Posts Tagged ‘birth interventions’

This week we are thrilled to feature Desirre Andrews (midwife assistant & ICAN President) of Preparing for Birth as she discusses how to say no to interventions after a previous experience with cesarean birth.

Let me begin by saying I am a VBAC and Cesarean mother of 4 boys. Officially I am designated as a 2VBA2C mother. I too, have walked this path out just like countless other women. Many VBAC hopeful mothers are in a club they did not ask to be a part of regardless of why or how the cesarean occurred.  The first or last birth leaves not only a uterine scar but different possibilities for any subsequent future pregnancy and birth. It can be a very sobering, shocking, even overwhelming realization that there may never be a vaginal birth in the future or again.  The option at birthing versus repeat surgical delivery can be determined by accessibility and cultural expectations, needs and desires.

Why would there be an issue of VBAC access by hospitals and providers? VBAC is not a procedure that requires specific training or skill, unlike surgery. In a nutshell, it is the usual extension of pregnancy and labor to push out a baby vaginally. In essence, it IS the biological norm and expectation. The uterus does have incredible resiliency in healing, like other muscles in the human body. It is also widely recognized by and large to be a safe, reasonable option for women and babies by the National Institute of Health  (NIH) and the American College of Obstetricians and Gynecologists (ACOG) as evidenced in 2010 statements all backed up by years of evidence.

Some issues in access availability are language in the previous practice guideline statements stating immediately available anesthesia is needed (this idea knocks out vast number of rural facilities from offering access), physician liability concerns (cost of liability insurance, thought of being sued), lack of true informed consent between mother and physician comparing repeat surgical risk and VBAC risk, physician fear and desire for making labor and birth a zero risk venture (life is not risk free, either is labor and birth and can never be), and overall physician/hospital culture (what pressures, protocols and practices are widespread in an area).

Yes even with all of these, some changes are being made toward more access, albeit very slowly in most area. Women are compelling providers and hospitals to offer access through determination, evidence, self-advocacy, exercising options, rights and open communication. It is possible. Another point to look at is women are more and more choosing alternate places to birth whether at free standing birth center or in the privacy of their own home (with a midwife or unattended) when access is declined in the hospital environment.  Women are increasingly saying no to those who refuse to give options and choice.

The culture in which a childbearing woman lives (family, friends, co-workers, faith community) affects decision making for the positive or negative. When some or all of those in these cultural areas are supportive of VBAC, she is more likely to choose going for it. When it is the opposite and she is told to just do the “easy” thing (for whom, surely not the one undergoing surgery), ask “Why would you WANT to labor? How lucky you are to be able to get out of it.” or “What does it matter anyway? All you want is an EXPERIENCE, A healthy baby is all that matter anyway….”  All of these negate the woman herself. It is more than okay to want the vaginal birth. It is good to look at what is the healthiest birth avenue. That goes a long way to seeing how the best experience is also the healthiest experience for both mom and baby.

I asked a recent VBAC mother, Katie Z. how her culture affected her decision to go for a VBAC. She stated “Friends and family were extremely supportive, especially after seeing what I went through with (my) cesarean and subsequent PTSD. The community (at large) most was surprised it was no longer once a cesarean, always a cesarean.”

She was able to more readily and easily pursue the desire and need to have a healthier experience because she was fully supported by those in her life. Conversely, some women are willing to buck the trend within their culture and have a VBAC. With lack of support, fear mongering and too often misguided advisement, it is much more a challenge to gestate peacefully and prepare for birth. It is possible, but much more difficult when those a woman cares most about are not be in her corner. I will share that with my fourth son; very few in my world shared my point of view. Thankfully my husband and certified nurse-midwife did. That was really all I needed. Frankly, it can be a dangerous thing to tell a determined woman “no”. She is very likely going to find a way.

Bottom line, there are options though to exercise them it may require much effort, research, relocation, financial planning, meeting with administrators, changing providers and more.

For more information on VBAC www.ican-online.org and www.prepforbirth.com

Desirre Andrews, CCCE, LCCE, CLD, CLE, Midwife Assistant & ICAN President. Preparing For Birth, LLC – http://www.prepforbirth.com.


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This week, we are thrilled to feature the voices of two leading birth advocates, Ricki Lake and Abby Epstein. The below interview features Ricki and Abby as they speak to overcoming traumatic past birth experiences.

