Labor Induction and Prematurity

Induction rates in the US and elsewhere, including india, are steadily rising, causing concern to ACOG (the American College of Obstetricians and Gynecologists), among others. labor induction refers to the artificial initiation of labor, often by cervidil application to the cervix, administration of Pitocin (synthetic oxytocin) through an IV, and/or artificial rupture of membranes (AROM).

One of the many risks/disadvantages of labor induction is potential prematurity. Because due dates are not exact, a doctor who may think s/he is inducing at 36 or 37 weeks, might actually be inducing at 34 or 35 weeks.

This month’s Journal of Pediatrics published a study that found that babies born even slightly premature, at 34-36 weeks, are six times more likely to die in the first week of life than those born after 37 weeks (full term).

Every day in the last weeks of pregnancy is crucial for the development of the baby. During these days, the mother passes antibodies to the baby to fight infection, the baby gains weight and strength, his/her lungs mature, and his/her suck-and-swallow coordination continues to develop.

For more about why it is so important to let labor begin on its own, click here.

More research that breastmilk boosts IQ

Smarty Gene: Breast-fed kids show DNA-aided IQ boost

Bruce Bower

Scientists have achieved a breakthrough in deciphering the genetics of intelligence. Ironically, they did it by accounting for a key environmental factor.

Breast-feeding boosts children's IQs by 6 to 7 points over the IQs of kids who weren't breast-fed, but only if the breast-fed youngsters have inherited a gene variant associated with enhanced chemical processing of mothers' milk, reports a team led by psychologist Avshalom Caspi of King's College London.

The new finding supports the controversial hypothesis that fatty acids in breast milk enhance newborn babies' brain development. Moreover, the results demonstrate that intelligence researchers must examine how children's genetic natures interact with the ways in which they're nurtured.

"Genes work via specific environmental experiences to shape intellectual development," Caspi says.

He and his colleagues present their data in an upcoming Proceedings of the National Academy of Sciences.

Two groups of children participated in the study: 1,037 boys and girls born 34 to 35 years ago in New Zealand, who are still living there; and 2,232 boys and girls born 12 to 13 years ago who are growing up in England.

In DNA isolated from blood samples, the researchers probed the gene fatty acid desaturase 2, or FADS2. This gene assists in breaking down fatty acids present in human milk. FADS2 comes in two forms, one of which enables the body to process fatty acids more efficiently than the other does.

Only breast-fed children who carried one or two copies of the more efficient gene displayed an IQ advantage.

In the two groups of children, 90 percent of youngsters possessed the critical FADS2 gene variant. Roughly half of all participants were breast-fed regularly during infancy, according to reports collected from the mothers when their children were 1 to 3 years old. The formula-fed infants typically received no fatty acids in their diets.

The New Zealand children completed standard IQ tests at ages 7, 9, 11, and 13. The British children took an IQ test at age five.

The scientists ruled out several alternative explanations of the findings. For instance, normal- and low-birth-weight babies carrying the critical FADS2 gene displayed equal IQ hikes when breast-fed. The same held for children from wealthy and poor families, and for kids with high-IQ and low-IQ mothers.

Also, no evidence indicated that mothers carrying the more efficient FADS2 gene produced better-quality milk or breast-fed more often than mothers carrying the other gene variant did.

Until now, researchers have largely failed in attempts to find genes that affect intelligence independently of environmental factors, Caspi says. However, a new genomewide analysis of more than 10,000 7-year-olds tagged six regions as weakly but significantly associated with IQ, including one on FADS3, another fatty acid gene. That study, directed by King's College psychologist Lee M. Butcher, appears online Nov. 2 in Genes, Brain and Behavior.

"Both of these new findings suggest an important role for the regulatory mechanism of dietary fatty acids and its possible interaction with environmental factors in intelligence," remarks biological psychologist Danielle Posthuma of the Free University of Amsterdam.

