My OB Said What?!

Oh, it's funny but it's sad. Real comments made by birth professionals in earshot of their clients.

http://myobsaidwhat.com/

If you think you might want an epidural

[My apologies to anyone who has read this post in its horribly-formattedness...hope this is better]

then you should know the risks. An anaesthesiologist will probably not list and discuss these with you before letting you decide whether or not to have it - and the middle of labor is not a time to process information well. Whatever choice you make, it's better to understand the benefits (it hurts less), consider the risks (some are listed below), discuss it with your doctor or midwife, make a decision and then discuss it with your practitioner again :) so everyone is clear, before you go into labor.

The following chart lists only the possible complications to the progress of the labor, not for either the mother or the baby; those may be found at Seattle-area doula Kim James' site at http://www.kimjames.net/epidural_risks_and_side_effects.htm, from which this chart is taken (and at which you may find her sources of information).

Risks and/or side effects	How often this happens	Why is this a problem?	What you can do
Prolonged 1st stage of labor (while your cervix is dilating; usually the longest stage by far)	Common[30]	The anesthetic in epidurals weakens all the muscles below the epidural site. This can dampen the strength of uterine contractions. · Can be exhausting, boring, or otherwise discouraging for both mother and father. · Greater use of Pitocin needed to strengthen contractions can be stressful on baby and/or uterus, which may lead to cesarean section. · Greater incidence of maternal fever.	·Give labor time to happen. The risks increase the longer Pitocin and epidural anesthesia are in your system. However, as long as mother and baby are doing well, allow time for labor to work. Do not accept arbitrary time limits. There is no “magic amount of time” for labor to be finished. · Ask your nurse and care provider for reassurances that you and the baby are well. · Negotiate with your care provider, before labor happens, how long you’ll be able to labor. Find out when your care provider will begin suggesting cesarean section for failure to progress
Increase of malpresentation of baby’s head (the baby's head doesn't come into the pelvis at the best angle; lengthens the pushing stage)	20%-26%[31]	· Relaxation of the pelvic diaphragm predisposes malpresentations, as does lack of mobility and switching positions.	· Choose a CSE or intrathecal epidural. · Wait until baby is very low in pelvis (at least +1 or +2 station) before requesting epidural. · Wait until at least 5 cms dilation before requesting epidural
Increases the need for Pitocin augmentation.	Almost always, especially if epidural is given before 5 cms.[32]	· Some babies simply do not tolerate pitocin-induced contractions, the result being abnormal fetal heart rate after administration of pitocin. · Abnormal fetal heart rate may necessitate an emergency c-section. · Pitocin has a myriad of side effects. Please see Epidurals and pitocin below.	· Refuse an induction and wait to go into labor on your own unless the risks of continuing the pregnancy outweigh the risks of induction. · Wait until 5 cms dilation before requesting an epidural. Give your body a change to establish labor on its own and you’re less likely to need augmentation. · Ask your care provider to wait at least 2 hours before Pitocin is started to give your body a chance to adjust to the epidural. · Your body must also process the IV fluids that were administered before the epidural. That much fluid very often dilutes the oxytocin in your body, resulting in weaker, spaced out contractions. Give your body a chance to process the excess IV fluid and catch up. · You may want to practice active visualizations in an effort to speed up your own oxytocin production.
Prolonged 2nd stage of labor (pushing stage)	Especially true for first time mothers [33]	· May go against some care providers’ philosophy (ex: 2nd stage must be finished in 2 hours).	· Wait to start pushing until the baby’s head is visible on the perineum. · Negotiate with your care provider, before labor begins, how long you’ll be allowed to push. Find out when your care provider will being considering forceps or vacuum extraction or cesarean section for failure to progress. · Change positions and use downward gravity to help push your baby out. · Again, stay off your back.
Decrease in the ability to push effectively	Common[34]	· The build up of anesthetic simply weakens muscles to the point of ineffectiveness. · Mother may be able to push a little, but may not be able to effectively help the baby to rotate and descend. · Leads to increase in operative delivery.· The build up of anesthetic simply weakens muscles to the point of ineffectiveness. ·· Leads to increase in operative delivery.	· See above.
Increased likelihood of forceps or vacuum extraction delivery	Five-times greater likelihood.[35]	· Less efficient uterine contractions may keep baby from rotating naturally, and the diminished urge to push may keep baby from coming down. · Muscle weakness may not allow mother to push effectively.	· Consider letting the epidural wear off for pushing. · Don’t request an epidural until at least 5 cms. The fewer hours the epidural anesthesia is in your system, the less muscle weakness you’ll have to contend with.
Increases the likelihood of needing an episiotomy[36]	Depends on care provider philosophy	· Goes hand-in-hand with increased use of forceps and vacuum extraction. · Episiotomies are far more likely to tear beyond the original incision. · Take longer to heal, with greater scar tissue, than natural tears. · More postpartum pain for the mother.	· Talk to your care provider about their philosophy towards episiotomies. Find out when they are most likely to cut an episiotomy and how often this happens in their practice. · Strengthen your pelvic floor muscles before labor.
Increase in cesarean section	50% if you get the epidural when your cervix is dilated to 2 cm; 33% 3 cm; 26% 4 cm; After 5 cm, no difference in non-epidural group.[37] [38] Often depends on care provider philosophy	· Cesarean section deliveries carry far more risk to both the mother and baby than vaginal births do. · Mother may feel cheated out of a vaginal birth experience. · Postpartum recovery time is significantly longer than a vaginal birth.	· Don’t request an epidural until at least 5 cms. dilation. This will give you the greatest opportunity to get labor established on your own and to be upright and active.

