supporting mothers and their families in Westchester and Fairfield Counties
This recipe is great for mamas who are breastfeeding. It can help keep your milk supply up or increase your milk supply. Use more brewers yeast and oatmeal if you want to increase your milk supply. This recipe makes about 4 dozen.
Written by: Jessica Grose and courtesy of NYMag.com
What the new book Labor Day gets wrong.
I love a good birthing yarn. Sure, most happy labor narratives have the same general shape (they begin with contractions; they end with a baby), but the emotional and physical details are so particular. I want to know how you felt in the third hour of pushing. I want to hear what your partner said to you. I want to find out if you pooped.
So I was excited to crack open my copy of the new anthology Labor Day: Birth Stories for the Twenty-First Century — and disappointed by the overwhelming sameness of the stories within. Whether or not the women involved had natural childbirth (and the majority did), with one or two exceptions they are all still marinating in the same birth culture. It’s a culture that reveres midwife Ina May Gaskin, is populated by doulas with nose rings, and frames the decision to have a natural childbirth as a moral choice. And it’s a didactic, judgmental culture. If the vision of childbirth presented by editors Eleanor Henderson and Anna Solomon is to be believed, the movement that began as a pushback to ‘50s and ‘60s medical paternalism has become tyrannical in its own way.
Edan Lepucki, a writer who wanted a home birth but ended up needing a C-section, is a good example of the childbirth moralists in Labor Day. She writes that she doesn’t like to talk about her labor because:
I feel the need to explain my whole long story; otherwise, you might think I’m a clueless everywoman who let the doctors do what they did because I didn’t have faith in my own body. Because I was weak, because I’m not in touch with my physical powers.”
Over and over again, the choice to have an epidural is framed as “weak” and “fragile,” even by the women who end up asking for them (the exceptions are Nuar Alsadir and Cristina Henríquez). Here’s how Joanna Smith Rakoff describes it: “I was complying, admitting defeat, succumbing to my body’s inferiority to the miracle of modern medicine.” Cheryl Strayed admonishes women, “Don’t believe you can’t withstand enormous amounts of pain,” and “Don’t believe a pregnant woman is psychologically fragile and should be protected from the realities of labor and birth.”
Amy Herzog goes even further, writing, “In my personal pregnancy mythology, an epidural would be a disgrace, a C-section a tragedy of Greek proportions.” Herzog is being self-deprecating here, especially because the epidural turns out to be a minor issue when her daughter is born with a congenital muscle disease and must spend weeks in the NICU. But her initial feelings about the epidural show how pervasive the natural childbirth pressure is on a certain kind of pregnant woman.
The “strength” of a natural childbirth is equated with agency: You’re telling the medical establishment to piss off every time you reject their dulling drugs! But it’s inadvertently condescending to women who do choose to have pain relief. It’s telling them they’re “clueless everywomen” who just aren’t properly educated about what their bodies can do, when in fact they may just not want to go through the pain if they don’t have to, or they may be facing complications beyond their control (à la Herzog). As a columnist for the New Statesman put it earlier this year, “That which at first seems empowering — it’s all in your hands! — turns out to be a burden.”
The message to such women is that they didn’t experience “real” childbirth if they took pain medication. Here’s Edan Lepucki again, on women who had epidurals near her while she was in labor: “I felt both envious of their comfort, and also sad. If that sounds self-righteous, so be it. Feeling my body work to give birth to my child was unlike everything I’d ever experienced, and in the moment I couldn’t understand why a mother wouldn’t want that.” First off, modern epidurals are not like the twilight sleep of the ’50s: I can say from experience that you still feel a whole lot going on. And more important — while this seems like it should be obvious — not every mother wants the same things.