Adds psychologist Jeremy R. Gray of Yale University, "An IQ advantage of 6 to 7 points is unquestionably large enough to have a real-world impact on individuals."

If you have a comment on this article that you would like considered for publication in Science News, send it to editors@sciencenews.org. Please include your name and location.

BIRTH INDIA INAUGURAL SEMINAR

BIRTH INDIA INAUGURAL SEMINAR 2007
At the Rotary Club Juhu Tara Road Santa Cruz, Bombay

Friday November 30th / 10am to 7pm
Saturday December 1st / 10am to 2pm (Our AGM and action plan for change for Birth India members and international guests only will be from 3 - 6pm.)

Rs. 250 (Contributions would be most appreciated. We request anyone wishing to hand out their business card to please give a further contribution to do this.)

Papers presented on the following topics:

The risks of obstetric technology and obstetric procedures in maternity care
The role of midwives in conflict and disaster
Concerns re: obstetric practices and opening birth centers
The role of dynamic childbirth education in creating confidence in birthing women
Rural maternal health care and ANMs
Traditional Birth Attendants, women's rights and the work of the Society of Midwives
Alternative birth in the hospital environment: the value of Yoga.
The value of doula work and the need to integrate labor support into obstetric care
Indian cultural legacies of birth and the female body
Postpartum depression

Please RSVP to india.birth@gmail.com. To register as a sponsor, please contact zia@quantacare.org.

Movement and positions during labor

I've heard many accounts of women who've given birth in Bangalore who say that nurses and doctors in hospitals constantly ask them to lie in bed. This makes no sense! Especially when it's not to check the baby's heartbeat or to do a vaginal exam. I've never seen or even heard of a woman (who is not medicated for pain) want to be in bed. movement -- rocking, swaying, walking, squatting, etc. -- helps women cope with pain and uses gravity to encourage the descent of the baby.

here's a recent new york times article about how the hands-and-knees position helps ease delivery.

Bangalore Birth Network's first meeting

On sunday we had our first meeting of the BBN. five of us got together at my flat and talked about what we want the group to be. We spent the majority of the time coming up with a mission statement – not an easy task! This is a work in progress, so we are very interested in people’s feedback. We used a worksheet for guidance, and read mission statements of organizations doing similar work, such as the coalition for improving maternity services (CIMS). We all threw out words like education, support, informed choice, evidence-based, training, advocacy, trust, normal birth, accessibility, and continuity of care. Here’s what we came up with:

The Bangalore Birth Network is a group of professionals and concerned citizens in Bangalore whose purpose is to raise awareness of and promote safe and supported birth and evidence-based care, from pregnancy through postpartum. We aim to provide information and education to women and their families that enhance the understanding of birth as a normal life process and enable them to make informed decisions. Through education and advocacy, we seek to provide training to practitioners that will encourage this quality of care.

If you are interested in joining us, or know anyone who might be interested in joining us, PLEASE contact me! we're looking for doctors, childbirth educators, prenatal yoga teachers, prenatal fitness instructors, nurses, midwives, moms, moms-to-be, anyone who cares about how women are treated during childbirth!


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Click to join bangalorebirthnetwork

My new article and the Business of Being Born

Two unrelated topics, actually. My new article for the Chillibreeze expat newsletter is an account of three expats who gave birth in bangalore hospitals. Check it out here.

Secondly, I just saw Ricki Lake's award-winning documentary (out in US theatres soonish?), The Business of Being Born. It's excellent and I highly recommend watching it! I'm hoping to organize a childbirth film festival here in Bangalore in December or January where we'll feature this film. Stay tuned for more details!

Possible link between Pitocin and autism

Check out this article about the potential link.

An excellent article about birth shock

Here's a lovely article by Pam England about "birth shock" and how to take care of new moms immediately after labor and birth. It's called the profoundly sacred transition during a newly-born mother's return from laborland.

