Tuesday, July 15, 2008

Can I Afford A Doula?

This question is a big one in the doula community and I am sure for those deciding whether or not to hire a doula.

A better question would be can I afford not to hire a doula?

With the c-section rate sky rocketing and the financial burdens that accompany having a c-section it might be seen as penny wise pound foolish not to hire a doula.

The World Health Organization believes that c-section rates should not exceed 15%. Currently the statistics show that 30% of all healthy pregnancies are ending up in c-sections in the United States. Most of them are unnecessary.

In NYC the rate is closer to 50%.

We are one of the most educated generations. Most moms-to-be are going to birthing classes and reading tons of books and yet the c-section rate is climbing.

Acoording to womensenews.org, in 2005 the average cost of a vaginal birth was $5,574 compared to $11,361 for a c-section.

I know I know...YOU aren't paying for it, your insurance company is.

In the June 1, 2008 edition of the NYTimes, writer Denise Grady tells us that many insurance companies are dropping women who have had c-sections because they are pretty much a guarentee that another c-section will be incurred due to the pressure from hospital policy, not medical evidence. So where does having a c-section lead you then?

Aside from the financial aspects of having an unnecessary c-section the physical risks are as follows:

- blood clots, strokes, emergency hysterectomy, infection, long lasting pain, fertility problems, placental problems in later pregnancies such as ectopic or abruptions.
Generally the recovery time is six weeks without complications.

babies -
- breathing problems, surgical injury, reduced breast feeding and asthma in later childhood.

I think it is really amazing just how many books moms today are reading. However, much like reading about how to ride a bike, it's just not the same until you experience the situation.

Childbirth has so many variables today that one cannot possibly be expected to know how to handle them without a trained doula by her side. There's so much pressure to follow what the doctor wants you to do and those of us who have been to many births know that there is very little consistency in what those protocals are. The only consistancy most of us do find is the push to comply with interventions that have a high rate of ending in c-sections.

That is why study after study for more than 30 years have concluded that having a doula with you even when your spouse is available and supportive, halves your chances of having an unnecessary c-section as well as shortening labor time and pain levels.

A great book to get you started on the truth about birth is by Ina May Gaskin called Ina May's Guide to Childbirth.

In NYC currently the average cost of an experienced doula (10 or more births is ) $1500-$3000. A Trained Doula with less than 10 births and/or going for her certification usually charges $500-$800. On Long Island the average charge is $1000-$1500 for an experienced doula.

Doulas visit with you before the baby is born to discuss your birth wishes, work with you from the time active labor starts until one hour after the baby is born, and visit again once to see how you are doing and give you information on postnatal support professionals if needed. Doulas are also on call the two weeks leading up to your due date and take unlimited emails and calls from you.

The average hourly wage for most doulas fees amount to $10-$25 an hour and in most cases about one-weeks salary in the NYC area.

We understand that in some cases for some income levels this is not affordable. If you earn $30K or less in the NYC area these fees can be adjusted. Many doulas will also do volunteer births for teenagers.

For middle income couples a trained doula might be your best option while those earning slightly less might ask for reduced fees or payment plan options. If having a doula with more than 10 births is very important to you then hiring a doula at the higher range of the fee scale will be necessary.

Each doula comes with unique experiences that will be invaluable to your birth of your baby regardless of the experience level of that particular doula.

For more information on my doula services please visit www.nycdoulaservice.com

Friday, July 11, 2008

Jennifer Block Author of the New Book Pushed Responds to ACOG on Home Birth

From the Los Angeles Times

Big Medicine's blowback on home births
Why do U.S. doctors strong-arm women into our standard maternity care system?

By Jennifer Block
July 9, 2008

Jennifer Block the author of "Pushed: The Painful Truth About Childbirth and Modern Maternity Care" wrote an amazing piece in the LA Times on July 9.

Key points from her published piece are as follows: (taken directly from her article)

Her friend in Britian received the following care last year:
  • As a healthy woman with a normal pregnancy, she saw midwives. And one of their first questions to her was, "So, would you like to give birth in the hospital maternity ward or at home?"
  • Britain's national health guidelines call water the safest, most effective form of pain relief. A woman will be helped to give birth in positions that are effective and protective: sitting, squatting, on hands and knees, even standing.