The childbirth moralists seem motivated by a desire to be good girls, to do everything perfectly. And in their culture, “good” equals “no drugs, soothing music, birthing tub glugging in the background.” Sarah Jefferis writes that when her cervix doesn’t open properly, “I thought I was doing labor wrong. And I wanted to do it right. Not just right. Perfectly.” Jane Roper writes as if she is going to be graded on her birth plan. “Overachiever that I am, I wanted to get through the birth without drugs if I could.” Again, there is a glimmer of self-deprecating humor here, but it doesn’t discount the fact that Roper is laboring under the same set of expectations as the other writers included.
I want to make clear here that I am not blaming the individual essayists for sharing their personal experiences of childbirth, and I’m not dismissing their reactions to their own births. I’m blaming the editors for not trying harder to find a more diverse set of views and experiences among the essayists. Eighty-three percent of women delivering in America use some kind of pain relief, so it probably would not have been that difficult to find more women writers who not only used medical interventions, but didn’t judge themselves or other mothers for doing so.
There is no way to do labor “right” or “wrong,” and it’s damaging to perpetuate a one-size-fits-all approach to having babies. Taking pain meds doesn’t make you a weak or fearful person. It doesn’t make you a bad mother. Taking pain meds just makes you a person who would like to experience somewhat less pain. That’s all.
Please click on the link below for the story, broadcast March 9, 2015:
The Gentle Cesarean: More Like A Birth Than An Operation : Shots – Health News : NPR.
LONDON — Reversing a generation of guidance on childbirth, Britain’s national health service on Wednesday advised healthy women that it was safer to have their babies at home, or in a birth center, than in a hospital.
Women with uncomplicated pregnancies — about 45 percent of the total — were better off in the hands of midwives than hospital doctors during birth, according to new guidelines by the National Institute for Health and Care Excellence. For these low-risk mothers-to-be, giving birth in a traditional maternity ward increased the chances of surgical intervention and therefore infection, the regulator said.
Hospital births were more likely to end in cesarean sections or involve episiotomies, a government financed 2011 study carried out by researchers at Oxford University showed. Women were more likely to be given epidurals, which numb the pain of labor but also increase the risk of a protracted birth that required forceps and damaged the perineum.
The risk of death or serious complications for babies was the same in all three settings, with one exception: In the case of first-time mothers, home birth slightly increased that risk. Nine in 1,000 cases would experience serious complications, compared with five in 1,000 for babies born in a hospital.
The findings could affect how hundreds of thousands of British women think about one of the biggest questions facing them. Nine in 10 of the roughly 700,000 babies born every year in England and Wales were delivered in a hospital.
As recently as 2007, the guidelines had advised women to be “cautious” about home birth in the absence of conclusive risk assessments.
Mark Baker, clinical practice director for the health institute, said first-time mothers with low birth risks would now be advised that a midwife-led unit would be particularly suitable for them, while mothers who already have given birth would be told that a home birth would be equally safe for the baby and safer for the mother than a hospital. But women are still free to choose the option they are most comfortable with, Dr. Baker said. “This is all about women having a choice,” he said.
Not everyone was at ease with the new guidelines. “Things can go wrong very easily and we do feel this advice could be dangerous,” Lucy Jolin of the Birth Trauma Association told the BBC.
So far doctors have not expressed any outrage over the decision. “If we had done this 20 years ago there would have been a revolution,” Dr. Baker said. “The penny has dropped. We’ve won the argument.”
With the exception of the Netherlands, where home births have long been popular and relatively widespread, few developed countries have significant numbers of women opting for nonhospital deliveries. In the United States, where a culture of litigation adds a layer of complication, only 1.36 percent of births took place outside a hospital in 2012. Two-thirds of those nonhospital births took place at home and 29 percent at free-standing birthing centers, according to the National Center for Health Statistics.
“We believe that hospitals and birthing centers are the safest places for birth, safer than home,” said Dr. Jeffrey L. Ecker, the chairman of the committee on obstetrics practice for American College of Obstetricians and Gynecologists. Under Britain’s integrated health system, if there is a complication, “they have a process and protocol for appropriately and quickly getting you somewhere else,” said Dr. Ecker, who added that he did not believe the British-style guidelines would come to America anytime soon. If such a recommendation were made in the United States, doctors might worry about losing patients to midwives.
