Saturday, May 9, 2015

Midwives Delivered The Royal Baby!!


Editors note: I'm not gonna lie, I am TOTALLY geeking out over this!! 



Royal baby: Meet the midwives who delivered the new princess after winning Kate's trust

Arona Ahmed and her boss Jacqui Dunkley-Bent, Professor of Midwivery at Imperial College Healthcare NHS Trust, together helped welcome the princess into the world


"Meet the two midwives who delivered the royal baby and are said to have become "close" to the Duchess.
Arona Ahmed and her boss Jacqui Dunkley-Bent, Professor of Midwivery at Imperial College Healthcare NHS Trust, together helped welcome the princess into the world yesterday and are pictured smiling outside the hospital after Kate's short 154-minute labour.
Professor Dunkley-Bent, 51, is said to have built up a rapport with Kate as she also delivered Prince George in 2012"..... Read more




Friday, April 24, 2015

CHDs and Homebirth

Baby G

On a balmy March night back in 2014 I attended what I then thought was going to be a normal birth. This was the mother's seventh child, and the sixth one that my mom would help her with. The birth its self was amazing! The baby was a surprise OP, and the mamma pushed him out in TWO pushes!! It wasn't until after he was delivered that we realized something was wrong. Even though he started breathing right away he never cried, and after his first breath he went limp. He never stopped breathing, but we had to get him stimulated to use his muscles again. After he was flexing and moving, we continued with the normal checkup, and cleanup, and the whole time he never cried. I can only describe it as a laziness, he seemed fine other than the fact that he refused to cry, and he never opened his eyes. ( he also had some signs that he might have downs syndrome, but I never heard if they got a conclusive diagnosis) Since he was breathing fine, nursing, and his heart sounded fine, mom decided that we would let the family rest that night and discuss taking him to the doctor the next day. The next day while talking to another midwife mom found out that sometimes that laziness that we had seen is the only indication that there might be something wrong with the baby's heart! Of course after that mom recommended that the parents take the baby to the doctor right away, so they did, but the doctor couldn't find anything wrong either! Fast forward a week or so, and a few more doctors, finally the fourth doctor they saw heard a murmur. It turns out that he had been born with a hole in his heart so small that a stethoscope couldn't pick it up at all. It was only after the blood had been pumping through it for a few weeks that it was big enough for the stethoscope to detect it. Fortunately they caught it before it got too big, and they did surgery on it, and now he is doing fine.


The next time I would encounter a CHD baby would be just over a month later.



Baby W

Early on a Saturday in May my mom woke me up to tell me that we needed to head to our client's house that was about two hours away because she was in labor. After we had only been on the road for about 30 minutes the Doula called and said she saw the head!! Needless to say, I floored it! I know for a fact that I got up to 110mph, and I might have been going faster. While I drove like a maniac, mom got ready to walk the dad through delivering the baby if it came to that, and we all prayed like crazy that we would make it in time for the birth. When we finally arrived we flew into the house, (we even forgot to close the car doors!) and found the mom lying down on the floor of her bathroom, thankfully without a baby. This mom had really wanted a water birth, but my mom had advised that she stay out of the water if her husband was going to end up catching the baby, so when we got there she went ahead and got in the birth pool. Not even five minuets later, we had a baby!! Let me tell you that was the calmest baby I have ever seen! She came up out of the water and gave one little cry, and then settled on her mom's chest and just looked at everyone! After we cut the cord and got mamma and baby out of the water we proceeded with her newborn check and everything looked and sounded normal. Two days later the mom called to ask us to pray as they were headed to the ER with the baby after she had had a really big cry and then her responses had slowed . When they got to the hospital the doctors found that the left side of her heart hadn't developed!! They quickly life flighted her to a heart specialist hospital and she had the first of her life saving heart surgeries. She is now doing well. 


Unfortunately Baby W's story isn't as rare as you would think. Every year 1 in 100 babies is born with a Congenital Heart Defect (CHD) and many of them have no outward symptoms, and prenatal ultrasounds don't always detect them. The CDC even addresses that fact, "Some babies born with a critical CHD appear healthy at first, and they may be sent home before their heart defect is detected. These babies are at risk of having serious complications within the first few days or weeks of life, and often require emergency care."1 



So what are we supposed to do to prevent these normal appearing, but critically ill, newborns from slipping through the cracks until it is too late? 


The answer is a simple test that can be incorporated into the normal newborn exam. The CDC's website explains, "Newborn screening for critical CHDs involves a simple bedside test called pulse oximetry. This test estimates the amount of oxygen in a baby’s blood. Low levels of oxygen in the blood can be a sign of a critical CHD. The test is done using a machine called a pulse oximeter, with sensors placed on the baby's skin. The test is painless and takes only a few minutes.

