Archive for August, 2009

The Benefit of Breastfeeding Toddlers

Posted on August 25, 2009. Filed under: Breastfeeding, extended breastfeeding | Tags: , , |

I am still nursing my almost 17 month old. He generally nurses twice a day, sometimes only once  and sometimes three times but average twice. He HAS to have his morning nursing to start his day. It’s his morning coffee. During the day he may ask to nurse once or twice more depending on how busy we are and he if he thinks about it or not. He sleeps through the night and hasn’t had a night feeding since he turned one with the exception of a few nights where he was teething or not feeling well. I have no intention of weaning him until he is at least two and hope that he doesn’t self wean before then as he has a lactose sensitivity and I have no intention of giving him cows milk, especially while we are in Korea because the organic kind isn’t always available and I refuse to use the other kind plus I generally believe cow’s milk was intended for calves and not my toddler.  If he chooses to drink a little milk here and there later on (if he outgrows the lactose sensitivity), I won’t mind, but I certainly am not going to get into this whole idea of requiring or forcing him to drink a preset number of ounces of it daily. I feel confident in our very veggie heavy, very low processed food diet that he will get the proper nutrition and healthy fats without supplementing with cow’s milk.

People are often times surprised to learn that I am still nursing. The response ranges from ‘oh wow’ (as in ‘that’s cool!’) to ‘ooooh wow’ (as in ‘you freak!’). I have learned that the more shocked one is the less likely it is that they ever breastfed or they breastfed only a few short months. I am surrounded by mostly mainstream moms so it is not surprising to me and I actually enjoy telling them  because I hope that I am planting seeds in their minds for their own babies.  That said, I do enjoy sharing the information with them on the benefits of breastfeeding and extended breastfeeding.

Because my toddler nurses about 2 times a day off both sides for a total of about 15 minutes, I am estimating that he gets about 12-15 ounces of milk. I am not really sure as my breasts do not leak or get engorged and haven’t in months. I haven’t pumped in over a year so I probably couldn’t use that as a reliable way to tell what kind of supply I have either, I am pretty sure that I wouldn’t get much out if I tried. But just based off every thing I know about breastfeeding, I think I have a pretty fair estimate.  Below is a breakdown of what the nutritional value is of that amount of milk.

  • In the second year (12-23 months), 448 mL (15 ounces) of breastmilk provides:
    • 29% of energy requirements (calories)
    • 43% of protein requirements
    • 36% of calcium requirements
    • 75% of vitamin A requirements
    • 76% of folate requirements
    • 94% of vitamin B12 requirements
    • 60% of vitamin C requirements

    Dewey KG. (2001) Nutrition, Growth and Complementary Feeding of the Breast-fed infant. Pediatric Clinic of North America

These are amazing numbers, especially considering how tough it can be to get a toddler to eat sometimes! This is also way better than an artificially made vitamin as the vitamins from the breast milk are better assimilated by the body and the mother would never have to worry about vitamin toxicity. It’s perfectly made and balanced.

In addition to dietary benefits, there are many other health benefits.  Nursing toddlers have fewer allergies and  are sick less often.

  • The American Academy of Family Physicians notes that children weaned before two years of age are at increased risk of illness (AAFP 2001).
  • Nursing toddlers between the ages of 16 and 30 months have been found to have fewer illnesses and illnesses of shorter duration than their non-nursing peers (Gulick 1986).
  • “Antibodies are abundant in human milk throughout lactation” (Nutrition During Lactation 1991; p. 134). In fact, some of the immune factors in breastmilk increase in concentration during the second year and also during the weaning process. (Goldman 1983, Goldman & Goldblum 1983, Institute of Medicine 1991).

Some people think that nursing a toddler will create a clingy child. I completely disagree. My little guy is so independent that it drive me insane sometimes (like in the parking lot when he won’t hold my hand!). La Leche League’s statement for this is:

Breastfeeding a toddler helps with the child’s ability to mature. Although some experts say a toddler who is not weaned will have difficulty becoming independent, it’s usually the fearful, clingy children that have been pushed into situations requiring too much independence too soon. A breastfeeding toddler is having his dependency needs met. The closeness and availability of the mother through breastfeeding is one of the best ways to help toddlers grow emotionally.

