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Cutting Baby Costs

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Having a baby can feel like a financially monumental event.  There are many ways to cut traditional costs from baby-having and baby-raising to help cover other items, such as hiring a doula!  Here are some of my favorite suggestions:

1.  Ask friends to chip in for big-ticket items and make smaller purchases yourself.  A great example of this is car seats, which are absolutely necessary and can be very expensive.  $100 to one person is a lot of money, but split between multiple people it becomes doable!  If you have lots of friends and family, asking each of them to chip in $5 or $10 to your doula fund might get the full cost covered. If a gift certificate is an option (click here to see mine), that is another way to let friends/family share in the cost.

2.  Buy used where you can.  This is NOT a safe suggestion for certain things, such as car seats (which are considered unusable after a car accident and have expiration dates for safe use) or cribs older than a few years (safety regulations change often).  When buying used items, it is generally a good idea to check for recalls.  A quick google search should suffice, or you can check the CPSC.  Some items that are easy to find used:  clothes, cloth diapers, carriers, strollers, blankets, bouncers and swings.

3.  Hold off buying items your baby may not like.  Many, many babies do not like swings or bouncers or certain types of baby carriers.  This can also be said for cribs, as many mamas find co-sleeping (safely, of course!) to be better for both, especially when breastfeeding. Wait until after baby is born and try out a friend or neighbor’s item before you buy!

4.  Use cloth diapers.  While not for everybody, I have found cloth diapers to be a major saver…both for my finances and my sanity.  No midnight dashes to the store because someone didn’t notice the diapers were almost out.  There is a bit of a transition with laundry, but I quickly found that I didn’t notice or feel as though I was doing lots more laundry.  Buying used or accepting hand-me-downs from friends can reduce this cost even further.  I estimate that I spent less than $500 diapering my FOUR kids.  If you’re feeling really bold, check into Elimination Communication, which will further reduce your costs and encourage you/baby to follow baby’s cues for pottying.

5.  Accept every usable hand-me-down that comes your way.  Invest in a few sturdy tubs and store those items until baby grows into them.  I haven’t needed to truly buy my oldest clothes until the last year or so, which is THIRTEEN years of practically free (I’m sure I bought some things!) clothing, bedding and more.  At the very least, accept the items and sort through, keeping what you like and donating or passing to another mama what you don’t.

6.  Breastfeed.  Feeding baby artificial food, formula, is usually the largest expense (second maybe to the actual birth, depending on care provider, setting, interventions and insurance coverage) and one that can often be completely avoided.  To learn more about breastfeeding and its benefits for both you and baby, check out this page on my site, visit a La Leche League meeting in your area or talk to some breastfeeding moms.  Breastfeeding is FREE, although having a quality pump for a full-time working mom may be a bit pricey (still cheaper than formula and many insurance companies are now covering them!).

7. Forego any unnecessary, but often absolutely adorable, baby items.  There is a plethora of items geared at your baby, 99% of which are just not necessary.  Your baby needs you and very little else.

8.  Start planning and saving now.  This isn’t so much a way to cut costs, but if you’re planning to have a baby in the near future or planning to try to conceive, start saving for necessities now.  Having money put away for that time will help ease the financial burden as well as provide you the opportunity to have some wiggle room should you decide you want to be home with your baby after he/she is born (assuming, of course, that you’ve been in the workforce).  **Disclaimer:  I am HORRIBLE at planning and have never managed to accomplish this goal, so no judgment on my part! ;)**

9. Have a regular swap with friends. This has worked well for my group of women. Once a year, or whenever you choose, we get together and make a huge pile of things we want to get rid of in the middle of the room. Sometimes, we make a game out of it and everyone gets to choose, then “steal” from others. Get creative and have fun!

10. Check with your insurance company and/or HSA to see if any service you are looking at is covered. Some companies are now covering or reimbursing midwives, doulas, chiropractors and more. HSAs are sometimes a little more flexible on where the money goes, so be sure to see if your funds can go toward any of those.

All of these ideas are small, but each *small* saving can add up to an overall substantial amount! Where have you been able to save while having kids? What purchases could you simply not live without?

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The Birthing Site

 

The Birthing Site is an all-encompassing website for expectant and new parents.  You can find articles on just about every topic, or ask questions.  Their directory has categories ranging from clothing to lawyers to chiropractors to doulas.  I am proud to have a listing on their site, as well as occasionally contributing some of my own writings to their pages.  In honor of Doula Week, they have opened up their Facebook “wall” for parents to ask doulas questions.  Each person who asks a question gets entered into a contest!

 

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New Research On Cutting The Cord, And Some Cool Pictures Too | Being Pregnant

New Research On Cutting The Cord, And Some Cool Pictures Too | Being Pregnant.

