Giving thanks where thanks is due.

    Cesarean sections do save lives. Every day mothers and babies are able to meet each other because of necessary medical interventions. For this we should be thankful.  I want to briefly touch on an incomplete list of times when cesareans are a blessing

    Placenta accreta is the term used to describe the clinical condition where in part of the placenta, or the entire placenta, invades and is inseparable from the uterine wall. When delivery happens the placenta does not detach from the uterine wall and this can lead to massive hemorrhaging. As many as 90% of patients with placenta accreta require blood transfusions, the maternal mortality rate associate with this is reported to be as high as 7%. Tragically the incidents of placenta accreta are increasing, with a reportable tie to increase in cesarean rates.

“The incidence of placenta accreta has increased and seems to parallel the increasing cesarean delivery rate. Researchers have reported the incidence of placenta accreta as 1 in 533 pregnancies for the period of 1982–2002 . This contrasts sharply with previous reports, which ranged from 1 in 4,027 pregnancies in the 1970s, increasing to 1 in 2,510 pregnancies in the 1980s.”

The scar tissue formed from previous cesareans can cause the placenta to grow into the uterine wall, resulting in the accreta. Diagnosing the accreta before delivery is beneficial, as the medical staff can properly prepare for the complications associated with delivery.

Placenta previa occurs when a low lying placenta covers all or part of the cervix. This can cause complications and bleeding before or during delivery. Normally the placenta attatches to the top of the uterus and the umbilical cord flows down from there. You may be restricted from some physical activity of if you have placenta previa. In some cases the placenta will move off of or away from the cervix as pregnancy progresses.

In both of these cases a cesarean can provide a means of safe birth for mother and child.  Some other cases where cesarean birth may be indicated include HELLP syndrome, preeclampsia, multiple fetuses where the fetuses share one amniotic sac, and a few more. My knowledge on all of these is by no means exhaustive and this post is not meant to treat or diagnose anyone. These are merely jumping off points for more self education, which I encourage!

you need a c-section because…

Today I want to touch on another reason that your care provider may require delivery via cesarean section.

A big one is breech positioning, which is when the baby does not assume the head down position in readiness for the birth canal. There are a couple of different presentations that can be referred to as “breech“. Frank breech is when the baby is sitting in the uterus with it’s butt right above the cervix and it’s legs crossed or up towards the head. Complete breech is when baby is sitting with its knees bent so that the butt and feet are by the cervix. Footling breech happens when one or both feet are by the cervix and would be the first part to deliver.

In years past care givers were trained to deliver breech babies and though it could be risky it was not impossible to find a provider who was experienced in breech delivery. In modern day is is very difficult to find a provider who will deliver a breech baby. If you are told your baby is breech there are still options for mama to try before scheduling a cesarean. One choice is to find a chiropractor who practices the Webster Technique. I would also suggest visiting Spinning Babies, a site that can teach you how to discover your baby’s positioning and offers techniques and positions for encouraging the baby to turn. If it is not offered to you as an option you can ask your provider about an External Cephalic Version, in this procedure your provider attempts to manually turn the baby from outside the belly.

If your baby does not turn it can be difficult to find a provider who will deliver a breech baby. However, it is still beneficial to baby to stay in utero for as long as possible. Please consider requesting to schedule that c-section after 39 weeks to give baby as much time to grow and mature as they need. Also, you can always request/demand an ultrasound prior to your cesarean to confirm positioning, if baby has flipped you are within your rights to go home and wait for labor to begin naturally!

April is Cesarean Awareness Month. Are you aware of the facts?

Welcome April! I am ready for you here in Northern Virginia. I am excited for long walks and short sleeves, for warm days and cold popsicles, blooming gardens and blossoming Mamas!

It is also a month where roughly 25% of first time mothers in our area will deliver their babies via cesarean section.

That means 1 in 4 women will have a major surgery instead of a vaginal birth.

Let me start off by saying that cesarean sections are not evil. They serve a purpose, they save lives and they have a place in our world. However, the WHO (World Health Organization) states that the best outcomes for women and babies appear to occur with cesarean section rates of 5% to 10%. Rates above 15% seem to do more harm than good. (Althabe and Belizan 2006).

What gives Northern Virginia? Where do we get that extra 10%?

In my opinion we get that extra 10% when we practice fear mongering among a vulnerable population (mothers) instead of evidenced based medicine.

We get the extra 10% by telling tiny moms that they can’t deliver big babies. Even though the definition of fetal macrosomia is a “baby weighing more than 8 pounds 13 oz at birth” and occurs in only 9% of births, with risks associate with vaginal delivery only increasing when the baby is 9 pounds 14 oz or bigger. Even though we know that predictions of a baby’s birth weight tend to be inaccurate, with a variation of 11.6 to 19.4 oz of error.

We get the extra 10% by putting laboring mothers on a time clock and telling them that they are not progressing quickly enough.  This is a great article that explains Freidman’s Curve and the results of it’s use better than I ever could. Basically, we are putting women on a curve to predict progression of labor that has been proven to be inaccurate since its conception in 1955. Unlike in 1955, when active labor began to progress more rapidly at 3cm (96% of the studied births were medicated in some way) in 2014 active labor is seen to start progressing rapidly on its own at 6cm. In the article I linked above 4 in 10 cesarean sections were performed at 5cm, citing “failure to progress”.