More evidence that women shouldn't be made to labor alone

Many, many women in India, especially poor women, go through labor alone. Government and even private hospitals do not allow anyone to accompany the laboring woman. This practice is not only ludicrous and inhumane, it makes no sense given what we know about how women who are supported in labor have better health outcomes, as do their babies. I think this should be one of the first issues to be tackled by our newly forming Bangalore Birth Network (BBN)!

Women happier with childbirth when accompanied

NEW YORK (Reuters Health) - Women who go through labor and childbirth with a companion of their choice are more satisfied with the experience, and the care they receive, than women who deliver alone, Brazilian researchers report.

Furthermore, the presence of a companion did not create any safety issues, In fact, women with a companion on hand were about half as likely as unaccompanied women to have amniotic fluid stained with fetal stool -- meconium -- which can be dangerous to infants if it is inhaled.

While having a companion to provide support during labor and delivery is accepted practice in much of the world, many health facilities do not allow companions or discourage their presence, Dr. Odalea M. Bruggemann of the Federal University of Santa Catarina in Florianopolis and her colleagues note. This is especially common in the developing world, they add.

Bruggemann and her team randomly assigned 212 women to solo labor or labor with a companion of their choice, to compare childbirth experiences.

About half of the accompanied woman (47 percent) chose their partner or the child's father, while 30 percent chose their mother and 23 percent chose another female relative or a friend.

The women who received support from a companion were significantly more satisfied with labor and delivery than those who went through childbirth alone. They were eight times more likely to be satisfied with their labor experience and nearly six times as likely to be satisfied with delivery.

The accompanied women were also more satisfied with their medical care and medical guidance during labor and delivery. "Perhaps because there was someone else in the room, medical staff were more forthcoming and user-friendly than when no support person was present," the researchers note in their report in the online journal Reproductive Health.

Women with companions were 49 percent less likely to have amniotic fluid stained with meconium than women who delivered on their own. This may have been because they were less anxious and fearful, Bruggemann and her team suggest.

"If on one hand there is a general belief that a labor companion has always positive effects, there are, on the other hand, still a lot of health facilities where companions are not allowed, especially in developing settings," the researchers write. "It is expected that the results of this study could help providers to acknowledge and respect women's rights during birth."

SOURCE: Reproductive Health, July 6, 2007.

Copyright 2007 Reuters News Service. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

Copyright © 2007 ABC News Internet Ventures

"Cry it out" approach found to be harmful

Children Need Touching and Attention, Harvard Researchers Say

By Alvin Powell
Contributing Writer

America's "let them cry" attitude toward children may lead to more fears and tears among adults, according to two Harvard Medical School researchers.

Instead of letting infants cry, American parents should keep their babies close, console them when they cry, and bring them to bed with them, where they'll feel safe, according to Michael L. Commons and Patrice M. Miller, researchers at the Medical School's Department of Psychiatry.

The pair examined childrearing practices here and in other cultures and say the widespread American practice of putting babies in separate beds -- even separate rooms -- and not responding quickly to their cries may lead to incidents of post-traumatic stress and panic disorders when these children reach adulthood.

The early stress resulting from separation causes changes in infant brains that makes future adults more susceptible to stress in their lives, say Commons and Miller.

"Parents should recognize that having their babies cry unnecessarily harms the baby permanently," Commons said. "It changes the nervous system so they're overly sensitive to future trauma."

The Harvard researchers' work is unique because it takes a cross-disciplinary approach, examining brain function, emotional learning in infants, and cultural differences, according to Charles R. Figley, director of the Traumatology Institute at Florida State University and editor of The Journal of Traumatology.

"It is very unusual but extremely important to find this kind of interdisciplinary and multidisciplinary research report," Figley said. "It accounts for cross-cultural differences in children's emotional response and their ability to cope with stress, including traumatic stress."

Figley said Commons and Miller's work illuminates a route of further study and could have implications for everything from parents' efforts to intellectually stimulate infants to practices such as circumcision.