Great post, with links, about the benefits of delaying clamping the umbilical cord after birth.  If you only have a few minutes and are unable to read the entire article, be sure to check out the pictures.  The difference in the immediately-after-birth cord and fifteen-minutes-later cord is HUGE!

If you are interested in delaying the cord cutting after your child’s birth, be sure to speak with your care provider *before* labor begins.  Many physicians (and even some midwives) routinely cut the cord almost immediately after baby is born.  Sometimes, a little advanced notice of your wishes are all it takes to make them a reality!

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New ACOG Guidelines on VBAC

For those of you considering vaginal birth after cesearean (VBAC), the road has probably been rife with fighting.  Perhaps your doctor doesn’t think it is safe or perhaps your hospital doesn’t “allow” them.  Take heart, as the American Congress of Obstetricians and Gynecologists (ACOG) has revised its’ earlier, more restrictive guidelines for more evidence-based ones.

While I can not pretend to agree with most of what ACOG says and does, I do appreciate that they are potentially taking a step towards opening some doors for women who desire a VBAC.  I hope that having these guidelines in hand will empower some women to have the VBAC they desire instead of feeling forced into a reapeat cesarean.

To read the press release on ACOG’s website, click here.

To read International Cesarean Awareness Network’s (ICAN) response, click here.

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Are Kegels All They’re Cracked Up to Be?

Interesting article on the merits (or lack thereof) of kegel exercises, with alternatives.  For those of you who have worried about incontinence, this is a must read!  To read the article on the Mama Sweat blog, click here.

Monday, May 17, 2010

Pelvic Floor Party: Kegels are NOT invited.

You now have permission to pee in the shower. Recently I met a woman who told me she used to be a runner. Naturally, I asked: Why don’t you still run? The answer: “Because 60 hours of labor with my first child and a forceps delivery ruined my desire to run anymore.”
To sum up for those who still may not infer the problem: She pees her pants when she picks up the pace.
My friends and I joke about sneeze pee, jumping jack pee, trampoline pee, and other bladder challenges. But full blown incontinence is no laughing matter. I’m a firm believer that a strong pelvic floor is the answer to incontinence (although pharmaceutical companies and surgeons often try to persuade people with other remedies). A strong pelvic floor, I’ve learned, not only makes the difference between wet and dry running shorts, but also keeps me running pain-free: I no longer suffer from the back and hip problems that used to plague me.
So today I bring you an interview with Katy Bowman. I have had the opportunity to interview Katy for magazine articles. Since becoming a freelance writer 13 years ago I have interviewed scores of sources. Very few I remember. Katy made an impression. She is a biomechanical scientist who applies her knowledge on the human body. Among other things, she has her own DVD program, “Aligned and Well,” and is the director of the Restorative Exercise Institute. Her blog, Katy Says, is amazing (and she’s as funny as she is smart). I like that combination so I asked her to chime in about the pelvic floor. I had no idea she would rock my pelvic floor world. Even if you’ve never peed in your running shorts even a little bit, you should still read what she has to say about pelvic floor strength.

Mama Sweat: First, a lot of women just assume it’s childbirth that causes incontinence, but I’ve read that pregnancy itself puts a strain on the bladder (so a c-section won’t necessarily save you) and that most women, as they get older–whether they’ve had children or not–will likely experience problems with incontinence. And even men aren’t immune. All this suggests that a weak pelvic floor doesn’t discriminate.

Katy Bowman: Nulliparous women (that’s women who’ve never had a baby) and men are equally affected with PFD (pelvic floor disorder) so while child birth may accelerate PF weakening, it is not a primary cause of PFD. PFD is first caused by slack in the pelvic floor due to the fact that the sacrum is moving anterior, into the bowl of the pelvis. Because the PF muscles attach from the coccyx to the pubic bone, the closer these bony attachments get, the more slack in the PF (the PF becomes a hammock).

MS: So rather than a hammock, you’d rather your PF be more like a stretcher–more firm and able to hold up weight without buckling?

KB: I like to think of the PF like a trampoline–the material is supple, but taut…the perfect muscle length.

MS: And kegels. Everyone on my blog has heard me preach about kegels. I want to make sure all my readers are doing them right. Suggestions?

KB: A kegel attempts to strengthen the PF, but it really only continues to pull the sacrum inward promoting even more weakness, and more PF gripping. The muscles that balance out the anterior pull on the sacrum are the glutes. A lack of glutes (having no butt) is what makes this group so much more susceptible to PFD. Zero lumbar curvature (missing the little curve at the small of the back) is the most telling sign that the PF is beginning to weaken. Deep, regular squats (pictured in hunter-gathering mama) create the posterior pull on the sacrum. Peeing like this in the shower is a great daily practice, as is relaxing the PF muscles to make sure that you’re not squeezing the bathroom muscle closers too tight. Just close them enough…An easier way to say this is: Weak glutes + too many Kegels = PFD.

