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Must Know Info

What Birth Can Be Like

by Andrea Crossman, RN, BS, BA on November 5, 2010

in Labor & Birth,Pics & Vids

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I started working as an L & D RN again, and I am so thankful that my and other facilities exist for mamas with high-risk conditions or for whom surgical birth via caesarean section is medically indicated (ex. placenta previa, placental abruption, previous uterine rupture, and other relatively rare complications of pregnancy). That said, for women with normal, healthy pregnancies, and the providers who care for them, I wish there was a greater awareness, knowledge, and experience of how women naturally birth their babies, and have for time immemorial. This video is a brilliant example of what normal birth looks like, and a possibility everyone should know exists.

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Documentary Trailer: Guerilla Midwife

by Andrea Crossman, RN, BS, BA on November 5, 2010

in Labor & Birth,Midwifery,Pics & Vids

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Interesting trailer for a documentary called Guerrilla Midwife. Quote from the trailer:

At the fulcrum of first breath, I defend the smallest citizens of our planet, advocating for them a gentle, natural, culturally appropriate birth, and bonding with their mother and family.

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Amazing Animation: How You Are Born

by Andrea Crossman, RN, BS, BA on October 28, 2010

in Pics & Vids,Pregnancy

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Having seen births at hospitals, birth centers, and homes, I have to say it is amazing how differently the process unfolds when we don’t mess with it. If you are a low risk mama and are hoping for a peaceful, natural birth and bonding experience, please make sure that you choose a provider who trusts birth and a venue that supports birth as a normal part of life, not a medical event to be managed. What you see in this video is possible (probable, in fact!) when we let it be.

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Effectively balancing the art and science of maternity care is a work in progress for too many providers and facilities.

This post from Birth Sense, a blog written by a certified nurse midwife with a hospital based practice, is definitely worth a read:

Where’s The Evidence? 10 Ways Modern Obstetrics Ignores Evidence

The author covers maternity care hot topics including induction, pitocin to speed labor, continuous fetal monitoring, immediate cord clamping, pushing and more. Her insight is spot on, and something to consider when you decide where and how you want to have your baby. As always, the number one most important thing a mama-to-be can do is to choose a provider who she trusts, and a birth venue that meets her needs. If you do those two things you can relax and not have to undergo a complex negotiation of what will and will not “be done to you,” which is stressful and often leads to disappointment.

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Guest Post: Midwife Kate Prendergast on Earth Birth

by Andrea Crossman, RN, BS, BA on October 11, 2010

in Midwifery

The Earth Birth "ambulance"

A good friend of mine, Rachel Zaslow, is the co-founder of Earth Birth, an International Women’s Health Collective run by midwives to foster a movement that encourages and promotes safe and peaceful birth as an act of social justice and community healing. Rachel is a homebirth midwife who lives in Brooklyn when she is not on-site at Earth Birth in Uganda. We met a few years ago when I was at work as a labor and delivery nurse, and was assigned to the laboring mama Rachel had transferred to the hospital. We had an instant connection as we did Reiki together and supported this family in welcoming their newest member. Last night I was talking to another midwife I met through Rachel, Kate Prendergast. Kate spent six weeks volunteering at Earth Birth and she shared with me the ways that experience impacted her current practice. I found it fascinating, and thought you might too. Kate agreed to write a guest post for Holistic Doula NYC, here it is:

Midwives Rachel Zaslow and Olivia Kimble founded Earth Birth to reduce maternal and infant mortality in several locations around the globe by providing maternity health services in environmentally sustainable facilities. One of the goals is to teach the use of safe, economical protocols and sustainable equipment to the local birth attendants. Dependency on expensive, disposable and imported equipment and medication eventually leads to worse outcomes when those supplies are not available. I was lucky enough to spend 6 weeks volunteering at Earth Birth in Northern Uganda and now, almost a year later, I have begun to realize how two aspects of that experience have influenced my homebirth midwifery practice here in the New York and New Jersey metro areas.

Kate and some of the traditional birth attendants in Uganda

The first influence was my official title while I was in Uganda: “Senior Staff Midwife”. I am normally not one for titles and labels and did not think much of it at the time, but in retrospect I can feel how the title combined with the reality that when Olivia (who was onsite in Uganda during my 6 week stay) was away or busy with the other business of the project I was the obstetric authority everyone looked to if problems arose. My role was to teach and supervise the local midwives, helping them gain skills and overseeing prenatal appointments, labors, births and postpartum care. The reality that at times, “I was it,” had a great effect on me, and my confidence level. The other influence was the simplicity of the birth kit.