Breastfeeding can help a toddler understand discipline as well. Discipline is teaching a child about what is right and good, not punishment for normal toddler behavior. To help a toddler with discipline, he needs to feel good about himself and his world. Breastfeeding helps a toddler feel good about himself, because his needs are being met.

The research is out there and the data proves it true: extended breastfeeding is healthy and beneficial. The American Academy of Pediatrics currently recommends that “Breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child..”  The World Health Organization and UNICEF recommend that babies be breastfed for at least two years.

I think it’s important to have maternal instinct validated at times. I would nurse to at least two or beyond anyway but it is nice to know that the facts and data are on my side.

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Reducing Infant Mortality (Video)

Posted on August 22, 2009. Filed under: Birth, Breastfeeding, reducing infant mortality |

I can’t add certain types of video here but I am providing the link to this very well done video. It explains how our health care system is failing babies and mothers and what we can do about it. The video focuses on the issue of prematurity that we have in the US, the high rate of infant mortality and the difference in the midwifery model of care versus the obstetric model of care. Please watch and send to as many people as possible. Now would be the time to forward this to legislators as health care reform is a hot topic in the US today.
Go HERE to watch the video.


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Avoiding a Tear After a Prior Episiotomy

Posted on August 19, 2009. Filed under: Episiotomy, Vaginal Tear | Tags: , , , , |

This is an email response to the question:

If I had an episiotomy during my first delivery, will it increase the risk of tearing next time? Does perineal massage help?

First, here is some statistical information on tears…

How common are tears/episiotomies?

Most women who have a vaginal birth have either a tear or a cut. A few women have both.

We don’t know exactly how many women have a tear in the perineum during childbirth. Doctors and midwives don’t always record small tears. Experts think that at least a third of women in the United States have a tear large enough to need stitches.

In one study from the United Kingdom, more than 8 in 10 women had a tear or cut during a vaginal birth.

And about 7 in 10 needed stitches.

Bad tears, which go all the way from the vagina to the anal opening (third-degree or fourth-degree tears), happen less often. But we don’t know exactly how many women in the United States have a bad tear. In one study from Canada, about 7 in 100 women who give birth had a bad tear.

Your chance of having a cut (episiotomy) depends on where you live. In the United States, about a quarter of women have a cut. In some eastern European countries, nearly all women have a cut during delivery.

Sources for the information on this page:

  1. Graves EJ, Kozak LJ.National hospital discharge survey: annual summary, 1996.Vital Health Statistics. 1999; 13: i-iv, 1-46.
  2. Audit Commission.First class delivery: improving maternity services in England and Wales.London: Audit Commission Publications, 1997.
  3. McCandlish R, Bowler U, van Asten H, et al.A randomised controlled trial of care of the perineum during second stage of normal labour.British Journal of Obstetrics and Gynaecology. 1998; 105: 1262-1272.
  4. Sultan AH, Kamm MA, Hudson CN.Anal sphincter disruption during vaginal delivery.New England Journal of Medicine. 1993; 329: 1905-1911.
  5. Wagner M.Pursuing the birth machine: the search for appropriate technology.In: Wagner M. Pursuing the birth machine: the search for appropriate technology. Ace Graphics, Camperdown, Australia; 1994.
  6. DeFrances CJ, Hall MJ, Podgornik MN2003 National Hospital Discharge Survey. Advance Data from Vital and Health statistics No 359Advance Data from Vital and Health Statistics 2005.
This information was last updated on Nov 07, 2008

I have had this question a few times because most of my doula clients are second timers. While I have not found any hard studies on this topic (I am sure there have been some but I can’t find any), it has been suggested that up to 50% of women with an episiotomy scar will have a 2nd degree tear in subsequent births. That’s a big number but there is a lot of explanation that needs to go with that.

It is also important to understand that a vaginal tear is generally better than having an episiotomy. Tears typically do not tear as deep and far as a cut will and episiotomies actually increase the risk for a third or fourth degree tear. This is because once the cut is done the head emerging can cause the cut to tear farther back and deeper into the muscle. Tears will usually heal faster too.  (this was not in the original email).