Pulse oximetry screening does not replace a complete history and physical examination, which sometimes can detect a critical CHD before oxygen levels in the blood become low. Pulse oximetry screening, therefore, should be used along with the physical examination"2


Now that we know how to check for CHDs it is critical that we get that information out there! I really didn't know much about CHDs before these births. I have a cousin who was born with a CHD, but his was caught on a prenatal ultrasound, so I didn't really pay a lot of attention to how easily they are missed until it happened to me. You can ask your midwife, or doctor, how they check for CHDs, and if they don't, refer them to pulse oximiters. It could be a matter of life and death, and it is too simple to justify skipping it. 





Baby W

Baby G




1&2 lhttp://www.cdc.gov/ncbddd/heartdefects/cchd-facts.html

Wednesday, January 14, 2015

A Textbook Overview

Textbook Overview for
Myles Textbook for Midwives Eleventh Edition
By Megan Scott



The diagrams and illustrations in this book are amazing. It is very helpful to be able to picture what you reading about, and Myles does and excellent job of providing helpful diagrams along side the detailed explanations. The down to earth descriptions in this book are very refreshing. With so many medical text books you can get so lost in technical jargon that you miss the whole point of what you are reading. With Myles you get an explanation that actually makes sense, and can be practically applied.


This textbook is very useful to both beginner students and advanced students. For beginners this book offers a very comprehensive introduction into midwifery care, and for more advanced students it is useful for reviewing something quickly. While still being instructive, and not “dumbing down” the information, Myles is written in plain, easy to comprehend, English.

Topics covered in this edition of Myles include: how to conduct prenatals, malpresentations (and how to deal with them), nutritional guides for the pregnant woman, what a normal pregnancy looks like, abnormalities of pregnancy and labor, and much more. A particularly interesting section of this text book explains the laws that regulate midwifery in Great Britain.


The chapter on malpresentations is very informative, and detailed. It is broken down into separate sections for each presentation, and then outlines the full mechanism of labor for that position. In addition it explains the common reasons for the malpresentation, the most likely outcome, and has diagrams many showing how the presentation looks and feels from different angles. For example, occipitoposterior positions may be associated with an abnormally shaped pelvis. Out comes of an OP position are not all the same. Sometimes the baby will rotate before birth and be born in an anterior presentation. Other malpresentations covered in this chapter include, face, brow, and all of the varying breech presentations.


The first publication of Myles textbook for Midwives was published in 1953, and was written by Margaret Myles. The next nine printings were also solely written by Mrs. Myles. The eleventh edition is the first multiauthor version. Ruth Bennett and Linda Brown were the joint editors, and co-ordinated a team of midwives, and a physiotherapist to make this edition possible.


The eleventh edition of Myles Midwifery has a very comprehensive index, but is lacking a glossary. The attention to detail, and the organization, of this book is very helpful for studying. It is very easy to look up a specific topic, and if it is covered, you wont have any trouble finding its location.



In conclusion, Myles Textbook for Midwives is a very thorough volume of information, and should be included in every midwifery students education.  

My First Book Critique

Book Critique For
Ina May's Guide to Childbirth”


Overall I would recommend this book to all pregnant women. As far as methods of practice go I don't have many disagreements. Some of her ideology, including evolutionary theories and weird spiritualism, do not sit well with me, and I would preface any recommendation with that disclaimer.


Basic Foundations
I agree with the underlying principle that birth is natural, and that we as humans are designed to give birth without a problem. The psalmist refers to being made by God, “...thou hast covered me in my mother's womb. 14 I will praise thee; for I am fearfully and wonderfully made:..”, and Mrs. Gaskin writes that “ Your body is not a lemon. You are not a machine. The creator is not a careless mechanic.”. Women need to know that their bodies are not only capable of delivering children, but were created to deliver children. Too often in today's society women are scared of birth because doctors treat pregnancy and childbirth as a nine month long disease to be cured by interventions. Mrs. Gaskin points out that too many women today fear the pain of childbirth because they don't view it in the correct perspective. In our society today pain is bad, and we do everything in our power to alleviate, and mask, pain to the point that we forget that labor pain has a use. If you have a bad headache you take a pain reliever, if you are having a baby you need drugs to kill the pain. Women don't realize that if they worked with their bodies, rather than fought them, birth would be easier.


