also improvements, such as delaying cord clamping/cutting in the OR during cesarean births in several hospitals (with certain providers) in our area!

So What Are We Waiting For?

What are the benefits?

• Increases blood volume
• Decreases the risk of brain bleeds by 50%
• Increases iron levels (when delayed for at least 2 minutes)
• Is linked to long-term neuro-developmental benefits (improving fine motor andsocial skills)
• Less chance of baby needing a blood transfusion for low blood pressure and/or anemia
• Decreases the chance of late-onset sepsis (a bacterial infection usually caused by environmental factors)
• Provides a higher respiratory rate, and lowers the risk of developing infant respiratory disease
Are there any risks?

What are the potential risks?

There may be a slight increase in billirubin levels increasing the chances of needing phototheraphy for neonatal jaudice. Studies range from “no significant difference” to ‘a slight increase’ in the risk of jaundice. A study (McDonald and Middleton's), found that 3% of babies who experienced early cord clamping, compared to 5% of babies who experienced delayed cord clamping required treatment for jaundice. Despite the increased risk, WHO, ACOG and many other organizations around the world state that ‘the benefits of delayed cord clamping outweigh the risks of jaundice’.

What medical circumstances might interfere with your decision to do delayed cord clamping?

The World Health Organization states that delayed cord clamping in under a minute should occur “when a newly born term or preterm babies require positive-pressure ventilation, the cord should be clamped and cut to allow effective ventilation to be performed.” - And/or - "newly born babies who do not breathe spontaneously after thorough drying should be stimulated by rubbing the back 2–3 times before clamping the cord and initiating positive-pressure ventilation.” Basically this means that anytime a term baby is born, it should be given the opportunity to cry while being dried and stimulated on the mother’s belly for at least a few seconds before clamping and cutting the cord and handing it over to the NICU team for more care.

A preterm baby may not get even a minute depending on how small they are,
and how they are reacting immediately after birth. If a preterm baby is doing well, it is extremely beneficial to delay clamping the cord.

Sometimes providers will not delay cord clamping/cutting when there is thick meconium present at birth. Many providers are more comfortable handing the baby over to the NICU team immediately after birth so that they can start suctioning the baby’s mouth and throat before vigorous crying occurs. However, the newest Neonatal Resuscitation guidelines (starting in 2015), state this protocol: “Non-vigorous newborns with meconium-stained fluid do not
require routine intubation and tracheal suctioning; however, meconium-stained amniotic fluid is a perinatal risk factor that requires presence of one resuscitation team member with full resuscitation skills, including endotracheal intubation.” Most babies come out crying before suctioning can be done, so many hospitals are now taking a ‘wait and see’ approach and suctioning well after birth if it is needed.

The United States would be wise to implement a table such as the LifeStart where bedside resuscitation can occur while keeping the umbilical cord attached. Birth centers and home birth midwives already have this practice in place, by having portable oxygen nearby. Instead of bringing baby to the oxygen equipment, they bring the equipment to the baby! Hospitals across the globe are using the LifeStart (or other similar tables) for bedside resuscitation, why can't we?

What non-medical reasons are there for cutting the cord early?

The main reason for implementing this practice is care providers preference. According to the study “Attitude of obstetricians towards delayed cord clamping: A questionnaire-based study” published in July of 2009 by Ononeze & Hutchon (1) - the main reason for not doing it? “Difficulty with implementation in clinical practice”. Hmmmm. I’m not sure why it’s harder to hand the baby to it’s mother and wait a few short minutes, but my bet is on the fact that waiting is boring and time consuming. (Oops, did I just get cynical?)

Some providers are still hesitant because of the myths that have been perpetuated through the years (stated in the first paragraph). I truly believe that they feel it is very unsafe to implement this practice (and I’ve heard some go as far as to tell clients that they have seen baby’s go to the NICU because of it)! Any provider who says that it is NOT safe or not beneficial to delay cord clamping needs to challenged to come up with a recent study as to why it is NOT safe or
beneficial. (They can’t). There are some that will refuse to implement this practice at all, while others will say they will only to change their minds during the birth. A few more are likely to meet you somewhere in the middle. Some will say they can “milk the cord” for a few seconds (no proven benefits), some will be okay with a 30-60 second delay. More often than not, from what I have seen, more than half of the providers that say they will wait, end up finding a reason to cut it sooner anyway. 

Cord blood banking may be another reason delayed cord clamping can’t/won’t be done. Most cord blood banking companies require a specific amount of blood in order to bank it - and this requires cutting and clamping the cord sooner. There *are* some cord blood banks that can bank a much smaller amount and claim that parents may be able to delay up to a full 2 minutes. It is never a guarantee that you will get both, so make sure you have a final decision to do one or the other if it comes down to it, so you don’t have to make that split-second decision!

Are there any medical reasons for cutting the cord early?

Yes, there are medical circumstances that may require more focus on the mother or baby. For example, placenta abruption, or even if the placenta is partially (and prematurely) separating from the uterus. When this happens, there is less oxygen transferring to baby, and baby may not benefit much or at all from the cord staying intact anyway. In some cases, the mother and baby may both need attention separately.

When is the ideal time to cut when both mom and baby are doing fine?