In an American hospital a large cart with drawers is at the ready with many instruments and medications. In addition, disposable and washable linen, disposable pads, oxygen and IV poles, infant resuscitation and monitoring equipment are in every room. For my homebirth practice here in America, both my partner and I carry multiple large bags with equipment and medication. The expectant family also assembles a large tote box of towels in various sizes, baby blankets and clothing, and orders a variety of supplies from one of several businesses set up for this purpose. Typically American families will also have a myriad of other infant equipment from a car seat to a boppy pillow.

Earth Birth co-founder Olivia Kimball with a group of traditional birth attendants

In contrast, the birth kit at Earth Birth in Uganda fits entirely in a dishpan or locally woven basket. It consisted of: a plastic sheet, a cotton sheet, 3 or 4 towels, a pair of scissors, a Delee and bulb syringe, all of which had been washed and hung to dry in the sun after the previous birth. Gloves, two lengths of cord tape and a handful of cotton wool were the only disposable items. A fetoscope, blood pressure cuff and stethoscope completed the standard equipment in the birth room. Sutures and some medication were available in an adjacent storage area. The family brought a small bundle of rags for pads and diapers.

The effect of these two realities—full responsibility and sparse equipment—on my personal process as a midwife deepened my already strong faith in the normalcy of birth and in my skills and ability to address complications with only my heart, mind and hands. My gratitude for the availability and proximity of higher levels of medical care is now deeper then it was before. Most people, including my midwifery partner Carole, who visit Africa on a medical care mission, are forever changed by the experience of seeing the disparities in resources around the world. I am thankful for the ways Earth Birth changed me.

Kate is currently taking home birth clients and is also available for postpartum doula work. Kate has been doing birth work since 1996 and has two grown sons of her own.

Rachel is also available for home birth clients and can be reached at rzaslow@gmail.com.

If you want to help support Earth Birth, click here, and to view Earth Birth’s amazing flickr photostream, click here.

Construction on Earth Birth's flower-shaped birth center. Click the pic to find out Earth Birth's current needs.

Check out the amazing progress! Click the pic to see more photos and to join Earth Birth's Facebook page for the latest updates.

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It’s National Midwifery Week!

by Andrea Crossman, RN, BS, BA on October 7, 2010

in Midwifery

National Midwifery Week is being held across the country this week. As part of Midwifery Week, Holistic Doula NYC encourages women to take charge of their health care and their lives. Nurse-Midwives are here to help empower women to take charge of their health.

Let’s continue to advance women’s health, together. Take Charge! For more information, visit the American College of Nurse-Midwives’ Web site at www.midwife.org.

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Complications from circumcision, including death, are not something considered by many parents who choose to circumcise. The blog Peaceful Parenting wrote a great post, Death from Circumcision, on the topic and the case of Ryleigh McWillis in British Columbia. Here is an illuminating quote shared in that post:

In their statement on the increased dangers of neonatal circumcision, Doctors Opposing Circumcision(DOC) physicians and surgeons reported:

The prepuce is highly vascularized, so it is likely to hemorrhage when cut, and severing the frenular artery is very common. Infants have a miniscule amount of blood in their tiny bodies and can tolerate only about a 20 percent blood loss before hypovolemia, hypovolemic shock, and death. A 4000 gram male newborn has only 11.5oz (340 ml) of total blood volume at birth, 85 ml per kilogram of weight. Blood loss of only 2.3oz, (68 ml), 20% of total blood volume at birth is sufficient to cause hypovolemia. Many newborns, and especially premature infants, weigh much less and a smaller amount of blood loss would be sufficient to trigger hypovolemic shock in those infants. Circumcision of infants, therefore, carries the inherent danger of hypovolemic shock and death.

Here’s another very unsettling, and largely unknown, fact from Peaceful Parenting:

The reality is that today more baby boys die from circumcision surgery each year in the United States than from choking, from auto accidents, from suffocation, from SIDS, and from the (newly recalled) sleep positioners.