MS: OK, I had to step away from my computer a moment to fully process this. First of all, you just said it’s OK to pee in the shower, but what really has my head spinning–did I catch this right?–you said: Too many Kegels can cause PFD? Did everyone hear that loud screeching noise? You realize this goes against everything I’ve ever heard or read; that kegels are the be all end all for pelvic floor strength.

KB: I know, I feel like I’m running around saying The Sky is Falling, The Sky is Falling. The misunderstanding of pelvic floor issues is so widely spread, I’m a Team of One right now. But, I’ve got all of the science backing it up and it makes sense, the kegel is just such a huge part of our inherited culture information, no one bothered to fully examine it. Anyhow, your PF is underneath the weight of your organs, and the strength your PF needs is equal to this weight (you don’t need SUPER STRONG PF muscles, just enough to keep everything closed). When you run, the extra G forces (2-3) actually increase the “weight” while running, but the PF should be adapting, just like all your muscles. One of the biggest misnomers is that tight muscles are “strong” and loose muscles are “weak.” In actuality, the strongest muscle is one that is the perfect length – you need Pelvic Floor Goldilocks – it’s juuuuuust right. The Kegel keeps making the PF tighter and tighter (and weaker and weaker). The short term benefits are masking the long term detriments. Ditch the kegels and add two to three squat sessions throughout the day (anywhere). The glutes strengthen and as a result, they pull the sacrum back, stretching the PF from a hammock to a trampoline. Viola! You can still practice opening and closing your PF in real-time situations, but you don’t have to approach it like a weight-lifting session or anything. It doesn’t need to be on the To Do list 🙂

MS: I am ALL for scratching items off my to-do list! Before we get too carried away with our newfound freedom from Kegels, I want to get back to the role of our glutes. What you’re saying–and I love this–is that there’s a much better reason, besides aesthetics, to avoid the flat butt syndrome found in most older women (further exacerbated in “mom jeans”). Having a booty–as in strong glutes–will not only do wonders for your view from the backside but prevent you from peeing just a little (or a lot) when you sneeze. This is revolutionary. I love what I’m hearing.

KB: Ok, I’m yelling this: YOU REQUIRE YOUR BUTT MUSCLES! There aren’t any extraneous parts on the body! Every muscle is really a pulley that is holding your skeleton just so. When you let your glutes go, you allow the bones of the pelvis to collpase into themselves. The squat is the most effective and natural glute strengthener–using the full range of motion and your body weight. It is entirely more effective than any gym machine or contrived exercise. The hunter-gathering folks squat multiple times a day (or at least once in the morning), so they had a nice routine down over a lifetime. Doing this four to five times a day, every day of your pregnancy will improve the delivery as well!

MS: I’ve also read that squatting during pregnancy helps prevent the posterior position during delivery (when babies emerge face up, rather than face down), which causes excruciating back labor and with it more interventions, more cesarean deliveries. In America, where we tend to sit back and put our feet up rather than squat and sit forward, the posterior position is more common than in countries where squat sitting is the norm. I was a squatter during my pregnancies, but now I will continue: when I’m playing with The Boy, picking weeds in the yard, pulling laundry out of the dryer or getting a pot from the cupboard. Lots of opportunities to squat!

I know you’ve brought up posture as a culprit too. How does posture play a roll and how do we keep good pelvic posture?

KB: You can only have optimal PF function when the pelvis is in a particular position. The two bony points on the front of the pelvis (where you put your hands on your hips) should be vertically stacked over your pubic bone. Most women have become “tuckers” based on their mom or gram telling them to not stick their butt out. Athletes tend to be super-tight through the quads and psoas, which also keeps the pelvis tucked under. Wearing high heels requires women to reposition their joints to deal with the torque at the ankle, and many women will post-tilt the pelvis there as well. For optimal pelvic health, one needs to make sure the posterior muscles (glutes, hams, and calves) aren’t pulling the pelvis under and keep the psoas and groin loose as well.

MS: So, this requires that we stretch out the muscles in front and strengthen the muscles in back?

KB: The muscles are weak because they are tight. More “strength” or tension-increasing exercises are going to make it worse. Instead, muscle lengthening exercises–especially stretching the calves, hamstrings, groin (adductors)–are the best prescription. Also, you need to learn how to hold your pelvis correctly to optimize strength!

MS: Which brings me to your DVD with the awesome title: “Down There.”

KB: The DVD is designed to get the pelvis in the correct position so the PF can work optimally. Typical PF treatment is trying to strengthen the PF muscles with the pelvis itself is in the wrong position, which means the treatments don’t work very well. That’s why once you have surgery, the statistics say you will have to have a 2nd, 3rd, and even a 4th in your lifetime! It is not a permanent fix, so it’s better to not even go down that road. The DVD will teach you to stretch and relax the muscles that are pulling the pelvis out of alignment–and let the correct muscle tone of the PF re-establish itself.