When the cord stops pulsating - or at least 3 minutes after birth.  It's pretty easy to tell when it's time to cut the cord.  First of all, you can feel for a pulse by squeezing the cord near your baby's belly 'button'.  You can also see the changes as well: 
At first, the cord is dark blue and coiled like an old fashioned telephone cord and you can feel the pumping easily with your fingers. As the blood supply drains from the placenta into your baby, the cord becomes white and flat while the pulse in the cord becomes weak until non-existent.  A great visual can be found here:  https://www.nurturingheartsbirthservices.com/blog/?p=1542

If your provider is still hesitant, don't be afraid to find out what their concerns are.  Have they read the updated guidelines, and if so, why are they not implementing them yet?  Can they meet you somewhere in the middle?  How strongly do you feel bout this?  Would you switch care providers if they are against delayed cord clamping in normal birth situations?   Tell me your thoughts below! 

References:
(1) “Attitude of obstetricians towards delayed cord clamping: A questionnaire-based study” published in July of 2009 by Ononeze & Hutchon -
www.tandfonline.com/doi/full/10.1080/01443610802712918?scroll=top&needAccess=true
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1564438/
http://www.medicalnewstoday.com/releases/70525.php
Downey C, Bewley S Third stage practices and the neonate. Fetal and Maternal Medicine Review 2009;20:229–46
http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Delayed-Umbilical-Cord-Clamping-After-Birth

More reading:
https://www.scienceandsensibility.org/p/bl/et/blogid=2&blogaid=526
http://www.bellybelly.com.au/birth/delayed-cord-clamping/
See my Pinterest board on delayed cord clamping for more reading and video resources!

Doulas - The Modern Day Birth Sherpas

Sherpas are regarded as elite mountaineers and experts in guiding people through the most treacherous of mountain terrains.  Even expert mountain climbers hire Sherpas for serious mountain climbing such as trekking the Himalayas or climbing Mt. Everest.  Do they have to?  No, but word gets around fast;  Hiring a Sherpa will make the experience so much easier.  Sherpas can be invaluable to making the experience safer and more pleasant.  Doulas are birth Sherpas.  We know birth inside and out.  We walk families through the process from start to finish.  We are experts you can lean on in every situation, every step of the way.  Partners aren’t left to stare at a map and try to figure out which move to make next, their Sherpa knows all the pathways and alternate routes already.

Let’s say your goal is to climb to the top of a huge mountain such as Everest.  You learn all that you can.  You take classes, you poor through books, and even watch some videos.  Sometimes that is enough.  What if while doing your homework,  you polled everyone that climbed that mountain and discovered that most people had trouble making it to the top on foot without the help of a Sherpa?  What if you found that the people who hired a Sherpa were much happier with their experience?  Less likely to need medical help?  Hiring a doula is very much like that and more.  Studies show that when a woman receives continuous support from a doula, they are more likely to have spontaneous vaginal births, less likely to have pain medication, vacuum or forceps-assisted births, negative feelings about childbirth, and their chances of having a cesarean were greatly reduced!  In addition, their labors were shorter, Pitocin augmentation was used less, and their babies fared better, having higher APGAR scores at birth, and lower NICU transfers.   

So why can’t your mother or partner “be the doula” and do the same thing?  Well, those studies were done, and for some reason the studies did not provide the same outcomes.  In fact best results occurred when women had continuous support from someone NOT from the mother’s social network or even provided by the hospital staff.  --2012, Hodnett et al.  It’s easy to understand why, but perhaps I’ll leave that for another day.  The bottom line is doulas know birth.  They are the birth Sherpas of this world.  They have climbed that mountain many times and know so many tricks to make it a safer and easier journey.  

You might be thinking – “well what if I don’t want to take the long hard trek up the mountain”?  “What if I want to take the elevator and enjoy the view once I get to the top”?  “Why would I need a doula for that”?  The answer is simple.  Even if you want an epidural, or even an elective cesarean, a doula can help you plan for the safest passageway to the top.  She knows some awesome things that will make the view on the way up much more pleasant and beautiful.  She is there if the elevator gets broken and you have to climb to the top via the stairs, or even through the mountainous terrain.  Yeah that happens sometimes!  

No matter how you climb that mountain, your life has changed forever. Birth changes you.  Being a parent changes you. You have a tiny new human to feed and carry home. Your doula will most likely come to your home at least once after the birth to check on you and help provide those last minute resources, tips and tricks to get your footing again.  If parenting in those early weeks scares you more than climbing Mt. Everest, than consider a postpartum doula to help ease your transition in those early weeks too!  Yeah, there’s a doula for that too!  

Book Recomendations

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I give all the following books a 5 star recommendation! 

Books on Pregnancy

The Healthy Pregnancy Book by Dr. William (and Martha) Sears is full of great information! 

This book has a little bit of everything.  It covers all the topics from finding the right health care provider to how to sleep better, eat better, manage stress, and ultimately - how to have a healthier baby and birth! 

You may recognize the chapter on "appreciating the hormonal symphony of pregnancy and birth" if you have taken my 2nd class in my childbirth series. Dr. Sears can say it so much better than I can :-)  

I have this book in my lending library, but let me tell you now -- you need your own copy! You can always give it to a pregnant friend later, (if you can stand to part with it)!


