Month: July 2012

Doctors, Choices, Homebirths

The Ties that Bind: How Belief Creates Birth Realities
 

http://www.midwiferytoday.com/articles/ties.asp

© 2003 by Kim Wildner. All rights reserved.

[Editor’s note: This article first appeared in Midwifery Today Issue 68, Winter 2003.]

There is a story told of a baby elephant in Tibet (1) tied about the ankle with a rope. The rope would not hold an adult elephant, but it holds the baby tight even as it struggles to free itself. The baby resigns itself to the fact that it cannot move outside of the parameters of the rope, no matter how hard it tries.

Eventually, the elephant reaches adulthood, the same little rope about his ankle. Now, little effort would be required to snap the rope and walk away, but the elephant doesn’t even bother to try. He is bound only by his belief that he is unable to escape, which is just as effective as his captors.

Women giving birth today have more options than ever before, yet perceive very few. Information is available in unprecedented quantities at the touch of a fingertip, yet erroneous beliefs impact decision-making more than cold, hard facts.

Women believe that birth is a dangerous medical event. The fact is that normal birth is safer than many things we do each day without a thought (2).

Women believe that U.S. technology makes birth safe. The fact is that birth is much safer in countries where technology is more appropriately utilized (3).

Worse yet, women are often not making decisions at all. Like the elephant that cannot conceive that he has the power to walk away, women simply do not see the options before them.

A mother called me regarding private childbirth classes. During the course of the discussion, she explained that she wasn’t even sure the classes would help her, as she was planning a VBAC (vaginal birth after cesarean) and doubted it would “work.” Further discussion revealed that her doctor was insisting on certain “conditions” in order to “attempt” this VBAC.

  • The mother would be induced if she went “over due,” as determined by an ultrasound (4).
  • The mother would be induced if her baby got “too big,” as determined by an ultrasound estimation (5).
  • The mother must deliver between 7:00 a.m. and 5:00 p.m. when an anesthesiologist would be on hand. If that looked unlikely, induction or augmentation would be required. If she did not dilate steadily and quickly she would be augmented with Pitocin or Cytotec. If she were still laboring near the end of her given time frame, surgery would be inevitable (6).
  • The mother must labor with an epidural (7).

The reason for these restrictions was that the American College of Obstetricians and Gynecologists (ACOG) had issued new “guidelines” for VBAC, supposedly from a study that “proved” VBAC was unsafe (8).

However, what the study showed was that “obstetrically managed VBAC” was unsafe. The factors that made VBAC unsafe were mainly—hold on to your seat—pharmaceutical induction agents that are known to cause uterine rupture in non-scarred uteri (9). In other words, any woman in labor who gets them, not just VBAC mothers. Instead of investigating the drugs, which are not FDA-approved for nonmedical indications, the recommendation became to put restrictions on VBAC that bring about the very conditions that are singular to the drug/VBAC combination, not the VBAC itself. That “logic” is just lost on me, but it’s beside the point, anyway.

The story of the elephant mentioned above doesn’t parallel the illogic of ACOG; it parallels the thinking of the mother who contacted me. She was quite distraught that she probably wouldn’t be able to meet all of the conditions set by the doctor. She was right. She had as much control over them as she has over the tides, the moon or the sun.

She asked me if I thought she had a bad doctor. She asked me what I thought about the hospital policies. She asked me if she should change hospitals or doctors. None of this is my call to make, even if I knew her or her doctor, which I didn’t. I told her I thought she had some tough decisions to make. As a childbirth educator, I could provide her with the information she needed to weigh in order to make a sound decision, which I did. I gave her several book recommendations and links to studies showing the conditions she was being asked to meet were not only impossible, but flew in the face of science and plain old common sense.

I reminded her that the criteria for making sound decisions must include determining if the choice she was being asked to make was based on facts (it wasn’t), if it was in her and her baby’s best interest (it wasn’t) or if it would improve her experience (it wouldn’t) (10).

I heard from her again at a later date. She had read some of the material and she was getting anxious about her predicament because she didn’t feel she had any options. She ended her communication with the thought that she would probably just go with whatever her doctor wanted because, “What choice do I have?”

She didn’t believe she had options, so she didn’t have any. Perception is reality. While I refused to make her decisions for her, I felt I had given her enough information to broaden her options.

She could:

  • Present scientific references that challenge her doctor’s conditions and request that he provide evidence to support his stance.
  • Request that the hospital base its policies on the safety of her and her baby instead of concern over its liability.
  • If either or both refuse, find a doctor who did practice evidence-based care.
  • If one could not be found in her area she could
    • Choose a homebirth midwife;
    • Choose the nearest freestanding birthing center;
    • Choose a hospital/doctor in a neighboring county;
    • Choose to go out of state to somewhere like The Farm in Tennessee, where she could stay and safely birth her baby.

Granted, not all of these are easy choices to make, but other mothers have made them. It is not only the right, but also the responsibility, of women to ensure that the options they are offered are safe and in the best interest of their babies. If not, they need to seek new options. I’m sure there are others I haven’t thought of, but the point is she certainly not only had a choice, but several. The data I provided on evidence-based care and safe birth did nothing to illuminate this mother’s options because it wasn’t about facts, it was about belief.

In the last few months, I have received two other calls that illustrate this point just as well.

The first call came from a mother who had talked about hiring a midwife for her second birth because of her disappointing first birth. The first time around, she had done beautifully with HypnoBirthing® for most of the birth. Her caregivers had raised several red flags, however, during the course of her pregnancy, giving her warning that they would say what she wanted, then do what they wanted. Still, for some reason she thought it would be different for her. (There seems to be a common belief among pregnant women that somehow they will magically be able to change their caregivers when others have failed.)

Predictably, at the very end, the caregivers did what they promised they wouldn’t: they coached her to “purple push”—that horrid, harmful purple-faced pushing seen on those awful birthing shows. Amidst the yelling and counting, she couldn’t stay focused on “breathing the baby down,” not to mention the fact that she was afraid for her baby. They had promised they would only do this if it were necessary “for the sake of the baby.” The baby was never in peril. The mother (predictably) tore badly, which meant her early months of mothering were consumed with physical and emotional pain. Energy that should have gone to her child was wasted on trying to heal a relationship that struggled through the stress of a sexless existence.

In the years it took her to recuperate from this betrayal, she insisted she would have a homebirth with a midwife for the next baby. However, once she actually got pregnant, she went to an in-hospital birthing center, which started right away with routine ultrasounds scheduled at eight, 12 and 20 weeks. Knowing the suspected risks of ultrasound, this made her uncomfortable, but she was staying with the center because she said, “I have no choice. My insurance doesn’t cover homebirth.” Even if changing providers was impossible—though I believe nothing is impossible with enough determination—she still had choices. She could refuse the routine technology and let it be known that if there was a legitimate medical indication that could be substantiated (they had given her a “medical” reason for the intervention that, with a little research, was shown to be nonsense), she would surely cooperate for the sake of her baby.