It is so important that women are able to have safe, empowering births in whatever manner they feel best suits their needs and the needs of their babies.  Having a traumatic or less than ideal birth experience can affect a new mother in a variety of ways, such as impeding her ability to bond and breastfeed, contributing to post-partum depression or lowering her confidence.

So many women have come to us to share their birth stories.  Many have shared some rather distressing first births where they were given a cascade of interventions that ended in unnecessary Cesareans.  It’s getting more and more common for women to go into a hospital setting, be given some sort of interventions, such as Pitocin or Cervadil, to speed up the process of labor.  The problem is that if a woman is given one intervention, the chances of them needing another intervention for some reason or another will vastly increase.

We hope to empower women who have had traumatic or less than ideal previous birth experiences to overcome them by digging down deep and doing the research necessary to prepare for a more positive, gratifying and gentle subsequent birth.

Ricki: Although I wouldn’t classify my first birth as traumatic, because a lot of things went right, I was able to give birth vaginally and I had a lot of skin-to-skin contact with my baby right away.  I had a beautiful healthy baby when all was said and done, but there were definite reasons why I chose to do my second birth completely differently.  In retrospect, I had a lot of interventions that I really hadn’t needed the first time around, like Pitocin and regular cervical checks.  I got to thinking about whether or not these types of routine interventions were really necessary.  When I became pregnant with my second baby, I had done a ton of research and decided to have a water birth at home with a midwife.  I trusted my body.  My second birth was so gentle.  Completely different from the first.

Abby: Although my first birth (an emergency C-section) was traumatic, I never felt that my baby and I were in any danger or that my birth team couldn’t handle the situation. I surrendered to the birth my baby needed, and I never felt disappointed. When I became pregnant again, I chose to stick with the same practitioner whom I trusted and I was able to have a vaginal birth after cesarean (VBAC). I can’t say that my VBAC itself was a transformative or healing experience for me – it was a difficult birth for me and my son. But immediately after the birth — I was empowered to realize that I was made of stronger and tougher stuff than I knew.  And I have really felt the benefits from the VBAC over the first year of my son’s life as we have been able to bond and breastfeed in a more gratifying way that I was able to do after my first birth.

We truly hope that our stories encourage mothers to listen to their hearts and trust their bodies, so that they can heal from traumatic past experiences and have the birth that is best for them and their babies.  Our biggest suggestion for overcoming previously traumatic birth experiences and preparing for your next birth is to do the research and decide what kind of birth is best for you and your baby.  Be at peace with your decision and surrender to the birth, even if things don’t go as planned.  Trust your body and your baby.

And… please stay tuned for our soon-to-be released “More Business of Being Born,” a four part DVD series that will feature midwife Ina May Gaskin, Vaginal Birth After Cesarean, and tons of amazing celebrity interviews, including Gisele Bundchen, actress Molly Ringwald, actress Alyson Hannigan and musician Alanis Morrisette!  Please join us on MyBestBirth.com to stay up to date.

Have you had a traumatic birth experience that was difficult to overcome?  How did you come to celebrate the miracle of birth?

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This week, Mother’s Advocate is proud to present well-known and respected childbirth educator and author, Nicette Jukelevics. Nicette is blogging on behalf of the Coalition of Improving Maternity Services (CIMS), and has given us a straightforward, detailed look at labor induction.

Although there is no evidence to show that non-medically indicated inductions improve outcomes for babies, inductions for non-medical reasons have been on the rise in the U.S. Increasingly, labors are being induced for psychosocial reasons and for medical convenience. What’s more, the majority of expectant mothers are not aware of the risks of elective induction when they request one or when their caregiver schedules it.

We are learning, however, that with a healthy pregnancy, not waiting until labor starts on its own may have far greater health consequences for babies than we knew. Research shows that when births are induced or cesarean sections are scheduled — especially before the 39th week of pregnancy — newborns may appear mature, but they are at greater risk for short- and long-term complications.

Labor Induction: Alarming Statistics

In 2005, 22.3 percent of all U.S. births were induced — a 50 percent increase since 1990. A national survey by Childbirth Connection showed that 21 percent of U.S. women who gave birth in 2005 tried to self-induce labor because they were tired of being pregnant. They wanted to induce to avoid a medical induction, to control the timing of their birth, or because their caregivers were concerned about the size of the baby.