Pregnancy, Childbirth, and the Newborn (4th Edition): The Complete Guide by Penny Simkin, April Bolding, Ann Keppler, and Janell Durham

Although I have the older version of this book in my lending library, this revised edition has an easier to read format, and is more up to date in the research department.  Forget that book everyone tells you they have read (hmm- something about what to expect....:-) -- this is the one book with evidenced-based research, and should be your go-to pregnancy and birth resource!  It covers information from pregnancy to newborn care and will compliment any other books you might want to read. Be empowered, be informed, and enjoy this book!

Books on Birth

The Birth Partner -Revised 4th Edition: A Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions by Penny Simkin

This is great for moms, but dads seem to really enjoy this 'birth manual'. I've had many dads refuse to pick up a pregnancy or birth related book, and when I ask them to look through this book, they read it cover to cover!  (Even if you can't read a book from cover to cover, this book has tab sections, so you can look up information quickly and easily). This is a must for any birth partner to help them understand birth and how to help a laboring mother cope. This book is required reading for many doula organizations for doula certification. Sheila Kitziner sums it nicely; “Penny Simkin shows how giving support in childbirth is not only a matter of helping a woman through labor and delivery—important though that is—but also of enabling her to cherish a meaningful memory of birth.” – Sheila Kitzinger, author of Rediscovering Birth and The Complete Book of Pregnancy and Childbirth

Ina May's Guide to Childbirth by Ina May Gaskin
Before I give a summary of the book, I have to tell you a little about Ina May Gaskin. Ina May Gaskin is one the nations' leading midwives, in fact, the obstetric world uses "The Gaskin Maneuver" to help resolve shoulder dystocia (stuck shoulders) in labor - the first obstetrical procedure to be named after midwife. Gaskin has traveled around the world lecturing to both physicians and other midwives. Her midwifery practice on "The Farm" in Tennessee was the first birth center to be founded in the United States -- and has the lowest birth interventions and cesarean rates, and most importantly, mortatility rates in the nation! This was was compared to 14,000 physician attended hospital births (including those typically labelled as high risk) by the published study “The Safety of Home Birth: The Farm Study,” authored by A. Mark Durand, American Journal of Public Health , March, 1992, Vol. 82, 450-452

All that being said, Ina May has a lot of good information to say, and she has many books to say them in. This book is one of the easiest to read, and enjoyed by most everyone! The book starts out with birth stories and continues on about birth, birth practices and safety. Ina May has a way of taking the fear out of childbirth and portraying it as it should be -- a happy, and healthy, normal event. 

Birthing from Within: An Extra-Ordinary Guide to Childbirth Preparation
by Pam England CNM MA and Rob Horowitz Ph.D.

Okay, I will admit, there are some parts of this book I can't swallow hook, line and sinker, but there is still some great information in a very easy-to-read-format. If you aren't into the art projects that are supposed to help you overcome birth fears, and if the new-age, hippy parts of the book leave a bad taste in your mouth, you can skip to chapter 16 and get some great information on how to cope with labor and birth.   There's something for everyone in this book!

The Thinking Woman's Guide to a Better Birth by Henci Goer

Henci Goer wrote her first book, Obstetric Myths Versus Research Realities, in 1995 and it has become a staple for childbirth professionals since. Its successor, Optimal Care in Childbirth: The Case for a Physiologic Approach, written in 2013 -- won the American College of Nurse-Midwives “Best Book of the Year” award. The Thinking Woman's Guide to a Better Birth is loved by birth professionals and parents alike. It explains all the common birth procedures along with their risks and benefits, so it will definitely provide you with all the information you need to build an informed and educated birth plan! Some of the information is slightly outdated, and that is why I cannot stress enough that you should always take a well rounded childbirth class. That being said, this is still probably my most recommended and borrowed book in my library. 
You are always welcome to borrow it if you don't want to purchase your own. Actually, I have two copies, but be warned:  Neither sit on my book shelf very long :-)


Creating Your Birth Plan: The Definitive Guide to a Safe and Empowering Birth by Marsden Wagner, MD

Ahhhh...Marsden Wagner. What can I say? I love him. Not in a "I-want-to-marry-you" kinda way, but I just love to hear him talk. I love his passion. Some people cannot stand his somewhat, crass, opinionated manor, and his undoubted bias for natural birth, but maybe that is why I love him! Dr. Marsden was a perinatologist and perinatal epidemiologist and was also the Regional Officer for Maternal and Child Health in the European Regional office of the World Health Organization for 15 years. He knows medical birth and he knows natural birth. He knows how births take place in the hospital and how women give birth at home and in birth centers -- and he makes no bones about which he prefers for low-risk women. This book isn't for everyone, especially if you aren't already aware of birth politics and practices we have here in the US. However, if you tend to be a wee bit cynical, or even have an open mind to the birth crisis we have in America -- and want to make a truly informed birth plan -- read this book! This is one of my personal favorites, but it's not for everyone :-) This is another book I have available in my lending library. Here was the last interview Dr. Wagner did back in 2008 https://www.youtube.com/watch?v=Cm8ErQxTFyo. May his soul rest in peace.
 