That concern is absent in Britain’s taxpayer-funded system. “There are no financial incentives in the U.K. for doctors to deliver in a particular setting because there is no personal gain,” said Dr. Baker of the health institute. Childbirth is “effectively an N.H.S. monopoly,” he said, referring to the National Health Service, Britain’s public health system.
Holly Powell Kennedy, the immediate past president of the American College of Nurse-Midwives, an organization in the United States, praised the guidelines, saying, “This is how the practice should be happening.” In a hospital, “you are less able to labor without interventions,” Dr. Kennedy said.
Reducing the number of hospital births would save the health service money, but British officials said budgets had not factored into the new guidelines. A traditional hospital birth costs the country’s health system about $2,500, with a home birth roughly $1,500 and a birth center about $2,200.
“Yes, it’s a very expensive way to deliver healthy babies to healthy women,” Dr. Baker said about hospital births. “Saving money is not a crime.”
Sitting on a chair for hours on end (as many of us do while at the computer) is not good for your posture, or health. So, during your pregnancy, try sitting on a chair with a fitness ball built in instead of your regular office chair, and see how helpful it is in keeping your spine straight and body centered.
When your body and baby are laboring, you want to keep your pelvis open and moving. Slow dancing with your partner is a great way to do this. Sitting on a birth ball (aka fitness ball) is also great. Whatever kind of birth you choose, with or without medication, you can literally rock your birth (and potentially shorten your labor) with the help of a birth ball.
During labor, birth balls are simple to use, and as long as your upper body is supported so you don’t fall off, safe. Simply sit on the ball and lean on whatever feels best to you: into the arms of your partner, your doula, the edge of the bed. The forward leaning position will help align and center your baby and is usually one of the most comfortable positions during strong contractions. Since the ball is waterproof, you can also sit on it while in the shower. Mamas I’ve worked with have sometimes stayed in their hospital room shower enjoying the warmth and relaxation of the water while laboring on the ball for hours at a time!
Another kind of ball you can use in labor is the peanut ball. As you’ve no doubt been told, lying on your back in labor is the worst place you want to be — both for your baby’s positioning, and your comfort. Lying on your side, however, is a great way to rest. Placing a peanut ball between your legs helps widen your pelvis and allows the baby more room to descend and rotate.
Birth balls are widely available (Target sells them in the sports section) and many hospitals already have them available for you to use when laboring there (White Plains Hospital and Greenwich Hospital, for example). Since it is best to keep your hips open and pelvis rotating in pregnancy anyway, you may want to have one available at home to sit on. Rock on, mamas.
by Maria Pokluda, co-creator of Birth Boot Camp DOULA
1. The research says you should.
2. Your partner will be able to eat, grab a cup of coffee and go to the bathroom knowing that he is not leaving you alone.
3. A doula won’t leave at shift change….even if your labor progresses through more than one shift change.
4. Doulas know the “best” for all things pregnancy. Be it in the search for the perfect care provider or the perfect maternity bra…doulas know and will share their knowledge.
5. Doulas give good foot rubs during labor.
6. Doulas give good back rubs during labor.
7. Your doula works for YOU. Not the hospital and not your care provider.
8. When a couple has a doula, they have better breastfeeding success.
9. Labor hurts less when you have a doula.
10. Labor is often faster when you have a doula.
11. When you are approaching your due date, your doula will never ask you, “Have you had that baby yet???”
12. A doula has a rebozo and knows how to use it.
13. Your doula will tell you that you are beautiful even if you are wearing a hospital gown. She totally believes it too.
14. She will listen and relive all the details of your birth both in the moments right after delivery and in the weeks to follow. She will probably even still remember details years later.