Elective induction rates vary widely among hospitals (12 percent to 55 percent) and among individual physicians (3 percent to 76 percent). But more than four out of 10 mothers (41 percent) reported that their caregiver tried to induce labor. For some women, an elective induction can almost double the risk for a cesarean, depending on the individual physician’s practice style and medical specialty. And all of these statistics are even more frightening when compared to the World Health Organization’s recommendation that appropriate induction rates in any geographic region should not exceed 10 percent.

Labor Induction: The Risks

With an elective induction, babies are more likely to suffer from hypoglycemia, to be admitted to a special care nursery, and to need ventilator support. A recent study of a U.S. healthcare system showed that babies born at 37 weeks were 22.5 times more likely to need a ventilator at birth, and babies born at 38 weeks 7.5 times more likely, when compared to babies born at 39 weeks. Babies born too soon are also more likely to experience serious complications, including fever, infection, respiratory distress syndrome (RDS), and transient tachypnea of the newborn (TTN).

These babies may look normal, but have an increased risk of difficulties with vision and hearing, feeding and digesting their food, regulating their body temperature, and are more likely to need phototherapy to treat jaundice.

The newest research on babies born before term indicates the potential for neurological problems and learning difficulties that may not show up for years. The March of Dimes is educating healthcare professionals and mothers alike about the important brain growth and fetal neurological developments that take place in the very last weeks of pregnancy. At 35 weeks, a baby’s brain weighs two-thirds what it will weigh at 39-40 weeks. At 37 weeks, the brain weighs only 80 percent of its weight at 40 weeks. The cerebral cortex — the part of the brain that controls functions such as cognition, perception, reason and motor control — is the last to develop. Researchers have found that babies born pre-term are more likely to have learning difficulties at school age. It’s essential for baby’s brain development that the pregnancy goes to full-term.

Labor Induction: Consider This

An induction of labor is a complex process that often requires additional medical interventions to keep the mother and baby safe from successive potential complications. Inducing labor with pitocin when the cervix is unripe (long and closed) sometimes causes the mother to labor for long hours with little progress. Subsequently, confining the mother to bed, using continuous fetal monitoring and IVs, and administering an epidural for pain are commonplace with an induction. Shoulder dystocia (when the baby’s shoulders cannot fit through the pelvis), and the use of forceps or a vacuum extractor are also increased with induction. All of these interventions and complications can lead to higher risk of cesarean section — failed inductions are not uncommon.

Labor Induction: When it’s Helpful

Regardless of all the risks, there are several medical indications for inducing labor — when the mother or the baby’s health would benefit more from the induction than from continuing the pregnancy. These may include diabetes, pre-eclampsia (high blood pressure), or a uterine infection in the mother. Or when a baby in utero is not growing at a normal rate (small for gestational age) or the pregnancy is post-term (more than 42 weeks). Induction may also be favorable when the bag of waters breaks prematurely (also known as PROM, premature rupture of the membranes).

Labor Induction: Questions to Ask Your Provider if it’s Suggested

  • Why are you scheduling an induction of labor?
  • What are the risks of inducing my labor?
  • I know that my due date is only an estimate. What precautions will you take to make sure my baby is not born too early?
  • How do you plan to induce my labor?
  • How will an induction affect my labor and the health of my baby?
  • I know that compared to waiting for labor to begin on its own, an induction is more likely to lead to a cesarean section. What measures would you take to reduce my odds for a cesarean?

If both you and your baby are healthy and stable, don’t hesitate to take time to consider your caregiver’s recommendations and explanations. Feel free to leave the appointment, with a follow-up scheduled — or to get a second opinion. After all, this is your birth.

The last week or two of pregnancy may be difficult. Priorities at work, or scheduling maternity leave to accommodate childcare or family needs may be a priority. However, waiting for labor to begin on its own is safer for you and your baby — and safety is of the utmost importance!

Nicette Jukelevics, MA, ICCE is a childbirth educator, researcher and author of “Understanding the Dangers of Cesarean Birth: Making Informed Decisions.” She is also the founder and publisher of VBAC.com. Nicette is past-chair of CIMS, and now serves as chair of the CIMS Coalition Building Committee. She has also served on the Board of the International Childbirth Education Association and DONA International. For more than 25 years, Nicette had the privilege of helping thousands of expectant families prepare for childbirth, VBAC and early parenting. She has presented on cesarean and VBAC issues at national conferences, and for advanced doula trainings across the U.S. With co-author, Henci Goer, Nicette recently published “The Risks of Cesarean Section & Expectant Mother’s Checklist,” a Coalition For Improving Maternity Services (CIMS) Fact Sheet.

