My Website

I'm very pleased to announce the launch of my website! Check it out here for more information about my birth and postpartum doula services in Austin, Texas.

I'm in Austin

I'm finally coming up for air and I thought I'd write a brief post to let folks know that I'm now in Austin and quickly meeting lots of childbirth and parenting professionals, which has been wonderful. I look forward to meeting mamas, dads, and babies, too!

If you're in Bangalore, please scroll down to see the next post. I'm still getting e-mail inquiries from expectant parents there, and sadly, I'm not able to help very much, being that I've moved back to the US. However, the Bangalore Birth Network is still going strong and getting stronger, so I encourage you to write to them at bangalorebirth@gmail.com so that you can connect with other moms and birth professionals.

I'm No Longer in Bangalore

I have been meaning to post this for the last two weeks, but have been a bit sucked in to life here in New York and New Jersey. It's great to be back but was very hard to leave such a wonderful community of birth advocates and new and expectant moms in Bangalore! I'm still receiving e-mails from women who are interested in having a doula at their birth and/or taking Lamaze classes. Although I don't know of any other Lamaze-certified childbirth educators or doulas in Bangalore, I thought I'd refer those of you who are looking for support to the following links:

* Tehelka piece on alternatives to hospital birth

* Chillibreeze article on how to prepare for childbirth

* Another Chillibreeze article highlighting three expats' experiences giving birth in Bangalore

* Goa Birthing Center

* "Having a Baby? 10 Questions to Ask"

* Here are, in my opinion, the best links:

1. Childbirth Connection (up-to-date evidence-based information and resources on planning for pregnancy, labor and birth, and the postpartum period)
2. International Cesarean Awareness Network
3. Lamaze International
4. La Leche League International (breastfeeding information)

On the right side of this blog you'll find recommended reading and more links. I think in the absence of good quality childbirth classes, you will need to do a lot of research and self-advocacy. It's unfortunate, but hospitals are set up for one kind of birth (quick) and you will need to have a doctor you trust and communicate well with.

After some time traveling in the US, I'm moving to Austin, Texas. I'll still be working as much as I can on the Bangalore Birth Network, which will have a website up in the next few months. If you'd like to know more about the BBN or to become a member, please e-mail bangalorebirth@gmail.com.

I'm still reeling from my experience supporting new parents in Bangalore and setting up the Bangalore Birth Network!

Breastfeeding Protects Against Arthritis

As if there weren't enough health benefits of breastfeeding for both mother and child to convince women to breastfeed, here's another one. According to a Swedish study, breastfeeding reduces the risk of rheumatoid arthritis for the mother. Researchers found that women who breastfed for up to one year reduced their risk of arthritis by 25%, and that those who breastfed for more than a year reduced their risk by 50%. For more on this study, click here.

Chinese Cop Helps Quake Effort by Breastfeeding

This came across on one of my lists, but without a link:

CHENGDU, China - A Chinese policewoman is contributing to the country's massive earthquake relief effort in a very personal way -- by breastfeeding eight babies.

A newspaper in Chengdu, the capital of quake-hit Sichuan province, devoted a special page to the 29-year-old woman, calling her a "hero."

The woman from the quake-ravaged town of Jiangyou has just had a child herself, the Western Urban Daily said.

She is nursing the children of three women who were left homeless by the quake and are too traumatised to give milk, as well as five orphans, the report said.

The babies who lost their parents have been put in an orphanage which does not have powdered milk, it said.

An estimated 50,000 people were killed in the May 12 earthquake, China's worst natural disaster in a generation.

- Sapa-AFP

Fantastic Birth in Bangalore!

I want to share a little about a birth I attended a week ago. I'd been traveling up north and returned to have a prenatal visit with my clients . My client, who I will refer to as C, looked beautiful, felt good and was excited about the upcoming birth. As her due date was only three days away, she and her doctor had discussed her doc's induction protocol, which was that she would need to go in for induction six days after her due date. C had a feeling her baby would come late, as both she and her brother had been more than a week late. (The American College of Obstetricians and Gynecologists has a guideline of 42 weeks, or two weeks after the estimated due date; given that due dates are often so uncertain and most first-time babies come late, allowing only six days before inducing isn't giving the baby much of a chance!) She very much wanted to avoid being induced, so during our prenatal visit we talked about natural induction methods: sexual intercourse (prostaglandins in semen help ripen the cervix), nipple stimulation, acupressure and herbs.

Her husband, D, called me at 12:30 that night and said she was having contractions that were four minutes apart! I said I'd meet them at the hospital, got dressed and was on my way. Luckily, we arrived at the same time, and by the intensity and frequency of C's contractions, I could tell that she was in transition. We went straight to the delivery room, where we met the on-call doctor and a few nurses. The doctor checked C: fully dilated and ready to push! Of course there was no time for pain medication, and my clients had come prepared with a birth plan, which stated clearly that the doctor and medical staff should avoid common and often unnecessary interventions such as shaving, enema, IV, episiotomy, oxytocin, immediate cord clamping, separation of mother and baby, etc. C was amazing, listening to her body and following its natural urges to push, while D supported her in the most gentle and loving way until their baby boy was born at 2:19 am. He was placed on C's chest immediately and kept there, skin to skin, for 40 minutes. (It's extremely unusual for doctors/hospitals to allow this much time to pass before they take the baby away, but as long as a newborn is pink and breathing, all newborn procedures can and should be delayed for at least an hour so that mom and baby can be skin to skin and establish breastfeeding.)

