Transitions Birth Services, LLC

The Evansville Birthnetwork has received a grant from Birthnetwork National to have an online survey asking local women about their maternity care experiences.  The survey is open to any woman who has given birth in the last three years within a 50 mile radius of Evansville, IN.  We hope to use the responses to help other women make informed decisions about their maternity care.  If you would like to take the survey, click here-

https://www.surveymonkey.com/s/EvansvilleAreaBirthSurvey" target="_blank">https://www.surveymonkey.com/s/EvansvilleAreaBirthSurvey

All questions, except the first, are optional.

On May 19th from 1-2:30pm, I will present a Birth Options Class at Little Ants, 1450 Bellemeade Ave.  Mothers/ couples who are expecting or planning to become pregnant can come learn about options they have in labor and birth.  I will be answering questions such as "How can I tell if my doctor or midwife is supportive of a low intervention birth?"  "Should I have a birth plan?"  and "What choices make having an unmedicated birth most likely?"  Having attended dozens of births, I have good insight into local birthing practices.

The class is free.  Please RSVP to andie.gunter@insightbb.com.

If a mom has had a cesarean and is planning another birth, she has two options.  She can have a repeat cesarean or a vaginal birth after cesarean (VBAC).  There are risks and benefits of both options.  The main risk of having a VBAC is uterine rupture.  Uterine rupture happens about .8% of the time during a VBAC.  Most uterine rupures are not dangerous- many aren't even noticed until a cesarean or other abdominal surgery is done.  But occasionally, a rupture can cause serious consequences- the death of the baby or mother. 

On the other hand, having multiple cesareans poses risks too.  Cesareans increase the risk of placenta problems in future pregnancies such as placenta previa and placenta accreta.  The chances of these occuring increase with each cesarean.  These conditions are serious and can be life threatening.  Cesareans also increase risks such as breathing problems for the baby and NICU admissions.

In 2010, the National Institutes of Health held a conference on VBACs.  You can read their Consensus Statement, which includes information on the risks and benefits of VBACs and repeat cesareans. 

Another helpful resource is A Woman's Guide to VBAC, which explains the NIH Statement. 

The Internation Cesarean Awareness Network (ICAN) has lots of great resources about cesareans and VBACs.  The website includes information to help moms make the decision between repeat cesarean and VBAC, webinars, forums, and a listing of hospitals' VBAC policies. Recently, a chapter of ICAN was formed in Evansville.  You can find information about meetings on their Facebook page or on ICAN's website.

You can also watch vol. 4 of More Business of Being Born:  The VBAC Delimma.  The video is available on demand for $4.  You can also borrow the video from the Evansville Vandergurgh Public Library.  The video includes information about risks, benefits, issues that keep many doctors and hospitals from offering VBAC, and stories of moms who have VBACs. 

If you are a mom considering VBAC, please contact me.  I can provide information on local options for VBAC and give you tips for having a VBAC.  Several moms in the Evansville Birthnetwork have had VBACs and are willing to talk about their experiences.  EBN also has a yahoo group where you can post questions and get input from other local moms. 

In most births, the baby's umbilical cord is clamped within seconds of being born.  Recently, this practice has been called into question.  There have been several studies that show benefits to waiting  even just a minute before clamping the cord.  More moms are beginning to ask for delayed cord clamping, and sometimes their doctors are not familiar with the benefits of it.

Nicholas Fogelson, an OB/GYN, has this blog post which summarizes the research on delayed cord clamping.   Much of the research he looks at focuses on preterm babies.  Some of the benefits seen in preterm babies include fewer cases of intraventricular hemorrhage and late-onset sepsis, higher red blood cell volumes and hematocrits and less need for mechanical ventilation and surfactant.  In term babies, there were higher iron stores at 6 months.

There is this study in the Journal of the American Medical Association which Dr. Fogelson doesn't discuss that looks at term babies:

Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials.  Hutton EK, Hassan ES.  Source: Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario.

In that study, babies had better iron status and less anemia. 

Dr. Folgelson also has this video of a Grand Rounds presentation he did looking at delayed cord clamping.  The video is 50 minutes long and divided into four parts.  In the video, he compares immediate cord clamping to robbing the baby of 40% of its normal blood volume.