Commons has been a lecturer and research associate at the Medical School's Department of Psychiatry since 1987 and is a member of the Department's Program in Psychiatry and the Law.

Miller has been a research associate at the School's Program in Psychiatry and the Law since 1994 and an assistant professor of psychology at Salem State College since 1993. She received master's and doctorate degrees in human development from the Graduate School of Education.

The pair say that American childrearing practices are influenced by fears that children will grow up dependent. But they say that parents are on the wrong track: physical contact and reassurance will make children more secure and better able to form adult relationships when they finally head out on their own.

"We've stressed independence so much that it's having some very negative side effects," Miller said.

The two gained the spotlight in February when they presented their ideas at the American Association for the Advancement of Science's annual meeting in Philadelphia.

Commons and Miller, using data Miller had worked on that was compiled by Robert A. LeVine, Roy Edward Larsen Professor of Education and Human Development, contrasted American childrearing practices with those of other cultures, particularly the Gusii people of Kenya. Gusii mothers sleep with their babies and respond rapidly when the baby cries.

"Gusii mothers watching videotapes of U.S. mothers were upset by how long it took these mothers to respond to infant crying," Commons and Miller said in their paper on the subject.

The way we are brought up colors our entire society, Commons and Miller say. Americans in general don't like to be touched and pride themselves on independence to the point of isolation, even when undergoing a difficult or stressful time.

Despite the conventional wisdom that babies should learn to be alone, Miller said she believes many parents "cheat," keeping the baby in the room with them, at least initially. In addition, once the child can crawl around, she believes many find their way into their parents' room on their own.

American parents shouldn't worry about this behavior or be afraid to baby their babies, Commons and Miller said. Parents should feel free to sleep with their infant children, to keep their toddlers nearby, perhaps on a mattress in the same room, and to comfort a baby when it cries.

"There are ways to grow up and be independent without putting babies through this trauma," Commons said. "My advice is to keep the kids secure so they can grow up and take some risks."

Besides fears of dependence, the pair said other factors have helped form our childrearing practices, including fears that children would interfere with sex if they shared their parents' room and doctors' concerns that a baby would be injured by a parent rolling on it if the parent and baby shared the bed. Additionally, the nation's growing wealth has helped the trend toward separation by giving families the means to buy larger homes with separate rooms for children.

The result, Commons and Miller said, is a nation that doesn't like caring for its own children, a violent nation marked by loose, nonphysical relationships.

"I think there's a real resistance in this culture to caring for children," Commons said. But "punishment and abandonment has never been a good way to get warm, caring, independent people."

Calling all gentle birth advocates in Bangalore!!

If you or anyone you know is interested in joining our efforts, please contact me!

The Bangalore Birth Network (BBN) is a group of professionals and concerned citizens in Bangalore who share the beliefs that:

• Pregnancy and childbirth are normal physiological processes as well as social events in the life of a woman and her family.

• Women, not medical practitioners, are the primary caregivers for themselves, their fetuses, newborns and families.

• Every woman should be treated with respect in every phase of her care from pregnancy through postpartum. Respect includes, but is not limited to complete, unbiased information about tests, treatments, and procedures, fully informed consent, preservation of privacy, and polite respectful communications by all involved with her care.

• Intervention in the process and the application of technology are only justified when their use can be shown to enhance wellbeing and improve outcome for a particular mother and her baby. Routine protocols not based on research evidence should be avoided. Maternity care should be grounded in evidence, and care providers should be accountable to the mother and family for the mental and physical outcomes resulting from their actions or inactions.

• A primary maternity care system that offers a variety of options in prenatal care and birth settings and in choice of caregivers is essential to meeting women’s needs. Each birthing woman has individual needs, and it is her right to select the care provider and setting for birth that best fits those needs.

• Professionals and citizens must actively promote the allocation of resources towards measures that support the basic needs of women and their babies, while reducing the over-use of expensive obstetric technology.