Something that I found very interesting was a study done to compare a group of Dutch women's expectations of labor with those of a group of U.S. women. Both groups were informed of the potential negative effects of the pain-relieving medication, and nearly two-thirds of the Dutch group labored and delivered without narcotics, as compared to only one-sixth of the U.S. group. Interestingly in both groups, the proportion of women expecting pain and those getting medication, were nearly identical. I like that she mentions that too often in the United States natural birth is viewed as an extreme sport, rather than the normal way to have a baby. Right now, in the words of Mrs. Gaskin's mother-in-law, we are “too well bred to breed well”.We need to make women more aware of the fact that pain medication is not harmless, as we are led to believe by most doctors, and that if you approach labor with the expectation of working with the pain, rather than fighting the pain, your labor will go more smoothly.


We need women to realize that when avoidance of pain becomes the major emphasis of childbirth care, the paradoxical effect is that more women experience a great amount of pain after the birth. Frequent use of epidural anesthesia drives up the rate of c-sections, episiotomies, and forceps use. If you labor without pain medication you will have pain during the labor and birth, but it will be over as soon as the baby is born. If you have pain medication during labor your chances of needing an intervention to help deliver the baby go up, and when you have interventions you will most likely need even stronger pain medication after the birth to relieve the discomfort and pain caused by the c-section, episiotomy, or forceps.




The next thing Mrs. Gaskin has figured out is something a lot of people would laugh at, but that I agree with, is the connection of mind and body. Now I don't believe in some of the mysticism mind/body stuff that she does, but there is a connection there. If there wasn't why would placebo pills work? I have personally seen one case of this, and have heard of another. In the case I saw, the midwife checked the dilation and found her to be eight cm dilated. The mother then decided she was done, and informed the midwife that she was ready to push. The midwife told her to wait until she was fully dilated to push, but checked again any way, only to find that the mother WAS fully dilated. She had dilated from eight cm to ten cm in less than two minutes, simply by putting her mind to it. In the second case, a friend of mine's sister was induced early in the morning, and, as is usual with inductions, by about six o'clock that night was only at about seven cm. She was then informed that if she didn't have the baby by six thirty she was going to be taken back for a c-section. Her baby was born at six twenty-seven. Our minds are powerful, and we need to remember that when it comes to birth they can help, or hinder, the process.


Sphincter Law
Mrs. Gaskin and her partner midwives operate according to a basic set of principles that they have termed sphincter law. Most U.S. women and virtually all obstetricians believe in a set of assumptions that OB's call the Law of the three P's. The three P's are Passenger (the baby) the Passage (the pelvis and vagina) and the Powers (the strength of the uterine contractions), under the law of the three P's if there is a problem with one of the P's it can hinder a successful vaginal birth. “The major philosophical difference between Sphincter Law and the Law of the Three P's is that the latter blames woman for what medicine calls “dysfunctional labors”.” According to the Three P's if a woman doesn't birth the baby in the time allotted it is her fault: She grew too big a baby, she has too weak a uterus, or her vagina and pelvis are too small. According to Sphincter Law if a woman doesn't have a normal birth in a “reasonable” it is because of a lack of privacy, fear, or stimulation of the wrong part of the woman's brain.


Basics of sphincter law: Sphincters do not obey commands, Sphincters function best in an atmosphere of familiarity and privacy, Laughter helps sphincters open, Sphincters may slam shut if their owner is startled or frightened.


Ina May is correct in her assessment that stimulating the wrong part of the brain will slow labor, however she refers to a “new” brain and an “old” brain but I believe that we have had a whole brain since God first created us. We do have different parts of our brain that control different functions, but the parts are all the same age. It is true that stimulating the neocortex (responsible for abstract thought) can hinder labor, and that the brain stem controls the hormones that help labor, the brain stem is not “primitive” brain. I also disagree with her statement that we have evolved to the point that we forgot the Sphincter law. I think that we have continually tried to “play god” and control a created process to the point that we have forgotten that it is natural. Also she states at one point that “you need to let your monkey do it” assuming that we have evolved from, and are related to apes. I disagree with this statement completely. She also encourages women to imagine themselves as a strong mammal during labor to help them remember that they are capable of giving birth. I don't think it is right for a human that is created in the image of God to imagine that they are an animal, though realizing that God causes animals to give birth without a problem most of the times is helpful, I would recommend memorizing Isaiah 66:9 ”Shall I bring to the birth, and not cause to bring forth? saith the Lord: shall I cause to bring forth, and shut the womb? saith thy God.” We can let our bodies work the why God designed them to work without imaging that we are just animals.