Some local moms have talked to their doctors about delayed cord clamping.  One objection the doctors have had is that they believe if they put the baby on the mother's belly after birth and do not clamp the cord, the baby's blood will drain back into the placenta, or the blood in the placenta will not be able to get to the baby.  Dr. Fogelson addresses that issue in Part 2 of the video, starting around minute 6:30.  He discusses a study that says that babys who are placed on their mother's stomachs after birth get the same amount of blood from the placenta as babies held even with the birth canal or as babies held slightly lower than the birth canal. 

So if you are interested in having delayed cord clamping at your birth, look at these resources and share them with your doctor or midwife.  Feel free to contact me for more information.  I'd love to hear your experience of asking for delayed cord clamping and whether your doctor or midwife was supportive.

Eating and drinking during labor can give a mother energy and keep her hydrated.  It also helps her avoid feelings of hunger and thirst, which keeps her more comfortable.  Many birth locations restrict moms from having anything more than ice chips.  But are these restrictions necessary?

Not allowing moms anything to eat or drink started in the days when most moms gave birth while unconscious- under twilight sleep.  When someone is unconscious, they can vomit and the contents of their stomach can enter their lungs, causing a serious and sometimes fatal condition called aspiration pneumonia.  Today, it is rare for moms to give birth under general anesthesia.  And even when it happens, precautions are taken to help prevent aspiration.  A breathing tube is inserted into the mom's trachea to help prevent stomach contents from entering the lungs.  An antacid is given to help neutralize the acid in the mother's stomach. 

In 2010, the Cochrane Collaboration looked at policies restricting moms from eating and drinking in labor.  They found that, for low risk mothers, policies that restrict eating and drinking are not justified.  The review is available here-

Singata M, Tranmer J, Gyte GML. Restricting oral fluid and food intake during labour. Cochrane Database of Systematic Reviews 2010, Issue1. Art. No.: CD003930. DOI: 10.1002/14651858.CD003930.pub2

Available at: http://www2.cochrane.org/reviews/en/ab003930.html

The American College of Obstetricians and Gynecologists has this to say about drinking in labor:

“According to ACOG, women with a normal, uncomplicated labor may drink modest amounts of clear liquids such as water, fruit juice without pulp, carbonated beverages, clear tea, black coffee, and sports drinks. Fluids with solid particles, such as soup, should be avoided, however. Women who have uncomplicated pregnancies and are scheduled for a cesarean delivery may also drink these clear liquids upto two hours before anesthesia is administered.”          - from the ACOG press release “Recommendations Relax on Liquid Intake during Labor.” Available at http://www.acog.org/from_home/publications/press_releases/nr08-21-09-2.cfm

The American Society of Anesthesiologists has this statement:

“The oral intake of modest amounts of clear liquids may be allowed for uncomplicated laboring patients. The uncomplicated patient undergoing elective cesarean delivery may have modest amounts of clear liquids up to 2 h before induction of anesthesia. Examples of clear liquids include, but are not limited to, water,fruit juices without pulp, carbonated beverages, clear tea, black coffee, and sports drinks.”   - from the statement Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia available at: http://www.guideline.gov/content.aspx?id=10807

And the American College of Nurse Midwives has this to say:

 “The newest Clinical Bulletinfrom the American College of Nurse-Midwives reviews evidence relevant to providing oral nutrition to women in labor and concludes that drinking and eating during labor can provide women with the energy they need and should notbe routinely restricted.”  -from an ACNM press release “AMERICAN COLLEGE OF NURSE-MIDWIVES PUBLISHES CLINICAL GUIDELINES FOR ORALNUTRITION DURING LABOR” available at http://www.midwife.org/siteFiles/news/ACNM_Clinical_Guidelines_on_Nutrition_in_Labor.pdf

So if your doctor, midwife or hospital routinely restricts moms from eating and drinking in labor, you can ask if those restrictions are justified, or consider switching to a different provider or birth location.

Here is a chance to meet me and some other great area doulas.  On Monday, October 17th from 6-8pm, Evansville Birthnetwork will host a "Meet the Doulas Night" at Oaklyn Library.  Area doulas will be present to talk about how a doula can benefit you during labor.  It should be a great time.  Come join us!