Nutshell: The epidural is almost never medically necessary, BUT if you must have one, here's what you can do to minimize negative side effects:

• Keep changing positions and stay off your back.
• Labor at home as long as you can before heading into the hospital; this makes Pitocin augmentation, which causes unnaturally strong pain, less likely.
  
• Wait till your cervix is dilated to 5cm.
• Let it wear off during pushing (2nd stage of labor). This also helps avoid side effects to the baby.
  

A basic principle for all labor pain-relief techniques is that, in general, what makes it hurt less (i.e. epidural, horizontal positions) slows it down and what makes it hurt more (i.e. upright positions, Pitocin) speeds it up. The main exception to this is the fear-tension-pain cycle - if you reduce fear/tension, you will experience less pain and your labor will also be faster. More on that later, it's important...

Diaper Service

Cloth diapers are great--cheaper than disposables, better and more comfortable for baby's bum and better for the environment. And modern cloth diapering systems make it easier (and way cuter!) than the older method with pins and vinyl pants. There's just one thing that sposies have over cloth--time (well, and if you're really squeamish...but diapers are diapers and you will come in contact with baby poop regardless; it washes off, don't worry). But there's a solution for that: Diaper service, in which a company drops off clean diapers with all the accessories (reusable waterproof bags for dirties, soft cloth wipes, cute waterproof covers) and, a week later, picks them up and launders them, leaving you with a fresh stash. Gotta be expensive, right? I thought it must be, but I'd never looked into it before now.

Introducing BA Cloth Diapering, a local diaper service operating out of Topeka and serving Topeka, St. Louis & the KC area. Their service is $20 a week with all necessary accessories (you don't have to buy your own diapers, but if you have them you can use them), and that's a huge number of diapers--90 for newborn-size, 80 for infant and 70 for large. Definitely enough.
[To compare, an economy pack of Pampers Swaddlers newborn disposables (204 diapers) is $59.95 plus shipping, plus wipes, on Amazon.com--and in an emergency you can't toss those in your washer and have more for free, nor do they wipe up spitup equally well.]
And they use local work-at-home-mom-made diapers, covers, wipes and wetbags, so you're supporting other parents. Check it out! They also offer reusable breast pads and post-partum bleeding/menstrual pads (which I highly recommend--SO much more comfortable and breathable than the disposable pads!)

Prego Group

Mercy & Truth has a sort of informal seminar on pregnancy, birth and breastfeeding, primarily for pregnant women, every other Monday evening at 6:30PM at their Raytown clinic. It's led by certified professional midwife Debra Perry and doula Shannon Carter, and it's a lovely, informal place to think through the many decisions that come with pregnancy, birth and parenting with knowledgeable and experienced leadership. Worth going to for every pregnant mom; young children are welcome but it's a small room :) so if you have a rocket baby like mine it might be best to leave him/her with dad.

Mercy & Truth: not just a birth center

Group B strep infection: That means antibiotics in labor, right? *updated*

http://drmomma.blogspot.com/2009/09/treating-gbs-group-b-strep-are.html

Nutshell: Testing positive for GBS at 35-37 weeks, as about 30% of women do, does not necessarily require antibiotics in labor--and there's a good non-antibiotic alternative acceptable to medical personnel around the world! In fact, you're likely doing your baby and yourself a favor by refusing the IVAB.