Books on Breastfeeding

The Ultimate Breastfeeding Book of Answers: The Most Comprehensive Problem-Solving Guide to Breastfeeding from the Foremost Expert in North America by Dr. Jack Newman and Teresa Pitman

I read this book during my breastfeeding counselor training, and it was super informative. Dr. Jack Newman is probably the number one expert in the breastfeeding business. Don't ask me how a guy got to know so much about breastfeeding! It's not because he is a pediatrician, because unfortunately most do NOT know much about breastfeeding at all. Maybe it's because he was a father of four breastfed children, but I think it most likely has to do with the fact he has been helping mothers breastfeed for 30-some years. 
Women, especially here in the US, are afraid they can't breastfeed. There are so many misconceptions, and Dr. Newman gets right down to business dispelling myth after misconception. Dr. Newman will be the first to tell you that breastfeeding is not always easy, but he will also be the first to say most women can breastfeed with the right help and the right information. This book will have answers to all of your questions from how to breastfeed to how to get through common breastfeeding troubles. You will see that I print out many of his handouts and put them in your binder, and are also given in my breastfeeding classes as well. His website is an invaluable resource: http://www.breastfeedinginc.ca/index.php 

The Womanly Art of Breastfeeding
by LA LECHE LEAGUE INTERNATIONAL, Diane Wiessinger, Diana West Teresa Pitman

This book is a classic!   Published first in the 1950's this book is now on it's 8th revision, and going strong. It continues to be a number one seller, and has been read by thousands (if not millions) of women! This book is huge (about a hundred more pages than Dr. Jack Newmans book) -- but you don't have to read it cover to cover. Read what you need!
Some people are put off by this book claiming it is too judgmental. (It does talk about the benefits of getting the best start by having an unmedicated birth, and it also talks about how going back to work is hard on brestfeeding moms) -- but this book is too good to throw out the baby with the bathwater in my opinion.


So That's What They're For!: The Definitive Breastfeeding Guide by Janet Tamaro

When I had to read what seemed like a hundred books about breastfeeding, during my breastfeeding counselor training, I can tell you I was not looking forward to yet another book!  I had read everything from clinical to breastfeeding politics, and I was pretty sure I was going to have trouble staying awake reading the same information yet again. I was pleasantly surprised and instantly captivated by this book! Janet Tamaro was funny, and she was up-to-date!  I recommend starting with this book and then adding one of the two other books listed above for more in depth trouble shooting and information.  Sometimes it helps to get the same information in a different way, but this book will not be as detailed on the how-to's. Get one of each, take a good breastfeeding class, and get ready to breastfeed!  
 

Books on Baby Care

The Baby Book: Everything You Need to Know About Your Baby from Birth to Age Two by William Sears, Martha Sears, Robert Sears, and James Sears

This is a huge book, and if you only buy one book on babies, this should cover it all for ya!  My sister likes to call it the 'baby bible', and she loves to give this book out as a gift to pregnant friends and family. You'll see why...it's huge!  It has information on everything! You obviously don't have to read this book from start to finish -- just read up on the information that you need in the moment. Not everything in this book is going to work on your parenting journey, and you may readthings you do not agree with. Some of the advice might even offend some people (attachment parenting, co-sleeping etc). Personally, I have no problem reading through and taking various pieces of advice and adapting it to my own needs, and you can too :-)  Even Dr. Sears and his wife talk about how you have to do what is right for your family. This book is still a treasure! There is so much information that is helpful and dare I say necessary to have as a reference -- like how to take a temperature, or ways to get the medicine down that makes it worth every penny.  Trust me, you'll wear the cover off this one if you give it half a chance! 

The Happiest Baby on the Block by Dr. Harvey Karp
 
I loved this book so much that I became a Happiest Baby on the Block educator :-)  If you want to understand why babies cry, and how to get them to stop crying in seconds, you might want to pick this one up. Dr. Karp has found there IS a remedy for colic and it works for every baby unless there is a medical condition for their crying. Some books will provide information that works for one baby, while a completely different book only works for a different baby.  That's why we have so many parents saying "well this worked for me," while another mom is frowning in frustration because that didn't work for her baby! The Happiest Baby will work for everyone, and the solutions are so simple that they are really just techniques done for centuries but sometimes suppressed or forgotten by our modern day society. 
If you don't want to read the whole thing, that's okay, my Happiest Baby Class will give you the "cliff notes" -- and also receive a parent kit that includes a DVD and Soothing Sounds CD. You'll be ready to proclaim that you are the proud parents of the "Happiest Baby on the Block!" 

Other Books:

Pushed:  The Painful Truth About Childbirth and Modern Maternity Careby Jennifer Block

Shameful confession here: I've never read this book! So I guess in all fairness I can't give it five stars just yet. I have read bits and pieces while sitting in the library, and what I did read, was awesome! Pushed is more of a political birth book, so it's not going to cover things like stages of labor and things of that nature. This book is about the sorry state of birth in the United States and her research will show the reader how the over-use of technology isn't always best, and tries to shine light on the question "do women have the right to normal birth?"  Is the obstetric community letting mothers who are low risk have a normal birth? Do we even know what normal is anymore? I digress. Read this book, and you might understand that birth isn't what you think it is in the land of the free.  

