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The Gift of Birth is Love Itself

Light and love are inherent in many holidays, especially this time of year.  We love to see light and we feel peace when we feel loved. One characteristic of love is attraction. Newborn babies are full of love – oxytocin is the hormone of love and what helps a woman’s uterus contract to birth her baby. Therefore, levels in the mother and baby are very high at the moment of birth. The gift of birth is love itself.

Newborn babies fill us with awe and wonder. We want to be near to hold and touch them. New parents wonder “Where did you come from?” when looking into their babies’ eyes. This remains a mystery. Did you know a baby’s eyes at birth are about the same size they will be as an adult? https://birthworks.org/do-human-eyes-remain-the-same-size-from-birth-to-death-by-cathy-daub-cce-cd-bwi/  One mother said, “I looked into my baby’s eyes and saw the universe!” Women’s lives are transformed when they become mothers. This is because of love’s transforming potential.

The holidays are also a time of giving.  What are the most special gifts to give our babies, children, parents and each other?  What if we have only positive thoughts and words, seeing what is good, hearing what is good, touching what is good, tasting what is good… so all newborn babies absorb those energies and feel safe. A mother and her newborn are a dyad – they are so connected that what mom feels is felt by her baby and vice versa. Parent/baby skin-to-skin contact sets off a cascade of hormones in both of them. These hormones help lay down pathways in the baby’s limbic brain which impact them for life. Respecting the primal period – from conception to the end of the first year of life – is essential for our health as an adult and it all begins at birth.

The practice of human values of love and giving is the foundation The BirthWorks Experience which is empowering and transforming. Birth in a holistic sense means that the more joy and love we feel for each other, the more the baby feels it in the womb and after birth. In BirthWorks, we establish a deeper awareness of key connections between babies and parents. We do this by holding parents in awe of the gift of birth and nature’s perfect design.  For example, the process of having the smell of amniotic fluid in the womb is similar to colostrum’s smell, which helps the baby find life-giving food at the breast at birth. Breastfeeding establishes an emotional language which later leads to speech – all so perfectly designed for our miraculous growth and development.  In The BirthWorks Experience, we encourage trusting how the universe put all this together, helping every baby have the most positive experience for a good start in life.

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Risks and Benefits of Fetal Monitoring During Births

In a recent article in the August 1, 2020 edition of American Family Physician which is a peer reviewed and editorially independent journal of the American Academy of Family Physicians, there is an interesting study discussing “Intrapartum Fetal Monitoring.” It explains that continuous electronic fetal monitoring (CEFM) was developed to screen for evidence of fetal distress including hypoxic ischemic encephalopathy or fetal acidosis (compromised brain function due to inadequate circulation and oxygen delivery to the brain), cerebral palsy (which
is most likely caused by factors prior to birth), and impending fetal death during labor. Because of the low frequency of occurrence of these events during labor, CEFM has a false positive rate of 99%. In other words, lkg99% of the time when the monitoring shows a pathologic pattern, it is not indicative of an immediate danger for the fetus.

CEFM leads to increased rates of cesarean delivery

The widespread use of CEFM has led to increased rates of cesarean and other operative deliveries without any significant improvements in outcomes for the newborns. CEFM is a very blunt tool for detecting fetal distress. CEFM is falsely positive for fetal acidosis 67% of the time and when actually present, has a low sensitivity of 57% of correctly detecting fetal acidosis. When fetal acidosis is not present, there is a low specificity of CEFM with only 69% of the time showing a negative or normal result. Further complicating this is difficulty interpreting the CEFM tracing with agreement between experts on interpretations of the CEFM tracings only half of the time.

Structured Intermittent Auscultation (SIA)

Structured intermittent auscultation is preferred for women without risk factors as detailed below. ‘The main antepartum factors indicating high risk labor and the need for CEFM include any condition in which placental insufficiency is suspected such as intrauterine fetal growth restriction, known fetal anomalies, maternal preeclampsia/gestational hypertension or maternal type 1 diabetes mellitus. Intrapartum factors indicating high-risk labor and requiring CEFM include presence of meconium, presence of tachysystole (overactive uterine
contractions), signs or symptoms of intrauterine infection, unexplained vaginal bleeding, or use
of oxytocin or other uterine stimulants for labor induction or augmentation.