Other resources: California Maternal Quality Care Collaborative

Tell us about your labor. Did (or will you let) your labor begin naturally? Was (or are you planning on having) your labor induced? We’re looking forward to hearing about your experiences!

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Maternal mortality rates in the U.S. are much higher than statistics show, and birth interventions are often responsible. Beginning today, the Mother’s Advocate Blog is presenting a 3-part series about maternal mortality — the ultimate price of unnecessary interventions. This week, Maddy Oden shares the tragic story of her daughter and granddaughter’s deaths, and how she’s raising awareness about maternal mortality.

Tell me a little bit about your personal experiences with birth, and how they inspired you to become a birth advocate.

I had three of my own children, and all were natural births in a hospital — they were beautiful births. I had also been at many births of my relatives and friends. Then, my daughter was induced with cytotec — she died as a result, and my granddaughter died with her. I then became determined to make sure that cytotec (which, although was a standard of care for inducing labor wasn’t approved by the FDA to induce labor — it was approved for treating ulcers), wasn’t used anymore. I became an advocate because of what happened to my daughter, and subsequently found out that she wasn’t the only one. A lot of women have adverse effects from being induced by cytotec, up to and including death. I formed the Tatia Oden French Memorial Foundation in honor of my daughter, and in my pursuit of making sure cytotec is not used.

These events also led me on a path to become a doula. I have since attended a number of births to ensure that what happened to my daughter doesn’t happen to anyone else. My goal is to be at any birth I can, and to make sure it’s a safe one.

The prevalence of maternal mortality isn’t something that most women are aware of. Why does this need to change?

It needs to change because women in the U.S. don’t know about it. It needs to change because it happens a lot. Maternal mortality doesn’t happen as much (thank God) as cesarean sections, but it still happens a lot. One of the largest problems is that maternal mortality isn’t reported as much as it happens — the statistics are skewed. We know that many causes of maternal mortality are created by the medicalization of birth — the use of technology and interventions — but until all maternal deaths are reported and investigated thoroughly, women will never know the true incidence. My daughter’s death wouldn’t have occurred if we had known about cytotec. Women need to be aware of the incidence of maternal mortality, and know that as soon as interventions begin, their chances increase.

What is the most rewarding result you’ve achieved from all of the work you’ve put in to standing up for birthing mothers and their babies?

Babies being born healthy and un-medicated. And moms having an un-medicated birth, no matter where it is.

How does being a doula bring your journey and quest for safe and healthy birth full-circle?

Well, for one thing, if I knew what I know about birth now in 2001 when my daughter died, she wouldn’t have.

Also, when I’m in a position when I have to be present at a cytotec birth, I can be there with the mother, to ride out the gamut of effects. When a mother is in the hospital and cytotec is administered to soften her cervix, the nurses can’t sit there and watch her. The machines they’ll hook a woman up to really do pick up most everything that’s going on, but humans have to be watching the machines to prevent complications or an emergency. As a doula, I sit there, and when breathing or contractions are slamming a woman against the wall, I can call in the medical team and they can react much more quickly — preventing complications and saving the lives of both mom and baby. I can (try to) make sure the mother doesn’t die.

Regardless of cytotec, if I can decrease the intensity of a mother’s contractions through all the means we have — changing positions, herbs, heat, walking around, soaking in a tub, using acupressure — that to me is also very rewarding, and brings it full-circle, because nobody could (or did) do that for my daughter.

Tell me about the Safe Motherhood Quilt Project, and how you’ve since become allies with some of birth advocacy’s most prominent supporters?

When my daughter died, my son-in-law was on the Internet a lot, and found the Safe Motherhood Quilt Project. He asked me to make a square for Tatia, so I reached out to The Farm Midwifery Center to get the specifics of the square. Weeks went by, and between the grief and forming my nonprofit foundation, I just couldn’t make it. I called The Farm back, and gave them my apologies.

Ina May (Gaskin) later called me up, told me that she had made a square for Tatia, and asked if she could stop by and show me, as she was going to be in California. Ina May and I ended up having tea and chatting for hours, and in the process, I asked her if the quilt was on display any other places than in Tennessee — I wanted to have it displayed in Oakland. She suggested I call the Mayor’s office, so I did, and he ended up paying for an entire maternal mortality event at the Oakland Museum. Ina May and Dr. (Marsden) Wagner spoke, and about 300 people attended. I believe it helped bring the issue of maternal mortality into public view.

