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Bishops Score

Before considering labour induction, you can determine your chances of a successful induction by scoring yourself using the Bishops Score table, below.

A lower score can mean induction may be more difficult, longer, and will most likely be harder on you and your baby.

The higher the score, the more favorable the cervix. Clinical trials showing a score of 6-7 or more were associated with successful inductions, but most agree that a score of 9 is preferable.

Cervix	Score
	0	1	2	3
Position	Posterior	Mid-position	Anterior	---
Consistency	Firm	Medium	Soft	---
Effacement	0-30%	40-50%	60-70%	>80%
Dilation	Closed	1-2cm	3-4cm	>5cm
Baby's Station	-3	-2	-1	+1, +2

Further Bishops Score considerations:

Add 1 point to your score for:

• Preeclampsia
• Each prior vaginal birth

Subtract 1 point from score for:

• Postdates pregnancy
• Nulliparity (if this is your first baby)
• Premature or prolonged rupture of membranes

Website DOWN

So, my website is down and I'm bummed. So, while we are trying to figure it out, please feel free to just browse this site or the Wiregrass BirthNetwork site, or just email or call me if you have questions.

Hopefully it won't be down forever. :(

What pain reliever is ten times more effective than Valium?

Oxytocin!

Immediately before orgasm, levels of the hormone oxytocin rise by 5 times, determining a huge release of endorphins. These chemicals calm pain because the pressure in the brain's blood vessels is lowered while we love.

This is why natural oxytocin (the love hormone) in labor signals the brain for endorphins and lessons the pain of contractions.

The primary conscious behavior or thought process that increases oxytocin is caring for another. Appreciation, generous touch, gratitude, and emotional connections with others also raise oxytocin levels. In addition, oxytocin appears to be behind many of the health benefits from meditation, massage and acupuncture.

In addition to oxytocin's powerful effects on the body, it strongly affects your mind and behavior. It is nature's antidepressant and anti-anxiety hormone. It creates feelings of calm and a sense of connection, so it actually shapes how you view the world. The whole universe looks like a better place when you feel tranquil and loving.

Cesarean Rate Jumps Again

For Immediate Release

Cesarean Rate Jumps Again To Record High; 32.3% of Births Resulting In Major Abdominal Surgery
12th Consecutive Year to Show Increase

Redondo Beach, CA, April 6, 2010 – The National Center for Health Statistics has reported that the cesarean rate hit another record high in 2008 with a rate of 32.3 percent, up 2.6 percent from 2007. The findings reflect the 12th consecutive year of increase.

“Every U.S. woman in childbearing years should have deep concern over this rate,” said Desirre Andrews, president of the International Cesarean Awareness Network (ICAN). “With the cesarean rate showing no signs of decreasing and VBAC access being limited in many areas across the U.S., women need to be well educated and well versed in self advocacy during pregnancy and birth.”

With the preliminary number of 4,251,095 U.S. births reported in 2008, a 32.3% cesarean rate results in approximately 1,373,103 women undergoing surgical deliveries. This total is equivalent to the entire population of Philadelphia, Pennsylvania or the combined populations of Alaska and Washington, DC. “This real life comparison highlights how serious the near 1 in 3 percentage of pregnancies resulting in major abdominal surgery is,” said Andrews. “Evidence shows that cesareans put women and babies at increased risk for morbidity and mortality immediately and long term. Cesarean sections are being overused in the United States and as the rate continues to rise, mothers and babies are exposed to these risks avoidably. The repeat cesarean rate of over 90% is undoubtedly helping to drive this record setting data."

ICAN has a variety of educational, advocacy and support options on-line through webinars, forums, blog, twitter and white papers at www.ican-online.org.

About Cesareans: When a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. Potential risks to babies from cesareans include: low birth weight, prematurity, respiratory problems, and lacerations. Potential risks to women include: hemorrhage, infection, hysterectomy, surgical mistakes, re-hospitalization, dangerous placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased percentage of maternal death. http://ican-online.org/ican-white-papers.