Born Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First
by Marsden Wagner (sigh... :-)
Okay, if you don't think you can take Dr. Wagner's book on birth planning, then definitely don't pick up this book. He takes cynical to a whole new level :-)  This quote really says it best: "*Starred Review* The outspoken former director of Women's and Children's Health at the World Health Organization believes maternity and perinatal care in the U.S. are seriously flawed. To make the point, he cites recent Centers for Disease Control findings that 28 countries have lower maternity-mortality rates; 41, lower infant-mortality rates. This despite the fact that the U.S. spends twice as much or more per capita on health care than any other industrialized nation. Wagner places responsibility squarely on the shoulders of obstetricians and the lobbying power of the American College of Obstetricians and Gynecologists. Interested in one thing above all else--maintaining control of a lucrative market--that group, he avers, foists unnecessary, expensive, and invasive medical interventions upon women when none are needed. Obstetricians are only necessary, he says, in a minority of cases in which serious medical problems threaten the life of mother or child. For the most part, childbirth isn't a medical condition, and infant and maternal mortality rates are lowest in countries in which midwives attend to it. Speaking from his experience as a clinical perinatologist and a perinatal epidemiologist and supplemented by the hoard of credible sources cited in the copious endnotes, Wagner pulls no punches in advocating a woman's right to control the entire reproductive process, from conception through birth."  Donna Chavez Copyright © American Library Association. All rights reserved --This text refers to an out of print or unavailable edition of this title.
 

The Vaccine Book: Making the Right Decision for Your Child by Robert W. Sears

This book really breaks down the tough decisions about vaccinations. This book is fairly easy to read and Dr. Robert Sears does agreat job of telling you about a particular disease, how common it is, how dangerous (or harmless) it is, and then goes on to cover the vaccination ... from the ingredients of the vaccine, to any possible side effects from the vaccine.  The information is presented in an unbiased manner, so you can decide what vaccinations you want for your child and when to get them. 

Cut It Out: The C-Section Epidemic in America by Theresa Morris

Another book I'll admit I have not read, but when I saw these videos, I knew I wanted to read the book.  It's definitely on my wishlist! 

 VIDEO:

The Business of Being Born - DVD produced by Ricki Lake and directed by Abby Epstein

This documentary has changed so many peoples lives!  I cannot tell you how many of my clients would not have considered a natural childbirth ever ... and then they watched this movie. This movie has commentary from some of the most respected birth professionals in the world (including Dr. Marsden Wagner). It covers the medical and political politics of birth and why the maternity care in the United States is in crisis. Just watch the trailer, and if you like what you see, buy the DVD and show it to all of your friends who are pregnant :-)  
 

Can't Have an Epidural? Let's Make a Game Plan!

If an epidural is not an option for you, it might be helpful to stack the cards
in your favor as much as possible.  It's time to make a game plan!


Here are my top 10 tips when you can’t have an epidural.


Tip #1 - Take a quality childbirth class.

Not a crash course, or one that happens to be at the nearest hospital. You need a well-rounded class that will help you understand all the tips listed below, as well as comfort measures. You need to know what to expect, the options available to you, how to cope, how to get baby into a good position, and get psyched to do this!

Do not skip this step. Even if you have taken a class before. There are many great childbirth classes out there. Do your research, talk to the instructor, and get a good outline of what they will teach. Don’t just take a class that is going to teach you how to breathe, or how to relax. While those things are great and even necessary, it will benefit you to learn many other hands on techniques as well.

Bonus points if your class will teach you the benefits of going natural (i.e, the hormones in labor)

Tip #2 - Hire a doula.

You're going to need someone to help you remember the stuff you learned in class.  Someone to help you get through this as fast as possible.  It doesn't matter how good your spouse is at helping you.  A doula is a professional.  She knows birth inside and out.  You're going to need all the support you can get.  Studies show that women who receive continuous support from a doula, are more likely to have spontaneous vaginal births, less likely to have pain medication, vacuum or forceps-assisted births, and their chances of having a cesarean were reduced! In addition, their labors were shorter, Pitocin augmentation was used less, and their babies were less likely to have low Apgar scores at birth.. --2012, Hodnett et al.

Bonus points if your doula knows spinning baby techniques, and has experience with unmedicated births.

Tip 3# - Scope out your hospital and your provider.

This is where your childbirth class and your doula will both come in handy. You need to make sure your hospital and your provider are familiar with natural birth. You need to know what pain relief options are available to you and are allowed. For example, do they have wireless monitoring available, tubs, showers, etc. What other forms of medication can they provide you? (See tip # 10). If you are planning a birth center or homebirth, then ask your midwife about the hospital you would transfer to, should that need to happen.

Bonus points if you do your research and find that the only hospital that will fully support your choices is an hour or more drive, but you are willing to drive that far, because you know how important a supportive environment will be!

Tip #4 - Use a tub or a shower.

This goes with tip #3. If you can find a place where you can labor in a tub, this might be your life saver. We don’t call it an aqua-dural for nothin’ :-) You may have to switch providers, and even place of birth, but if you can’t have an epidural, you may really want a tub available to labor and possibly birth in. If your hospital doesn’t have a tub, ask if you can bring one in (your doula or childbirth educator may have resources on where to get one locally). Try laboring at home in your own tub until active labor. 

Bonus points if your place of birth and your provider does waterbirths!

Tip #5 - Consider using a TENS unit.