If one of the following is detected during SIA for a low-risk patient switching to CEFM is recommended to assess the National Institute of Health and Human Development category and to determine necessary clinical management: irregular fetal heart rate, fetal tachycardia (<160bpm for >10 minutes), fetal bradycardia (<110bpm for >100 minutes) or recurrent decelerations following contractions (<50% of contractions) or prolonged decelerations (>2 minutes but <10 minutes).

Risks of CEFM

The main risks of CEFM are increases in cesarean and operative vaginal delivery rates without improvements in fetal outcomes. Along with the increases on operative deliveries also come costs of longer hospital stays and higher risks of complications such as infections, bleeding, and bladder injury, etc. Another important consideration is that the ability of the laboring woman to move around and walk or assume a position that facilitates her delivery and labor is very restricted, making a normal natural labor and delivery almost impossible to achieve.

Barriers to Implementing SIA

Not all birthing facilities offer the option of SIA because of barriers in nursing staffing and education and physician oversight. Most organizations, including the American College of Obstetricians and Gynecologists (ACOG) and the American College of Nurse Midwives (ACNM) recommend instituting SIA with the onset of the active phase of labor. However, there are differing ways of defining active labor. The two most commonly used are 4 cm of cervical
dilatation and 6 cm of cervical dilatation but regular uterine contractions which are strong and frequent (<5 contractions in a 10 minute period averaged over 30 minutes) without uterine stimulants is also important for active natural labor. Be sure to ask your birthing facility if the option of SIA is available.

Choosing Wisely Campaign: Advice for birthing women

A recommendation from the Choosing Wisely Campaign is to not automatically initiate CEFM during labor for women without risk factors, and consider SIA first. Another very important recommendation from the Choosing Wisely Campaign is: Don’t separate mothers and their newborns at birth unless medically absolutely necessary. Instead, help the mother to place her newborn in skin-to-skin contact immediately after birth and encourage ongoing skin-to-skin contact and always keeping the newborn in her room during the hospitalization after the birth.

Breastfeeding within a half an hour after birth is optimal both for the mother and infant’s health along with exclusive breast feeding for the first 6 months of life after which appropriate complementary foods should be introduced, and the infant should continue to breastfeed for one to 2 years or longer as desired. Worldwide, the lives of an estimated 1.5 million children less than the age of five would be saved annually if all children were fed according to this standard.

References:
1. “Intrapartum Fetal Monitoring,” American Family Physician American Family Physician,
2020;102(3):158-167
2. For more information on the Choosing Wisely Campaign, see
http://www.choosingwisely.org. For Primary care see
https://www.aafp.org/afp/recommendations/search.htm

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BirthWorks Birth Prep!

This virtual experience is a fantastic way to prep for birth now from home!!
What a brilliant gift to give yourself or to give to new parents you know!

The BirthWorks Experience helps every woman find her own best way to birth. First-time parents (as well as parents having another child) will love our engaging, interactive format of evidence-based and emotional childbirth preparation which highlights:

…understanding ways to labor that can minimize interventions

…how human-values practice increases confidence and decreases fear in birth

…understanding Four Principles of Optimal Pelvic Positioning to shorten and ease labor and birth

energy, relaxation, affirmation, primal health and more!

What is unique about BirthWorks innovative and experiential approach? 

In two short virtual Zoom sessions, parents experience a balanced, non-judgemental approach to childbirth preparation including:

  • Experiential energy work to empower and transform
  • The most gentle, amazing relaxation exercise!
  • Chance to identify beliefs about birth
  • Creating powerful affirmations to overcome and release fears
  • Knowing how to position your pelvis for an easier birth
  • Birth anticipations and expectations
  • How hormones work to your advantage and “Adrenaline Language”
  • Non-pharmacological comfort measures and the HPA axis
  • Exercises to relax the pelvic floor before and during labor
  • Understanding Primal Health – the importance of mother/baby skin-to-skin contact on brain development
  • Mother-Daughter Relationships
  • Common Sense Nutrition

If this resonates with you, join our August Birth Prep or sign up for fall BirthWorks Birth Preps now offered monthly! Questions? Please reach info@birthworks.org

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Book Review: Natural Labor and Birth: An Evidence-Based Guide to the Natural Birth Plan by Michelle Aristizabal, MD