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. There are over 130 ICAN Chapters across North America and internationally, which hold educational and support meetings for people interested in cesarean prevention and recovery.

Call Harri Anne Smith NOW!

Wiregrass Ladies! We need your help, NOW! From the Alabama Birth Coalition:

Dear ABC Supporters,

Although yesterday was a good day in Montgomery and we talked to many senators who said they will support SB414, as of this moment, we do not have the majority we will need for our bill to pass the Senate.

If your senator is on the following list, please make a call today or tomorrow and ask him/her to vote yes on SB414, the bill to license Certified Professional Midwives in Alabama:

• Scott Beason, district 17
• Roger Bedford, district 6
• Ben Brooks, district 35
• Steve French, district 15
• Rusty Glover, district 34
• Del Marsh, district 12
• Larry Means, district 10
• Hinton Mitchem, district 9
• Harri Anne Smith, district 29

Calling takes only a few minutes but can make a huge impact!

CALL Harri Anne today!

http://www.legislature.state.al.us/senate/senators/senatebios/sd029.html

SB 414!

Now is the time for action!!!

From the Alabama Birth Coalition:

We have made monumental strides with our legislative effort this session, and now we need your help! Senate Bill 414, the bill to license Certified Professional Midwives in Alabama, will pass out of committee and be brought to the Senate floor for a vote within the coming week or two. Before the vote, our Senators need to hear the message loud and clear: Alabama families support licensed midwives.

We urgently need each of our supporters, their friends and family to call their state senator and ask him/her to vote yes on SB414!

Each and every phone call is vital to successful passage of the bill in the Senate. One does not need to have had (or plan to have) a midwife-assisted birth--anyone can still voice their desire for Alabama families to have that option. Please do not be intimidated by the idea of calling your legislator. Legislators do not know what their constituents want if they do not hear from them. Believe me, they will be hearing from our opposition so it is extremely important that they hear from constituents in even larger numbers.

CALL CALL!!!!

Container Syndrome

I was reading an article from October today.

"Car Seats can be Dangerous Outside the Car"

Ok, so finally - an article to back up my thoughts! I see the desire to have one of those "travel systems".. it's convenient, it's easy... but what is NOT easy about wearing your baby? And it is so much nicer to be close to your baby, and you can snuggle them and smell their "BABY" smell. Ahhh.... I digress.

More than 8,700 infants end up in the emergency room each year because their car seats are used improperly outside the car, according to study presented Monday at the American Academy of Pediatrics' annual meeting in Washington.

Interesting. So first, I was wondering what on earth are they doing with these car seats? Leaving them on the roof? Flinging them around? But then I read on...

Most of the injuries in Parikh's study occurred when car seats fell off tables, countertops or other high surfaces. In some cases, babies who weren't securely buckled fell out of the seats. Babies also were injured when car seats flipped over on soft surfaces, such as beds and couches, where infants can suffocate, he says.

But, THIS is what I thought was the MOST important part of the whole article.

Spending too much time in car seats can cause other problems.

Physical therapists are seeing more babies with "container syndrome," or weak muscles and flat heads caused by too much time spent lying on their backs, says Colleen Coulter-O'Berry of the American Physical Therapy Association.

And a study in Pediatrics in August found that car seats can make it difficult for babies to get enough oxygen, which led the authors to suggest that the seats be used only while infants are in cars.

Think about it... how often are we putting our babies "IN" things. Swings, Bouncers, Car Seats, etc. They don't NEED these things. Sure, they help if you need a shower... but you just can't use them ALL day because they calm them.

Container syndrome is a relatively new term, first popularly used in mid 2008 to describe a condition observed by a variety of pediatric health care providers. In a survey sponsored by Pathways Awareness, pediatric health care workers have noted an increase in motor delays in infants, that may well be related to the amount of time infants spend on their backs. The broad strokes of container syndrome theory is that children who are not given adequate time on their tummies (tummy time) may be missing opportunities for natural and developmentally appropriate muscle development, especially of head and neck muscles.-WiseGeek

I suppose the bottomline is that we, as mothers, need to be MORE connected to our babies, both physically AND emotionally. We have to take them out of the "container" and hold them, love them, nurse them, carry them, wear them, interact with them.