• Every woman has the right to accessible, affordable, proficient maternity care.

In keeping with this position, the Bangalore Birth Network will:

• Promote childbirth practices and guidelines for care which enhance the normal physiological process;
• Promote the allocation of resources towards measures which support the basic needs of women and their babies as a priority, such as improved nutrition and social support during pregnancy;
• Continuously evaluate intervention and the use of technology in midwifery and obstetrical practice and take measures to avoid unnecessary interference;
• Provide information and education to women and their families that enhances the understanding of birth as a normal life process and enables them to make informed decisions; and
• Promote research and training in evidence-based maternity care coalition-building, communications, and networking with other organizations to achieve our vision.

Article about doulas on CNN.com

Doulas Deliver Help for Laboring Moms
By Judy Fortin

ROSWELL, Georgia (CNN) -- The lights were dimmed, soft music was playing and a scented candle burned on the counter. In the center of it all was Julie Trotter -- moaning through hard labor contractions.

Doula Kai Martin Short works to ease Julie Trotter's pain during labor.

For more than six hours, Trotter, a 23-year-old from Duluth, Georgia, tried different techniques to ease the pain of natural childbirth. Not only was her husband offering encouragement, but so was her doula, Kai Martin Short.

"She definitely was a lifesaver for sure," Trotter says. "She used a lot of counter-pressure through each contraction, and that helped so much."

Doula is a Greek word meaning "woman's servant." Part birthing coach, part mother's assistant, doulas are showing up in more delivery rooms than ever before.

Short, from Atlanta, Georgia, is among 2,500 certified doulas in the United States.

"Doulas trust birth and are not afraid of it even when the mom and dad get afraid," Short said. "We're there to just say things are fine; you're doing great; this is all normal."Video Health Minute: Watch how a doula helps a woman through labor »

Short offers more than comforting words. For a flat fee of $700 per client, she meets with the parents before the baby's due date to talk about their expectations and to share techniques to be used during labor. She is by the mother's side in the delivery room and visits the parents at home after the baby is born to offer advice on such topics as breastfeeding.

In her three years as a doula, Short has attended more than 30 births. Her training with a group called DONA International involved 26 hours of instruction on pregnancy, childbirth and comfort measures. "Whatever [mothers] need, whether it be changing positions, encouragement, massage or saying comforting words, there are so many things we do to help with the process," Short said.

Short tries to create a calm atmosphere in the delivery room with music and candles. Throughout the labor, she massages the birthing mother's back and rubs her head. Another one of her tricks to relieve pain involves having the woman sit on a big rubber exercise ball during contractions.

She encourages the father or other family members to get involved in the process and shows them how to help the mother breathe through contractions.

"I think it's really hard for a loved one to see their loved one in pain," Short said. "They don't really know how to help them."

While Short has plenty of advice for parents, she has no medical training and is not supposed to offer a medical opinion. She does not take the place of a doctor, midwife or nurse. Her role is to strictly work with the family and motivate the mother during labor and delivery.

But Dr. Sean Lambert, an OB/GYN who delivered Trotter's baby at North Fulton Hospital in Alpharetta, Georgia, says that sometimes, doulas can cross the line.

"It's almost as if some women and some couples have turned to them for too much advice and guidance," he said. "Occasionally, it will cut across what we recommend on a medical basis."

Short says she's never had any clashes with medical professionals. "Really, it's separate roles," she said. But she can understand how the relationship can get tricky. "It can be territorial sometimes if the doula is a little bit more strong-minded or opinionated."

Short encourages her clients to ask questions, and she's careful in her approach to the answers she gives.

Ten days after the birth of her son, Braydon, Trotter reflected on the experience. "It was a perfect one in my eyes," she said. "I think having a doula definitely would be helpful for anybody, and I wouldn't change anything about the birth."

Short enjoys seeing new families come to life and concludes, "The best part for me is helping women realize what their bodies can do. Just having that support can make all the difference."