When I am working with a mother who cannot have an epidural I ask her two questions: “Does the place where you are birthing have a tub?” and “Would you be like to use my TENS unit?” Obviously I am a huge fan, but you do have to meet the requirements and your provider has to be okay with it’s use too. I’m not going to explain what they are in this blog, but you can read about them here. A TENS unit may help you to relax and may help increase your natural endorphins (your natural pain killers). It’s best to start it in early labor, but if you skip that part for some reason, it’s still something in your bag of tricks that just might help you get a little further in labor without feeling the need to climb the walls.. I do suggest a TENS unit that is made for labor, as that has shown to have the best results. There are TENS units out there given to people from a chiropractor, or their physical therapist, and while they can help, it is best to use one designed (or preset) for labor. Unfortunately, TENS are not readily available everywhere, and as previously mentioned, you do have to meet the requirements to use one. I’ve not had a mom yet that needed to have an epidural-free birth, use the TENS and tell me that they would not use the TENS again for their next labor. Not everyone will love the TENs, but it's worth trying!

Bonus points if your doula is trained in TENS and double points if she has them available to use!

Tip #6 - Stay home in early labor, maybe even active labor!

Most women are relaxed when they are in their own familiar environment. It’s nice to be able to move around without asking permission, to lay down in your own comfy bed, to light candles and eat and drink as you’d like. Most hospitals and providers prefer women (who are in the low-risk category), stay at home until they are good and active anyway. Napping in between contractions helps you to reserve your energy for later, and it’s almost impossible to do this at the hospital where machines are beeping, and nurses are asking you a million questions - not to mention taking your vitals and messing with the monitors every few minutes. The more rested you are, the less pain you’ll perceive later. The more relaxed you are, the better the flow of oxytocin and endorphins - both of which you’ll need to have a faster and easier labor. Having a doula with you will help you relax and help you decipher when it’s time to head to the hospital or birth center.

Bonus points if stay home and relax until active labor, have a doula to help you at home, use a TENS unit, take a good childbirth class so you understand the stages of labor, utilize hydrotherapy (when not using the TENS), and choose a place of birth where they will be hands off if you do get their too early!

Tip #7 - Relax

Relaxing encompasses so many of the other tips listed her...having a doula, using the tub or shower, staying at home when possible, etc. If you can, use them all. Relaxing can also mean sinking in and letting go. Try tensing a muscle somewhere on your body right now. Now let it go, now try to get it to relax even more. Lay down and try that with your feet, your legs, your bottom, your back and shoulders, your face, your arms...you get the idea. You will learn how to do this in your childbirth class, and it will benefit you to practice.

Bonus points if you practice relaxation techniques on a daily basis.

Tip # 8 - Spin that baby.

Head down is half your battle, but it will also help if baby is facing the right direction. A posterior baby may cause a longer labor, and sometimes they have a harder time coming out. A good childbirth class and doula should be able to show you what causes this, and how to prevent it. A doula that is knowledgeable in spinning babies, is going to help you have a shorter labor, if you are able to do what she suggests. 30% or more of all babies start out posterior at the onset of labor...don’t think it can’t happen to you. If the doctor does an ultrasound and says baby is in a great position, don’t assume that he/she will stay that way. It can change on a dime. Continue to do what is necessary to keep baby in a good position! If you can’t have an epidural, the last thing you need is a longer labor :-)

Bonus points if you begin practicing and living these techniques at least 4 weeks before your baby may arrive.

Tip # 9 - Bring in extra support - but don’t make it a family reunion.

Throughout history, women have provided other women with support during childbirth. If you have a spouse, then I wouldn’t be surprised if they are #1 on your list of people who will be there to support you :-) The second person on your list, would be your doula. The third person is that extra woman in your life who will mother you. It might *be* your mother, but it can also be a close friend, relative or even another doula. Someone who will mother you, but can also be strong, and willing to provide an extra pair of hands, and heart. Imagine you leaning on your main support person, while your doula squeezes your hips. The third person can be grabbing the water for your to sip after the contraction, keeping the wash cloths cool, going for food runs - and doing whatever else needs to be done, so that there is no interruption of support. She is there to help the doula, to help dad, and to be the pintch hitter when dad needs to sleep, or the doula needs to rest. Most often, a doula can do all of those things without extra help, but in a long birth, it really does help to have an extra pair of hands ready to go. That being said, the laboring mom has to be comfortable with everyone in the room. If you can’t shower or pee in front of that person, then she isn’t ‘the one’. This person should also be ready and willing to leave (the labor room), at anytime the mother requests it. A person who feels watched in labor, or feels uneasy with anyone in the room, may actually take longer. This is why I say you should not make your birth into a family reunion. If there are people in the room who are watching the clock, or talking too loud, or are even just sitting there in the corner doing nothing but looking at their phone - it is a distraction to everyone. You support people will need a place to sit when they can rest anyway. Distractions slow labor, and well meaning comments can slow labor too, (like when they turn to the doula and ask “how much longer do you think this will take”?) Consider the type of person you are. If you are a very private person, then it might be best to keep your support to your spouse and your doula.

If you are birthing at home or in a birth center, make sure your support person is completely comfortable with this!

Bonus points if your support person has given birth unmedicated.

Tip #10- Know your options.