Yeah yeah - I know! You have "things" to do, laundry to fold, dinner to cook. Why not try a sling - AND NOT THE ONES AT TARGET - but a real sling or wrap... Check out Maya Wraps for a good place to start.

It's not THAT hard to hold your baby. :)

Maternal Mortality Rates Rising

"New Study Shows More Women are Dying After Childbirth, but Most Deaths are Preventable"

Full Text Here

According to the World Health Organization, the U.S. ranks behind more than 40 other countries when it comes to maternal death rates, with 11 deaths per 100,000 pregnancies when measured in 2005. More women die in the U.S. after giving birth than die in countries including Poland, Croatia, Italy and Canada, to name a few.

My first instinct is to loudly shout, "I told you so!!!", but I am going to refrain. At least for the moment.

The popularity of scheduled C-sections has also been cited by public health experts as a possible cause for rising maternal mortality rates. The latest data from the CDC shows that 31 percent of the mothers now choose to have C-sections, up 50 percent since 1996. Studies have repeatedly shown a higher rate of mortality in mothers who have a C-section delivery, especially those who have multiple C-sections. "If the risks of a Cesarean birth are small, they're magnified greatly when you add many more Cesarean births each year," said Main, adding that "not that many women actually choose to have an elective C-section at the beginning, but it's easy to fall into a pattern of care that ends up resulting in a C-section."

I'm really biting my tongue now. I mean, HELLO!!!!!! Where have the doctors been when the natural birth advocates are shouting - "NO, it's not JUST about OUR experience... it's about safety!"

And, it drives me crazy - because they aren't looking at ways to REDUCE the underlying cause - the cesarean - they are looking for better ways to warn and treat mothers AFTER they have the cesarean. While this is important, this DOES NOT solve the problem... or even ATTEMPT to solve the problem.

Essentially we're saying - "Hey, I know that your risk of dying is higher if you have this completely unnecessary elective cesarean, and even more so if you decide you want more children... but we'll just put some compression boots on your legs and let you know that if you feel funny, you should tell someone... and that will make it all better."

BULL!

Cesarean surgery is associated with 33 serious complications – a number 8 times greater that the risks of vaginal birth.

In comparison with vaginal birth, a cesarean increased harm due to:

- Death, related to surgery or anesthesia (rare)
- Emergency hysterectomy
- Blood clots and stroke
- Injuries from surgery
- Longer hospitalization
- Rehospitalization
- Infection
- Severe and long-lasting pain
- Ongoing pelvic pain
- Bowel obstruction (due to scar tissue and adhesions)

In comparison with cesarean, vaginal birth (both spontaneous and assisted with vacuum or forceps) increased harms due to:

- Perineal pain
- Any urinary incontinence
- Any bowel incontinence

The risk of maternal death 3 to 5 times greater during or after operative delivery.

We should be focusing on the cesarean rate, the induction rate, the rate of routine and unnecessary interventions to the normal labor and birth process...

But, now I'm moving on to a completely NEW post, and I will save that for later.

Placenta Encapsulation, Part 2

So, Amy and I finished the encapsulation process today. We took the dried placenta pieces and ground them up in a coffee grinder. Then, we PAINSTAKINGLY filled each capsule. My capsule machine didn't come it, AHH!

It took about an hour and a half, and in the end we had 138 capsules.

Dosage is 2 capsules, 3x a day for the first 2 weeks postpartum, and then taper off as desired.

I will post pictures when I have them!

Induction Increases Cesarean Rate

REALLY? No... You must be joking.

Ok, so enough of my sarcasm and on with the facts...

To start with, here is the full text of the article.

NEW YORK (Reuters Health) May 15 - Elective induction of labor significantly shortens the active phase - by an hour, on average - but nearly doubles the risk of cesarean section, researchers report in the May issue of Obstetrics and Gynecology.

Did you get that, one hour. You are shortening your active labor time by one hour, and in return, you're doubling your chances of getting major abdominal surgery. What is the draw here?