MS: Should we watch it in the bedroom with the shades drawn or is this something we can do with the kiddies around?

KB: Yes! You can keep the lights on and even the front door open. The exercises are mostly inner thigh and back-of-the-leg stretching, so if you don’t tell anyone what it’s for then they’d never know. And it’s also a great program for kids to follow–especially if they are having problems wetting the bed–the muscle tension pattern is the same in the kids as they are in incontinent moms.

MS: OMG! If you were sitting here in front of me I’d kiss you right now! I am forever washing bedsheets. I can’t wait to try it out.

Let’s get back to peeing in the shower. Now that you’ve legitimized it for us (I don’t advise this practice at the gym, however), let me ask this: Why do I feel the urge to pee a little (or, OK, I’ll say it, sometimes a lot) when I hit a warm shower? Wasn’t this covered in a Seinfeld episode? Seriously, what is it about the warm water that makes me want to let go?

KB: When the PF is weak, women start to use the glutes and adductors to keep the bladder closed (instead of the sphincter muscle of the bladder itself). When you hit the shower, those external muscles relax and HELLO! you realize that you don’t have actual control of the deeper, internal muscles of the PF.

MS: OK. I thought my PF was strong, but I see I have more work to do. I suppose it’s like any muscle, strengthening must be an on-going practice. But for someone who is suffering from incontinence, or this friend of mine who is afraid to run, how soon should they expect to notice a difference once they start a “training program”? And at what point should a woman consider pharmaceutical or surgical options? Ever?

KB: I don’t think a surgical option is ever a good idea, as the problem isn’t coming from one time damage, but the accumulation of 1) bearing down a lot and 2) from squeezing the PF all the time. Working on relaxing the PF and keeping it closed “just enough,” stretching the backs of the legs to free up the pelvis, doing regular, daily squats to strengthen the glutes, and ditching the heels (except in special occasions) are things you can do all the time for all-the-time improvement. Also, doing tons of crunches where you are bearing down on the PF will only make PF health worse. It’s better to do transverse abdominal stabilizing exercises – like the plank – that will decrease any bearing down that sprains pelvic organ ligaments. Once you get yourself out of the weak and overcompensating PF tension cycle, you should feel like you have better bladder control within a few weeks. If you are already experiencing organ prolapse (it is way more common that people realize) you need to skip the run and switch to long, endurance walks (minimize G forces), and do your pelvic-aligning exercises every day–maybe even twice.

MS: Wow. This is revolutionary. And it makes sense. I can hardly believe I’m just. now. learning. this. I can’t be the only one who’s feeling a little cheated. Women (and men) need to know all this. Thank you, Katy, for answering my questions and sharing your knowledge. I know this information will change a lot of lives. And if I can stop buying nighttime pull-ups for my girls, the benefits are more far reaching than I thought!

Do you want your own copy of the “Down There” DVD? I have one to give away! Katy was kind enough to send one to me. I just got a look-see and what I love most is that it’s short and sweet, my kids were able to follow along too, and most were multitasking exercises I could do while waiting for the school bus or in line at the grocery store. Efficient!

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Ergo Giveaway!

The Bragging Mommy is giving away an Ergo baby carrier!!!  If you have a baby, you NEED this carrier.  I started using mine when my baby was around three months old and I haven’t stopped yet.  I wear it every day.  It is quite possibly the most comfortable and versatile carrier I’ve seen, and I’ve seen a lot of them.

Hop on over and enter for a chance to win….good luck!

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Crying It Out

I recently read this post by Woman, Uncensored.  She does an excellent job of paralleling how an adult feels when forced to be treated in this manner.  Really makes you think, no?  How would you feel if your partner turned his back on your tears?  How would you feel if he suddenly stopped sleeping next to you in bed (remember, your baby has been sleeping inside of you, listening to your heartbeat, for nine months!)?

I remember hearing this advice only a few times when my daughter was a baby.  I felt lucky to be surrounded by loving, supportive family members who appreciated and respected the importance of her needs.

I also remember the story of a family friend whose husband held her outside her infant son’s door to keep her from soothing his cries.  The pain on her face, even after 10 years, as she told this story made me feel it.  Other stories from other mothers didn’t affect me as much.  One mom, from a playgroup I was in, told of how she always ran the vacuum to drown out her child’s cry.  She advised another new mom to take a walk around the house so she didn’t feel so bad.

The way I see it, if you feel the need to comfort your child…you should.  There’s a reason that we, as mothers, can not stand to hear our babies cry.  They need us.  They need to be comforted, to be fed, to be warm, to be held.  They are incapable of manipulating us.  I wonder what happens when that feeling is ignored long enough?  Does it go away, along with the natural attachment fulfilling your child’s needs brings?