The scar tissue is a weakened area so it is more likely to give way but there is no guarantee that it will tear in a subsequent delivery. It’s not that the scar prevents vaginal stretching, it’s that the scar itself is weak and not as pliable as vaginal tissue. I had a client who had a huge episiotomy her first birth, it require 50 stitches and took months to heal. She had a surface tear her second birth and only needed 3 stitches. Many docs and mw’s wouldn’t have even stitched what she had. She said that within three days she felt completely normal and fine.

Also, 2nd degree tears are really not that bad. They will usually heal on their own without stitches but most OBs and hospital MW will stitch them. Homebirthers tend to opt out of 2nd degree stitching (because it is invasive and interferes with bonding) and they do fine. A 2nd degree tear doesn’t tear into the perineal muscle, it’s more is a skin tear. Of my 3 clients that had 2nd degree tears, two felt fine in less than a week and one was fine after less than two weeks. My point to all of that is that you would much rather tear a 2nd degree tear than to have an episiotomy so don’t let that scare you. Another thing worth mentioning is that none of them felt the tear as it happened and none of them had any kind of drugs during labor.

When you crown unmedicated, you feel the ring of fire for a few minutes, then the area goes numb because the nerves have so much pressure from the baby’s head. It’s natures own anesthetic and it’s also natures way of helping you not to tear. When a woman is left to push as her body tells her (rather than a nurse or doc coaching her) then she will instinctively not bear down when crowning because it burns. This allows the vaginal tissue to stretch as opposed to being push on as hard as possible and forcing the baby’s head out to quickly. This is why it is so very important to instinctively push rather than have cheering leading and counting pushing. Of course, it’s pretty much necessary when you have an epidural because you can’t really feel what your body is doing but when you are unmedicated you know exactly what’s happening. It’s also hard to get staff to let mom push instinctively. Most are so used to coaching epiduralized moms that they do not even realize that an unmedicated mom in an upright position needs absolutely no help.

This is also why it’s so important not to push on your back in the bed because then you aren’t giving the staff free access to everything. In addition to keeping people off your vagina, horizontal pushing also helps you stretch better because of gravity (increased blood flow to the area helps stretching plus it brings baby down with less effort). A squat position (like using a squat bar on the bed) also helps you to stretch better just by way of positioning. It just opens everything up. This is REALLY hard to achieve in a hospital birth most of the time. You will have to be firm and aggressive to make it happen and you will also have to be strong enough to initiate it during labor. Really you should hire a doula but you knew I would say that before you even emailed me;)

That said, there are a few women who require an episiotomy and I say require very lightly, I don’t really think there is any reason to give one other than a SERIOUS decel in the fetal heart tones that requires immediate delivery but that is very rare. It unfortunately is way over used as a reason. There is a difference in a decel and a very serious decel . When this happens to an unmedicated mom, a pressure episiotomy is done but can only be done that way after the ring of fire is no longer felt, meaning the nerves are numb and mom won’t feel pain from the cut. It sounds horrifying and it is but like I said, there is no cutting pain. If the nerves are not numb then a local anesthetic can be given if there is time. Again, these are very rare circumstances and there are ways to prevent this from happening.

The debate is out on perineal massage. Some people swear by it others say it doesn’t work. Don’t allow anyone to do it during pushing though, as it does increase the risk of tearing. If you think about it, it makes sense, someone else is touching you and they cannot feel what they are doing, only you can. You would touch more gently or firmly because you know what is happening. The best thing anyone else can do is to use warm compresses and perineal support which is still easily done if mom is upright. I recommend that moms support their own perineum because again, you are the one that is feeling what is happening and know how much or little pressure you need.

As for perineal massage during pregnancy, even if there is no solid evidence that it works, it can’t hurt and if nothing else it teaches you to relax your bottom. If your partner can do it for you it will teach you how to let the muscles go. For instance, he would use a finger on each side at the bottom of your vagina (while you are sitting up against the headboard or wall, oh and use lube). Then he would gently sweep the fingers out in opposite directions and kind of down and while he is doing that you just completely relax and concentrate on letting the muscles loose. Here is a link

http://www.bestdoulas.com/perineal.pdf

But if your partner were doing it he would use his index fingers instead of thumbs.