The Influence of TV
I agree with Mrs. Gaskin that TV is giving woman the wrong impressions about birth because drama sells, but I don't think that the answer to that problem is to explicitly show natural birth on public TV. I also agree with her opinion that TV producers are hypocritical to say that natural un-medicated birth is too graphic, but that they will show many other things that are actually more graphic. I would propose that birth videos were more accessible to expectant mothers, that the TV shows cut back on the emergency births, and intersperse some normal births. Also I think that who ever the mothers care provider is should make sure that she doesn't have and irrational fears based off of TV, and encourage her to educate herself on normal birth so that she doesn't go into labor with all of the fake scenarios in her head. I think that would help alleviate some of the fear that surrounds birth, and wouldn't make a spectacle of something that is usually a very private experience.


Miscellaneous
I would recommend a balanced omnivorous diet to all pregnant women instead of vegetarian,
though if a client was a vegetarian I would just monitor to make sure that they were getting all of the needed vitamins, minerals, and fats, and recommend supplements when required.

Ina May says that puns and witticisms will not work when a mother is in labor and recommends telling off colour jokes to encourage mothers to laugh, which helps open the sphincters, but I think you can come up with something just as funny that isn't crude to help a mother laugh during labor.

Conclusion

I would strongly recommend this book expectant mothers and anyone else interested in natural childbirth. The birth stories in the first section of the book are very helpful, and Ina May does a wonderful job describing why the way they practice works so well in the second half of the book. When recommending this book I would just clarify with the person that I do not agree with all of Mrs. Gaskin's “theology”. Over all this book is a great resource, and a valuable addition to any midwife's library. 

Wednesday, April 16, 2014

We Are Made To Give Birth

Recently I have been re-reading "Ina May's Guide To Childbirth" by Ina May Gaskin so that I can write a book critique on it. While reading I have come to realize that she has such great success with her midwifery career because she has discovered some basic, but unfortunately forgotten, principles of birth. However sometimes she attributes these things to the right source, God, and sometimes to the wrong source, evolution. At one place in the book she says that, " Your body is not a lemon. You are not a machine. The Creator is not a careless mechanic." I agree whole heartedly with that statement.  A little later though she refers to "old" and "new" parts of the brain, and how we have "evolved" to not know how to give birth, and that if we let our primitive "old" brain work we would be much better off. Her conclusion that letting the brain stem work uninhibited to produce the hormones needed for a successful labor and delivery is correct, as is her conclusion that stimulating the neocortex inhibits labor. However I know that when God created us we had all of our brain.

Further on in the book she recalls the history of how we got to the modern idea of birth, and says that if we forget all of those ideas and just "let our monkey do it" we will be better off. I agree that we need to come to birth with the assumption that birth is a normal process, but we aren't descended from monkeys, so I would say that you just need to trust that God made your body just fine, and you need to let your body work the way it was created to work.  Another thing she says is that "imagining yourself as a powerful mammal can help you feel empowered". I think it is helpful to look at animals and see that they give birth just fine, usually without any help at all, and say to yourself  "if God designed animals to have babies just fine, then I know I can have a baby without unnecessary intervention." But to imagine that you, who are created in the image of God, is just an animal is, in my opinion, wrong.

I would recommend that instead of trying to let your monkey do it, or imagining you are an animal, you should memorize Isaiah 66:9 "Shall I bring to the birth, and not cause to bring forth? saith the LORD: Shall I cause to bring forth and shut the womb? saith thy God." I found that verse completely by accident one day, but I wrote it down because it is a great promise to remember when you are pregnant, or in labor. I remembered it earlier as I was trying to critically read through and find what I disagreed with, and why.

I realized then, that while she was right in stating that we need to get our thinking brain out of the way of our acting brain, attributing natural birth to a primitive evolutionary instinct that we need to tap into is wrong. What we need to tap into is the fact that God designed us to give birth and that we need to not try and "play god" with our unnecessary medical interventions.

This post is not to say that all medical advancements are bad. I've never said that, and I never will. It was simply an intriguing thought to me that you could have the correct knowledge and attribute it to the wrong source.

Monday, November 25, 2013

The Game of Hurry up and Wait...

This is about two weeks late, I apologize for my tardiness in posting.

If you ask anyone in the military they will tell you that it's all just a game of hurry up and wait, and I have found that midwifery is exactly the same. Now I'm not comparing being a midwife to being a soldier, I just liked that they both start with the letter M, which also happens to be my first initial and my favorite letter. :) Now on to the story...