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Birth Center in St. Louis

Below is an article about the new birth center, The Birth and Wellness Center, opening this summer in O’Fallon.  Click here for the website view.

Birth center set to open in area
birth

Genevieve Calkins, business manager, (left) and Jessica Henman, nurse midwife, are opening the Birth and Wellness Center this summer in O’Fallon, Mo. The photo was taken in Calkins’ home. (Sarah Conard)
ST. LOUIS POST-DISPATCH
03/11/2010
The first birth center in the St. Louis area is expected to open this summer in O’Fallon, Mo., giving women a birthing choice that is increasingly in demand. Advocates say it could be a key to improving the U.S. maternity care system.

Certified nurse midwife Jessica Henman and Genevieve Calkins expect to open the Birth and Wellness Center in June. They are waiting for approval of their lease application before announcing the location.

Henman, 35, of Wright City, will care for pregnant and laboring women while Calkins, 30, of St. Peters, will serve as the business manager. They will work with a doctor who will handle patients whose pregnancies become high-risk or need to be transferred to a hospital.

Birth centers serve healthy women with low-risk pregnancies who desire a birth with little medical intervention. Birth centers are commonly staffed by nationally certified and trained midwives, who focus on education and care that promotes physiologic birth. The centers are home-like environments with private rooms, each with a birthing tub.

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Even before the doors have opened, Henman said nearly a dozen pregnant women have planned to deliver their babies at the center; and another group is willing to fund an effort for her to open a second center in St. Louis County.

“There is a wave coming across Missouri. Women are searching for more options and more say in their health care,” Henman said. “Hospital care isn’t the only care that should be available.”

The wave mirrors a nationwide desire for more birthing choices. A federal report released last week found that after a gradual decline from 1990 to 2004, out-of-hospital births increased more than 3 percent from 2004 to 2006. States with increasing access to birth centers and midwives saw steep increases of 15 percent or more, while other states saw declines.

“When it is an option, women will choose it,” said Kate Bauer, director of the American Association of Birth Centers.

More birthing choices is one of several key recommendations for maternity care that were recently released by Childbirth Connection, a 92-year-old nonprofit that works to improve maternity care through research. More than 100 stakeholders representing providers, hospitals, health plans, educators and consumers worked for two years on the recommendations after agreeing on some serious shortcomings in care.

Several challenges remain, however, for out-of-hospital providers. Missouri’s only other birth center, in Columbia, closed at the end of last year.. Groups wanting to open birth centers in other parts of the state and in Illinois face hurdles. For Henman and Calkins, the road wasn’t easy.

‘BETTER CHOICE’

One of Henman’s first patients will be Joanna Sargent of Maplewood, who came across the center’s website while searching for midwifery care. She is due in September with her fourth child.

Sargent delivered her other children in hospitals, but she has since learned more about the midwifery model and risks associated with interventions commonplace in hospitals.

“I feel more educated about the birthing process; and I feel, for me, the better choice is away from the hospital,” said Sargent, 35. “I had considered home birth, but it wasn’t something my husband was totally set on. The birthing center was a good compromise for the both of us,”

Sargent is the typical demographic of women seeking out-of-hospital birth, which is a woman who is white, married, over the age of 25 and has previous children, according to the report released by Centers for Disease Control and Prevention.

The authors stated women may choose home birth for a variety of cultural, religious and economical reasons; or like Sargent, they share a desire for a low-intervention birth.

Women stand to make significant gains in the quality and value of their maternity care, says Childbirth Connection director Maureen Corry. While most women and their babies are healthy and low-risk, routine care is technology-intensive, she said. Risky procedures are overused and wasteful, while proven ones are under utilized and generally less expensive. Wide variations in use of interventions and outcomes can be seen across regions, facilities and providers.

Six of the 10 most common hospital procedures in 2007 were maternity related, and cesarean section was the top operating procedure, according to last year’s report by the Agency for Healthcare Research and Quality. Maternal and newborn hospital charges exceeded $86 billion in 2007, with Medicaid paying for 42 percent.

Medically induced labor has more than doubled since 1990 to 22.5 percent of births in 2006 (some studies suggest the number is closer to 34 percent). The cesarean rate has hit an all-time high — 31.8 percent.

‘BLUEPRINT FOR ACTION’

Recommendations developed by the stakeholder groups called upon by Childbirth Connection include everything from payment reform to promoting a cultural shift in fear-based attitudes about childbearing. Their “Blueprint for Action” was printed in January’s Women’s Health Issues medical journal,

One key action step is implementing policies that foster physiologic childbirth and decrease excessive use of elective procedures. This would include changing state laws and insurance regulations to promote access to midwives and birth centers and providing more training options for midwives. Ideally, midwives and obstetricians would collaborate to create a continuum of care.

