Archive for December, 2009
I don’t know if every woman planning to VBAC considers the location of her placenta at all when preparing to birth. I don’t know if it is something commonly thought about or it is brought up by the midwife or doctor at some point. I tend to think that if the mom has an ultrasound and the placenta is posterior (on the back wall of the uterus) that nothing is ever brought up at all and most moms probably never really think much of it. On the flip side, if an u/s is done and the placenta is found to be anterior (on the front wall) then it is mentioned and the mom begins to learn about the risks associated with an anterior placenta when planning to VBAC and she begins crossing her fingers that as her uterus grows that her placenta moves up high above her c section scar. For a mom with a prior bikini cut, ‘high above the scar’ doesn’t require a whole lot of movement as the scar is in the lower segment of the uterus.
I went into my pregnancy thinking about an anterior placenta. I didn’t dwell on it, it just crossed my mind a couple of times because of my inverted t incision. I don’t think I manifested an anterior placenta or anything but because it can create real problems and because I know (too much sometimes) this, I just thought a few times that “I really hope my placenta is not anterior because I don’t want the added worry. ” I began to suspect that it was a week ago though. I found the baby’s heartbeat with my doppler at home at 9weeks and 5 days. It was really hard to find but definitely there. Almost two weeks later I couldn’t find it. I could see it pick up briefly so I knew it was there (plus I totally still feel pregnant!). I never thought I had miscarried or anything like that, I just thought ‘hmm wonder if the placenta is in the way.’ By 11 weeks the placenta is a good size and I figured it was big enough to block the heart tones.
I had my 12 week appointment today and my doc offered to do an u/s. He is a solo practitioner and has a machine in house and I think he likes doing them himself. He would probably offer every month, of course, I have no intention of having a monthly u/s but today when he offered I told him no that I didn’t need one. I found the heartbeat with a doppler and if he wanted to check he could that way. Then I told him I found it a few weeks ago but I couldn’t find it last week and that I thought the placenta was anterior. So he said ‘let’s take a look.’ I knew immediately when I saw the screen and he confirmed. He didn’t seemed worried at all which is great. Most mainstream and American docs would have gotten nervous. He just said, it’s early and it will move and hopefully it moves way up high and out of the way. He also reminded me that scar tissue was very strong. Then he said that if it stayed in the front on top of my scar as it is now, because it is big and my uterus is still small, then it probably wouldn’t cause problems in labor but could cause detachment problems after. He said, ‘you’d still have your vaginal birth and I would take care of everything after, don’t worry.’ I really appreciate his mentality. I can’t imagine too many docs that have that kind of attitude. There are some serious complications that can occur from placentas attaching to c section scars.
AIP= accreta, increta and percreta, where the placenta attaches to the scar or grows into the scar or grows through the scar to the outside of the uterus. It can cause massive hemorrhage and often require hysterectomy. I’m not going to go into too much detail on all this because I am not really too hung up on it. I just didn’t want the anterior placenta so that none of this would have to cross my mind. Because it has crossed my mind I will now think about it until I see that the placenta has moved up and safely away from the scar. If I find that it hasn’t moved, a 3D u/s or an MRI can detect AIP. If there is any AIP then I will obviously have a very different remainder of pregnancy and birth and I can live with it because our safety would be compromised.
Chances are it will probably move up. There is a lot of growing left to do and I know this. There is not any information to be found on VBAC with an inverted t incision and an anterior placenta so I thought I post about it and see what kind of feedback and response I got. If anyone has VBACd with an anterior placenta, please share, regardless of incision type.Read Full Post | Make a Comment ( 26 so far )
I frequently get emails from women asking questions about pregnancy, birth, breastfeeding, circumcision and all things in between. I get phone calls from random strangers or from friends of friends. I get approached by both women I know and do not know that know I am a doula. I always have an open ear and I always try to the best of my ability to point these women to the direction of the best information to answer their questions.
I am both a DONA trained birth doula (CD DONA) and have trained as a Lamaze Certified Childbirth Educator (LCCE). There is extensive training and worked involved in both of these designations, but especially in the LCCE. I take my exam in April and I will tell you I am preparing for it harder than I ever worked on any high school or college exam and I have an accounting degree if that gives you any indication of the amount of work I am putting into this. While it is true that I am not medically trained I am trained and have been exposed to a variety of topics pertaining to women’s and infant’s health, birth, pregnancy and breastfeeding. I do not give medical advice. When I am asked a medical question, I may give my opinion based on what I know but it is always preceded with ‘ask your doctor.’ What I do is give information, facts, data, research results and how to find this information and decipher it.
I also have spent and do spend a good bit of time talking to both OBs, general practitioners and RNs including labor and delivery nurses. When I attend a birth I ask a lot of questions about the clinical procedures carried out during the birth even it is something as simple as a charting requirement. Of course that all depends on how friendly the staff is and how open they are to sharing information but most are. They see that I am there with the sole purpose of supporting my client and that I am in no way trying to interfere with the clinical needs of her birth and they respect that and are typically happy to answer my questions. They usually realize that I have a genuine interest in both my client and all aspects of her birth and it makes for a much better experience overall for everyone. It also helps to plant good seeds of thought on doulas for wary staff who have not been exposed to them before me or who may have had bad experiences with a doula in the past.