I was very pleased with Dr. Aristizabal’s book, “Natural Labor and Birth”, although I must admit I went into it thinking I would just be reading about things I already knew as I’ve attended over 700 births as a doula. That was true in most cases, but I really liked her approach. It was an encouraging book to read because it didn’t come across as judging interventions. While it championed natural birth as a viable and healthy option for women, it also acknowledged the prudent use of interventions. It has been my experience whether in personal interactions or in
books or the media, that one side is so staunchly defended to the detriment of the other. For instance, natural birth is touted as so much of an ideal that anything unnatural is judged inferior. Likewise, when women speak of their plan for a natural birth they are often met with resistance from friends and family, or even their providers or nurses. And that simply isn’t fair, especially since it is the woman’s journey. It has always been important to me that birth be
approached with an open mind from all involved. And I feel Dr. Aristizabal does this.

There is a clear defense of natural birth, as the title describes. But I found it enlightening and interesting when I encountered places in the book where she would use evidence to discourage the presumed correlation between interventions. The most popular one that comes to mind is the often-warned connection between an epidural and the increased likelihood of a c-section. She compares a decent number of studies and couldn’t even draw a correlation between an early epidural versus a late epidural and their impact of having a c-section. It’s just not a cut and dry issue. No labor is. She also goes on to say that the most predictive factor in whether one might be increasing their chance for a c-section is their providers’ philosophy of care. And since the studies to date don’t appear to have evaluated the impact the patient may have on the process, it’s still somewhat murky. But the intervention is not the culprit as much as the people deciding or defending its use. Honestly, that was the point in the book that caught my attention the most. I found her perspective refreshing. And for it to be evidence- based was just icing on the cake.

I also appreciated that she didn’t stop at birth but continued her analysis of studies relating to the postpartum time frame. She addressed the huge deficit in postpartum support that protects the fourth trimester. She also acknowledges how to bolster breastfeeding success. So much can be done to improve what is offered to mothers in the hospital especially, but also at home. She also discussed the importance of postpartum care at home, including pelvic floor and core strengthening exercises, in addition to mental health well-being assessments. I appreciated her holistic, whole-istic and balanced approach by covering every important issue in regard to pregnancy, birth, and postpartum.

In a country where homebirth is just now starting to take hold and grow, it’s important that we present options for a natural birth in the hospital without vilifying the medical system. There needs to be a level of trust to labor well, and finding the balance within the hospital setting for making a natural birth most likely, while still being flexible in case there are changes in the plan, is the best of both worlds. Trusting providers, trusting options, trusting a woman’s intuition, and trusting the process can all be incorporated within the hospital and result in a very high likelihood of a natural birth. And with books like this one, it will only make a natural labor and birth within the hospital a more recognized and realistic option.

*Michelle Aristizabal, MD, FACOG, is a board-certified General Obstetrician and Gynecologist in
Montclair, New Jersey. She runs a busy, private practice with a special focus on supporting women who desire low-intervention, unmedicated births.

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Birthing Language

Words are powerful, so it is important to consider what words to use around a laboring mom. Her senses are already elevated and she is on high alert, and she is perhaps now in her “primal brain”. What is said to her or in her presence is sure to have an impact on her labor and possibly even her labor progression. Words are not always necessary at birth, and even kind and encouraging words may inhibit the mother from fully being in her labor state of mind which could possibly interrupt her labor. Not all women enjoy listening to others during their labor. It is important to know when to talk and when not to. When language is needed or wanted, how we talk is of great importance. Please allow me to explain this further.

The volume at which we speak should be considered. Is the mom vocal herself, perhaps moaning loudly? Is the room full of distractions? Are you trying to assist her in finding something to focus on? She may appreciate a loud, direct tone, but often, I think it is more so the case that a woman needs a soft voice spoken to her. A whisper in an ear can be received stronger than a yell. The loudest voice in the room isn’t always the most impactful. It is important to evaluate the situation, know the mother and follow your intuition when deciding on how to speak to the laboring mom.

Where we are when we are talking to mom is also important. Are we across the room or are we near her and close to her in her laboring space? Depending on where a woman is in her labor, she may only be aware of the bubble around her. To properly communicate with a laboring mom, you must be near her and in her space, while being respectful of that space as well. It is hard to whisper across a room to someone who may not even see or feel you.