Her insurance didn’t cover homebirth. That’s because it didn’t originate to help people get better care; it originated to help doctors get paid. Regardless, the co-pay for her hospital birth-center birth was about the same as what a homebirth midwife charges. If this woman ends up having surgery, the co-pay will be much more, not to mention the ripple effect of what it will cost during her recovery and in subsequent births, and the emotional toll.

She believed she had no choice, so she had no choice. Perception is reality.

The second call that illustrates this idea came from a woman who commissioned me to do some birth art for her. During the time I spent with the woman, she expressed anxiety about the fact that her doctor was starting to talk induction. She had read about the dangers of nonmedically indicated induction and wanted to avoid it “at all costs.”

She was a healthy woman with a healthy baby, two weeks away from her estimated delivery date, which could be as much as four weeks from actually delivering. She enjoyed being pregnant and had a lovely support system in her husband and family. Her doctor’s only reasoning behind mentioning induction was that she “looked about ready.”

This mother’s vehemence in her insistence that she wanted to avoid this intervention was impressive, but it didn’t translate into action. When I asked what she was going to do to avoid the induction, she replied, “I guess I’ll just have to do it. I don’t really have a choice.”

Have you any idea how often these words pass over an expectant mother’s lips?

Women always have a choice. The question is not whether they have a choice, but are they willing to make a choice. Changing a belief system, especially one that’s held collectively, like ideas about birth in the U.S., is a subject too complex for one article. I spend a great deal of time discussing how to identify our faulty assumptions so that we may make better birthing decisions in my book, Mother’s Intention: How Belief Shapes Birth (August 2003).

Even if a woman doesn’t instantly revise her beliefs about birth, the only factors that should have any importance are these: whether her choices are based on fact, if they are in her best interest and if they affect her experience positively or negatively. She need not concern herself with what is good for the hospital or doctor. Her only responsibility is to look out for the child, and by extension, herself.

<!– –>Kim Wildner is the author of Mother’s Intention: How Belief Shapes Birth (Harbor & Hill Publishing). She has been a childbirth professional for 12 years, holding certification with ALACE and the HypnoBirthing® Institute. She has one homeborn daughter.

Notes

  1. This universally understood story has many variations, with different locations and even different animals.
  2. Mortality statistics for motor vehicle accidents, heart disease, unintentional injury, cancer, HIV and other causes of death can be found at www.cdc.gov/nchs.
  3. The U.S. is rated 27th in the world for infant mortality and 13th in the world for maternal mortality (see www.savethechildren.org/mothers/report_2003/ for more information on the 2000 State of the World’s Mothers report).
  4. Ultrasound is only accurate to within two weeks on either side of an estimated due date. Only about 5 percent of babies are actually born on their “due date.” See www.birthsource.com/articlefile/Article86.html.
  5. Ultrasound is no more accurate than an educated guess at fetal weight. It is only accurate to within two pounds on either side of the actual weight. Considering that most obstetricians consider a normal eight-pound baby to be “too big,” if they induce because ultrasound estimates the baby is nearing eight pounds, the baby could really be only 5 lbs., 15 oz.
  6. See www.obgyn-wolfson.org.il/Content/Articles/ArticlePDF/AriclePDF655.pdf and www.midwiferytoday.com/enews/enews0326.asp.
  7. See www.childbirth.org/articles/episec.html.
  8. ACOG and other caregivers are now using a study found in the July 5, 2001 issue of the New England Journal of Medicine to suggest that VBAC is unsafe. See http://content.nejm.org/content/vol345/issue1/index.shtml.
  9. Visit www.hencigoer.com/articles and www.ican-online.org, where there are many articles that attest to the truth of this statement.
  10. Decision-making criteria adapted from Dr. Phil McGraw. See www.drphil.com/advice/advice.jhtml?contentId=1055_litmuslogic.xml.

References

  • Baum, J.D. et al. (2002, March). Clinical and Patient Estimation of Fetal Weight vs. Ultrasound Estimation. Journal of Reproductive Medicine 47 (3):194–98.
  • Lydon-Rochelle, M. et al. (2001, July 5). Risk of Uterine Rupture During Labor Among Women with a Prior Cesarean Delivery. New England Journal of Medicine 345 (1): 3–8.
  • U.S. Dept. of Health and Human Services. Maternal Child Health Bureau. (2001). Child Health USA 2001. Washington D.C.: Health Resources and Services, p. 22.

RELATED POSTS:
Everything You Need to Know About a Home Birth
Vaginal Birth After Cesarean – Make an Informed Choice

Recipes to Try

Other recipe posts

Peaches & Cream Cake

from Mel’s Kitchen Cafe

Cake:

Peaches and Topping:

  • 29-oz can sliced peaches or 1 quart home-bottled peaches Dole Coupons
  • 16 oz (2 packages) cream cheese, light or regular, softened to room temperature Cream Cheese Coupons
  • 1 cup granulated sugar
  • 6 tablespoons reserved peach juice
  • Cinnamon and sugar for sprinkling

Preheat the oven to 350 degrees. Lightly grease a 9×13-inch baking pan with cooking spray and set aside.

In a medium or large bowl, combine the flour, baking powder, salt, sugar and cornstarch. Blend. Make a well in the center and add the vanilla, eggs, milk and melted butter. Whisk together until well combined. Spread the batter evenly in the prepared pan.

Slice the peaches into bite-sized pieces, scattering them over the top of the batter evenly. In a medium bowl, beat the cream cheese, sugar and reserved peach juice together until light and creamy. Dollop the cream cheese mixture in tablespoon-sized spoonfuls over the top of the batter and peaches and then use a spatula to evenly spread together to form a creamy layer. It doesn’t have to be perfect, just try to spread it as evenly over the top as possible (it’s ok if peaches are peeking through in spots). Sprinkle the top of the cream cheese layer generously with cinnamon and sugar.

Bake for 45-60 minutes until the edges are puffed and golden and the cream cheese layer has bubbled slightly on top. This is a difficult cake to test for doneness because of the gooey cream cheese layer. If the middle is still jiggly, bake until it no longer jiggles and the cake batter layer is puffed and no longer runny. Serve warm or at room temperature.

************************************************************************************************************************************

Grated Carrot Salad

Grated carrot salad is a favorite dish for French kids. They eat it regularly for school lunch, and it’s popular at home as well. Even adults enjoy it as a starter. They more finely grated the carrots, the more the natural sweetness of the carrots will dominate the flavor of this dish. For kids who have a hard time with crunchier textures, this might just be the dish that convinces them they love carrots.

8 large carrots
2 tablespoons
olive oil
Juice of one orange
Juice of half a lemon
One bunch flat leaf parsley
Optional: a dash of Dijon mustard Pinch of salt
Dressing: Mix the orange and lemon juice with the olive oil and the salt.