“Most U.S. births are attended by specialists trained in high-risk pregnancy and disease management, a large number who have little training or experience in protecting, promoting and supporting physiologic birth — the most appropriate care for most of the population,” the report stated.

Dr. Tina Foster, an obstetrician at Dartmouth-Hitchcock Medical Center who contributed to the blueprint, said whatever choice a woman makes should be informed and supported in the safest way possible.

“We need to support the woman who wants an unmedicated physiologic birth, and the other woman who knows she wants an epidural,” she said. “We need to understand what people want and be willing to provide it.”

LABOR COACH

Henman became a registered nurse in 1996 and worked in cardiology before becoming a childbirth educator and labor coach. Helping women through labor sparked her desire to be a midwife, she said.

At the time, certified professional midwives (who have no nursing degree) were illegal in Missouri. Henman set out to get her advanced nursing degree in midwifery through the distance learning program at Frontier School of Midwifery and Family Nursing in Kentucky. She and her family had to move to Pennsylvania last fall to cram in her clinical requirements at a busy birthing center.

Her biggest challenge in opening a birth center, however, has been finding a doctor to sign a “collaborative practice agreement,” a legal document outlining their responsibilities. Missouri law requires nurse midwives to have the written agreement in order to practice. While national standards for nurse midwives require collaboration with physicians much like primary doctors and specialists, the requirement of a legal document scares off many doctors in today’s litigious atmosphere, she said.

Henman said she contacted more than 50 doctors before finally finding one willing to work with her. He asked not to be identified until the document is finalized.

Finding a collaborating doctor is what caused the state’s only birth center in Columbia, Mo., to close at the end of December after the physician left for a career change. The center is staffed by certified professional midwives, who can practice without a written agreement, but need a doctor in order to get reimbursed by insurance.

“There’s a lot of people willing to support it (out-of-hospital birth), but the laws are still funky; and until it gets straightened out, it’s going to be a struggle” said Ivy White, a midwife at the Columbia center.

Another challenge in Missouri is the state’s licensing requirements for birth centers, which Henman and others are trying to change, Birth centers are licensed as ambulatory surgical centers even though no surgeries take place. Many of the requirements are expensive and unnecessary, says nurse midwife Rachel Williston, 34, who wants to open a birth center in Independence, Mo.

Difficult legal requirements in Illinois for birth centers are also holding up groups in Illinois who want to open the state’s first centers.

While many barriers still remain, efforts to provide more birthing choices for women are clearly on the rise, said Corry at Childbirth Connection. “It’s not revolutionary, it’s evolutionary.”

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Circumcision

Circumcision can be a very controversial topic, and emotions tend to run high when discussing whether or not a parent should make this decision for their child.

There seem to be three main camps when it comes to this decision:

1.  Those who feel that a circumcised penis is cleaner, healthier and safer.

2.  Those who circumcise solely for religious reasons.

3.  Those who feel that an intact penis is healthier, safer and/or the decision to have a part of the body altered belongs exclusively to the person whose body it is.

In an effort to aid parents who are trying to decide, the Boys Health Advisory has launched a new website called Circumcision Decision-Maker.  I am passing this along for those of you who would like to do further research before deciding.

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Article: A Doula Makes the Difference!

A facebook friend of mine recently shared the following 1998 article from Mothering magazine (you can also click here to go to the site and read article there):

I will add only that there are now several different organizations that train/certify doulas in addition to DONA.

A Doula Makes the Difference!

Karen Nugent
Issue 87, March/April 1998

We couldn’t have done it without our doula!

Despite difficulties encountered during an arduous 96-hour labor, my husband Paul and I cherish the birth day of our first child.

We were fortunate to have a doula who provided continuous emotional and physical support, and worked as our advocate to complement the midwife’s medical expertise. This personalized labor assistance enabled us to achieve our childbirth goals, which included birth without medication or other unnecessary medical intervention. We couldn’t have labored alone as successfully.

The doula made the difference.

Doula is a greek word meaning “woman helping woman.” Dana Raphael first coined the term in her book The Tender Gift, which underscores the fact that women need women to assist in childbirth and to provide continued emotional support and guidance throughout the joyous and turbulent postpartum time. A doula, by definition, is present to serve. She helps a woman integrate the day she will never forget.

“Labor support is Centuries old, but its advantages have now been validated in six controlled studies, and its positive benefits should not be overlooked,” says neonatologist Marshall H. Klaus, MD, adjunct professor of pediatrics at the University of California and director of academic affairs at Children’s Hospital in Oakland.