Once respecting the importance of volume of our voice and location of ourselves in relation to the mom, we must carefully craft our words. As a doula, I am careful to not interrupt a mom’s labor as sometimes silence is needed and wanted. With that said, I also know when to use words to encourage, reassure, inspire and affirm. I would not want to mislead her by using arbitrary words. I must also be careful to not give subjective medical advice if she asks
questions on what she should do if given options by her provider. These words could easily derail a mom from her labor.

A carefully crafted sentence is important and how we phrase what we are trying to convey to mom should be considered before speaking.
Nurse: “You are 4cm dilated.”
Mom: “JUST 4cm?!”
(insert pause to think, consider her feelings and gently touch mom while looking at her)
Me: “You are making great progress! Your body is working to open so your baby can
come out.” (Refrain from analyzing numbers)

In that exchange of words, I wanted to be careful not to mislead her. I didn’t want her to feel as if she had so much more to progress, but I also didn’t want to convince her that the next part of her labor would be fast. I simply wanted to support her by giving her well-earned credit for her hard work and remind her that her cervix is not a crystal ball.

“This is hard!”, says the mom. My reply would be simple, “…and you are strong! You are doing good work to meet your baby.” I would be careful not to choose words that give herself doubt. I want her feel confident herself. Labor is of course hard work, but it would not be helpful to affirm that or remind her. What would be helpful is to remind her that she is strong enough to birth her baby.

What if mom says, “I can’t do this.” I can recall saying this when in labor with my first. I also remember hearing, “You have to, sweetheart.” Maybe the reply was said with empathy and some endearment, but it did not leave me feeling confident, positive or optimistic. I felt helpless. A better reply would have been, “…but you are already doing it. I am right here with here with you.” I think it would have been helpful to be reminded that I was doing it and that I
wasn’t going to be alone.

These are several examples of what can be said to a woman in labor, but ultimately it is important to remember the timeliness of our words, the volume at which we say those words and where we are communicating them from. If we remember to speak from our hearts, we are more likely to speak what is perfect at that moment in time.

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BirthWorks Reborn

The birthing of my career as a childbirth educator and doula began over 18 years ago, on a cold fall evening as I pushed out my VBAC baby into the bed he was conceived in, surrounded in peace and love and welcomed earth side by his parents, grandmother, and loving midwives. There is something so otherworldly and generational when a baby’s first introduction to human life involves dim lights, hushed voices, warm hands, and landing safely on mother’s soft breast. How I wish all babies were introduced to this world in such a manner. Not all of my six children were born in a gentle way, but because of my knowledge and inner knowing of the BirthWorks philosophy, my children were all consciously
welcomed in awareness and peace.

Life has brought me great surprises through raising children, navigating a divorce, and entering the life of single motherhood. And though I have had to take other jobs to provide an income for my growing family, always my heart has been with birth work… my life’s passion to witness and hold space for the women who birth themselves as they birth their babies. I have found that the choices I made in life to raise my children often coincide with how they were birthed… in love and peace and with a lot of wide open space for them to feel safe to explore who they are.

Recently, as I was attending a therapy session to release some past trauma and difficult feelings that I was holding onto, I was led into visualizations that reminded me so much of the work we do in our BirthWorks childbirth classes that it bought me back in time in my body to a workshop many years ago while attending training with Cathy Daub. Cathy was helping me release and deal with the grief from the separation from my daughter after her traumatic cesarean birth a few years before. The three day separation from her had caused significant trauma and guilt that I had not yet dealt with. It was crucial to release this in order to move forward in my path as a childbirth educator and doula. When Cathy led me through the guided visualizations to help my body create a new memory, I was holding my baby in my arms as soon as she was born. This is the memory my body has of her birth now. And I was changed from the inside out.

As I sat through the therapy this past week releasing feelings of grief and hurt, my body instantly reminded me of my experience during that childbirth training so many years before. And I knew in that moment where my next step was… that I belong with birthing women. One of the most amazing things about BirthWorks has been the inner knowing and trusting of my own intuition that it has instilled in me. How easy it is to forget who we are and what we are all about in the busyness and chaotic pace of life. And how easy is it that in a moment our body can remember and teleport us back to a time that has been imprinted into our cells.

The world is in the middle of a tumultuous and uncertain time. Yet, life continues on and babies will be born. And so it is a deep honor and with gratitude that I step back into the path of serving birthing women and their families and accept my calling alongside the women who have paved the way before me.  I am BirthWorks reborn!

Blessed be.