You may want to add more oil, or lemon, depending on your tastes. But don’t overdress this salad! It should be nicely coated, but not swimming in the dressing.

Carrots: Peel the carrots. This is important, because the skin is often more bitter than the interior! Grate the carrots in fine shreds using a hand grater or machine. (These food mills are popular in France, and make fine, delicate shredded carrot—if you have one, use it!) The finer the strands, the more delicious the salad.

Parsley: Chop a quarter bunch of flat leaf parsley, in fine, small (I mean teeny, tiny) pieces. Make sure you don’t include any of the stems—just the leaves.

Note: You don’t want dried parsley, as the fresh parsley offsets the texture of the carrots perfectly, whereas dried parsley tends to taste a bit crunchier and, well, dry.

Combine the carrots, parsley, and dressing just before serving. Best served slightly chilled or at room temperature. Bon Appétit!

**********************************************************************

http://gogoquinoa.com/recipes/quinoa-broccoli-and-squash-casserole/

Quinoa, Broccoli and Squash Casserole

Ingredients

2 cups of red quinoa
4 cups of hot water or broth
1 tablespoon of olive oil
1 medium yellow onion, diced
1 red bell pepper, diced
1 medium zucchini, sliced finely
2 garlic gloves, minced
2 cups, peeled and diced butternut squash
¼ cup of fresh parsley
Salt and pepper to taste
2 cups of broccoli florets

Preparation

Preheat oven to 375F. In a medium skillet, heat oil. Brown the onion, red pepper, zucchini and garlic for about 5 to 7 minutes. Transfer the grilled vegetables into a medium casserole dish. Stir in water, quinoa, squash, parsley, salt and pepper. Cover and bake for 25 minutes. Remove the casserole dish and add the broccoli, stir the mixture and then put back into oven for another 10 minutes until all the liquid is absorbed. Remove from oven and let stand for 10 minutes before serving.

**********************************************************************

Butternut Squash with Quinoa

If you can’t find quinoa, you can substitute couscous and cook for less time (5 minutes).

Ingredients:

  • 1 tablespoon extra virgin olive oil
  • 1/2 cup of yellow onion diced
  • 3 cloves of garlic minced
  • 1 tablespoon of fresh ginger
  • 3/4 cup golden raisins
  • 2 cups butternut squash, peeled and diced small
  • 1/2 teaspoon sea salt
  • 3 cups of water
  • 1 cup quinoa, rinsed
  • 3 tablespoons of fresh parsley chopped
  • 1/2 teaspoon of fresh nutmeg grated

Directions:
In a large saucepan, heat the oil and add onion, garlic and ginger. Cook for 4 minutes. Add raisins and cook another 2 minutes. Add squash and salt and heat over high heat for 2 minutes. Add water, and bring to a boil for about 10 minutes. Reduce heat to boiling simmer and cook uncovered for 25 minutes or until squash is tender. Once the squash is tender, stir in quinoa, parsley and nutmeg.  Cover and cook for another 10 minutes or until water is absorbed and quinoa is done. Remove from heat and fluff the quinoa.

RELATED POSTS:

https://singlemomontherun.com/2012/06/13/six-week-bran-muffin-batter-yum/

https://singlemomontherun.com/2012/06/11/aunt-valeries-baked-beans/

Everything You Need to Know About a Home Birth

WHY A HOME BIRTH?
When my husband I found out we were pregnant we simply basked in the wonder of growing humans in other humans. Miracles. I had had a baby 10 years previous in the hospital with a midwife so I wasn’t without some experience. It was funny, though, at about 10 weeks pregnant I said, “Babe, maybe we should get some prenatal care going…I should try to find someone.” And my husband said, “Do we really have to have the baby in a hospital? Can’t we just have our baby at home?” So it was with my husband’s initiative that lead us on the home birth path…and now we’re on a home birth high horse especially after having experienced both a hospital and a homebirth.

HOW TO FIND YOUR BIRTHING MIDWIVES
It is a matter of being your own advocate. Medical doctors generally don’t attend home births. Some midwives attend home births and some don’t.

USE THE INTERNET
Find the local midwifery services in your area. Googling “Homebirth midwives in [YOUR TOWN]” will likely lead to a local midwifery group. Set up appointments and interview a few midwifes until you find the one that fits best for you.

BIRTH KITS
Most midwives will have you purchase a birth kit for the big day. These kits can be bought on-line. You midwife might have a specific place they like to order from so talk to them about what you should get. Here is a sample birth kit and some on-line places to order from.

A Sample Birth Kit Includes:
10-23×24 Underpads, Economy
5-23×24 Underpads, Economy
2-40×60 Plastic Backed Sheets
1-Peri Bottle
1-Stockinette Newborn Hat
6-2.7gram Packets Sterile Lubrication
2-Plastic Cord Clamps
1-Paper Tape Measure
12-Alcohol Prep Pads
2-Flex Straws
1-Dozen Sanitary Pads
12-Sterile 4×4 Gauze Pads
1-Bulb Syringe 2.5 ounces
1-Mesh Brief
3-Pairs Sterile Gloves
6-Single Sterile Gloves
1-4 ounce Povidone Solution
1-“Welcome” Birth Certificate
1-Disposable Footprinter

http://www.midwifesupplies.com/Home-Birth-Kits-PEA0059-p-BirthKits.html
http://inhishands.com/

A SAMPLE CHECK LIST OF THINGS NEEDED FOR A HOME BIRTH
From http://pregnancy.about.com/od/homebirth/a/supplylist.htm

  • A bottle of isopropyl rubbing alcohol (70%)
  • A pint of 91% alcohol (or 99% alcohol, grain alcohol, or 180 proof Golden Grain
  • Cotton balls
  • A plastic drop cloth or plastic sheet (an old shower curtain or large plastic table cloth works wonderfully)
  • Plastic trash bags (AT LEAST 4 large) dark colored
  • 2 fitted bed sheets to fit your bed
  • 2 flat bed sheets to fit your bed (4 flat sheets is acceptable)
  • 4 bath towels
  • 4 wash cloths
  • 8 receiving blankets
  • Large mixing type bowl
  • Small mixing type bowl (prefer bowls not be glass)
  • Working flashlight and extra batteries
  • Extra toilet paper (at least 2 6-roll packs)
  • Several kinds of juice (at least one citrus and 1 non-citrus)
  • One extra bag of ice
  • Protein you like that is easy to fix (peanut butter, cheese, or eggs for example)
  • Clothes for you for after the birth (gown and panties)
  • Clothes for the baby (2 pair socks or booties, 2 onesies, 2 sleepers)
  • Diapers for the baby
  • Large cookie sheet
  • Silver duct tape (preferably new roll)
  • Thermometer (if digital, include probe covers)

We organized the kit and all the extra supplies she requested (towels, washcloths, etc) into 2 large Rubbermaid bins and stored them under a 4 foot table we set up in our room – also requested by midwife.  Once labor started, we made up the bed with plastic and a new set of sheets.  We purchased a roll of clear plastic, self-sticking carpet protector (like they use in model homes) and covered our carpeted bedroom floor with it.