Afterward, both Ina May and Dr. Wagner agreed to be on my foundation’s board, and I help Ina May reach out to families who have suffered a loss from maternal mortality (about making quilt squares or to simply console). We work together to provide support to families in need.

What is the next step?

What is definitely needed in the U.S. is a uniform death certificate, although there’s bound to be political pushback. The Center for Disease Control estimates that maternal mortality is four times higher than reported. So, there needs to be a mandatory box on the death certificate in every state that designates whether a woman was pregnant at her time of death. If the box is checked, a mandatory, thorough investigation into the cause of death should occur. It’s the only way statistics will ever be correct, and the true causes of maternal death will be known — which is the only way maternal mortality will ever decrease. When my daughter died, California didn’t have box — so she wasn’t counted as a mother who died in childbirth.

Also, women need to know that we can birth our own babies, even catch our own babies — and that complications arise, but not nearly as much as they say. We’re not taught that birth is a natural process, so research needs to be put out there, alternatives and options presented, and if nothing else — we need to learn to trust in birth.

Maddy Oden, birth and community advocate, is mother to three children, Tatia, Marcus and Kofi, and grandmother to seven grandchildren. She is the founder and executive director of The Tatia Oden French Memorial Foundation a doula, and a hospice volunteer.

Mother’s Advocate wants to facilitate a safe and supportive community for birth advocates, educators, and expectant mothers. You’re welcome to share any thoughts about or experiences with maternal mortality.

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We’re thrilled to have Deb Flashenberg join us again on the Mother’s Advocate blog! This week, she explores the due date debacle, and shares the importance of letting your baby come into the world when it’s right (and you’re both ready)!

Ah … the infamous question: “When are you due?” Of course you know this date — it is circled, highlighted and has little stars drawn around it on your calendar. You know it so well, in fact, that it’s easy to get very attached to this date. However, according to the American Congress of Obstetricians and Gynecologists (ACOG), only 5 percent of babies arrive on their exact due date. Full term gestation is seen as 37-42 weeks — so it’s more like a due month than a due date.

There are a few different ways to determine a due date. One way is by ultrasound, and another is by measuring the uterus. The third (and commonly used) method is called the Naegele’s rule, in which the due date is calculated by taking the first day of a woman’s last period, counting back three months, and then adding seven days. This calculation is assuming that every woman regularly has a 28-day cycle and ovulates on day 14. If the pregnant woman has a longer cycle, therefore ovulating later, she will likely have a longer gestation period and her given due date may be off. A study done through the department of Epidemiology at Harvard School of Public Health concluded that when estimating a due date for private-care white patients, one should count back three months from the first day of the last menses, then add 15 days for primiparas (a first time mother) or 10 days for multiparas (a mother who has already given birth), instead of using the common algorithm for Naegele’s rule.

Given the wide range of interpretation and accuracy of determining the due date, it’s important to discuss with your health practitioner what his or her protocol is for passing the due date. Throughout my years working with the pregnant population, I have encountered some care providers that allow up to the full gestation period of 42 weeks before induction, while other care providers induce 10 days, one week or one day after the due date.

If the mother passes her due date of 40 weeks and would like more time before a conversation ensues about induction, she can ask her doctor if she should try natural alternatives to induce labor.

It is rather uncommon to actually pass 42 weeks of gestation. In fact, only 7 percent of babies are not delivered by 42 weeks. Pregnancies bypassing the 42-week marker are referred to as “post-term pregnancy.” Note: “post-term pregnancy” is NOT defined as simply passing the due by a few days, but passing it by a significant amount of time. For mothers who do pass the 42-week mark, the care provider will likely want to induce labor to avoid serious complications that can arise with post-term pregnancies.

Debra Flashenberg CD (DONA), LCCE is a graduate of the Boston Conservatory of Music. She spent most of her life performing, and was introduced to yoga through a choreographer in 1997. Soon after embarking on the path as a yoga teacher, she founded the Prenatal Yoga Center in New York City, where she continues to instruct prenatal yoga and train prenatal yoga teachers. Debra decided to also take her skills and passion for supporting normal birth outside of the yoga room, so she became a certified labor support doula with DONA and a certified childbirth educator with Lamaze International. For more information, please visit the Prenatal Yoga Center online.

Did you go into labor early? Late? Did you contemplate being induced? We would love to hear your experiences about the age-old question: “When are you due?”