According to research conducted by Klaus and his partner, John H. Kennell, MD, professor of pediatrics at Case Western Reserve University School of Medicine, the presence of a doula during the laboring process reduces the need for a cesarean by 50 percent, length of labor by 25 percent, use of oxytocin by 40 percent, use of pain medication by 30 percent, the need for forceps by 40 percent, and requests for epidurals by 60 percent. Comparable research studies on the effect of doula support have been analyzed by precise statistical methods and published in the Journal of the American Medical Association and the New England Journal of Medicine.

Along with the psychological and physical benefits of labor support, there are significant financial advantages. Klaus and Kennell report that births assisted by doulas could mean a $3,500 savings for individual families, and therefore reflect a $2 billion annual reduction in national medical care costs associated with labor and delivery. And no one can put a price on a woman’s birth memories.

In recounting the success of our doula-assisted birth with family and friends, we discovered that few people truly understand the affirming advantages associated with a doula’s services. Many wonder how a doula enhances the laboring woman’s process when she already has a partner present who has attended childbirth education classes and a midwife or doctor attending the birth. Some fear that the doula will interfere with the couple’s intimate experience or conflict with medical assistance.

However, more frequently than not, adequate emotional nurturing for the laboring woman is not routinely provided by mainstream medical caregivers. Doctors have separate concerns requiring medical expertise that take precedence over providing constant emotional support. As a result, women are too often encouraged to accept induction of labor, epidural pain relief, episiotomy, or other unnecessary medical intervention “to speed labor along,” rather than offered encouragement to value their own inherent process and power to give birth naturally.

We located our doula, Lori, through a birthing center. I was aware of Doulas of North America and found out that she is a member, so I telephoned her to see if we were “a match” before Paul and I met with her in person. From our first conversation, I knew that she would be the one to help us through our big event. She provided us with specific information regarding her services, along with a portfolio containing a job description and a contract outlining our agreement for services and fees. The contract included unlimited prenatal consultations, early labor and delivery support, transportation to the birth site, continuous care until two hours postbirth, lactation assistance, and postpartum care. The orientation packet also contained information on nonmedical support techniques for labor and birth, inducing exercise, acupressure, massage, aromatherapy, herbal therapy, color therapy, and use of a birthing ball–a large gymnastic ball for sitting or rocking. This was my favorite birthing tool, as it helped immensely with the incredible back labor I endured.

A three-hour consultation with Lori and her partner followed this first meeting. We discussed my needs for labor support and began to formulate a birth plan that, when complete, would be duplicated and distributed to any medical personnel we would potentially come in contact with at the birth. Having this plan in hand would enable us to focus on the birth, rather than having to be concerned about conveying our wishes to people we hadn’t met. This became one of our most beneficial exercises, especially when we unexpectedly found ourselves in the hospital on the night before the birth.

The series of events that preceded our overnight stay in the hospital unfolded like this: Paul had tirelessly comforted and coached me through contractions for two days and two nights before we decided we needed to utilize Lori’s fresh perspective and much-needed energy. She arrived on the morning of the third day, fixed Paul something to eat, and sent him to bed. Lori labored with me all morning. She brewed fragrant herbal tea and read poetry to me while I enjoyed some relief in a warm bath encircled in candlelight. She massaged me with lavender and patchouli oil, and reminded me to drink lots of juice and use the bathroom frequently to keep labor steady and efficient. We listened to music, rocked on the birthing ball, and mirrored yoga poses, as squirrels raced across the rooftop.

By early afternoon, contractions were difficult to manage. Paul packed the car, and we called the midwife. She wanted us to come in to the birth center. Once there, after a 45-minute drive with intense contractions coming every five minutes, the midwife examined me and found that I was 90 percent effaced, but my cervix was not dilated. Paul and I were discouraged and exhausted. Lori offered words of encouragement and praise for our hard work and commitment to the task at hand.

Knowing that we strongly desired an unmedicated, natural birth, the midwife recommended that I go to the hospital for a sedative to help me sleep. She felt that with rest I would more likely be able to manage the more painful phase of active labor yet to come. So, after careful consideration, we went to the hospital. Lori stayed with us all night. I woke up at 4:00 a.m. with bloody show. A full moon was out to greet us in the black morning sky. I knew that this would be the day.

The change of scenery from home to hospital had lessened the intensity of contractions; however, they were still rolling over me every five to seven minutes. Newly motivated after seeing the bloody show, yet feeling like settling in to nest, I began to move into that hazy world characterized by trance-like concentration required to sustain the business of birth–a place where sea meets sand and tide pools swirl when stirred like drops of white paint in a gallon of blue. Paul and I were both in a daze. We heard Lori remind us that we wanted to have our baby at the birth center. Paul got the nurse and, after I had been hooked up to the fetal monitor for two hours–“hospital procedure”–we were finally out of there by 6:00 a.m. and on our way to the IHOP for breakfast.