Another mom was caught off guard with a 36 week labor and delivery:

We’d wanted a water birth at home but our little one arrived 4 weeks earlier than we thought so we were truly unprepared. In fact, the birth kit that we ordered arrived via UPS about 3 hours after our baby was born. Fortunately our midwives always have a birth kit on hand just for these types of situations.

DO YOU GO TO A REGULAR DOCTOR’S OFFICE FOR YOUR CHECK-UPS IF YOU ARE HAVING A HOME BIRTH?
Whether or not visits are in the midwives’ office or at your house likely depends on the midwife you choose.

  • If you choose prenatal screening or to have an ultrasound this would occur in a clinic and you will need a referral from your midwife for the procedure.

PEOPLE YOU MIGHT WANT PRESENT AT YOUR HOME BIRTH

  • Midwives
  • A doula
  • Back-up midwife (probably already arranged by your midwifery group)
  • Friends
  • Family

If there are other children in your family, you might arrange to have a friend or family member be on-call to care for the child or children during the birth.

WHEN TO CALL THE MIDWIVES
You and your midwives will discuss at what point they would expect for you to call them in. If you have a doula, she can help you with this decision as well. Some laboring at home before the arrival of the midwife is normal.

When my water broke and I had started having semi-regular contractions, we called the midwife.  She came over within an hour or so because she happened to be in the area. 

WHO ASSISTED YOU WITH LABOR?
My husband and my midwives helped take me through all my rushes. We chose to call them rushes instead of labor since the word labor had some negative connotations for me. My daughter also helped with kind words, nice touches, and videotaping her brother’s birth, announcing the gender and the name!

WHAT WOULD YOU LIKE TO TELL SOMEONE CONSIDERING A HOME BIRTH?
I knew of women having their babies in places other than hospitals, but I honestly thought they were super hippies willing to have their babies in the woods, gnawing off the umbilical cord and eating the placenta on the spot. I had no idea that, for instance, where our home is situated has one of the highest rates of homebirths in the city.

It is SO much safer than hospital birthing. You can have your baby right at home and then you’re right there in your nest where you need to be. A home birth is intense and powerful. You don’t need to have a fancy house or apartment. You don’t need to have a clean house. There will be blood, there will be fluids, but the midwives know what they’re doing and they’ll clean up! Women need to know they can do it! People planning a home birth need to know that birth in a hospital is an odd new trend…birthing at home is the normal way to bring babies into the world. Women have been birthing babies in their “nests” since the beginning of time. In my opinion, hospitals have it all backwards and actually make birth harder. Home birth is simple. It un-complicates a very natural process.

ADVICE AND TIPS FOR THE HOME BIRTH

  • I would have planned a little earlier so I could have had a water birth.
  • I think I would have done a little more mental hypno-birthing preparation before my home birth.
  • I would also have liked to watch some home births on video.
  • We made the HUGE mistake of not hiring a doula!
  • Tour your local hospital in the event you need to transfer.
  • I also ate a high protein diet in an attempt to avoid pre-eclampsia and thus a birth too early for staying at home. 
  • I did pre-natal yoga and visited the chiropractor, though both not as often as I should have all during pregnancy and definitely not enough during those last few crucial weeks.

WATER BIRTHS AT HOME
Besides being a great comfort measure, a water birth can offer the following and more:

  • diminish stress hormones (called catecholamines) which increase pain and slow labor
  • reduce pain by increasing the body’s production of natural pain relievers (endorphins)
  • ease involuntary muscular tension, and enhance relaxation during and between contractions
  • lower blood pressure within minutes and decrease edema (swelling),
  • promote better circulation and increase the efficiency of uterine contractions
  • increase mobility so that it is easier to change positions to aid the progress of labor, especially when a woman is becoming tired

http://www.geneabirth.com/waterbirth.htm

If you want to have a water birth at home you will need to rent a BIRTHING TUB. Check with your birthing center or midwife to see where you can rent a birthing tub locally. Some birthing centers and midwife organizations will rent tubs, too.

In the Twin Cities these organizations will bring the tubs to your home, give you the instructions as to how to set it up, and will take the tub down for you after the birth. They also supply a list of things you will need for tub rental.

http://www.waterbirthresources.com/
http://bywaterbirth.com/
http://www.geneabirth.com/waterbirth.htm

BIRTHING STOOL

It is common for women giving birth at home to rent a birthing stool. They are made in all shapes and sizes. The above stool is a handcrafted wood stool.

 “A birthing stool is a stool which has been specifically designed for use during childbirth. It allows a woman to sit or squat while giving birth with support to help her if she begins to feel fatigued. Many advocates of natural birth support the use of a birthing stool, which may also be called a birth support stool or a birth stool. Such stools are available from companies which provide equipment to midwives, and they can also be handmade; some people have chosen to make their own to personalize the labor and delivery process.”

The concept of sitting or squatting during labor is ancient, and widely practiced in many cultures, and the use of the birthing stool is also quite old. A birthing stool is designed to bear up to a substantial amount of weight and pressure, and it is usually low to the ground so that a laboring mother can plant her feet firmly. Most importantly, a birthing stool has a hole in the middle, allowing a midwife to monitor the progress of the labor and providing a space for the baby to slide through.”

http://www.wisegeek.com/what-is-a-birthing-stool.htm

Your midwives might be able to advise you on were to go locally or on-line for this as well.

Video on the Birthing Stool: http://www.youtube.com/watch?v=RrXR7dK4Y2k

HOME VERSUS HOSPITAL: HANDLING POSSIBLE COMPLICATIONS

This labor and birth was way harder than my first due to what turned out to be a crooked (asynclitic) baby.  I know one thing for SURE—I would not have been as comfortable in a hospital as I was at home to birth in so many different positions, to walk around, to be naked, get in and out of tub, to vocalize, etc.  I think we would have had a very different outcome for this birth if we had NOT been at home.

I actually had some bleeding 3 days before I gave birth and because I was only 36 weeks, my midwives instructed me to meet them at the hospital because early bleeding could mean placenta previa…and if it was placenta previa I would need an emergency c-section. Placenta previa occurs when the placenta grows in the lower part of the womb and covers the cervix. This is very bad as you cannot push the life-giving placenta out first since both baby and mother would likely die. I hadn’t had any ultrasounds during my pregnancy, but I had to have one to ensure the placement of the placenta was at a safe location. It was. And even while I spent 10 hours in the hospital in contractions at only 36 weeks…I opted to return to my home though the MD there strongly advised me to remain at the hospital to have my baby. But I chose to voluntarily discharge. I felt like royalty walking out of the OB floor waving at the labor and delivery nurses as they stood with jaws dropped at a woman walking OUT of the hospital while in labor. 