I definitely would not use the same care provider that did your episiotomy the first time even if you like them. The thing is that even if you tell them you do not want it under any circumstance and that you would rather tear, those that use it, almost always use it and if they say “we only do it if it’s necessary” then you can count on having one. If you truly want to avoid another one and you truly want to reduce the risk of tearing, then you will need a provider that is more hands off and who will encourage you to get off your back and who is pro-natural birth. Most of them will SAY they are though so that’s the tricky part. This again is where I say hire a doula because doulas usually know the scoop on the different providers in the area. They see these docs and mws in action and know how they really are.

I am not trying to freak you out or be anti doc or negative it’s just that I have seen it happen. I have seen docs tell clients they are pro VBAC and want them to have the birth they want then threaten them with statistics that are not true or try to force a repeat c section on them. I have seen them tell clients that they support upright non coached pushing but in labor force them on their backs and start counting to 10. I think a lot of times they just tell mom what ever she wants to hear to get her to be quiet then when it comes down to the birth, they do whatever they want. Yes they do know best when there is a real emergency and either mom or baby is in trouble. hand down. But when it comes to unmedicated birth and leaving the body to do what it is supposed to do, they are not because the majority of American women get epidurals and that changes things. I would suggest finding that provider who supports your wishes and believes in your body so that you do not have to fight for what you are entitled to. If you are set on keeping the provider (if it’s the same one) then definitely hire a doula so you don’t have to fight alone. (sorry for the little speech:)

SO in short, you do have a risks but you have lots of options and you can set yourself up for the least risk of tearing.
EDIT: I am adding THIS LINK for more information on the history of episiotomies and their use today. This is a great read. Here is the intro…

The following piece was submitted by Rita Ledbetter, CNM ~ she is my midwife and works in the Medical Arts office in Moline.  I asked her if she’d be willing to share her knowledge on the subject of episiotomy ~ to cut or not to cut when delivering.  I am very appreciative that she took the time to write and submit this article so that expectant mothers can be more informed when developing their birth plans!

Hi -this is Abby’s midwife Rita.  She asked me to write a little about episiotomy – the cut made at the opening of the vagina (perineum) when a baby is being born.  Routine episiotomy is no longer recommended but still occasionally is needed.

History:
Birthing babies is not new and tearing or lacerations of the opening of the vagina have always been part of the process of birth.  Some women had tears, some did not.  In olden times it was common to allow as many cobwebs as possible to grow in the home as a woman prepared for childbirth.  If a tear happened during childbirth the sticky cobwebs were packed into the tear and the woman was kept in bed for 10 days or so with her legs closed to allow her bottom to heal…..Go HERE to read more

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Follow Up to Business of Being Born, looking for VBAC video

Posted on August 4, 2009. Filed under: Uncategorized, vbac | Tags: , , |

I am on the email list for My Best Birth.  The Business of Being Born did a really good job of bringing about a level of awareness of the crisis in US obstetrics and I think that it is fantastic that the follow up will be focusing on VBAC. I hope that they shed some light on VBACs for the mainstream community.

I received this email today…

A message from Ricki Lake & Abby Epstein to all members of VBAC Moms on My Best Birth!


As many of you know we have been working on a follow up film to The Business of Being Born, to be released this fall.

We are deep into the editing now and are hoping some of you might help us out by sharing 
your personal birth footage and photos. Specifically, we are looking for:


1. Homebirth video footage
2. Birth video footage from anyone who had a VBAC.
3. Video of a sonogram
4. Photos of women recovering post-birth, looking especially unhappy or suffering.
5. Video footage of a free-standing birth center (exterior & interior)
If you have any of the below materials and would be willing to let us use them in the film, please fill out and sign the release form posted under forum discussions and mail us your footage by August 15, 2009 on DVD, mini DV, DVCam or any format you have, to the address below. Please do not send us your only copy as we will not be able to return the copy you send us. If you have photos (for item #4) or any questions you can email us at info@mybestbirth.com.

Mail footage with a brief description and the release form to:

Amy Slotnick
Business of Birth
15 W 11th St #3A
NY, NY 10011

Please note we will blur out faces of any doctors, birth attendants or people in the footage from whom we do not have approval.