I urge pregnant moms and their partners to prepare for labor to be a slow and steady progression towards birth, rather than the predictable timed race we are taught to expect.

I will explore some more reasons for cesarean birth and some of the short term and lasting complications for mother and baby as April progresses.  I will share my own experience with cesarean birth and my subsequent VBAC (Vaginal Birth After Cesarean). Hopefully we will all learn something this month!

For today I will leave you with this thought: For some moms a cesarean is no big deal, but for some moms it is a crushing blow. Please do not minimize that mama’s emotions with the use of the popular phrase “all that matters is a healthy baby”. I think that every mother desires a healthy baby, but isn’t a healthy mom (physically and mentally) equally important?

Why “Tonglen”?

    The first time I saw the word tonglen I was reading Amy Poehler’s book “Yes Please!”. She was talking about learning this meditation practice and coming to understand that the word meant “to take take in pain and give beauty”. I was awe struck with the simplicity and reverence of that sentiment as it relates to laboring mothers.

    I went on to research more about this practice independently. I learned that more technically tonglen means “to take and give” or often “breathe in darkeness, breathe out light”. Still each definition still resonated in my mind as an observation about the nature of birthing.

    My next step was the correct pronunciation. I was concerned that if the “g” was silent it would be too hard for people I meet to translate what I told them into a written word. This would make me harder to find than is necessary, and so from a purely business standpoint I was worried about what to do in that case. It took me a shockingly long time to find a video of someone actually saying the word. There were mentions of it in many written explanations but no one saying. When I finally found a video of the word I was happy to hear it pronounced just as it looks. Tonglen.

    I spent quite a few restless nights debating whether or not to take on the word tonglen into my doula practice persona. I worried, and will continue to be sensitive, about a sense of culturally appropriating a word with which I am not intimately associated. I, myself do not practice yoga or meditation. That being said, I do believe that the visualizations and calm a doula can lead a mother to is akin to meditation.

    At the end of the day I decided that the beauty of the word and the imagery it provokes for me was enough to be at peace with using the word. I hope to continue learning about this meditation practice in a practical way also.

    I do believe that the way in which a Mom can take in incredible pain and darkness and give forth such beauty and innocent light is a really precious thing.

Building each other up

   I had the lovely privilege of spending the whole day with other student doulas in a DONA certification workshop. We have been learning and growing together for 3 Saturdays now and I have garnered so much knowledge from their personal and professional experiences.

    Today we sat in a circle and did some labor role play exercises. Our instructors would read the scenario and we would brainstorm ideas for how to support the laboring mother and her partner in that scene. Then two people would get up in front of the group and role play the scenario; with one woman as the doula and one as the laboring mother.

   It was an inspiration to hear how each woman entered the moment and brought calm to the mother. Even though the scenes were laid out for us and the labor discomforts were imagined the words of encouragement and the comforting touch were real. I found myself fully lost in the moment, as both doula and again in the role of mother.

   One thing that really impacted me was hearing over and over again, from all the voices in the room, the suggestion of validating the mother’s feelings, affirming her emotions, empowering her choices.

    Often, as women in particular, we live in a world where we tear each other down. We exist in spaces where the woman next to you may feel that you must fail for her to succeed. We are taught to shame each other, to belittle emotions, to invalidate fears.

    It was a rejuvenating breath of fresh air to be in a room full of women claiming the opposite. Women who know that we will all benefit by lifting each other higher. Women who understand that a mother can cope with almost anything if she feel that her desires and fears are being heard and acknowledged. Women who want to show respect and care for laboring mothers. These women will make such inspiring doulas, and I feel lucky to know them.

    It was good for my heart.

Hug your doula. She really cares about you.

Start Small

Part of claiming the birth experience is releasing the preconditioned response to be accommodating to the world around us. Women are shown from a young age that being small and quiet and agreeable is valued in our society. For some, this is a model of behavior that they will follow all their lives.

But. What happens when you are no longer taking up space for one, but for two? How do you reconcile not “rocking the boat” with getting your questions answered despite a care provider who minimizes your concerns with the same language you were raised on?

These are big undertakings, but very important if you aim to have a fulfilling and respectful birth experience. I suggest that you start small. Start with making sure you listen to your intuition. Follow that up with asking all the tough questions when interviewing your potential doulas, and please interview more than one doula!

Here is a starting place, a list of questions to ask your prospective doula:

   * What training have you had? Are you certified?

*Do you have one or more backup doulas for times you are not available? May we meet her/them?

*What is your fee, what does it include and what are your refund policies?

*Tell me about your experience as a birth doula.

*Can you share your philosophy about birth and supporting women and their partners through labor?

*May we meet to discuss our birth plans and the role you will play in supporting me through birth?

*May we call you with questions or concerns before and after birth?

*When do you prefer to join women in labor? Do you come to our home or meet us at our place of birth?

*Will you meet with us after the birth to review labor and answer questions?

This is a person you are inviting into one of the most special and formative days of your life, so if you feel uncomfortable please seek out a different doula.