Unlike in most hospital birth settings I've been a part of in Bangalore, the doctors and medical staff were kind, quiet (for the most part), calm, and respectful of C's wishes as stated in her birth plan. (That said, it was a very short labor, so it's impossible to know how much pressure for interventions there would have been if labor had slowed or did not progress as quickly.) She was not given an IV (just a hep lock) nor did the doctor cut an episiotomy. She tore naturally, and was extremely pleased to have a natural tear instead of an episiotomy. Both parents are very satisfied with the whole experience, and I'm so honored to have been a part of it!

Tehelka Article on Alternatives to Hospital Births in Urban India

Here's an article in Tehelka -- an independent news magazine -- that I was interviewed for. The title, in my opinion, doesn't really reflect the content of the article, but oh well.

Consumer First, Patient Second

One of our BBN members passed along this article, which talks about why it's important to find the right doctor for your birth. My experience in urban India is that women and couples have to do a great amount of self-advocacy in order to get accurate information, assert their birth preferences (assuming there are some!), and have some amount of control over their delivery. This is a crucial exercise for having a satisfying birth experience.

Here's an excerpt from the article, which speaks to what we in the Bangalore Birth Network have been discussing for awhile now:

If [physicians'] parameters of care include routine epidurals, episiotomies for all their patients, routines IVs, etc. then that is their place of comfort in giving care. If you don’t want any of those things, you’d be much better off finding a different physician than trying to convert this one to your way of thinking, because you’re asking them to take themselves out of their comfort zone to care for you. It’s important that as consumers of healthcare, women understand the pressures that come to bear upon care providers.

Click here to read the entire article.

Exercise During Pregnancy Benefits Babies

If anyone - your doctor, your mother-in-law, etc - tells you that it's not good to exercise while pregnant, think again! A new study found that moderate exercise - that is, moderate intensity aerobic exercise for 30 minutes, at least three times a week - has cardiovascular benefits for the baby as well as for the mother. Read more about it here.

Delayed Cord Cutting Benefits Babies

In most hospital settings, doctors routinely clamp the umbilical cord as soon as the baby is born, cutting off blood and oxygen flow from the placenta to the baby. However, waiting until the cord has stopped pulsating (just a few minutes) allows the baby to get his or her maximum blood flow and iron stores, and makes the placenta less bulky and thus easier to detach from the uterine wall.

A new study out of Canada, recently published in the Journal of the American Medical Association, challenges the common practice of immediate cord cutting. Read more about it here.

Dais in India, and I'd guess other Traditional Birth Attendants around the world, are quite puzzled and sometimes even appalled at immediate cord cutting. Here's an excerpt from Hearing Dais' Voices, a publication by Matrika:

"The practice of not cutting the cord until the placenta is delivered is common in all the areas we have studied. Doctors, health workers and anthropological literature report the custom throughout the country. Dais have the utmost respect for these parts of the female body usually considered as waste products by the bio-medical system or highly polluting by the Brahmanic religious texts. Dais consider the infant-cord-placenta as a package. They have been together for nine months with cord and placenta functioning to nurture the fetus -- why should they be severed too quickly? The placenta is considered 'another mother' to the baby. Sometimes this afterbirth is buried with rituals and prayers for the well being of the infant. It is believed that how the placenta-cord-sac is handled influences the child's health in later life."

IMBCI

The International MotherBaby Childbirth Organization (IMBCO) has just come out with their International MotherBaby Childbirth Initiatve (IMBCI): 10 Steps to Optimal Maternity Services Worldwide. It's based on the results of a survey of birth and breastfeeding organizations in 163 countries and on input from IMBCO's Technical Advisory Group, international representatives, and from birth experts all over the world who participated in its construction.

It would be great if the Bangalore Birth Network could use this in our advocacy work and to help hospitals improve their maternity care.

Step 1: Treat every woman with respect and dignity.

Step 2: Possess and routinely apply midwifery knowledge and skills that optimize the normal physiology of birth and breastfeeding.

Step 3: Inform the mother of the benefits of continuous support during labour and birth, and affirm her right to receive such support from companions of her choice.

Step 4: Provide drug-free comfort and pain relief methods during labour, explaining their benefits for facilitating normal birth and avoiding unnecessary harm.

Step 5: Provide evidence-based practices proven to be beneficial.

Step 6: Avoid potentially harmful procedures and practices that have no scientific support for routine or frequent use in normal labour and birth.

Step 7: Implement measures that enhance wellness and prevent illness and emergencies.

Step 8: Provide access to evidence-based skilled emergency treatment.

Step 9: Provide a continuum of collaborative care with all relevant health care providers, institutions and organizations.