15. Woman who have doulas reduce their odds of having a cesarean delivery.
16. Doulas are great for babies too! A doula reduces NICU admission and hospital stays for mom and baby.
17. Doulas know your birth experience matters.
18. Doulas help your partner support you.
19. Your doula can talk you through your options at every step of the way. They won’t ever make decisions for you but they will help you ask the questions so that you can make the best choices for your birth.
20. Doulas will support you no matter what happens!
*Curious about some of these statements about doulas? Many are backed by research. Check out Cochrane Review for more info.*
Maria Pokluda is a doula serving families in the Dallas/Ft. Worth area. She got involved in birth through her own experience of researching infertility and then pregnancy and birth. Maria is the co-creator and trainer of Birth Boot Camp DOULA.
by Dr. Kelly Brogan
The modern woman is task-oriented. She lives in a world demanding of her competence, attention, and efficiency. We use technology, tap into our communities, plumb the depths of our reserves to navigate an often hyper-masculinized world while retaining our most vital feminine powers. The power that fundamentally defines our exemption from this contemporary lifestyle trajectory is baby making. This primal empowerment forms the bedrock of a woman’s most untouchable gifts. We have lost sight of this fact; however, and have allowed our inner compass to be co-opted. It’s certainly no wonder, that after 9 months of hyper-medicalized pregnancy “management” (often following months to years of assisted reproductive technologies), birth is considered another task on the to-do list to complete. As a type-A taskmaster, myself, I understand the lure of a predictable and painless depositing of your newborn after the long and fear-punctuated journey of pregnancy.
I’m here to tell you; however, what your obstetrician won’t.
Labor is a physiologic process that recruits neuro chemical, endocrine, and immune systems into a dance that we barely have the tools to conceptualize. When we meddle with this, when we attempt to standardize it, we put women and their babies at grave risk – physically, psychologically, and even spiritually. We rob women of an opportunity for psycho spiritual transcendence. As a science-minded medical doctor, I don’t wield this phrase with ease! The process of conception, gestation, and birth cannot, however, be reduced to daily activities and routine life occurrences. There is something built into our consciousness that makes room for its own expansion around these life transitions. The process of bodily separation – woman from her newborn – involves a passage through a space of trance-like awareness. I can only describe it as the sensation of floating and grounding, simultaneously. It is an experience that demands we move out of the space of our mind and into a space of sensation without judgment. It is being present, truly present, to behold a glimpse of what we are capable of as mammals and most importantly, as a human female.
In this way, a natural birth is an opportunity for redefinition and reconnection to one’s most core self. It is the way women were intended to pass through the gates of motherhood, to the next chapter of their actualization. If you buy the potential significance of these considerations, you may want to know what represents your greatest obstacle and impediment in achieving this life milestone. You may be surprised to learn that it is epidural anesthesia. This discussion is meant to shine a light on elective epidurals – that, “Why not? Who wants to feel crazy intense pain?” choice that 2/3rds of women (and up to 90% in some hospitals) opt for every day. In my opinion, the epidural intervention is the most reprehensible of all – because of its largely dismissed risk profile, and because of its auspicious position in a cascade of interventions, unnecessary, ill-conceived, and rife with unintended consequences including death. If we can empower women to question the validity of this procedure, then they can retain the right to preserve the integrity of their birth experience.
What’s the big deal with Epidurals?
A 60% rise in C-sections since 1996 is prompting the American College of Obstetricians and Gynecologists to fidget self-consciously in their white coats. A study revealing the prolongation of the second stage of labor thanks to epidurals has been influential in identifying the iatrogenesis – doctor-caused harm – at the root of the cesarean problem.