FOR THE SIBLINGS

http://www.midwifesupplies.com/Were-Having-A-Homebirth-KM0050-p-BirthKits.html

 

LOCAL MINNESOTA BIRTH CENTERS AND MIDWIVES

Many thanks to Barbara Morgan and Claire DeBerg for their assistance with this article and for sharing their home birthing experiences and knowledge!

Mother-Baby Separation: The First Three Years

The following article is very much in line with my thinking about parenting. As a single mother who works, it is difficult to maintain this proximilty to my child. However, I value the co-sleeping time with my child and view it as valuable parenting and bonding time. Christina.

Mother-Baby Separation

By Dr. George Wootan, M.D., Author of Take Charge of Your Child’s Health

http://www.drmomma.org/2010/07/mother-toddler-separation.html

I’m going to open up a big can of worms here, one that gets me into as much trouble as my thoughts on weaning: mother-baby separation. Imagine for a moment, that you are at the grocery store with your six-month-old. She starts making hungry noises, and you look down and say reassuringly, “I’ll feed you in half an hour, as soon as we get home.” Will she smile and wait patiently for you to finish you shopping? Absolutely not! As far as your baby is concerned, either there is food now, or there is no food in the world. Right in the middle of the grocery store, famine has struck!

Babies and toddlers, up to the age of about 36 months, have little concept of duration of time. To them, there are only two basic times: now and never. Telling a young toddler that Mommy will be back in an hour, or at 5:00, is essentially the same thing as telling her that Mommy is gone forever, because she has no idea what those times mean.

Let me submit to you that the need for mother is as strong in a baby as the need for food, and that there is no substitute for a securely attached mother. When he’s tired, hurt, or upset, he needs his mother for comfort and security. True, he doesn’t need Mommy all the time, but when he does, he needs her now. If he scrapes his knee, or gets his feelings hurt, he can’t put his need on hold for two hours until Mommy is home, and the babysitter – or even Daddy – just won’t do as well as if Mommy was there.

So, yes, this is what I’m saying: A mother shouldn’t leave her baby for an extended amount of time until about the age of 36 months, when he has developed some concept of time. You’ll know this has begun to happen when he understands what “yesterday,” “tomorrow,” and “this afternoon” mean, and when your toddler voluntarily begins to spend more time playing away from you on his own accord.

Of course, if you know that your child always sleeps during certain times, you can leave her briefly with someone while she naps. If you do this, however, the babysitter should be someone she knows well, as there is no guarantee that she won’t choose this day to alter her schedule and wake up while you’re gone. This could be traumatic for her if the person is someone she casually knows, and doubly so if the babysitter is a stranger. It is important to make every effort to be available to her when she is awake and may need you.

I realize that not separating a baby from his mother for the first 36 months of life may be difficult. Living up to this presupposes that the family is financially secure without the mother’s paycheck, and, unfortunately, this is not a reality for some people. I would not argue that a mother who must work to support her family is doing less than her best for her children by working. However, I believe that many women return to work not out of necessity, but because they (or their spouses) want to maintain the two-income lifestyle to which they’ve become accustomed. These parents need to do a little soul-searching about what they really need and not sacrifice their child’s best interests.

If you must leave your baby for several hours a day, there are some things you can do to try and compensate for the separation. One of these, of course, is nursing until the child weans himself. Another is sharing sleep with your child until he decides he is ready for his own bed. If you have to spend 8 hours away from your baby, make an effort to spend the remaining 16 hours of each day in close physical contact. That extra effort will go a long way toward helping him feel secure an develop a healthy attachment with you.

In our family, we have found that many events that would require leaving our baby or toddler at home are the ones that we don’t particularly mind missing. We also have found that because our children have their needs attended to promptly, they are happy and secure, and we are able to take them to most social gatherings. I don’t mean to suggest that you’ll never encounter any problems, but generally, you’ll find that if you take care of your baby’s immediate needs by holding him, nursing him, and loving him, he’ll be a pleasure to have around, well into the toddler years and beyond.


George Wootan, M.D. is a board-certified family practitioner and medical associate of La Leche League International. He and his wife, Pat, are the parents of eleven children and the grandparents of twenty-one. Dr. Wootan has practiced medicine for 33 years with a focus on pediatric, family, and geriatric care and chronic illness. He speaks nationally on the subject of children’s health, healthy aging, nutrition, wellness and Functional Medicine.

 

Positive Parenting: Time Outs May Not Be the Best Choice

http://www.sheknows.com/parenting/articles/805746/positive-discipline-why-timeouts-dont-work

 

By Susan Stiffelman

Susan Stiffelman is a licensed marriage and family therapist, educational consultant and parenting coach. Through her private practice, public presentations, workshops, teleclasses and website, she has become a source of advice and support for parents around the world. Her book, Cool, Calm and Connected: How to Avoid Negotiations, Arguments and Meltdowns With Your Kids is now available in bookstores. Susan can be reached at www.passionateparenting.net.

Do time-outs work as punishment for children? Family therapist and author Susan Stiffelman explains why they don’t work, why they can actually cause clinginess in your child — and what techniques are much more effective.

There’s no doubt about it: Time-outs work. Sort of. They work because unless a child has become hardened and aloof, the experience of being separated from a parent’s comforting presence is unpleasant at best and intolerable at worst. But they come at a price, and eventually they stop working –because they violate one of the three primary drives of a child’s brain: the need for close and secure attachment.

Children need a secure attachment

Children are wired to be closely connected to their caretakers. Attachment is vital to their survival and well-being. Unlike the young of other mammals, little humans are utterly dependent on their guardians to provide food, warmth, shelter and nurturing; we simply cannot survive without being connected to those who care for us.

When a misbehaving child is sent to their room to “think about” their offense, the only thing they’re really thinking about is either how soon they can get back to Mommy or Daddy or how much they hate their parent for sending them away.

The former response is what we initially see in a younger child whose experience of anxiety at being separated from the parent shoots through the roof. The latter response — anger and contempt — happens when the child feels outraged at being ostracized.

What role does discipline play in parenting?

Why time-outs don’t work

The problems with time-outs are numerous. First, at the very time when the angry or misbehaving child is out of control and in need of the calming influence of a caring parent, they’re left to settle down entirely on their own. Most children are incapable of doing this. They need a grown up to help them come back to themselves when they’re swept up in the storm of their emotions. A child whose behavior has been so impulsive or destructive as to warrant being sent away shouldn’t be left to his own devices to become centered again.
 
Sending a child away when they’re distressed is essentially saying to them, “I can’t handle you when you show this side of yourself. Come back when you can be the manageable Susie or Johnny that I can handle.” Not only are we telling the child that we only find the good, compliant version of themselves acceptable, we’re also declaring our inability to cope with all of who they are.