But hospital maternity care in the U.S. is typically not supportive of this process.

  • More than half of women are induced into labor, or it is sped up with artificial hormones; the vast majority of women labor and push in the desultory flat-on-the- back or leaning-back position; and (perhaps not surprisingly) nearly one-third of women end up giving birth through major surgery, the caesarean section.
  • This has led to an epidemic of pre-term births in the United States. A 2006 survey showed that the majority of babies are now born before the spontaneous onset of labor, which leaves them more prone to breathing and feeding difficulties. Caesareans are also contributing to a rising maternal death rate, announced by the Centers for Disease Control and Prevention last year.

The choice to give birth somewhere other than a hospital is backed by sound science. Studies of "low-risk" women in North America planning out-of-hospital births with midwives have found that 95% give birth vaginally with hardly any medical intervention. The largest and most rigorous study to date, published in the British Medical Journal, found that in North America, babies were born at home just as safely as in the hospital.Organized medicine can't believe this.

In a joint statement last year, the Royal College of Obstetricians and Gynecologists and the Royal College of Midwives said, "There is no reason why home birth should not be offered to women at low risk of complications, and it may confer considerable benefits for them and their families."

For the full article please click on the link above.

Thursday, July 10, 2008

Survey of Mothers' Sleep & Fatigue

Texas Tech University Is Searching For Research Participants
"In this survey, we will be asking you some detailed questions about how well you and your baby sleep, where members of your family usually sleep, and how tired you feel on most days. We will also ask you some questions about things that can interfere with sleep. There are very few studies on this important topic, and we will use the results for a research study. There are no benefits to you for completing this survey, but your answers will help us educate providers about the realities you face as a new mother."

Please follow the link above to participate.

Tuesday, July 8, 2008

New Birthing Center Slated To Open In Manhattan

A group of midwifery advocates have banded together to open a new birthing center in Manhattan. This will fill the void of the closing of the Elizabeth Seton Center, which was part of St. Vincent's hospital, which I happen to have first-hand experince in saying is extremely birth and mom friendly.

If I had my pick of hospitals to labor and birth in NYC I personally would choose St. Vincent's for a hospital birth.

The new Birthing Center will be at 30th Street and 7th Avenue to open in 2010.

Apparently some high profile celebs are backing this new center, namely, Ricki Lake, Rosie O’Donnell and Gloria Steinhem.

The Seton Center, part of the Saint Vincent Catholic Medical Centers system, closed in part due to the soaring cost of malpractice insurance for midwives. The new center will require practitioners to purchase their own insurance, with midwives and doctors operating as independent contractors billing insurers directly.

Ricki Lake, Rosie O’Donnell and Gloria Steinhem are helping to raise money for the center. Much of the fundraising is being done through screening of The Business of Being Born, a documentary featuring the home birth of Ms. Lake’s second son. If you have a chance to go and see this documentary please do as it will help create and sustain this incredible new center.

Saturday, July 5, 2008

DONA's Press Release Response to ACOG's Position On Home Birth

In June, you covered Ricki Lake's controversial documentary about home births which instigated a growing battle between the American College of Obstetricians and Gynecologists (ACOG), the American Medical Association (AMA), midwives, and patients.

The conflict is about the perceived safety of home births and the useof Certified Professional Midwives (CPM) or “lay” midwives. Last month, the AMA issued a resolution asking for legislation against homebirths and against “lay” midwives.

As President of DONA International, the oldest and largest association of doulas in the world, we represent the thousands of woman who cherish their ability to choose where they give birth and with whom.We also question the evidence supporting the ACOG and AMA’s statements that “the safest setting for labor, delivery and the immediate post-partum period is in the hospital ….”

The largest, most respected study of home births found that among 5,000 low-risk pregnancies, babies were delivered just as safely at home with a CPM as in a hospital. Currently, twenty-one states license midwives to attend home births, using both CM certified midwives,which the AMA and ACOG recognize and CPM designated midwives, which they do not. Only about one percent of American births take place outside of a hospital. Because most doulas work with midwives and physicians in a hospital setting, DONA International has no financial interest in the outcome of such legislation called for by the AMA. Our interest is in the scientific evidence and in maintaining the conviction that pregnant women, just as all other patients, are intelligent enough to give informed consent.

