Saturday, December 22, 2007

Normal birth definition different in different areas of the world

"Normal Birth" is one of those hotly debated terms that has a wide variation of interpretation - trust me, when Lamaze was choosing to use that term in the care practices that support normal birth, there were long discussions on normal as well as natural and a ton of others. Hotly debated issues included normal as a mathematical term denoting frequency. If not normal, will women think abnormal? What role did pain relief have in a normal birth? Myself? I am partial to physiological birth. But that is another topic for another day!

Normal Birth is a term that is also used on a new initiative in the UK - "Making normal birth a reality." I recommend that you go to UK Normal Birth pdf and download the 8 page booklet and see how they are defining the term and advocating for an increase in normal births.

They clarify they are looking at normal "delivery" not outcome. The first classification is women whose labour (the British spelling) starts spontaneously, progresses spontaneously without drugs and who give birth spontaneously.

And they add "women who experience the following provided they don't meet the exclusion criteria listed later...."
augmentation of labour
artificial rupture of membranes (ARM) if not part of medical induction of labour
Electronic fetal monitoring
managed third stage of labour
antenatal, delivery of postnatal complications (including for example post partum haemorrhage, perineal tear, repair of perineal trauma, admission to SCBU or NICU.

The "normal delivery" excludes:
women who experience any one or more of the following:
induction of labour (with prostaglandins, oxytocics or ARM)
epidural or spinal
general anesthetic
forceps or ventouse
caeserean section or

So a completely different perspective with no mention of mobility, support, positioning, no separation of mother/baby or breastfeeding. The common ground seems to be labor starts on its own and the interventions.

So how do we work towards a universal definition?

Research suppports hot packs to the perineum

BIRTH is one of my favorite journals to read. And if you are a member of Lamaze you can get a subscription for half price! (I think that's now $44 but don't quote me) You can get it on-line which makes it so easy to save pdfs - so much easier than the old way of cutting up the journal and scanning etc. (or remembering which issue or what file you stuck the article)

In the December issue there is a research article on the use of hot packs in second stage. Here is the abstract:

Perineal outcomes and maternal comfort related to the application of
perineal warm packs in the second stage of labor: a randomized controlled
trial - Birth , vol 34, no 4, December 2007, pp 282-290 Dahlen HG; Homer
CSE; Cooke M; et al - (2007) BACKGROUND: Perineal warm packs are widely used
during childbirth in the belief that they reduce perineal trauma and
increase comfort during late second stage of labor. The aim of this study
was to determine the effects of applying warm packs to the perineum on
perineal trauma and maternal comfort during the late second stage of labor.
METHODS: A randomized controlled trial was undertaken. In the late second
stage of labor, nulliparous women (n = 717) giving birth were randomly
allocated to have warm packs (n = 360) applied to their perineum or to
receive standard care (n = 357). Standard care was defined as any
second-stage practice carried out by midwives that did not include the
application of warm packs to the perineum. Analysis was on an
intention-to-treat basis, and the primary outcome measures were requirement
for perineal suturing and maternal comfort. RESULTS: The difference in the
number of women who required suturing after birth was not significant. Women
in the warm pack group had significantly fewer third- and fourth-degree
tears and they had significantly lower perineal pain scores when giving
birth and on "day 1" and "day 2" after the birth compared with the standard
care group. At 3 months, they were significantly less likely to have urinary
incontinence compared with women in the standard care group. CONCLUSIONS:
The application of perineal warm packs in late second stage does not reduce
the likelihood of nulliparous women requiring perineal suturing but
significantly reduces third- and fourth-degree lacerations, pain during the
birth and on days 1 and 2, and urinary incontinence. This simple,
inexpensive practice should be incorporated into second stage labor care.
(42 references) (Author)

"A natural cesarean" - an oxymoron?

Recently on Lactnet - a listserve for people in Lactation, the link to an article from the UK on "a natural cesarean" was shared. I encourage you to read the whole article as it describes a skin-to-skin cesarean birth. Here's a quote:

"This groundbreaking approach to surgical delivery - Fisk calls it a "skin-to-skin caesarean", or "walking the baby out" - has been pioneered by him partly in response to the rising caesarean rate, which according to recent statistics reached a new high at 22.7% (of deliveries in England, 2003-04). "Whatever your view on caesareans, for some women it's always going to be the safest choice," he explains. "And while couples having normal deliveries have been given more and more opportunities to be fully involved in childbirth, very little has been done to see how we could make the experience more meaningful for those having caesareans."