As a health care professional, and an advocate for human rights, I do not recommend what is a medically unnecessary cosmetic surgery for patients who are unable to give informed consent. If boy children grow up wanting cosmetic surgery on their penises, I say let them make that decision when they are grown. That way if they want the procedure they can have it, and if they don’t, then they did not have to endure the experience of circumcision including an uncomfortable healing process, nor a life-long decrease in sensation and sexual pleasure without a choice in the matter. This seems like a very reasonable and approach.

If you are still considering circumcision and want more information, I highly recommend the Circumcision Decision Maker.

Click the pic to go to the Circumcision Decision Maker

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Photo credit: Brandi's Flickr Stream (click the pic for link)

This is the first post in my new feature Ask Andrea, wherein you get to ask this L & D RN, labor support doula, and childbirth educator all of your pregnancy and birth related questions. I love making the complex easy to understand, and providing the information you need to make the best choices for you and your family. I understand pregnancy and birth as normal, natural experiences with the power to transform. Questions can be sent to: hello@holisticdoulanyc.com.

Dear Andrea,

My wife is preggers with twins, so I have been reading quite a bit about cesarian section when it comes to twins. It seems that a cesarian is “necessary” in the majority of twin pregnancies. In your opinion, what are the chances of being able to deliver twins vaginally, and is there anything that can be done to increase the chances?

I hope everything is going great for you, and I look forward to seeing your response!

Sincerly,

Expecting Twins in the Twin Cities

Dear Expecting Twins,

Thank you for your great question, and congratulations! First of all, I think the chances for a vaginal delivery of twins can be very good! The key is to choose a birth provider and location that supports vaginal delivery of twins, and to do everything you can as parents to educate yourself about tipping the scales in your favor in terms of vaginal vs cesarean delivery. Here is my best advice on preparing for a vaginal birth of twins.

Find a provider who is skilled at both twin deliveries and breech deliveries

Much of the reason why vaginal birth of twins isn’t supported is because there are many providers out there who simply don’t have much experience doing it. In addition, many providers who will support a vaginal twin delivery will only do so if both twins are head-down. It is actually quite common for Baby B (that’s the 2nd one who will come out) to be foot first, and a skilled midwife or ob/gyn will be able to safely manage this kind of situation.

If you’re interested in working with a midwife, the experts in managing normal birth, I did a little research for you about options for you in the Twin Cities. I learned that the HCMC Nurse-Midwife Service cares for twin moms. They are the only midwife group that does and can be found here.

Follow the same recommendations I give all mamas on how to avoid a caesarean section

I share lots and lots of tips in these posts:

Make sure your provider and facility (if you aren’t birthing at home) will embrace the Lamaze Care Practices That Support Normal Birth

  • Labor begins on its own
  • Freedom of movement throughout labor
  • Continuous labor support
  • No routine interventions
  • Spontaneous pushing in upright or gravity-neutral positions
  • No separation of mother and baby with unlimited opportunities for breastfeeding

Hire a doula

My analysis of the birth on The Office provides insight into how and where a doula can really make a difference in you having a normal positive birth experience. By the by, the same person who gave my tips for a midwife in the Twin Cities sent me some doula recommendations, check your email, I sent them to you there!

Don’t listen to people who are fearful of natural birth with twins

Get educated and get inspired! A vaginal birth is totally possible with twins. As a labor and delivery RN I supported more than my fair share of twin vaginal deliveries. And there is an upside, twins are usually a little bit smaller! The intense sensations of dilation are the same no matter how many babies you have in there, but the pushing part can be a tad easier with a littler passenger. In addition, given that there is more baby weight resting on the cervix, it is possible that the dilation phase will move more efficiently. No promises, of course, but in can work that way. Let me leave you with this fantastic video celebrating natural birth of multiples.

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I hope that was all helpful, please let us know how it all turns out!

Love,

Andrea
RN, Doula, and Childbirth Educator

P.S. Twins can be breastfed as well, check out what La Leche League has to say about it here.

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Video | Madre De Muchos/Mother of Many by Emma Lazenby

by Andrea Crossman, RN, BS, BA on September 22, 2010

in Labor & Birth,Midwifery,Pics & Vids

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This is a glorious little animation portraying the incredibly hard and amazing work laboring mamas do, and the incredible skill and artistry found in the hands, hearts, and minds of midwives. Enjoy!

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