Debbie Young, President of DONA International

Friday, July 4, 2008

Are you being denied a VBAC?

"I’m a lawyer with the Northwest Women’s Law Center inSeattle. I’m investigating possible legal responses to bans on vaginal birth after cesarean at hospitals in the northwest states Alaska, Idaho, Montana, Washington and Oregon. If you are currently pregnant and want to have a VBAC, but are facing a hospital policy that would require you to have a c-section regardless of whether you want it and regardless of whether it is actually medically necessary, and you are willing to consider working with a lawyer on this, we’d like to talk with you. Please respond to vbacbanhelp@ican-online.org ."

On A More Serious Note

The following story is re-posted with permission from Candid Carrie.
Carrie is a mother of MANY. This is her story of the birth and loss of one of her twins.
When pregnant we never want to think about the possibility of loss, however, sometimes loss comes. Life has a funny way of twisting and turning no matter how much we think we are in control. Carrie shares her thoughts about how friends and family can truly be supportive in these times. Thank you Carrie for allowing me to share your story.

I need to speak about something serious today. I don't do that very often, so bear with me.

A couple of my friends (yes, even if I have never actually met you guys) that I know from blogging have had their lives altered because someone they know experienced the death of a child.

Having been there myself, I thought I would share my experiences with the resulting aftermath and reassure you that there really are some very simple ways that you can show your support during these difficult times.

First of all, let me tell you briefly about my situation. I say briefly because this post isn't really about me as much as how you can help others, but I don't want to leave anyone walking away without understanding where I am coming from here.

November of 1988, I had twins. I delivered at 38 weeks, a boy and a girl, each 18.5 inches and 5 pounds 2 ounces. No, they were not identical twins … one boy, one girl (fraternal twins). Madeleine was first, she came whizzing out, Apgar scores were six and eight and she was gorgeous, absolutely gorgeous.

Travis was next and it didn't go that smoothly. The umbilical cord was wrapped around his neck and my contractions had stopped completely. I was being prepped for a cesarean section, the sedatives were being administered and I told everyone to stop. I said I was delivering this baby now and I did. There were no contractions but I pushed and focused and it was really hard work, but out he came. Apgar scores were two and four. He was whisked down the hall at about six that morning and I held him for the first time at 10:30 that night.

I'll finish the story of Travis quickly, Travis is my nineteen year old son. He graduated from a Catholic boarding school in 2007, one of the top in his class. He finished his first year at Marquette University in Milwaukee Wisconsin this past May. He has played piano for fifteen years. Yes, fifteen years. He has played for schools, for churches, for weddings, for fun, for money, and just for the sheer love of it. He is back this summer working for the fifth year at a Cub Scout camp as a site manager. The only time this glorious child ever caused me any grief was those few minutes before he was born.

Now, back to Madeleine. During the commotion of Travis' birth, I was unaware that Madeleine's situation had changed. She was doing something called "choreatrophy." They weren't sure if it was a seizure or tremors and they decided to send her to a nearby hospital in Milwaukee. She was baptized and left Sheboygan about 10:30 that morning.

Obviously, there is much more to say about that day, but this isn't the time or my purpose.

Madeleine got her first gastrointestinal tube at age 3 months, her first tracheotomy tube was fitted at 13 months. She had twenty-four hour nursing care in our home for all seven years of her life.

Her official autopsy report indicated that had an undiagnosed (means they never really knew what it was) degenerative (means that she was always going down hill) neuromuscular (brain connecting with muscles) disorder (something is definitely not right here).

I have much more to write about Madeleine and I wasn't even quite ready to reveal all of that right now, but I needed to let you know about her to give myself some credibility on this topic

As I stated up front, I want to tell you things that you can do to help parents that have lost a child. This is a list of really simple things that can have a monumental impact on the child's family.

During that first week to ten days after the Madeleine's death, I was flooded with cards and mail (this was before e-mail). I opened and read every single piece and I was overwhelmed. There were cards from people who had lost a child, people who knew someone that had lost a child, people who had children that were born the same day as my child, oodles and oodles of people sent cards and letters.