It appears that, thanks to an antiquated but still sanctioned construct – Friedman’s curve – the hospital clock starts ticking loudly upon arrival, and the alarm goes off after 3 hours of second stage labor with a epidural. At this non-evidence-based juncture, interventions including IV fluids, continuous monitoring, food and drink restriction, and immobilization conspire to invite pitocin, forceps, vacuum, episiotomy, and surgery into the delivery room. Obstetrics is vulnerable to practicing consensus medicine – habitual practice that is not predicated on sounds science. As I discuss here, metanalysis has demonstrated that only 30% of current obstetrical recommendations are based on quality data. What’s the rest based on? Fear-mongering and personal opinion? Let’s look at what the evidence suggests about the risks of epidurals, considering that up to 41% of women never properly consented for this intervention. Epidurals are offered with a plethora of accoutrements including catheters for involuntary urination, blood pressure monitoring and IV fluids for changes to vascular physiology, and continuous fetal monitoring because of risk to the baby of decreased oxygen flow (1, 2). The changes to natural labor progression are compounded by risk of fever in the mother that leads to further separation of mom and baby after birth, secondary to testing and assessment for infection. This separation represents a stress to the shared adaptation to early postpartum life and may predispose to psychiatric pathology in both mom and baby through early epigenetic influences on gene expression (3,4,5). This separation may also interfere with breastfeeding establishment. In this way, epidurals may be directly and indirectly responsible for breastfeeding struggles(6,7). Breastfeeding appears to prevent the onset of postpartum depression if it is established within 3 months, in addition to being a continual source of immunologically essential information trafficked from mom to baby.
Shooting Up You and Your Baby
Epidurals are a delivery method for narcotic pain-killers that pass through the placenta to the baby and have largely unpredictable effects on the birthing woman. Evidence supports risks to the baby including reduced tone, poor feeding, jaundice, withdrawal, and sensorimotor impairment (8). Physiologic risks to the mother include acute and persistent problems such as numbness, tingling, dizziness, respiratory paralysis, cardiac arrest, nerve injury, abscess, and death (9,10).
Hurrying Up
When epidurals lengthen the second stage of labor, Pitocin, or synthetic mimic of the brain hormone, oxytocin, is delivered to augment the process. Because Pitocin does not cross the blood-brain barrier, it does not stimulate endorphin release. It also interferes with feedback loops suppressing natural oxytocin production while hyper-stimulating the uterus without appropriate relaxation between contractions. The significance of this is just being revealed and may even reach to risk factors for autism.
Cutting Up
The increased risk of c-section (11,12) in the wake of epidural anesthesia is easily explained by relaxation of pelvic muscles that detach a woman from the instinctive guiding forces of an uninhibited labor, by the baby’s increased distress secondary to narcotic exposure and malposition, by the recruitment of Pitocin which causes uterine and therefore fetal distress, and fetal monitoring which, while superficially reassuring results in increased interventions (2-3x c-section rate) without improved outcomes. Your doctor may fail to mention that a surgical birth brings with it these risk considerations: protracted recovery, infection (including necrotizing fasciitis), organ damage, adhesions, hemorrhage, embolism, hysterectomy, wound dehiscence, early infant separation, higher risk of respiratory problems for baby, and an exponentially increased risk of placenta accreta, a potentially lethal complication of surgical birth, contributing to a 3.6 fold increase in maternal death after cesarean relative to vaginal birth. Of primary interest to clinicians who appreciate the role of the gut microbiome in child and adult health, abdicating a vaginal transfer of beneficial bacteria may set the stage for chronic disease including a 20% increased risk of obesity.
Opting out of epidural anesthesia: Choosing to feel
What are the best ways to help your body, mind, and spirit align for this tumultuous but life empowering journey?
Movement – Staying active during pregnancy is optimal mind-body medicine. Yoga, home-based routines, and swimming in unchlorinated water are excellent choices, at least 3 times weekly.
Chiropractic – With advanced perinatal training, holistic chiropractors are critical experts in proper alignment and nervous system support to facilitate a physiologic birth.
Acupuncture – Applied before and even during labor, acupuncture can gently and effectively facilitate a healthy labor and delivery. According to a Cochrane Review, acupuncture and hypnosis meet evidence-based efficacy criteria for pain management in labor.