As I’ve said in many other articles, a child deeply needs their parent to function as the confident Captain of the ship in their life. When a parent sends a child away because they can’t handle their misbehavior, they’re effectively telling them that they (the child) have the power to render them (the parent) incompetent and helpless.

Time-outs increase separation anxiety

One of the characteristics I see in children whose parents routinely use time-outs is clinginess. Unless (or until) these kids become hardened and indifferent, they handle separation badly. While it usually works to tell a child who refuses to leave the park, “Okay, then, I’m leaving without you!” (most kids will indeed come running), the anxiety created by chronically threatening a child with separation damages their core sense of security and connection.

Time out for time outs?

What can you do?

When a parent functions as the Captain of the ship in their child’s life, there’s a natural dynamic at play that makes time-outs largely unnecessary. Sure, there are always times when our kids are cranky, hungry, jealous or running on empty, but if we do our best to anticipate problems before they manifest, we can usually avoid behavior getting out of hand.

For all practical purposes, time-outs are the equivalent of shunning a child. In most societies, shunning is considered the most dreadful form of punishment. When we instead manage a child’s misbehavior while preserving their sense of connection with us, we avoid the harmful effects of time-outs — which in the long run, create more problems than they solve.

How can you become the Captain of the ship in your child’s life, parenting without needing to bribe, threaten or resort to time-outs? Click here to read, “Avoiding power struggles: Parenting without bribes or threats.”

More on discipline

The “Let’s Go Outside” Revolution: How One Woman Found Her Lifetime Mission

ABOUT THE AUTHOR: Marghanita Hughes is a children’s author and illustrator and creator of the award-winning children’s brand, The Little Humbugs. She is a naturalist and founder of the “Let’s Go Outside” Revolution – a Canadian non-profit organization with a mission to change the way children spend their time. Throughout the year, Marghanita runs nature classes for children and “hands on” workshops for educators wanting to learn how they can connect children with the natural world. She strongly believes that all children should be given the opportunity to discover and explore the natural world.

By on June 25th, 2012

The “Let’s Go Outside” Revolution: How One Woman Found Her Lifetime Mission

All children deserve the right to have the opportunity to experience the magic that the natural world provides. I am fortunate to be able to witness this magic every day in my nature classes and during the school visits I make. Because of that magic, my life has been transformed.

A few years ago, I launched nature classes for 3 – 8 year olds. During the classes, we provide a natural space where children can run, play, dance, sing, squeal, shout or be silent in this forest space. They stand, kneel or crouch to paint or create the creatures, birds, trees, flowers and grasses, which are all around us. The children develop a beautiful relationship with Mother Earth. They get to feel who they are, happy and free. Over the past three years, I have expanded the classes, offering them after school.

How did I come to this mission? Throughout life, people come into our lives that help us on our way to finding our purpose in life. Or it may be a book that we read at a particular time in our lives that inspires change in us. One such book for me was Last Child In the Woods by Richard Louv. The very title haunted me. The book had such a profound impact on me that it inspired me to create my nature classes.

Now I believe there is a need to provide a way for people of all ages to benefit from nature in their lives. In Richard’s latest book The Nature Principle, he provides affirmation that adults are suffering from nature-deficit disorder, too, and are in need of reconnecting with nature just as much as children. He quotes Thomas Berry: “We have turned away from nature. The great work of the twenty-first century will be to reconnect to the natural worlds as a source of meaning.”  This is absolutely true.

The Nature Principle led me to add another element to my nature classes: adults. What I try to get across in my presentations to adults and children is that you do not need to be a biologist to teach children about the birds and trees in their backyard or park, or the need to be a life-long gardener in order to grow a small vegetable plot in the school grounds. The simple nature-based activities we teach in my workshops and classes are fun and easy, stimulating the child’s (and adult’s) body, mind and spirit.

During my presentation/workshop in Vancouver for the Early Learning Years Conference 2011, I was overwhelmed by the educators’ enthusiasm and their dedication to changing the way children spend time in their care. Witnessing their sense of awe and imagination was both heart-warming and exciting. It was easy to forget I was teaching adults.

Typically, I start the sessions by getting participants to close their eyes and to take a moment to think back to their own childhood. I ask them to think of their favorite outdoor activity as a child. The room instantly fills up with smiles and I ask who would like to share their fondest memories. Hands shoot up all over the room, eager to reminisce about their childhood outdoors. Having a room full of happy, enthusiastic teachers, excited to take their new knowledge of how to actively engage children and adults with nature, fills me with an abundance of joy and hope for the future. If a teacher is enthusiastic, he or she will get the children excited too.

Since registering as a participant in the Children and Nature Network some time ago, I have watched it grow and blossom into an amazing pulse of creative energy, a network of individuals, organizations and nature groups, sharing and connecting their ideas, dreams, solutions, and challenges: fueling the very movement Richard hoped would happen.

In Canada, I’ve been inspired to start what I call The Let’s Go Outside Revolution, a non-profit organization, providing help at the grassroots level — starting locally, growing organically. The response to has been amazing.

Here is just one example: An elementary school teacher from Vancouver got involved in our Revolution. At the time, she was the only teacher in her school to take classes out into a little forested area behind the school. In December she reported that every single teacher in her school was now taking their classes outdoors.

Yes, there is a long way to go, but a “New Nature Movement,” as Richard Louv calls it, is growing stronger and more powerful every day. We all have a purpose in life. I believe my purpose is to help return our children to Mother Earth and to help re-awaken the awe and wonder in adults who have forgotten or lost their inner child.

I am the revolution. You are, too.

RELATED POSTS
Documentary “Play Again”
Nature’s Playground
Beyond the Playground

Are Schools Breaking Children’s Spirits? Life and Learning Beyond Walls

Field Notes from the Future: Tracking the Movement to Connect People and Nature

by Kelly Keena

via ARE SCHOOLS BREAKING CHILDREN’S SPIRITS? Life and Learning Beyond Walls.

When starting out as a teacher, I heard Joseph Cornell say that keeping children inside one room five days a week is akin to breaking a horse.  I’m haunted by that analogy. Our tendency is to keep children in, especially as academic demands only increase. And for discipline or missed work what do we do? Keep them in at recess. Breaking horses.

What would happen if we gave students opportunities to go outside and interact with the natural world as part of the school day? Does a natural classroom give us a way to maintain our students’ inner wildness, as Mercogliano calls it?*

We know that nature is critical in children’s development.  We know that children are losing access to independent explorations in nature.  Schools canprovide children with experiences in nature, and typically, nature contact is not part of our national public schooling agenda.  Yet.  As teachers, we need to give children opportunities to be more than academics

Audrey was a sixth grade girl in a school with a schoolyard habitat that was used as an outdoor classroom. During science class in fourth grade, her attention was turned to a small, hard, dark woody case surrounding the stem of an oak shrub. It was the size of a marble and was in a cluster of five other small round cases.  As she looked to other branches, she noticed that the clusters of balls were quite common all the way through the tangled scrub oak.