Forgive me, I'm feeling annoyed about our skyrocketing induction and c-section rates. No, make that ANGRY.

With all this hot-air about health care reform and lowering health care costs... what on earth are we letting happen in Maternity Care? No matter how many studies are done, no matter the results.. nothing is changing. Studies have shown over and over that modern obstetrical protocols are causing more c-sections, more deaths and more bad outcomes than the traditional methods that midwives use.

This is NOT rocket-science people. Why is it so hard for us to understand that a c-section is not a minor, no-big-deal procedure? When are we going to start telling women openly , honestly that c-sections are major surgeries, with major risks, both for the current and in the future when that same woman gets pregnant again, and maybe again after that?

The induction rate MUST be addressed. It's insane for this many women to be consenting to inductions that are completely unnecessary.

You can wait another 2 weeks for your baby to be born. They will be healthier for it, and so will you... and so will the rest of the babies you have.

Tell me, which looks like more fun?

THIS ONE



OR

THIS ONE



Ok, rant done. Go ahead - call me the EVIL, ANTI-INDUCTION DOULA.

My FIRST Placenta Encapsulation!!

So, Amy and Morgan came over today to help me with the placenta encapsulation! The kids played, and we worked with a placenta!

The word placenta comes from the Latin for cake.

The placenta is an organ that connects the developing fetus to the uterine wall to allow nutrient uptake, waste elimination and gas exchange via the mother's blood supply.

So, first we had to rinse the placenta and drain the blood from it.



Once we removed the cord and drained the blood from it, we put it in the steamer.



And, steamed it...



While it was steaming, we took the cord and made a heart with it.



Once the steaming was complete, we cut it up and put it in the dehydrator.



Once it's completely dehydrated, I'll post about the next steps!

Movie & Discussion

Date: Wednesday, March 10, 2010
Time: 10:00am - 12:00pm
Where: Amy's House, RSVP for directions! (wiregrassbirthnetwork@gmail.com)

This month's movie is Born in the U.S.A.

BORN IN THE U.S.A. is the first public television documentary to provide an in-depth look at childbirth in America.

"Through the eyes of an obstetrician, a licensed midwife attending homebirths, and a nurse-midwife at an urban birth center, BORN IN THE U.S.A. explores the landscape of American maternity care. How do different caregivers answer these fundamental questions: What is "normal" birth? How much technology does safety require? What choices do women have? How do we decide what's best?"

The state of birthing in the U.S. is complex and controversial. While we now routinely use technology that saves countless lives that might have been lost just ten years ago, this technology has also led to one of the highest cesarean section rates in the world - one in five - and more than half of all births involve some type of surgical or operative procedure.

Bring a snack to share, there's room for kids and mamas!




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Tuesday's Baby!

I attended one of the most amazing birth's on Tuesday. The mom carried her baby to exactly 42 weeks. We did a lot of talking the last week, but we finally had a breakthrough the night before labor began.

I got funny text from her that morning around 7:30am. She called me after that to let me know that she was having these "cramps" that sort of "come and go" every 5 minutes or so. She then added that she'd had some bloody show about an hour before that when the cramps started.

We talked again around 11:30am. Things her picking up, but not much.

We talked again around 1:20pm. I could tell she was in active labor at that point. She seemed much less like talking, and a bit "weepy" and "complain-y". They said they didn't need me yet.

At 3:15pm came the next call. "We'd like you to come now". So I headed out - it's a long drive. I arrived at about 4:20/4:30pm. She looked panicked, but had her friend and husband helping her work through a contraction. I told her I was going to warm up my hands and she insisted that I don't, and put my cold hands on her belly.

At the next contractions, I could tell she needed some focus. I wrapped her arms around her husbands neck. He stroked her face and I helped him breathe with her, while I rubbed her back. After that, she seemed much more in control. She had a purpose during a contraction, a plan.

After a little while of standing and swaying through contractions, she went and laid down on her side on her bed. We worked through contractions, focusing on slow, deep breathing, relaxing her neck and face and hands.