Controlled Breathing/Meditation – Perhaps the most important tool for a new mother, learning to engage the relaxation response in pregnancy will help you to know what it feels like to be present to the labor experience, to go inward, quiet your mind, and release fear. Hypnobabies and hypnobirthing are well-regarded methodologies.
Diet – The physical experience of labor and delivery is best supported by stocking the shelves up front for a healthy hormonal response with minimization of inflammation and maximization of nutrient-density. Eat sustainable, organic meat, fish, eggs, veggies including root vegetables and squash, fruit, nuts, and seeds. Leverage the complexity of food-based information to promote optimal gene expression in that growing baby, and support a healthy delivery and postpartum experience.
Doula – Preparation for labor, and support for mother and spouse have been traditionally left in the hands of a woman’s most doting partner, a doula. No woman should birth in a hospital without this advocate. Evidence supports a doula’s ability to help you achieve an intervention-free birth.
While my most heart-filling emails every day are from my home birthing patients, I aim to sit in a place of true advocacy for the women that I treat and advise. I believe in informed consent, and I observe that this is not occurring in hospitals today. Explore resources that will help to expose you to the known risks and popularized benefits, so that you are making your own decision with your eyes wide open. As most women who have experienced natural birth would attest – just when you think you can’t do it and your mind demands surrender – you meet your baby, and the world stands still in a moment of unparalleled beauty and wonder.
About The Author
As an undergraduate at M.I.T., Dr. Kelly Brogan studied Cognitive Neuroscience and worked with Harvard undergraduates to create a public forum for the discussion of alternative medicine, directing conferences for the Hippocratic Society. She attended Cornell Medical School where she was awarded the Rudin Scholarship for Psychiatric Oncology and began her work in Reproductive Psychiatry, which she went on to train in during her residency at NYU/Bellevue. A strong interest in the interface of medicine and psychiatry led her to pursue a fellowship in Consultation Liaison/Psychosomatic Medicine at NYU/Bellevue/VA Hospital. Since that time, she remains on faculty and has focused her efforts on her private practice where she cares for women across the life cycle including pregnancy and postpartum. A passion for holistic living, environmental medicine, and nutrition are the bedrock of her functional medicine practice. She has published in the field of Psycho-Oncology, Women’s Health, Perinatal Mental Health, Alternative Medicine, and Infectious Disease. She is Board Certified in Psychiatry, Psychosomatic Medicine, as well as Board Certified in Integrative and Holistic Medicine.
You can learn more about her at http://www.kellybroganmd.com, and connect with her on Facebook, Twitter, and through her monthly newsletter.
Sources:
1 http://www.ncbi.nlm.nih.gov/pubmed/15957994
2 http://www.ncbi.nlm.nih.gov/pubmed/12011872
3 http://www.ncbi.nlm.nih.gov/pubmed/24552992
4 http://www.ncbi.nlm.nih.gov/pubmed/12011872
5 http://www.ncbi.nlm.nih.gov/pubmed/23972903
6 http://www.nutricionhospitalaria.com/pdf/6395.pdf
7 http://www.internationalbreastfeedingjournal.com/content/1/1/24
8 http://www.ncbi.nlm.nih.gov/pubmed/12011872
9 http://onlinelibrary.wiley.com/doi/10.1016/S0091-2182%2897%2900052-9/abstract
10 http://www.ncbi.nlm.nih.gov/pubmed/17447690
11 http://www2.cfpc.ca/local/user/files/%7B8030D89F-B698-4F9D-B6A7-190AD9866E59%7D/Kotaska%20Klein%20epidural%20oxy.pdf
12 http://summaries.cochrane.org/CD000331/epidurals-for-pain-relief-in-labour
– See more at: http://www.thehealthyhomeeconomist.com/epidurals-wolf-sheeps-clothing/#sthash.Wwo7fPmo.dpuf
Birth with Confidence 