But, here's what had the biggest impact on me. The cards that came after the two weeks were over. Those were the cards I remember the most vividly. The unexpected cards weren't an "after" thought, they were more of an "I'm still thinking" thought.

I would ask that if you know of someone in this situation, continue to send mail. Real mail, not e-mail. Something tangible, nothing says you care quite like a piece of mail. No need for profound wisdom either, just something simple like "I was thinking about you today" or "I am here if you need me" or anything, even just your name. If you can work something out so that a few people are sending cards on a regular basis, that is fantastic.

You will know when to stop sending the cards because the recipient will probably let you know. I was able to say, "Your cards have meant so much to me, but I am doing much better and I appreciate everything you have done for me." People get to that point at different times.

Another project that means the world is to have one person assigned to collect photographs. Quietly collect as many pictures of their child as you can and there is no need to worry about whether or not they are flattering photographs. Just get them from anyone who may have them. You can use an e-mail or word of mouth for that purpose.

Once you have collected them, put them on either a c.d. or whatever they are called today or set the photographs in an attractive box. Just don't put them in a scrapbook or photo album because that right belongs to the family. Even if you think it would be the sweetest thing to put them in an album, the family may not be ready for that or the family may believe it is therapeutic for them to process the pictures themselves.

After you have finished this project, tell the parents that you have collected all of the photographs that you could find and you will hang on to them until they are ready. I wasn't ready for two years. I never forgot that someone collected the pictures, I just wasn't ready to have them in my possession. Because of Madeleine's condition, she did not photograph well at all. Once she hit three months of age, the disease process sort of took over and altered her appearance. I was grateful to have the pictures collected, I was grateful to have someone holding them for me until I was ready, but my favorite pictures were and always will be of her as an infant.

Now, listen very carefully because this of the utmost importance. Don't underestimate the position of holding something until someone asks for it. If done in the right frame of mind, the keeper of the photographs has a thankless task. A great deal of energy went into the collecting and gathering and once you've made the announcement all you can do is wait for the day you hand them over. That is literally all you can do. To bring it up again would be inappropriate. The parents know you have the pictures, just wait until they are ready to have them in their possession and that works on their timeline, not yours.

Get out your calendar, your date book, your blackberry, whatever it is and record the day the child died. And the day of the funeral. And the child's birthday. Now put another note in the calendar a week before those dates and call your friend at that time. Every year.

Make a phone call and say, "Hey, I know it is getting to be about that time of the year and I want you to know I am available if you need me. It is alright if you don't need me and it is even alright if you call me in the middle of the night while everyone else is sleeping." Follow up with a tangible card and the offer again, include your phone numbers to make it more sincere and easier. And then really be there if you are needed.

I have friends today that never knew my daughter, but they know me and even if they don't know the exact date of the birth or death they are friends that I can trust my emotions with no matter when they surface. My friends also know that we never get tired of hearing our child's name, so please use it. Usually we spent a tremendous amount of time selecting that name and we weren't anywhere near hearing the end of it.

It is a weird club to be part of, parents that have lost children and there are days that we say and think the most ridiculous things but because we belong to that club we need to be forgiven quickly.

And finally, this needs to be said although it shouldn't need to be said. If you never lost a child but have lost a pet and you think you know how the parents feel, trust me … you don't and it is the last thing any family wants to hear is how sad you would be if you lost your dog because your dog is like your child.

Seriously, I've have lost many pets on my life's journey and there isn't any similarity at all. However, all "pain and grief" is relative and the loss of a pet "pain and grief " is genuine and deep and permanent. It just is in a different "pain and grief" category than children

So, I know this is a long post and I do have more ideas and ways to help families but I'll stop for today because I know this is a lot to handle right now and I know when readers stop here this isn't what they really expect.

And if you read to the bottom of this, I admire your tenacity to hang in there. I know it was a tough read.

It is alright if you don't leave a comment, this is awkward and you don't probably don't know what to say. You can close my blog and walk away, but please keep the information with you. I hope you never need to use it.

I do want you to know that it has been twelve years since Madeleine died I have the ability to look backwards and see how all of it lead me to be right here, today, sharing this with you.