Thanks for your help!

Warmly, Ricki & Abby

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Placenta accreta – a risk of cesarean section

Posted on August 3, 2009. Filed under: Cesarean, Placenta accreta, Pregnancy, uterine rupture, vbac | Tags: , , , , , , , , , , , , |

This is a very good article from vbacfacts.com.

“There is this idea that if you don’t VBAC and you schedule a repeat cesarean, that you will be safe from complications.  This is because during a “VBAC counsel,” women are often told of the risks of VBAC, namely uterine rupture, but they are rarely told the risks of repeat cesareans in their current and future pregnancies.

Abnormal placental implantation is one risk of cesareans that only present themselves when you get pregnant again.

Women who expect to only have two children, and thus opt for a repeat cesarean, might think that not VBACing is the safer, and more controlled choice, for them.

But what happens if you get pregnant again?  Now you have had two cesareans, your risk of placenta accreta (where the placenta grows through the uterus), placenta previa (where the placenta grows over the cerivx), and placental abruption (where the placenta prematurely separates from the uterine wall) all go up.  And here women think they are making the SAFER choice by having a repeat cesarean.

This news article from Canada illustrates this point.

I’ve underlined parts for those who like to skim.”


Complications worry MDs

Surgery carries risks, doctors say

By Sharon Kirkey, Canwest News Service August 1, 2009

Dr. Jan Christilaw was in the operating room the day a routine incision was made into a young mother’s abdomen to deliver her baby.

What happened next, Christilaw says, “is something we never want to see.”

Normally, the placenta separates from the wall of the uterus after birth. It’s lacy almost, and not like solid tissue. “You can take your hands and sort of scoop it up, it’s like breaking cobwebs as you go,” says Christilaw, an obstetrician and president of B.C. Women’s Hospital and Health Centre in Vancouver.

But the placenta had eroded through the wall of the uterus, a condition known as placenta accreta. As soon as they stretched the opening of the uterus to deliver the baby, “the placenta started bleeding everywhere,” Christilaw says.

They couldn’t get the bleeding to stop. The woman was losing two cups of blood every 30 seconds.

The only way to stop the bleeding was an emergency hysterectomy.  The woman was in the operating room for eight hours and lost 15 litres of blood.

It used to be that obstetricians might only ever see one or two cases of placenta accreta in their lifetime. Although still rare, obstetricians across Canada say one of the most feared complications of pregnancy is increasing as a direct consequence of the nation’s rising cesarean section rate.

Virtually all placenta accretas occur in women who have had a previous C-section, and the risk increases with each additional surgical delivery. The placenta attaches to the old C-section scar. Scars don’t have a proper blood supply to feed a placenta, so it keeps burrowing into the uterus until it finds one, sometimes pushing through the uterus completely and into the bladder or other organs.

The condition can be detected by ultrasound, but not always. “You almost never see it in a woman who has not had a C-section,” Christilaw says.

Today, about 28 per cent of babies born in Canada are delivered by caesarean. In 1969, Canada’s rate was five per cent.

More than 78,000 caesarean sections were performed in Canada last year, making it the single most frequently performed surgery on Canadian women.

“We don’t know what the ideal rate is,” says Dr. Mark Walker, a high-risk
obstetrician at the Ottawa Hospital and senior scientist with the Ottawa
Hospital Research Institute. “I think it’s fair to assume it’s lower than
where we are now.”

Walker says changing demographics — older first-time mothers, more multiple births from fertility treatments, more mothers with hypertension, diabetes, obesity and other health problems — are not enough to explain an almost doubling in the C-section rate since the early 1990s.

Neither is there evidence to support the idea that women are seeking
C-sections on demand.
Studies from Ontario suggest less than one per cent of caesareans are for “maternal request.”

The Society of Obstetricians and Gynaecologists of Canada says the vast
majority of caesareans are done for medically valid reasons. But there are concerns that too many are being ordered because labour isn’t progressing quickly enough, and that thousands of “routine” interventions are now being done that increase the odds of a woman needing a surgical birth.

What’s more, the number of women who give birth vaginally after a previous C-section is dropping dramatically, meaning more and more women are having repeat C-sections.