Intellectually, her curiosity was sparked.  Physically, she moved in long graceful strokes along the woods, her breath increasing and diminishing as she found other clusters, feeling the texture of them with her fingers, her notebook tucked under her arm.  Emotionally, she felt a sense of excitement build as she realized she had no idea what she was looking at, then wonder as she discovered that the balls were actually wasp galls – hard cases to protect the egg, then larva of the insect. For three years, Audrey visited the exact branch that first caught her attention and taught her classmates about the galls.

Jimmy was a sixth grade boy in the same school.  He was not interested in the woody galls. One morning in class, Jimmy and his classmates discovered a social trail through the scrub oak woods. The three boys crept carefully into the woods following the barely noticeable trail created by local coyotes or maybe deer.  The boys found that the trails wound through the very small patch of woods and that if they entered by the picnic table, they could emerge by the library.  Jimmy’s attention was fixed.

He went inside at the end of class that day, promptly opened his notebook, drew a map of the trails, and wrote a paragraph about the experience. That afternoon, we went back outside and he explored the woods on his own with a video camera.

The footage recorded his decision-making as he whispered to himself when he came to a fork in the trial, his breathing slowing and quickening in tune with the pace of his footsteps in the crunchy snow, and his exclamations when he found something unexpected.

Using these two stories out of hundreds collected during an eight-month study of this public, traditional school’s natural classroom habitat, there is evidence that supports children’s embodiment of so much more than intellect!  And yet, intellect and critical thinking was still very present in their experiences.  Through contact with a natural setting during the school day, the children in 4th-6th grade found imagination and adventure, critical thinking and curiosity, respite and relaxation, peace and calm, and ownership and identity.

The outdoor classroom developed the students’ sense of belonging to the school and to the natural world. The contact these children had with nature was also in a place where the children felt safe to explore at a distance from the teachers that felt safe. In some cases, it was the children’s the first contact with nature in a exploratory way.

If the question is about providing children with access nature, schools have an answer.  Even short, unstructured time in the schoolyard habitat with the sounds, textures, smells, space, and sensations showed value. The children were awake to the world, expanded to their own possibilities of their sensory channels, alive with curiosity and calm.  What a gift that schools can provide for an area of childhood that is vanishing at an alarming rate and at the same time, allow for children to feel the sense of wonder and joy in becoming familiar with the natural world.

*Mercogliano, C. (2007). In defense of childhood: Protecting kids’ inner wildness. Boston, MA: Beacon Press.

Photos by Kelly Keena

Additional Resources

C&NN Report: Children’s Contact with the Outdoors and Nature: A Focus on Educators and Educational Settings

The “Let’s Go Outside” Revolution: How One Woman Found Her Lifetime Mission

The Benefits and Joys of the School Garden

A New Role for Landscape Architecture

RELATED POSTS

Documentary “Play Again”
Nature’s Playground
Beyond the Playground

What is a Doula and Why Do I Need One?

So you’re having a baby? Great! You’ve decided on a doctor or a midwife, you’ve been taking your prenatal vitamins and you may even be starting to think about the birth itself. You’re in the beginning stages of developing a team of people who are going to support you through the birth process.

Regardless of whether you planning on delivering your baby home, at a birthing center or at a hospital, one of these people you might consider having present at your birth to support you is a DOULA.

A DOULA? WHAT IS A DOULA?
In essence, a doula is a fancy word for an old concept. In cultures all over the world, women attend births. Women have assisted other women in giving birth for thousands of years. With the onset of industrialization and the tendency for birth to be a medical procedure, rather than a naturally occurring event, the concept of a birthing assistant has fallen by the wayside. In recent years, the idea of employing women to attend births has come back into favor and thus enters the doula.

A doula (usually a woman) is a person who assists women with the birthing process. A birth doula is “a supportive companion professionally trained to provide physical and emotional support during labor and birth…She provides continuous support, beginning during early or active labor, through birth, and for approximately two hours following the birth. The doula offers help and advice on comfort measures such as breathing, relaxation, movement, positioning, and massage. She also assists families with gathering information about the course of labor and their options. Her most critical role is providing continuous emotional reassurance and comfort.”

http://www.transitiontoparenthood.com/ttp/Doula/doulahome.htm

Some hospitals are even starting to provide doulas to women when they come to the hospital in labor, but this is rare. Woodwinds Hospital, a local hospital in MN, has a volunteer program providing this service called Doulas at Woodwinds.

WHAT DOES A DOULA COST?
Most doulas charge a flat rate for the entire pregnancy and delivery and all services rendered during this time. As I recall, the cost generally ranges from somewhere around $800.00 – $1,500.00. (Just an estimate.)

WHAT DO YOU GET FOR THE COST?
Doulas general provide services for three purposes: (a) prenatal visits, (b) delivery of the baby, and (c) postnatal visits. The doulas are on call during your birth and will be there regardless of the day or the time of day, unless they have informed you otherwise. The frequency and content of the visits may vary from doula to doula so be sure to ask lots of questions when interviewing your doulas.

1. Doulas usually do a few prenatal visits and will help you prepare a birth plan. They will talk to you about what you want during your labor and delivery and go over some of the choices you might have (types of pain relief, cord cutting, membrane stripping, etc.)

2. Doulas come to your house when you start to go into labor regardless of where you plan on giving birth. Their philosophy is geared towards laboring at home for as long as possible. If you go into labor quickly and are delivering at a hospital they will come as soon as you are admitted and will stay with you until the baby comes and for a few hours afterwards. Their rate includes your entire labor even if you labor for 48 hours, God forbid. If you deliver your baby in your home or in a birthing center, they would do the same thing, only in those places instead.

3. They also make one or two visits to your home after the baby has gone home with you. They will assist with breastfeeding, comforting your baby and adjusting to being a mom, if it’s your first time.

WHAT IS THE ROLE OF A DOULA DURING THE BIRTH?
The role of the doula is to assist the birthing mother with whatever it is that she needs. She is like a personal assistant. If you want her to clear the room of people, she will do that. If she wants you to get your husband or partner to help out or give a massage, she will do that. Basically she is at your beck and call throughout the labor. She will help you find good positions to labor in and will be very active or play a background role depending on what you want. If your partner is actively involved in the delivery she might provide gentle suggestions on helping you through the labor and delivery. Her main role is to act as your advocate and to see that you are getting your needs met such that the delivery is as comfortable as it possible can be.

If you end up having a Cesarean the doula can also enter the operating room. They usually have a limit on how many extra people can be there so you may have to choose between your birthing partner, if you have one, and the doula.