My point to all of this is that between the work I have put in to have both the CD (DONA) and LCCE designations by my name plus the practical experience of attending births and exposure to hospital staff and systems I do have a lot to offer a woman who may have questions about her pregnancy or birth or newborn. Part of my training has included the tools and resources to provide evidence based information to women both in a class room setting and informally by email or what not. All of the information that I give women is fact based and generally given with references and resources so that they can research the information for themselves. I don’t want people to just take my word or believe what I am telling them just because I said it. I want to see people take responsibility for their bodies, births and babies and learn some things in the process.
I am a support person. I am a sharer of information. I strive to do the very best that I can to give good information and resources. It’s up to the individual to do the rest of the work. My hope is that after I have answered a question or sent and email that the asker will go forward and look into what I have told her. I know it doesn’t always happen and because I am human it frustrates me a little. I don’t want to see someone not heed my advice and have a bad experience but I am not also not on a mission to save any one either. It’s at that point I take a step back and not interfere with what a woman chooses.
Please keep the questions coming. I am always happy to help in any way I can. Please continue to give me your feedback. It is motivating not only to me but to other women who read these blog posts or hear about your positive experience. And thank you for sharing with me, I am always honored to be a part of any birth whether directly or indirectly.Read Full Post | Make a Comment ( 1 so far )
I actually had to write an essay about this for my doula certification. I will add it to this post later but for now I wanted to share with everyone what my friend and doula (well, one of them, I am actually having two) Karen had to say about being on my birth team.
Go HERE to read her blog post about it.
Karen is doing such great work to help women have better births. She has not formally trained as a doula but she has as a childbirth educator. She is a wealth of knowledge, especially here in Korea as far as the birth culture is concerned. She spends a good bit of time pointing women in the direction of the information that they need and because of this has helped many women have good birth experiences. I am very proud of her and proud ot have her on my birth team.
I will also have a Korean doula on my team. Her English name is Janice. She is a new doula and also trained as a childbirth educator. She works for a milk bank in Seoul, helping to get donated breast milk to mothers who do not want to use formula but cannot breast feed for some reason. She is also an RN here in Korea but does not work as a nurse any more. Her English is great as she lived in Hawaii for a few years and she is just all around a very nice person. I have referred doula clients to her and she will attend her first birth in January. Karen has also referred a client to her. By the time my birth comes around she will be fairly seasoned and experienced. Her role in my birht is different from the typical doula however, in that the will be in the background. She will be there to help communicate to the Korean hospital staff and admin and through the postpartum time at the hospital.
Because I am using Hynobabies I prefer for my support team to be in the back ground and my husband to be my main support if necessary. Karen and Janice will be there if I need them and that for me is such a huge confidence booster. I wish every woman could have that kind of support in birth. My hope is that one day every woman will.
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The Value and Purpose of Labor Support
Labor support can be priceless to a mother. As Doulas we often times do put a price tag on our services and time but the benefits received outweigh the cost. Studies have shown that by hiring a Doula a mother can reduce her need for pain medication, increase overall satisfaction with the birth experience, drastically reduce the risk of a cesarean and reduce the risk of assisted delivery by forceps or vacuum extraction. The studies have also shown a reduction in postpartum depression for mothers who had a Doula or continual labor support by a person trained in birth. I believe that much of this is the result of an increase in confidence levels by both the mother and the father. I have had several second time mothers tell me that their birth with a Doula was so much better than their first birth without one because they knew they had someone there whose sole purpose was to tend to her physical and emotional needs.
Part of labor support is empowering a mother to have confidence in her ability to birth. Having someone available for the entire length of labor provides security and confidence for the mother as practitioners are typically caring for multiple patients at a time or have other responsibilities such as the clinical needs of the mother and the baby. There is also paperwork that must be done and shift changes that bring in new people to the birth environment. Having a constant throughout the entire labor process provides a sense of familiarity and safety for a laboring mother. Doulas also help the mother and father both communicate with the staff which is necessary in a time such as labor when the parents are usually distracted with the labor itself. While it is not the role of a Doula to speak for the parents to the practitioner she should advocate in order to help the mother or partner speak for themselves. Helping the mother and partner ask the questions appropriate to their situation and navigating the terminology used is also often helpful.
Supporting a mother emotionally during labor and birth helps the mother to believe that she can do it. Sometimes being told that she can do it is all that a mother needs to hear to keep going strong during a long labor. Understanding that laboring women are vulnerable and that the birth space should be protected is very important. Laboring women should have peace and quiet and no unnecessary interruption and holding that space for a mother is a priority. When a Doula and a partner help create a peaceful and safe environment for a laboring mother often times practitioners will follow suite and respect that space. It allows a sense of calm for the mother that helps her to maintain stamina through labor. Emotional support doesn’t end at the birth however. Helping a mother to process her birth experience is equally important. In unforeseen complications or unexpected situations or traumas a mother needs the continued emotional support to facilitate healing. Being especially sensitive to these needs helps to reduce postpartum depression and negative feelings towards her birth.
Labor support also includes physical support for the laboring mother. Every woman has a different need in labor whether is continual touch, massage or counter pressure while other women want very little physical touch. Often times women will not know what their need will be until labor has progressed and it is important to be able to understand what the mothers needs are and at what time her needs are the greatest. Incorporating the partner into the physical aspect of labor support is often very affective as they usually already have a certain intimacy between them as a couple.
The needs of a laboring and birthing woman are very complex. Mothers deserve the continual support of a Doula, someone trained in labor support. I believe that if all women had a Doula that most of them would be able to birth without medication and with little medical intervention. The cost of maternity care would lower as a result and there would be higher success rates in breastfeeding. Postpartum depression rates would also lower. I believe that every woman deserves a Doula and that every woman that wants one should have one.