 On Thursday November 21st  I got off work, checked my phone, and found 6 missed calls, a new voice mail, and several text messages, all from Mom and Dad. Whoops! I called Mom back to find out what was going on, turns out that she was on her way to pick up some extra equipment from the cottage in Mississippi when she had a blowout!! Thankfully Dad was able to go rescue her because shortly after he got to where she was the call came in that our Mother To Be (Hence forth MTB) was having contractions three hours away. At this point I'm still in Alabama so I pulled up the GPS on my phone to find the routes that we could take that would meetup somewhere so that we didn't have to take two cars all the way to the birth. After confirming the routes with Mom I got on the road, and an hour and a half  later we met up and left her car in a parking lot.

Now comes the hurry part! On my way to the rendezvous I was only driving 80mph, but after I picked up Mom, and her bag of instruments that would legitimize our speeding if we were pulled over, I bumped it up to around 85-90mph. Well when we were 50 miles from our destination the MTB calls to tell us that her water has just broken!! After that I floored it!! At one point I was doing 105mph!! And I'm not gonna lie, it was FUN! :) Thankfully I didn't get pulled over, and we made that last 50 miles in about 30 minutes.

Then the wait... When we finally got to the house around 5:30 the MTB was doing well and was progressing, but was only about half way dilated. So after Mom checked the baby's heart tones we sat in the living room and waited, Mom had a magazine and I scrolled Pinterest.

At about 7:30 the dad informed us that he had just been asked to not leave the bed room where the MTB was laboring. Progress!! 

At about 7:40 mom checked the  baby's heart tones and the mom's dialation and and found that she was only at 8 centimeters, but she wanted to push. Mother told her not push, but two minutes later she could tell that the mom was going to push regardless and checked again and found full dialation!!!!
Two pushes later we had a head, and when mom swept the neck with her finger, to make sure that the umbilical cord wasn't wrapped around it, she bumped the tiny hand the had been born with the head and the baby grasped her finger!!!!!! (the hand was up under the chin and therefore didn't cause any problems with the delivery) That was the most AMAZING thing I have ever seen!!! After just one more push we had all 8lbs 10oz 20 1/2 inches of her at 7:51pm. 

After we weighed and measured her I got to dress and hold her. :) Mom and I stayed at the house for about three hours after the birth, cleaned up, changed the sheets (the not so exciting part of this job), checked the mom and baby again, and just generally made sure everything was hunky dory before we headed home. 

We finally got home at 2:15am, and I was back at work by 8:05 later that morning. :) 

She posed perfectly for me!! :)

Wednesday, October 23, 2013

Guest Post from the Senior Midwife a.k.a. My Momma :)

The Predicted Rise In Maternal Mortality Rates Is Sadly Here

 

The Maternal Mortality rate was quietly rising back in 2007.  The widely published book Pushed said solid numbers were soon to come1.  I hate to tell you, but they're here.  In 2010 California reported the number of women dying from birth had tripled.   Florida and New York have since followed suit.2  

 

The context, the cover-up and the uncanny about these statistics:  

 

Context

 

Maternal mortality reported rates are 21 deaths per 10,000 births nation-wide. 3   This is double digit losses amid thousands of births.  The increase over a generation is single digit.  Likely, you will never personally experience the mountain of grief behind these cold facts.  

 

Heart-numbing context aside, two things should be keeping Americans up at night:

1. Any preventable death is unconscionable. 
2. The number of dying mothers should be going down!



Cover Up

 

New York, California and Florida are likely the only regions conveying the truth.  The serious situation in other areas is lost to inconsistent data collection. Maternal mortality reporting in the US is so poor that  Amnesty International called it a human rights violation in 2010.

 

Uncanny

 

This very same scenario has unfolded before.  In 1918 a strange piece of news surfaced.  Counties were seeing scattered increases in maternal mortality rates.4 This trend spread over the next two years.  It was not until 1932 that a national level hearing was convened to determine the cause!! 5

 

Sadly, we have repeated our mistakes.  Digging back, we find the earliest rumblings of mounting risks to modern birthing woman.  They were heard back in 19946.  The rescue is way overdue!

 

Notes:

1. Pushed by Jennifer Block, 2007 Da Capo Press. Page 119

2. Birth Matters by Ina May Gaskin, 2011 Seven Stories Press. Page 126

3. http://data.worldbank.org/indicator/SH.STA.MMRT retrieved 10/18/13

4. Lying-in: A History of Childbirth in America by Richard W. Wertz, 1989 Yale University Press Page 155

5. Lying-in “  Page 161

6. Birth Matters by Ina May Gaskin, 2011 Seven Stories Press. Page 126

 

 

Next posts in the series:

Your Safe Haven In The Midst Of the Storm

Could a Maternity Solution Birth a Cure for Our Nation’s Healthcare?