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This week, we are thrilled to feature the voice of a leading birth advocate, Ricki Lake. The below interview features Ricki and her producer and coauthor, Abby Epstein, as they speak to their film, The Business of Being Born, their book, “Your Best Birth,” and the inspiration behind their mighty movement.

How have women responded to The Business of Being Born?

Ricki Lake: The reaction has been really incredible. Everyday I meet people who have been affected by it, and it’s not just women, it’s everyone. Even people who do not think they have an interest in the subject matter are suddenly interested in the story — are sucked in to the personal tales and the statistics that we reveal, and realize what an important issue this really is.

Abby Epstein: I love the stories that we hear. Someone saw the film, and then at 35 weeks dropped her OB and went to a birth center and a midwife. We also hear stories about those women who didn’t necessarily change providers or birth locations, but were able to advocate for themselves and talk their way out of a C-section. I love those stories, because I think that is the message of the film. It is not that everyone should have a home birth, that everyone should be at a birth center, or that everyone should use a midwife — at all. It’s really about education. Knowing your choices, being a really informed consumer, and not falling prey to the fear that so many women feel that makes them consent to things they may not have, had they known differently.

So you are actually changing people’s lives.

Abby: They tell us we are!

Ricki: We are definitely helping to make birth a better experience overall, and that feels really good.

What stories are you hearing from midwives? How are you changing their lives?

Ricki: Their practices are definitely doing better than before the movie. In many cases, we are hearing that their practices have doubled, that they’ve had to take on more midwives — it has definitely helped their businesses. And it has helped to change the perception of them.

How has the movie changed your own life?

Ricki: It is so hard to put into words. I always felt like my life had a lot of meaning — I am a mom and feel really fulfilled in that role, and I love the work that I do — but I have now given back in a way that is bigger than I had ever hoped. I feel that given my former career as a talk show host, I now have some legitimacy. I have something to say, and people want to hear it. It is just a really good feeling to have done a project that I believed in so whole-heartedly — a project that is from a really good place and is having this kind of positive effect.

What about the difficulties? What challenges have you encountered as a result of the movie?

Ricki: Day to day, I don’t really come up against a lot of opposition to the film. I am sure there are obstetricians out there that still don’t believe in our message, but I don’t know how you can argue with the message of women having choices. That is ultimately what it comes down to. I don’t feel that women walk away from the film feeling judged by the birth that they ultimately ended up having, or are going to have.

Abby: I agree, and one thing that worked in our favor was including the outcome of my birth in the film. I won’t spoil it, but because you see a birth that required intervention, you see a really lovely transfer from home to hospital, from midwife to OB, and the system working in the way that it could. I think including my birth in the film really mollifies the medical community in terms of saying, “Of course, there is a place for the hospital. Of course, there is a place for surgeons and technology when it is needed.” So I think that has really helped us balance the film and receive more respect from the medical community. Even though a lot of people really don’t agree with a lot of the points we make in the film, on some level they do embrace the message.

What do you think The Business of Being Born is accomplishing?

Ricki: It is definitely raising awareness; it is educating people and getting them to fight for their own choices.

What are your next steps?

Ricki: I am continuing to put myself out there and advocate for choice in birthing. I hope to make the system better and safer, to give women access to the information for their decisions, and to hopefully lower both the C-section rate and the maternal death rate. We want all of it. We want better maternity care, and for women to have as amazing, empowered experiences as possible.

How has this movie or being a childbirth activist changed your mothering style?

Abby: This whole idea of awareness, of being fully conscious to all the levels of motherhood. Ricki has a quote in the film that her peers just seem to want to “get this baby, acquire this baby, get this baby out,” and oftentimes, that is where motherhood starts. I think it is really a shame that a lot of women are not approaching birth and motherhood prepared, not doing their homework, not getting access to the right information. That many are having birth experiences that are disempowering and depressing, or that they are separated from their babies at birth — all things that can be very deeply wounding.

Do you want to tell us anything about your book?

Abby: It is called “Your Best Birth,” and it is meant to be a very practical guide to navigating your choices in the current maternity system that we are in. It is not a pregnancy guide, or a “What to Expect When You Are Expecting,” that tells you what your baby is doing at 34 weeks. It is totally about how to pick your provider, how to build your birth team, whether you should hire a doula or not, whether you want a midwife, explaining the different types of midwives and how they work, what you should be looking for in an OB, what a typical hospital experience is like, things you should ask on the hospital tour, things you should ask on a birth center tour. It’s a very practical, handholding guide aimed at women who may want totally different types of births. It’s definitely not just for women who want natural birth. But for women who want a more empowered, more personal birth experience.