Dr. Michael Klein calls it the industrialization of childbirth, where, in
today’s risk-averse society, women in labour are being treated “as an
accident waiting to happen” and where doing something is always better than doing nothing.

“Physicians and society have helped women basically believe that childbirth is no longer a natural phenomenon, but an opportunity for things to go wrong,” says Klein, emeritus professor in the departments of family practice and pediatrics at the University of British Columbia.

“But the fundamental issue is, we aren’t improving outcomes by doing more C-sections. For the first time in Canada, we are seeing the key indicators for mothers and babies going in the wrong direction.”

Risks to babies range from accidental lacerations when the surgeon cuts into the uterus, to neonatal respiratory distress. Research suggests two times as many babies born via C-section will end up in an incubator with water on their lungs, or with serious respiratory problems compared to babies delivered vaginally, because a C-section interferes with the normal hormonal and physiological changes associated with labour that prepare a baby to take its first breath.

Risks to women include higher risks of hemorrhage requiring a hysterectomy, major infections including blood infections, wound infections and bladder infections, and blood clots in the lungs — and every C-section increases the risk for another.

“If you have a caesarean section for the first birth, the probability of
having one the second time around is huge, because of the difficulty women have in getting a doctor to look after them once they have a uterine scar,
” Klein says.

The worry is that the scar will pull apart during labour, causing a uterine
rupture.

“If you have a catastrophic rupture, you can get into big trouble,”
Christilaw says. “You can have a negative outcome for mom or baby. In severe situations, the baby can die or become damaged — but that’s a very rare outcome.”

Her hospital is encouraging more VBACs — vaginal births after caesarean — in carefully selected women. “In those women who attempt a VBAC, our success rate is well over 80 per cent.”

But less than one in five women in Canada with a previous C-section
delivered vaginally in 2007-08. Eighty-two per cent had a subsequent
C-section.

Christilaw says the only thing preventing Canada from seeing “horrific”
complication rates from C-sections is the fact women are not having as many babies as they once did
.

“A C-section can be a life-saving manoeuvre for a mother or baby. Nobody is saying differently,” she says. “What we’re trying to say to people is, a C-section is not a benign thing. If you need one, that’s different. But you should not be doing this unless you absolutely have to.”

C-sections are frequently the end result of a cascade of interventions that
often starts with inductions.

Tens of thousands of women in Canada have their labours artificially induced every year, often via intravenous infusion of artificial oxytocin. Oxytocin is naturally produced by the human body. It’s what creates contractions in labour. Today in Canada, one in five women who gives birth in hospital is induced.

What doctors fear are stillbirths. But alarmed by the rising rates of
inductions, the Society of Obstetricians and Gynecologists of Canada
recently urged doctors not to consider an induction until a woman is at
least one week past her due date
.

Claudia Villeneuve says that women are getting induced “if they’re two,
three, four days overdue.”

“Inductions are rampant,” says Villeneuve, president of the International
Cesarean Awareness Network of Canada. “You have a perfectly normal mom who comes in with a perfectly normal baby, and now you put these powerful drugs into her system to force labour to start.”

The “humane” thing is to offer an epidural, she says. With an epidural, a
woman can’t feel pain in the lower half of her body. But epidurals slow
labour, sometimes so much that labour stops.
“Now you have to get this baby out,” Villeneuve says. Two-thirds of first-time C-sections are done for “failure to progress.”

Klein says epidurals are too often given before active labour is
established.

“The majority of women today get their epidurals in the parking lot.”

Kayla Soares had been in mild labour at home for 24 hours when her
contractions suddenly stopped. Doctors told the Edmonton mother she would have to be induced. She was three centimetres dilated when they started the oxytocin drip.

“It was the worst pain I’ve ever felt in the world,” she remembers. “I
wasn’t having contractions at all and then they put me on the oxytocin and every half-hour they would boost it up, so the contractions were coming every minute, pretty much. It was like going from nothing to being in crazy, absolute labour, and in so much pain.” Eleven hours later, she was still just three centimetres dilated. “That’s when they said it was enough, and they were doing a C-section.

“I didn’t want to do it. I was asking, could we just have more time?”