Judy Fortin is a correspondent with CNN Medical News. Producer Leslie Wade contributed to this report.

More research on baby videos

In a previous post, I linked to an article about how children under two benefit more from human interaction than watching television. Here's another article with new research on how Baby Einstein videos might actually delay language development instead of enhance it.

CDC survey: new moms turn to formula too soon

The US centers for disease control (CDC) just came out with a survey that found that only about 30% of new moms breastfeed exclusively at three months of age, and at six months, only 11% are breastfeeding exclusively. Why are these number so low when we know that breastfeeding results in better health outcomes for both mothers and babies?! I think it points to a few problems:

1) Traumatic birth experiences for women and babies: the cesarean rate is at an all-time high in the US, at 30%. In India it's likely to be double that in many hospitals. Babies born by cesarean are often separated from their mamas for several hours, making establishing breastfeeding particularly challenging. Even women who have vaginal births are often separated from their babies due to unnecessary hospital routines and policies.

2) Lack of support for breastfeeding moms: I've seen many women have trouble getting their newborn to latch on properly. Nurses in hospitals are not trained as Lactation Consultants, and when a hospital does have an LC, often they are overworked and extremely difficult to track down. I realize this varies by hospital, but certainly in India there are no LCs in any hospital, and it is very hard for women to get support early on.

3) An emphasis on independence: well-meaning advice-givers stress the importance of not being held too much, feeding schedules, and baby sleeping alone in a crib. These parenting practices make it difficult to breastfeed.

4) Short maternity leave: going back to work--often after only six weeks--means separation between mama and baby for many, many hours. Pumping is not always easy or convenient, and many nursing mothers face discrimination at work.

5) The insidious nature of formula companies' advertisements: many women in hospitals receive free formula samples in their discharge packs instead of helpful information on breastfeeding. Formula companies distribute posters and pamphlets to doctors and hospitals to leave in their waiting rooms. Because these materials are so prolific, women get the message that bottle-feeding is the norm.

As long as women receive mixed messages and are not properly educated, encouraged or supported, we can't expect these rates to go up. If E've totally depressed you, or even if i haven't, please watch this video which celebrates 50 years of La Leche league:

CNN article: Avoid episiotomies

Here's an excerpt from a recently published article on CNN.com, entitled 5 operations you don't want to get -- and what to do instead.

Episiotomy

It can sound so simple and efficient when an OB-GYN lays out all the reasons why she performs episiotomy before delivery. After all, it's logical that cutting or extending the vaginal opening along the perineum (between the vagina and anus) would reduce the risk of pelvic-tissue tears and ease childbirth. But studies show that severing muscles in and around the lower vaginal wall (it's more than just skin) causes as many or more problems than it prevents. Pain, irritation, muscle tears, and incontinence are all common aftereffects of episiotomy.

Last year the American College of Obstetricians and Gynecologists released new guidelines that said that episiotomy should no longer be performed routinely -- and the numbers have dropped. Many doctors now reserve episiotomy for cases when the baby is in distress. But the rates (about 25 percent in the United States) are still much too high, experts say, and some worry that it's because women aren't aware that they can decline the surgery.

"We asked women who'd delivered vaginally with episiotomy in 2005 whether they had a choice," says Eugene Declercq, Ph.D., main author of the leading national survey of childbirth in America, "Listening to Mothers II," and professor of maternal and child health at the Boston University School of Public Health. "We found that only 18 percent said they had a choice, while 73 percent said they didn't." In other words, about three of four women in childbirth were not asked about the surgery they would soon face in an urgent situation. "Women often were told, 'I can get the baby out quicker,'" Declercq says, as opposed to doctors actually asking them, 'Would you like an episiotomy?'"

What to do instead

Communicate. The time to prevent an unnecessary episiotomy is well before labor, experts agree. When choosing an OB-GYN practice, ask for its rate of episiotomy. And when you get pregnant, have your preference to avoid the surgery written on your chart.