A midwife's perspective (positive; she also mentions an herbal treatment used in late pregnancy to avoid testing positive at all): http://navelgazingmidwife.squarespace.com/navelgazing-midwife-blog/2009/9/6/hibiclens-discussion-for-gbs-women.html

Resources for Pregnant & New Mamas & Families

Some for the KC area, some are for everywhere. This list will be edited, enlarged and reorganized as I find/remember more.

• Mother's Refuge

for homeless or otherwise at-risk teenage (18 or younger) expectant and new moms (and their babies).
11004 E. 40 Hwy. Suite 132
Independence, MO 64055

(816) 353-8070 office
(816) 356-4797 ext 2 admissions

• Happybottomus

A local source for natural disposable & cloth diapers, baby carriers, bottles, teethers, clothing and other natural parenting and eco-friendly gear. Registries available!
225 SE Douglas, Lee's Summit, MO 64063
816-875-4617
happybottomus.com

• Rainey & Dave Rinaldi

Bradley (Husband-Coached) Childbirth Instructors
http://www.bradleybirth.com/ndweb.asp?ID=R337

• Zen Massage

Certified pregnancy massage; must be 12 weeks pregnant
13628 Black Bob Rd
Olathe, KS 66062
913.764.0000
http://zenmassageusa.com/locations-ks-olathe.htm

• Green Mountain Diapers

An exhaustive online resource for cloth diapering.
greenmountaindiapers.com

• Mercy & Truth Birth Center (Medical Ministries)
  

A homelike, family-friendly birthing space with certified midwives, RNs and obstetricians
mercyandtruth.com
Three locations:
5817 Nieman Road
Shawnee, KS 66203
913-248-9965

721 North 31st Street
Kansas City, KS 66102
913-621-0074

6303 Evanston
Raytown, MO 64133
816-356-4325

• The Pregnant Patients' Bill of Rights

What every pregnant woman, her birth companion(s), her midwife/obstetrician and nurses (if she needs or chooses to have them) need to know before she begins maternity care.
http://www.aimsusa.org/ppbr.htm

• La Leche League

A national breastfeeding support organization with local groups of women all over the country. Talk to a LLL leader for any nursing problems you might have.
lllusa.org

all area codes 816 unless otherwise noted

GROUP	Meeting Information	Leaders
Blue Springs	3rd Tuesday 7:00 p.m.	Holly 833-1905 3lf@sbcglobal.net Karen 347-8165 kurick4books@sbcglobal.net Morgan 352-6866
Plaza/Brookside	1st Wednesday 7:00 p.m.	Kim 913-649-6464 Jennifer 361-0586 Carrie 523-0947 Annie 268-8832 (Habla Español)
K.C. South/Lee's Summit	3rd Monday 7:30 p.m.	Cyndy 761-7212 Dotti 763-7227
Lee's Summit AM	1st Wednesday 10:30 a.m.	Morgan 352-6866
Jackson County (in Independence)	2nd Thursday 10:00 a.m.	Kartapurkh (Bibi) 816-737-9939 Adia 816-313-2116 (Habla Español)

But Ally, What Is This New-Fangled Foreign Word? -or-- What a Doula Is

Short answer: A doula is a trained perinatal companion, educated in nonmedical labor techniques and breastfeeding initiation/education. My specific vision is to provide the the Midwives' Model of Care* to women who likely would not receive it otherwise, particularly low-income mothers and those in high-risk pregnancies.

Eventually, this needs to be a 500-1000 word essay. Right now it's...a beginning.

*The Midwives Model of Care™ is based on the fact that pregnancy and birth are normal life events. The Midwives Model of Care includes:

• monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle

• providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support

• minimizing technological interventions and;

• identifying and referring women who require obstetrical attention

The application of this model has been proven to reduce to incidence of birth injury, trauma, and cesarean section.

The Midwives Model of Care definition above is Copyright © 1996-2001, Midwifery Task Force, All Rights Reserved, and is taken from http://mana.org/definitions.html#MMOC

Welcome

Hi! My name is Ally Gillotte and I'm a student doula working for her DONA certification--hopefully I'll have everything but the actual births done by the end of this year. If you're in the Kansas City area, are expecting a baby in December '09 or later and would like a lower-cost doula to assist at your birth, shoot me an email!

I also make custom soft cloth baby carriers: stretchy and gauze (woven) wraps, comfy padded mei tais, and custom-sized pouch slings. If you're interested in one of those, once again, please email me and we'll chat :)