Three weeks later, she still couldn’t get out of bed without help. Her
incision had become infected. “It felt like I was ripping apart every time I
moved. It was a pretty brutal recovery.”

Soares had her second baby in June. “I was dead set on having a VBAC,” a vaginal delivery after cesarean. “It was a fight, an uphill battle the  whole time with doctors.” One obstetrician asked her her shoe size. “She said that because I was a size five and smaller framed that I definitely was going to have another caesarean and that a VBAC wouldn’t happen. She said that because I was a ‘failure to progress’ the first time I’ll be a ‘failure to progress again.’”

Two weeks before her daughter was born, Soares started going in and out of labour. “They had me convinced it was causing stress to the baby even though the tests said everything was fine. They had me convinced it was enough, because I was overdue and they said my incision was going to rupture,” she says.

“They just kind of scared me into having another C-section.”

© Copyright (c) The Windsor Star

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Rebirth After Birth Trauma: My Story

Posted on August 2, 2009. Filed under: Birth, Breastfeeding, Cesarean, Face First/Mentum Presentation, Rebirth | Tags: , , , , , , , , , , , |

This post could be upsetting to someone who is currently pregnant. If you decide to read this and you are pregnant, please remember that many of the birth injuries mentioned are rare. You can also help prevent some of these injuries by preparing your body and your mind for an unmedicated birth as the use of forceps and vacuum extractions are reduced when unmedicated. Also, pushing in an upright or squatting position can help prevent the need for these interventions.

Birth trauma comes in many forms and can occur during vaginal deliveries and cesarean deliveries.  Trauma can be caused by:

fetal positioning
an irregular shaped pelvis
pushing in a supine (on the back) position
a very long or very fast labor
very large fetal head
fetal anomolies
sometimes there are unknown reasons

Trauma can range from mild to severe and can include:

Bruising and Forceps Marks – Sometimes a baby will have bruising on the face or head simply from passing though the birth canal, and from associated contact with the mother’s pelvic bones and tissues. If forceps are used during delivery, they may leave temporary marks or bruises on the baby’s head. Vacuum extraction can also cause bruising to the head, and may cause a scalp laceration. In extreme cases, forceps use can cause depressed skull fractures, which may require surgical elevation.

Subconjunctival Hemorrhage – This common birth injury results in bright red band around the iris of one or both of the baby’s eyes. This does not cause damage to the eyes, and usually disappears completely within a week to ten days.

Caput Succedaneum – This is a severe swelling of the baby’s scalp, and is more likely to occur as a result of vacuum extraction. The swelling will ordinarily disappear within a few days.

Facial Paralysis – Pressure on the baby’s face during labor or birth, or the use of forceps during childbirth, may cause injury to a baby’s facial nerves. If a nerve is merely bruised, the paralysis will ordinarily clear up within a few weeks. With more severe nerve damage, it may be necessary to surgically repair the damaged facial nerves.

More severe injuries include Brachial Palsy Injuries, broken bones and brain damage. These are all very rare. Fetal birth injury accounts for less than 2% of fetal death.

When a newborn has birth trauma it often times causes breastfeeding and bonding problems. I learned this first hand in the birth of my own son. He was in a mentum (face first) presentation and I labored for 52 hours before having a c section.  I discuss both mentum presentations and my birth story in separate posts if you would like to read them.

Because of my sons positioning, his face took the force of 52 hours of contractions. His birth by cesarean was violent.  His face was so wedged into my pelvis that he could not move forward and the doctors could  not pull him back out. The OB tried to pull his head out my pelvis with six failed vacuum extraction attempts. It eventually took three different people pulling on his little body at once to get him out. He was swollen to the point that he could not open his eyes, had bruising and abrasions all over his face,  a hematoma, and what we initially thought was a broken nose.  Luckily and thankfully his nose wasn’t broken and he had no long term damage. Today he still had a little bit of a ‘birth mark’ where some of the bruising was (he is 16 months old) and I personally think it was from his birth trauma.

Once he was born he had deep suctioning because we had thick black meconium and of course he was poked and prodded and force fed formula until he puked. He had also had the cord around his neck twice and because of the way his neck was hyperextended with his face first positioning it was very tight. He remembered it and my husband said that when he was in the nursery while I was being put back together, he kept reaching for his neck.