This interview, conducted by Maria Iorillo, was repurposed with permission from Mindful Mama.

Maria Iorillo, CPM, has been a practicing midwife serving the San Francisco Bay area since 1986. Maria co-produced It’s My Body, My Baby, My Birth, an educational childbirth film that tells the story of seven mothers in their emotional journeys to natural childbirth.

Have you seen “The Business of Being Born,” or read “My Best Birth?” How did these tools inspire or empower your birth?

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This week, Connie Livingston, a childbirth educator for more than three decades, discusses the ironic and challenging blend of technology and birth. Advancements in technology have increased tools for childbirth education — but also the opportunities for birth interventions.

When I began my journey to become a childbirth educator more than 30 years ago, little did I know that education would not indefinitely be limited to the classroom.

Beginning my career with a few home-drawn charts and a uterus knitted by a friend, my path of teaching expectant parents started in a small town in California. Drawn to serve in additional ways, I held volunteer positions for Lamaze International (then ASPO/Lamaze), ICEA, CAPPA and DONA International. The journey has been a long (and of course rewarding!) one, but as technology advances to an educational advantage, so does the technology that leads to increased birth interventions.

One challenging subject that has always been present, and more so today than in the 80s, is the topic of induction. Getting the vital information to both expectant parents and health care professionals proves to be complicated, but absolutely necessary.

Caregivers use a gestational wheel to determine the EDC or “due date” of the baby. This method assumes that all women cycle the same, and also that a woman’s body’s definition of term is the same. The reality, however, is that cycles vary as much as a few weeks from woman to woman. Usually, a more accurate measurement of a woman’s due “date” is more like plus or minus two weeks from the day. Therefore, a woman who carries to 42 weeks may not actually be “overdue.”

Unfortunately, many caregivers and pregnant women simply look at 38 weeks gestation (to the day) as when they feel a baby can safely be born. If the dates are not correct and they choose to induce, the baby may actually be born premature. This, in part, may be a culprit in fueling the high premature birth rate in the U.S., the rise in near-term infants in NICUs, and the skyrocketing cesarean section rate.

A woman’s body goes through a series of preparatory steps prior to beginning labor. Both the fetus and the mother seem to work together in determining when labor will begin. In order for an induction to be successful, oxytocin receptors must be in abundance on the uterus for oxytocin to bind and produce contractions. This may explain why a woman who is brought into the hospital for induction may not respond to the pitocin given to her. Unless her uterus is ready to accept the pitocin (oxytocin), the induction may not work.  There is a scoring system that physicians use, which identifies women who most likely will respond to an induction. This is known as the Bishop score. Women who score relatively high (8-9) will have a greater chance of the induction being successful. However, a woman with a cervix that is not dilated, effaced, softened or anterior (and has a low Bishop score) may likely have a long, difficult labor when induced, often ending in a cesarean delivery.

The March of Dimes recently posted an amazing diagram showing the difference in the size of a baby’s brain at both 35 and 39 weeks. This graphic, in addition to the need for lung development, vision/hearing development, and the ability to suck and swallow can be moving details both expectant parents and professionals should be aware of. They may prevent some (or many) unnecessary inductions.

Technology has come far since showing reel-to-reel movies in childbirth classes more than 30 years ago. We, as childbirth educators, can use the vast majority of the technology available to the benefit of all. From informative “Did you know … ” posts on Facebook to tweets about the latest studies, perhaps the additional technological push of education on induction (and other birth interventions, too) can truly create a decline in the unnecessary use of technology during labor and delivery.

Connie Livingston RN, BS, FACCE, LCCE, CD (DONA), ICCE, IAT is President of Perinatal Education Associates, Inc. She coordinates two Web sites, Birth Source and The Birth Facts, and a blog, as well as a Facebook page (Birthsource) and Twitter account. Her two grown daughters and husband of 32 years are vital parts of her company. Also check out her books, “Innovative Teaching Strategies Handbook for Birth Professionals” and “Creating and Marketing Your Birth Related Business.”

Mother’s Advocate wants to know what your opinions are about unnecessary use of technology during childbirth – leave a comment below telling us what you think!

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