Later, she went to the bathroom and then we stood and leaned against a wall. She started to enjoy it when we squeezed her hips, so we did that, and encouraged her to breathe.

She laid back on the bed a while later, and I massaged her feet and calves, which were really bothering her. Contractions seemed to become quite intense at that point. I pushed on her hip during each contraction. She started to completely sleep in-between contractions. I looked at her husband and whispered that we ought to be getting ready soon. It was a 30min (minimum) drive to the birth place.

Around 6:30pm, I managed to get everyone in the car. She was feeling pressure at this point, but not needing to push.

We arrive!

So now, we're trying to make everyone aware of the plan. They check her - she's 10cm/+1. They call the doctor.

They start bringing delivery stuff into this TINY, maybe 8x8 Triage room.... the baby warmer, the delivery cart. The doctor comes in, checks her, and then asks if they are going to move her to a room... he looked slightly perplexed. The nurses say no, and he walks out, I think a little annoyed.

At that point we only have one nurse, the nurse assigned to her there. She is wonderful. She listens and hears. We get the monitors off, and we turn her over on hands and knees over the back of the bed.

They decide to move her to her room, since she's still not pushing yet. We cover her with a sheet and wheel her down the hall to her room.

Once we get there, the nurse starts asking what the preferences are. Basically they want nothing done to them or the baby. So, she calls the doctor back in, so they can talk. He agrees to everything, including that the husband gets to help catch the baby. YAY!

So, she starts pushing around 8:10pm, on her hands and knees. She does this, well, for about 30min. We start seeing the baby's head sometimes, so the nurse calls the Dr in, and he gets ready, but after a while there is still no baby, so he leaves again. They monitored her twice during pushing, and baby was wonderful.

She starts to ask why it's taking so long, and I tell her and the nurse tells her that it isn't taking long and she's doing great. I ask if she wants to try a different position, and she does, so we put the squat bar up and break down the bed and get her squatting. We set up a mirror so she can see. Within minutes the baby's head is clearly visible. The doctor is called back.

With another few pushes he is out. Mom and Dad cry and cry and cry with joy! She sits back and dad picks up his new baby and holds him up like an offering to the mom. It was beautiful. Her friend managed to get the most amazing shot of this moment. I will never forget it. He places him on her chest and they love him and cry over him and it is amazing.

The doctor calmly watches... doing nothing. The baby nurse doesn't touch the baby, she only looks in-between them to try and gauge his APGARS.

Baby was 8lbs 8oz and the dad guessed his weight exactly.

It was AMAZING!!!

Statistics

So, I keep stats on all the births I attend. Mostly to get a general idea of how a doula is contributing in comparison to the averages in my area. Here are mine as of the end of 2009...

* 82% gave birth vaginally
* 18% gave birth by c-section
* 24% received an epidural or other pain medication during labor
* 71% were unmedicated during labor
* 18% were attempted VBACs, with 30% achieving a vaginal birth
* 24% received an episiotomy
* 18% were inductions
* 24% received internal monitoring
* 47% were first time moms

I'm happy with them. I don't really care much about the medication rate, so much as the vaginal birth rate. 18% is great for this area, since in 2006 the rate was around 38%+.

Still waiting on that birth to happen. :)

New Year, New Blogging!

So, I've been slow to begin blogging this year. I've been, well... busy. January was a lovely month, that included the entire household getting the flu. We are well again, mostly.

I am now waiting for the birthing to start! So, here is a rundown of the planned events for February.

8th - Sophia turns 4!!
9th - Client Due Date
10th - Movie and Discussion with Wiregrass Birth Network
12th - Wiregrass Birth Network Outing at Landmark Park from 12-2
14th - Valentines Day!
16th - Birth Network Meeting in Fort Rucker from 10-12
18th - Birth Network Meeting in Dothan from 10-12
19th - Cole turns 2!!
20th - Healthy Pregnancy Class at 2pm
25th - Potential Client Due Date

Busy busy busy.

I suspect my next post will be a birth story! YAY! I'm ready!