This was a very rough start for my little guy and for the  first two days he was very very sleepy. We had to undress him to make him wake up to eat. He had so many drugs in his system. After that two days, the crying began and he cried so much. I think he was shell shocked. I was shell shocked myself so I totally understood how he felt but I just didn’t really know how to make him feel better. He had complete breast refusal and even though we had no separation, we were not bonding. My body was also in a state of shock and hardly producing any colostrum to make him interested. I didn’t get milk until six days postpartum. By day three after he was born and of not being able to express any colostrum or having any luck getting the baby to quit screaming at the breast long enough to try to latch, we began finger feeding him formula. I refused to give him a bottle because I knew my milk would eventually come in and I didn’t want for him to have nipple confusion. In the mean time, I pumped as frequently as I could with the hospital grade pump.

My milk came in six days postpartum, the day we left the hospital. Because of how difficult our birth was, we stayed twice as long as most other c section birth stay at the Army hospital in Seoul. I guess I just needed to be home and able to relax a little bit but once it came it in I had a big full supply. For the three days that we had been finger feeding the baby I had continued to try to latch him at the breast and he continued to scream. Once we were home and I had my own milk to give him I decided to take a day off from latching him because quite frankly, I was a wreck about it. I felt that at least I could give him my own milk and not formula and for then that would be ok. The next day, my husband borrowed two breastfeeding videos from the nurse that taught the breastfeeding class at the hospital. At that time there was no lactation consultant, so I was own my own in fixing this breast refusal problem.

About halfway through the video, which by the way was Australian and I have no idea what it was called now, a woman with inverted nipples started telling her breastfeeding story. She talked about how difficult it had been and how her baby had been OP (face up) and that she pushed for over two hours and he came out screaming and wouldn’t latch. He developed breast rejection because of her inverted nipples but she didn’t give up. She said that she and her husband decided to perform a ‘rebirth’ and recreate the birth experience that they wanted for their baby. I was fascinated and willing to try anything so when I told my husband that we were doing it that night.

The idea of rebirth is to recreate the birthing experience for the baby so that he can be born in a gentle and peaceful way. We had a garden tub and filled it with warm water and lit candles and warmed the bathroom up. I got in and my husband passed the baby to me. He was seven days old at this time.  As soon as he was naked he was screaming but I put him in the warm water and held him close and he calmed down a little, just to a cry rather than a scream. After a few minutes I put him in the water, floating him around with only his face out of the water. He fought it a little at first but after a few minutes he completely gave in. His entire body went limp. We were completely amazed at this point. We had successfully recreated the womb and he remembered it! This was the most relaxed this baby had been since he was born.

In following the idea of infant rebirth, I slowing began to lift him out of the water. The idea is that the change in temperature and the removal of water from his environment will trigger the hormonal response that is similar to that of what a baby experiences in a peaceful vaginal delivery. I took him completely out and put him to my chest, just as I would have wanted had our birth gone the way we wanted. He didn’t cry or fight it, he just went limp against me. I let him lay quietly for a bit then decided it was time to try latching on again. I used the nipple shield because I wanted it to be as easy as possible for him. I had tried it before but he screamed at the breast regardless. Not this time, he latched right on. He latched and nursed for almost an hour. I was in awe and shock and disbelief.

We continued using the nipple shield until he was six months old. I tried to get him to nurse without it for months but he refused. I didn’t care, he was breastfeeding and I had a great supply. I knew we would eventually get rid of it and we did when he was six months old. As of 16 months old he is still nursing. Our bonding really began that day. I know that you can bond with your baby if you do not breastfeed but we had so much anxiety between the two of us that we needed that moment to begin healing from our traumatic birth.

I would recommend rebirth to anyone who has birth trauma. As soon as you get home from the hospital, get in the water. Get skin to skin. Recreate what you wanted for you and for your baby. Even if the baby didn’t have a birth trauma or injury of any kind, but you did, do it. If your milk is taking a while to come in, do it. It will help your body to relax and produce the hormones necessary for milk production. I truly believe in this process and it’s healing powers and hope that more moms can learn about the benefits of rebirth after birth trauma.

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