Get ready with Kegels. Working with a nurse or midwife may reduce the chance of such surgery, experts say; she can teach Kegel exercises for stronger vaginal muscles, or perform perineal and pelvic-floor massage before and during labor. Health.com: Me and my Kegels

Statement from ICAN Regarding the Deaths of Two New Jersey Women

The women of the International Cesarean Awareness Network offer their deepest sympathies to the families of Melissa Farah and Valerie Scythes, two New Jersey women who died after undergoing cesarean surgery.* This tragedy affects not just these new families; it is a tremendous loss to the community.

While any birth poses small but measurable risks to mothers and babies, it is well-established that cesareans increase the risk of a mother dying by 3-4 times. Common causes of maternal death by cesarean include: hemorrhage, infection, post-operative blood clots, and adverse reactions to anesthesia.

The World Health Organization states that a cesarean rate of above 10-15% cannot be justified and rates higher than that pose a health risk to mothers and babies. In the United States, the cesarean rate is 30.2% and in New Jersey it is 37%, the highest in the country. These rates suggest gross overuse of the surgery. Medically valid reasons for a cesarean section include:

• Complete placenta previa at term
• Transverse lie at time of labor
• Prolapsed cord
• Abrupted placenta
• Eclampsia or severe preeclampsia with failed induction of labor
• Large uterine tumor which blocks the cervix
• True fetal distress confirmed with a fetal scalp sampling or biophysical profile
• True cephalopelvic disproportion
• Initial outbreak of active herpes at the onset of labor
• Uterine rupture
• Failed induction with fetal distress

Women who are advised cesarean sections because of the following reasons should explore all their options since medical opinions differ in these areas:

• Macrosomia (large baby)
• Maternal age
• Assisted reproductive technology
• Cephalopelvic disproportion (CPD)
• Dystocia • Failure to progress
• Breech
• Fetal distress
• Prolonged pushing stage

When a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. When the surgery is overused without sound medical justification, however, it puts mothers and babies in harms way. Because of the increased risk associated with surgical delivery, ICAN works to reduce the number of cesareans that are medically unnecessary. Women can help reduce their risk of a cesarean section by following these tips:

• Choose a care provider with a low cesarean rate. Midwives can safely care for healthy low-risk women and have very low cesarean rates.

• Educate yourself on your birth options and your rights

• Hire a doula or labor assistant

• Avoid induction except for clear medical reasons

• Avoid common medical procedures which increase your chance of a cesarean

• Ask questions and explore all your options if you're told you need a cesarean because your baby is too big, you've gone "overdue," or your labor is moving slowly.

Ingesting placenta could mitigate Postpartum Depression

Pregnancy & Childbirth | USA Today Examines Practice of Ingesting Placenta To Mitigate Postpartum Depression
[Jul 20, 2007]

USA Today on Thursday examined the practice known as placentophagy, in which the placenta of a pregnant woman is saved, dried and emulsified, then placed in gelatin capsules and taken by the mother in the months after childbirth. Hospitals usually store placentas for a few days to allow for testing if there is a postpregnancy complication but then destroy them, according to USA Today. Some hospitals regard placentas as "hazardous medical waste" and are reluctant to let women keep them, while other hospitals allow women to keep the organ, USA Today reports.

According to USA Today, the practice of ingesting placenta "is far from widespread" and has been received with "great skepticism by more traditional medical experts." However, a "small but vocal contingent" of pregnant women and advocates "strongly" believe that the placenta is "rich in chemicals that can help mitigate fluctuations in hormones believed to cause postpartum depression," USA Today reports.