Click here to read about a new option/philosophy in cesarean birth
A more natural cesarean

What do you think?

Friday, December 21, 2007

Where does the fear in birth come from?

Passioneer Ann Tumblin sent me the link to another good cartoon produced by the Hathor the CowGoddess. Fear-mongering Trail

And this time of year brings up that phrase, no room at the inn....and how many women are told that being induced on such and such date is very important but when they go to check-in are told there is no room; it's not as urgent as they were led to believe; and to come back later. How disheartening! And fear invoking - something must be potentially wrong if I need to be induced and then when not induced the fear also increases - because they thought they needed to be.

Once again we as childbirth educators need to work hard to remove the fear around birth....whether the fear is internally or externally generated.

CIMS call activists!

Calling All Maternity Care Activists! Enjoy a Family Vacation and Reinvigorate Your Birth Activism! You are invited to attend the "CIMS Grassroots Advocates Ambassador Training for The Birth Survey" and become a project ambassador at the CIMS Forum in Orlando, Florida.

Interested in gathering obstetric intervention rates for the hospitals and birth centers in your area? Become a GAC STATS Ambassador and work with us to collect obstetric intervention data at the facility level for all 50 states. The public has the right to know what is happening in our hospitals. We will provide you with the support, tools and guidance you will need to connect with the right people in your state, access the data, and get the data out to the public.

Want to help spread the word in your community about The Birth Survey ? A consumer feedback tool similar to "Angie's List" or "Consumer Reports," but for maternity care where women provide and view feedback on specific doctors, midwives, hospitals and birth centers in their local community. Join the GAC Marketing Ambassadors and help make The Birth Survey a success in your area. We'll provide you with marketing tools and materials designed to engage the public and generate excitement.

If these activities are of interest to you, please come to the GAC Ambassador Training at the CIMS Forum. Thursday, March 6th from 9am-3pm in Orlando, Florida. CIMS

Scholarships: A limited number of need-based full registration scholarships are available for the forum and training. Apply online for a scholarship.

For more information on the GAC Ambassador Training and The Birth Survey visit The Birth Survey

Please pass this announcement along to other interested activists.

- CIMS Grassroots Advocates Committee

Saturday, December 15, 2007

Cesarean resource at Childbirth Connection

I just received my DONA email newsletter and they highlighted a free pdf download from a recent Mothering magazine that address Cesarean Birth in a Culture of Fear - the issues they raise are important! Thank you DONA, Childbirth Connection and Mothering for all the advocacy work they do and freely share for pregnant and birthing women!

Cesarean Birth in a Culture of Fear

While you on the Childbirth Connection website look around and if you haven't downloaded the Comfort in Labor handout do that as well and add it to the resource lists you give to your childbirth classes!

Thursday, December 13, 2007

Bisphenol-A (BPA)

As a lactation consultant and breastfeeding advocate I have been aware of the risks of Bisphenol-A (BPA) leaching from the plastic of baby bottles into the formula/breastmilk that is inside the bottles. However I never thought about BPA being in the storage containers of formula - Mothering magazine has posted the alert on their website - it's a good thing for childbirth educators to be aware of - the safety of babies being exposed to this is unknown. Mothering Magazine

Luggage issues - comedy

As many of you know I have had more than my share of luggage fiascos! Passion for Birth Trainer Kris Avery forwarded this clip about luggage problems and her advice to empty your bladder before watching was wise!

Wednesday, December 12, 2007

Fighting Death By Powerpoint

I think you might know my feelings about powerpoint...and this slide show shows what some of the downfalls are:

Wednesday, December 05, 2007

sad day of statistics

Well, I sensed it was coming but it's official. The teen pregnancy rate is up and the ceasarean rate is up. (And maybe my rate of Bailey's Irish Cream is going to go up - just kidding but what sobering numbers!)

"The cesarean delivery rate rose again in 2006, to 31.1 percent of all
births, a 3 percent increase from 2005 and a new record high. The
percentage of all births delivered by cesarean has climbed 50 percent
over the last decade."

teen birth

Did you want your Bailey's on the rocks?