While Lori and Paul finished breakfast, I walked around the restaurant chewing on a piece of English muffin and having contractions. Pancake syrup bottles became focal points, as the toothless waitress gave me advice and worried over the . poached egg I had just eaten. Outside, the dawning of the full moon cued us to move on.

After checking in at the birthing center to find that I was only 3 centimeters dilated, we decided to go to a nearby bed and breakfast to continue with our labor management techniques before returning to the birth center for the final push. The periodic changes in location seemed to help us feel like we were moving forward in what would have otherwise seemed like an endless, frustrating ordeal. Paul called friends and family, while Lori and I focused on tidal waves of contractions. She encouraged me to trust my own instinctive process and empowered me with a sense of inter-connectedness to all women who had given birth before me. We slowly swayed back and forth together, listening to the comforting rhythm of Enya’s Watermark.

At long last, we made the final trip to the birth center. Paul and Lori worked together to keep me comfortable. Paul’s presence gave me a grounded feeling of safety, and Lori was the only one who could effectively relieve my three hours of excruciating back labor, by using acupressure techniques. We were fortunate to have our favorite two midwives on call that day, making the experience extra special.

When the urge to push overcame me, I sank into the arms of one of the midwives. Lori whispered words of praise. Paul embraced me with his smile, as he watched the miracle of Kevin Paul’s birth. At 4:55 p.m., Paul lovingly placed our son in my arms, as Lori quietly observed our joyous family union. We couldn’t have done it without her!

At our postpartum closure meeting, Lori presented us with “The Birth Story,” a written narrative of our experience from her point of view. It was beautifully written, straight from the heart. She visits us periodically to see how we are coming along as a family. On Mother’s Day, she telephoned to wish me a happy day and to remind me of my great accomplishment. I feel the sense of pride and identity that Livingston describes, and I now clearly understand why Dana Raphael entitled her book about the positive impact of women helping women give birth The Tender Gift. Today, DONA carries on this tradition, helping women and families across North America.

THE ROLE OF THE DOULA
Doulas of North America (DONA) is an international organization of doulas cofounded in 1992 by childbirth educators Penny Simkin, PT; Annie Kennedy; Klaus and his wife Phyllis H. Klaus, MEd, CSW; and Kennell. According to the standards of practice outlined by DONA, the doula “advocates for the client’s wishes as expressed in her birth plan, in prenatal conversations, and intrapartum discussion. She helps the mother incorporate changes in plans if and when the need arises, and enhances communication between client and caregiver.” Likewise, the doula provides solace and support to the woman’s partner. Conversely, the doula does not perform clinical or medical tasks such as taking blood pressure, temperature, checking fetal heart tone, doing vaginal examinations, or postpartum clinical care. Rather, she is present to offer comfort and provide gentle reminders, in keeping with the predesignated birth plan.

“A doula gives straight from her heart to help another woman discover what birth and life are really all about,” says Connie Livingston, RN, DONA director of publications, and ASPOI/Lamaze educator. Doulas help women achieve “birth the way it was supposed to be,” adds Livingston. “They bring a calming feeling, in such a hurried society, to the deep and spiritual experience of birth and, as a result, enable women to look back on the day they give birth with a sense of pride and identity.”

DONA’S primary goal is to increase the availability of trained doulas in North America, through an international certification process. Their communications network connects certified doulas with pregnant women interested in their services.

“DONA helps women join together to network with and support each other, in order to facilitate better and more economical health care for women,” says Jennifer Nunn, DONA membership chairperson.

Membership is the first step toward DONA certification. Members subsequently receive a subscription to International Doula, the organization’s quarterly newsletter; discounts on DONA-Sponsored conferences, workshops, and training; and an information packet outlining certification requirements. Currently, DONA has 2,150 members and 425 certified doulas.

DONA-certified doulas are trained in the emotional and psychological processes of labor and birth; the anatomy and physiology of reproduction, labor, and delivery; comfort measures and nonpharmocologic pain relief techniques; appropriate topics for prenatal and postpartum discussion with clients; ethics and standards of practice for the doula; communication skills; and values clarification.

Certification requirements also include submitting recommendation letters, after providing continuous labor support, from three clients and either three nurses and two doctors or three midwives. Aspiring doulas must also maintain records from attending births, summarize selections from an extensive list of required reading, write a paper on the value and purpose of labor and support, and complete one of the following trainings: childbirth education; midwifery; or nurse’s training with work experience in labor and delivery.

On request, DONA will provide an updated listing of members and certified doulas. The local chapter of the International Childbirth Education Association (ICEA) may also know of practicing doulas in specific areas. Call 612-854-8660 for the current schedule of the ICEA Doula Certification Program.

Karen Nugent is an adjunct instructor in the Humanities and Social Sciences Division at Central Florida Community College in Ocala, Florida, where she lives with her husband, Paul, and their son, Kevin (2).