DO DOULAS HAVE MEDICAL TRAINING?
Doulas are not medically trained in the traditional sense. They do come with tons of knowledge about birth and labor and will provide you with suggestions about when to rest and when to move around and what positions you might try during labor. However, they are trained not to communicate with the medical staff directly regarding your medical condition. They will prompt you to communicate to the medical staff about a wish or desire that you had (such as not wanting the cord cut or skin-to-skin contact, etc.).

HOW DO I GO ABOUT FINDING THE RIGHT DOULA FOR ME?
1. The hospital where you are delivering may have a list of doulas that you can contact. In addition, you can read about them on the web (they may have their own websites) and if they look like someone you are interested in they will meet with you so that you can see if you like them and if you want to hire them.

2. On-line directories such as this one: http://doulanetwork.com/directory/Minnesota/ may be available in your area as well.

3. In Minnesota we have something called the Childbirth Collective and they have a “Meet the Doulas” night. It’s a great thing because you can meet a bunch of doulas all at one time and if you see one you like you can try to get an appointment set up for a meet and greet to see if you want to hire them.

From their website: The Childbirth Collective is a “collective of birth professionals who support women and families during the childbearing year. Perhaps you are looking for a birth doula, midwife, birth photographer, massage therapist or a postpartum doula. The Childbirth Collective is the place to connect with a growing and passionate community that cares about how you birth.”

Regardless of where you find your doula, make sure you interview a few so that you are comfortable with the one you choose. She is going to see you through one of the most challenging and amazing experiences of your life. Liking your doula will only make it a more positive experience.

WHAT ARE THE BENEFITS OF A DOULA?

From: “What is a Doula?

  • Reduces the need for forceps or vacuum extractor by 41%
  • Reduces need for Cesarean by 26%
  • Decreases medical intervention in labor
  • Reduces use of pain medication by 28%
  • Reduces dissatisfaction with birth by 33%
  • Reduces length of labor

Six weeks after birth, mothers who had doulas were:

  • Less anxious and depressed
  • Had more confidence with baby
  • More satisfied w/ partner
  • More likely to be breastfeeding

Homebirth Midwifery Care, Birth and Postpartum Doula Support and Massage Therapy Center http://www.geneabirth.com/

These two women look they provide a wonderful array of services. They provide Midwifery services, Doula services and Birth Massage.

They will also assist in at-home births for VBAC women, also known as the HBAC (Home Birth After Cesarean).

Awesome!

The massage service includes a two and a half hour massage during your labor with a certified prenatal massage therapist. Their massage therapist has also been a doula for eleven years and can guide you with the best positions to be in for early and active labor. The service includes meeting with the therapist to discuss the type of massage you would like to use in labor, and picking out the scents/s you would like to use in labor. She will then make an oil using Young Living Oils that you will bring home with you. In labor, the massage therapist will come to your home or visit you at the hospital/birth center for a two and a half hour massage that will help you to enter your labor in a calm and centered place. This massage is specifically tailored to you and your needs. She can come at any point during your labor, but early labor is usually the best.

NOTE: I know that for you around the country this particularly birth center might not be a possibility but perhaps there are other birth centers in your area that offer similar services. It’s good to know that places like this exist.

Additional Resources:

What is a Doula? (http://www.dona.org/mothers/index.php)
DONA International (http://www.dona.org/)
What is a Doula? (www.transitiontoparenthood.com/ttp/Doula/doulahome.htm)

Early Delivery (Prior to 38 weeks) May Lead to Delays in Reading and Math

As I’ve mentioned in previous posts, my first OB wanted to do a C-section at 36 weeks because of a previous uterine surgery. I bascially ended up going against her advice and delivering full term. You can read about it here. My daughter appeared at 42 weeks exactly so a 36 week delivery would have been six weeks earlier. The article below caught my eye and what I read was shocking! Academic acheivement scores in math and writing are lower for children born at 37 weeks versus 38-41?

Incredible. Read on.

Christina

Kids born just 2 weeks early have lower reading and math scores

https://singlemomontherun.wordpress.com/wp-admin/post-new.php
(accessed July 10, 2012)

Compiled by , Deseret News

Published: Monday, July 9 2012 11:12 a.m. MDT

Children born just two weeks early exhibit lower academic performance in reading and math, according to a new study published this month in Pediatrics.

“The evidence from this study would suggest that elective induction of birth should be approached cautiously,” said lead study author Dr. Kimberly Noble, assistant professor of pediatrics at Columbia University Medical Center and New York-Presbyterian Hospital. “The data suggest that children born at 37 or 38 weeks may have problems with reduced school achievement later on.” Noble encourages parents to be cautious before choosing an early birth for non-medical reasons.

Past research has indicated that babies born before 37 weeks are more likely to have difficulties in the academic sphere, Noble said. The widely held assumption that the development of babies between 37 and 41 weeks is indistinguishable may be inaccurate, she wrote.

“The study looked at data from more than 128,000 births of single babies born between 37 and 41 weeks, the span considered full term,” U.S. News reported. “When the children reached third grade, the researchers examined their scores on standardized tests to see if their delivery date suggested a difference in learning ability. They concluded that it did.”

Led by researchers at Columbia University Medical Center and New York-Presbyterian Hospital, the study is “among the first to look at academic achievement among children considered full term,” according to the Wall Street Journal.

“The math and reading scores of children born technically at full-term — 37 to 38 weeks’ gestation — lagged slightly behind their peers born just a little later, at 39, 40 or 41 weeks.”

Children born at 37 weeks had a 23 percent increased risk of moderate reading impairment compared to those born at the full 41 weeks. Of those children, 11.8 percent “born in week 37 had a mild reading impairment compared with average children their age versus 10.4 percent of children born in weeks 40 and 41, while 2.3 percent of kids born at week 37 had a severe reading impairment compared with 1.8 percent of those born in weeks 40 and 41,” the Wall Street Journal reported.

Experts have been unable to determine the exact cause of these academic struggles. “Perhaps there is something about the uterine environment that supports brain development in a favorable way in the last month of pregnancy and perhaps gets disrupted by earlier birth,” said Noble.

“While Noble acknowledges that her study could not determine why the babies were born before 39 weeks — such as whether the moms had voluntarily decided to induce labor, or whether an underlying medical condition prompted the earlier birth — the findings add to the evidence that the traditional definition of full-term pregnancy may need revision,” Time reported.

“The results should help both mothers and doctors appreciate that not all ‘term’ infants are the same,” she says, especially when it comes to cognitive outcomes later in life; those couple of weeks between 37 and 39 weeks may make a bigger difference than previously thought. “As with many other good things in life, therefore, delaying delivery may be worth the wait,” she added.

Rachel Lowry is a reporter intern for the Deseret News.

Related Posts:

Vaginal Birth After Cesarean – Make an Informed Choice
Skin-to-Skin Contact Following a Cesarean