Narcotic pain relief, nitrous oxide, pudendal blocks*, sterile water injections etc are some other medical ways you might get some relief.. Depending on the hospital and provider, you might have more than one option for pain relief, should you really need it. This is where scoping out your place of birth will be helpful along with talking to your provider. If you are birthing at home or at a free-standing birth center, talk to your midwife about the options available at the hospital you might transfer to. There are some birth centers that offer nitrous oxide, narcotic pain medications, or both.

Bonus points if you can find a place with a provider that offers all of the alternatives!
 

* Pudendal blocks may be contraindicated in a mother with low platelet

 

Medical Disclaimer:
The information on this website and blog is meant for basic informational purposes only.
It is not intended to serve as medical advice or treatment. Readers are advised to consult with their doctor or midwife before making any decisions concerning their health.


Baby Things You Don't Need

As a mom of six children, I have become a minimalist when it comes to babies. With your first, you tend to go overboard. You get sucked in by all the cute and handy items, and click everything on the registry. By the third baby, you just tell people you want the basics: Diapers, pads, and sleep.

As you put the final details on your nursery, and you wait for your upcoming baby shower, you might want to re-consider the following items:

A Boppy

Although they come in many cute styles, I don’t find them very useful for what they are made for (nursing). Unless your boobs hang down to your belly button, you’ll end up needing to prop pillows under it anyway. The " My Breastfriend" does seem to work better than the Boppy for getting baby up where you need him/her to be, but you will most likely ditch any nursing pillow after about a month anyway! Consider getting some new sleeping pillows, and prop them where you need them in those early weeks, and you’ll have something that serves as a dual purpose!

The Gentle Rocking Swing (whatever)

If you considering a swing that brags about how gentle, calm, and soothing it is, - just keep walking. You don’t want something that is going to gently rock your baby. A baby likes MOVEMENT, and the swings that they are coming out with these days just don’t cut it. The Lamby-Poo Cuddly Pro swing looks comfortable (and probably is), but you might want to consider the Rocket Launcher 3000. Yeah, that should do it. (Patent Pending- Trisha Blizzard)

Crappy Nursing Pads

If the nursing pads have “paper” as the first listed ‘ingredient’, then you are probably a masochist, and you’ll enjoy them throughly. There is nothing worse than sticking something akin to sandpaper on your probably-all-ready-sore nipples. Not to mention they don’t hold more than three drops of milk without ruining your shirt. You need something soft, and you need something that will soak up a gallon of milk when your milk comes in. If you are like me, you will need to buy stock in these nursing pads, because you will need them for the ENTIRE time you are nursing (at least on one side), others will find themselves lucky enough to not need them after a month or two.
 

The Diaper Trash Thingie

You know the one that you stick the diaper in, turn the lid and it’s supposed to encase the diaper, and then you can’t smell the it anymore? It holds like 25 diapers at a time, and when you pull it out it looks like a giant diaper sausage. Umm no. They lie. It still stinks, and you have wasted a ton of money buying refillable bags, only to ditch the whole thing 2 weeks postpartum. Do yourself a favor and just get a small trash can and empty often. Have them all over the house, because let’s face it, at 2am, you are not going to walk into the nursery and change the baby on the changing table, and use The Incredible Diaper Thingie. What will really happen is you will change the baby on your bed, and toss the diaper in the nearest thing that resembles a trash can and deal with it in the morning.  (Unless you enjoy not sleeping?)
 

The Pee-Pee Teepee:

I used the actual name this time, because you just can’t make this stuff up! The idea is that if you are having a boy, and have these wonderful pieces of cloth handy, you will be saved from getting sprayed. Let me tell you what I learned from having 5 boys. You do not have time to grab anything. You open the diaper and if his weapon is standing at attention, you COVER IT BACK up (with the diaper). Seriously, how many moms open a diaper, covered in poo, and think “oh yes, I need to get that Pee-pee Teepee on before I attempt to remove his soiled clothing from around his neck”. No this mom is wondering if she needs gloves and a Hazmat suit.

No wonder you first time moms are soooo tired! The next time I hear a mom crying because she was up all night because it took her 3 hours to change her baby’s diaper (½ hour to find the Pee-pee Teepee, ½ an hour to clean up from the blow out, and 1 hour to figure out how to get the diaper in the Incredible Diaper Thingie), I’m going to have sue one of these company’s for mental anguish and trauma.

Parents , do yourselves a favor, and get something useful for you and your baby! For example: A doula? Postpartum doula? Or how about that Rocket Launcher 3000!

 

About the Author:
Trisha Blizzard is a mother of six and is a certified childbirth educator and labor doula in Fort Worth, Texas.

 

Hiring a Doula for a Cesarean Birth

When people think of doula’s, they think natural birth. Some people even think homebirth, or birth center births, but did you know that most all doulas support hospital births? Did you know they can help you through a cesarean too?

The majority of my clients birth in a hospital, and I’d say that about 85% of them also want to go without medication (mainly wanting to avoid an epidural). Some of them don’t know if they want medication, while others hire me to get as far as they can without it. I support them all, no matter what their goals, planned or unplanned. For me, it doesn’t matter what kind of birth a mother wants as long as she is making an informed decision. My point is, that a doula will support a mother no matter WHAT kind of birth she wants, and furthermore she is still worth it. Maybe I will do a post sometime on how a doula can support a medicated birth, but today I want to focus on how a doula can help with a cesarean.