"I feel that it is what we as women are meant to do with the placenta," Jodi Selander -- who provides the encapsulation service at no cost to clients and is collecting testimonials of women who have ingested placenta for her Web site placentabenefits.info -- said, adding that other mammals eat their placentas. Mark Kristal -- a professor at State University of New York-Buffalo, who focused his 1971 doctoral dissertation on why animals eat their placentas -- said, "People can believe what they want, but there's no research to substantiate claims of human benefit." He added, "The cooking process will destroy all the protein and the hormones. ... Drying it out or freezing it would destroy other things."

Selander said she has sought FDA guidance but received no clear answers. FDA spokesperson Kris Mejia said the agency considers some statements on Selander's Web site to be unsubstantiated medical claims and will be reviewing the matter. "Human placental capsules that make treatment claims ... must be accompanied by well-designed and controlled clinical studies to support approval/licensure," Mejia wrote in an e-mail (Friess, USA Today, 7/19).

An article I wrote for an Indian website

I wrote this article about preparing for childbirth and the services I offer.

Some interesting parenting and birthing news

I recently came across two stories that might be of interest. The first is a study out of Wake Forest University that confirms the idea that toddlers learn language from people, not television. For more, click here.

The second is a firsthand account of the first hospital waterbirth in the Philippines. here it is:

Dear Everyone :)

Hello. This is my Waterbirthing Experience. I'm not a very good writer but I hope that I'm able to share my wonderful experience and I hope this will inspire other women to experience waterbirth - that there is another natural way of giving birth.

A lot of my friends and relatives have asked me why I opt to choose waterbirth. And I always answered them that "the water called on me." It's very difficult to explain this feeling. But ever since I got pregnant, I knew that I would be able to successfully give birth through the water. While some women chose waterbirth as pain relief or for gentle birthing. For me, there is this sense of inner of calling. I simply wanted to experience birthing without violence. That's why I prepared a lot for this birth during the whole duration of this pregnancy. I read books, I researched, I psyched myself, I exercised, I had acupuncture sessions… Psychological, physical, spiritual, emotional… etc.

While I gave birth to my daughter, 300,000 women all over the world are also experiencing the same thing. I might just be one of these women who chose to give birth through the use of water. Isn't this a great accomplishment?

Thank you for reading My Waterbirth Experience.

By the way, I saw the news and they said that this is the first ever recorded hospital waterbirth in the Philippines.

Cheers to all the mothers and the soon-to-be-mothers and of course the fathers!!!

Take care,
Velvet, Jonathan Adam, Jehielle and Voegelle Roxas

Active management of long labors

The other day I had the privilege of attending a Metropolitan Doula Group (MDG) meeting at which midwife Cara Muhlhahan spoke about managing long labors. [I'm in New York for 2 weeks, heading to Texas for some family time, and then back to Bangalore at the end of July.]

Cara emphasized the importance of not pathologizing long labors. When the baby is in the occiput posterior (OP) position (back of the baby's head is facing the back of the mother, accounting for about 15-30% of labors), latent labor can last three to four days while the baby's head molds to fit into the mother's pelvic opening. Long labors are not harmful to mothers or babies, rather, they are physiologically normal. The head must mold before the cervix can open, and it's best to simply wait it out without wearing the mother down or suggesting that the she is at fault.

Cara pointed out that women are looking for any excuse to believe they are inadequate. It's no wonder sometimes, when you look at hospital practices, in the case of long labors, for example. Most doctors would never let a woman labor for three days. She would be called in to the hospital, given Pitocin to augment the labor, and the cascade of interventions would begin, potentially leading to a cesarean birth.

We know this happens often in many hospitals, including those in Bangalore, where cesarean rates tend to reach 70%. (The world health organization (WHO) recommends a safe target rate of 10-15%.)

It was pretty amazing to be back at an MDG meeting; more than twenty doulas attended, including a few from the Brooklyn group I'd been hosting at my apartment in New York last year. I miss going to regular meetings and consistently having opportunities to share information and get support and inspiration from like-minded colleagues in the birthing field. I hope this blog serves to connect people interested in normal birth, both new and expectant mothers as well as childbirth professionals.