Some of my most precious births have been cesarean births. The mothers did not plan a cesarean, but circumstances did not make a vaginal birth an option. Most of the moms had time to process the situation, and we had time to cover the options they might still have some control over. I provided them prenatal support, birth support, breastfeeding support and postpartum visits in the home for those who wanted it.

So what does it look like when you hire me as your cesarean birth doula?

Prenatal support 24/7:

Just like any other pregnant mom, you’ll still have questions! From “I think I’m losing my mucous plug, but I was going to go swimming, is it okay?”, to “what can I do for this sciatic pain?” It’s nice to not have to bug your care provider for the small stuff, and your doula will let you know when a call is warranted! A doula also carries with her a list of trusted referrals for just about everything from acupuncture to postpartum depression.

Prenatal Education:

The doula that helps with cesareans can still provide a LOT of education. For me, this is where being a childbirth educator AND a doula comes in super handy!

I like to start my first prenatal visit off with collecting as much information about the pregnancy and situation as I can. I provide my clients with options they didn’t even know they had for their birth. We discuss family centered cesareans, delayed cord clamping, types of suturing available, as well as the procedure, and recovery. I listen to and address the fears, obstacles, and ideas they have to make the experience the best possible.

The next prenatal covers newborn care, because no matter HOW you give birth, you still have the same baby to take home :-) My clients get my full “Newborn Basics” class, complete with handouts and a book that provides access to videos on everything from cord care to bathing. We usually take some to talk about the pregnancy, and any other things that may have come up since our last visit.

Finally, to build a stronger rapport, I offer an additional class. For those who want to breastfeed, they take me up on my Breastfeeding Basics Class. We discuss how this will look for her cesarean birth, and the options that she might have depending on her unique situation. Since I am familiar with most all hospitals in the Fort Worth area, and some on the Dallas side, I can provide feedback on if her breastfeeding goals are in line with the hospital she is birthing at.

For those not breastfeeding, they make take me up on my Happiest Baby Class - because who DOESN’T want a happy baby?! Again, this is just another chance for mom and dad to get to know me better before I share such an intimate day with them.

Birth Support:

 I like to talk to mom the day before the cesarean via phone or Skype. We go over last minute jitters, concerns and questions. We talk about when they would like me arrive, and what they would like my support role to look like.

The day of the cesarean, I arrive an hour or two prior to the cesarean. If mom and dad want to keep it light, we laugh, if mom and dad want help calming nervous, I’m on it. If they want to pray, we pray. I want to be calming, and reassuring. I am sometimes the sounding board for the range of emotions that mom and dad might be feeling on that day. I might rub legs, feet, hands or do scalp massage. If the surgery is delayed and dad needs to eat, I can stay with mom so she isn’t left alone. We go over the plan one more time, and make sure that everyone’s role in the room is clear. I answer questions and provide information on what is coming next as nurses come and go. When mom goes back for her sugery, she is as ready as can be expected. I make sure dad gets suited up properly (as dad can’t go back for about 20 more minutes). If we are at a hospital where the doula cannot go back, I’m prepping him on comfort measures, and filling his pockets with all the things he needs to get through the next hour.

If I am allowed to go back to the OR, I provide the comfort techniques, and do my part as discussed previously. If baby has to go to NICU for any reason, dad can leave mom without worrying that she is being left alone. After the surgery is over, I help with breastfeeding (if that was in the plan), and help mom through the first hour of recovery. After mom, dad and baby are settled, I leave and tell them to call me if they need any help, and let me know when they would like a postpartum follow-up visit. For a scheduled cesarean, I am usually with my clients at least 4 hours, but have been there as long as 12 when needed.
 

Postpartum Support:

I offer mom and dad a postpartum visit. This looks different with each client. Some want to go over newborn care, some need help with breastfeeding. Some moms just want to talk about postpartum recovery ideas, while others need hands on help around the house. I provide them with a time line of their baby’s birthday, and I make sure they know that for the next six weeks, I’m still available 24/7 for questions or concerns.

My cesarean support varies from client to client just like a vaginal birth does! I might spend 8 hours total with one couple, and 36 total hours with another because everyone has different needs. Each doula will provide a different approach, so ask your doula what her support might look like for you :-)

If you are one of those people out there trying to decide if you should hire a doula for your cesarean birth - ask yourself if you would hire one for your vaginal delivery and why. You may have been able to justify the cost with a vaginal birth because you know that your partner may need time to eat, time to sleep and that the birth might be long and hard. There are many women out there that didn’t regret hiring a doula for their fast births. Don’t you deserve support no matter how your baby enters this world? If you want someone who can guide you through the process, and make it as smooth as possible, hire a doula! She is going to guide you through this unfamiliar territory, and make this the best experience possible. She’ll show you some things you didn’t know existed or were possible.

If you are one of those people out there shaking their heads, wondering why you should hire someone to comfort you through the most amazing day of your life - then you are probably good to go without one. Some women look forward to their cesareans, have no fears, or concerns, take newborn classes at the hospital, and will call a friend if they need a referral.

If I had the money, I would hire a doula to take me to the dentist (oh wait, I did that once!), to be their for my first (and hopefully only), colonoscopy, and I would have a doula with me when I die :-) My husband has always been there for me, and a doula could never replace him. However, he can’t take the place of my doula either!   Sometimes, it really does take a village.