Step 10: Strive to achieve the BFHI 10 Steps to Successful Breastfeeding.

"Nutritional Supplements" for Newborns

I just visited a client who was told to give her healthy, exclusively breastfeeding newborn a supplement called ViSyveral. It occurs to me that this might be routine at hospitals around Bangalore, though it's the first time I've heard of it. Please note that babies do not need anything other than breastmilk for the first 6-9 months (not even water). This "nutritional supplement" has the following information on the box:

"May be administered by mixing in water, sweetened formula, fruit juices, desserts or water, cereals, soups, desserts or any other liquid or semi-liquid food."

"Ingredients: liquid glucose, sucrose, vitamins, gum acacla, coconut oil, sodium bicarbonate, disodium EDTA and antioxidants."

"Contains added flavours and class II preservatives."

?!?!?

These drops are problematic on many levels for a newborn. For starters, the directions might be confusing to some. We shouldn't be feeding newborns anything besides breastmilk, especially not desserts, soups and fruit juices! Secondly, look at the first two ingredients: SUGAR! Is it a mystery why there is a global epidemic of obesity? For more on sugar's effect on children's development and how to reduce your child's intake, click here. Don't forget that formula isn't really anything like breastmilk; click here for more on what's problematic about infant formula. Finally, food preservatives have been linked to childhood hyperactivity, and I don't even want to think about the chemicals in "added flavours"!

Readers Respond to New York Times Article About Doulas

A couple of weeks ago, the New York Times ran this pretty negative article about doulas and lactation consultants. I wanted to post the letters to the editor that were published a week later.

New York Times
March 9, 2008
Letters in Defense of Doulas

To the Editor:

Re "And the Doula Makes Four," by Pamela Paul (Sunday Styles, March 2): I recently gave birth to my son with the assistance of an experienced doula, without an epidural and other interventions that I had hoped to avoid. Your article, in emphasizing negative experiences with doulas who seem to be acting inappropriately and outside their scope, does a disservice to parents. Medical literature has demonstrated that with a qualified doula, a mother is likely to have a shorter labor with fewer complications, including a lower chance of Caesarean section.
Diana Graham, M.D.Raleigh, N.C.

***

To the Editor:

Your article reported that "44 percent of women described the relationship between their hospital nurses and doulas as hostile, resentful and confrontational." In fact, this study - which surveyed a total of nine women from a single hospital in north-central Alabama - found that four women described their nurses as behaving that way. The doulas, on the other hand, were described as "calm," "respectful" and "the best investment I have ever made in my life." In my experience as a doula, the vast majority of nurses welcome doulas' respectful support and nonmedical role. I can only hope doulas will become more widely available so every woman who wants one can have this kind of support during childbirth.
Dorian Solot
Albany
The writer is a birth doula certified by DONA International, a
professional organization that provides training and certification as
well as information for prospective clients.

***

To the Editor:

It seems Americans do more research on car purchases than on medical providers and hospitals. I did my research and had an amazing doula for the birth of my first child. When my second son was born, we had trouble with breast-feeding. A certified lactation consultant saved our breast-feeding relationship. While I am sure there are bad doulas and lactation consultants, I believe the majority are excellent and much needed in our over-medicalized birth environment and pro-formula society.
Corinne Griswold
North Granby, Conn.

Being Born: Films from Around the World

In today's Friday Review section of the Hindu, there's a great review of the films screened at the Bangalore Birth Network's film festival, entitled "Being Born: Films from Around the World." It was held during the first weekend of February and featured The Business of Being Born. We had a great turn-out and interesting discussions after each screening. Stay tuned for more BBN events! Read the Hindu article here.

Birth, A Play by Karen Brody

I love the idea of performing this in Bangalore. If you're interested in being part of the organizing committee, please let me know! Click here for more.

Open Letter to Christina Aguilera from Jennifer Block

Christina Aguilera has scheduled her cesarean. Read a letter to her from Jennifer Block here.

Wagner Article: Being Seduced to Induce

Being Seduced to Induce: What Women Should Know About Their OBs

By Marsden Wagner M.D.

Women will only agree to caesarean section if they are convinced it is safe for them and their baby. One of the first efforts of obstetricians promoting caesarean section has been to take the scientific evidence on risks of caesarean section and torture the data until it confesses to what they want it to say.

One example: Obstetric hype in popular and professional magazines says research shows 60% of women who have vaginal birth have urinary and faecal incontinence. But a careful reading of the research papers they refer to reveals something very different. The hype lumps all women with vaginal birth together instead of doing what the researchers did – dividing them into risk groups. When analysis of risk was done, they found that women at high risk for urinary and faecal incontinence have had large numbers of births; have had babies weighing over ten pounds at birth; and most importantly, have been the victims of unnecessary, aggressive obstetric interventions during their labour and birth.

What are these aggressive, invasive obstetric interventions that have been proven scientifically to cause permanent damage to the pelvic floor and urinary tract and also lead to more otherwise unnecessary caesarean section? One example is the use of powerful and dangerous drugs to start or accelerate labour, a practice that has doubled during the past 10 years. These drugs make labour abnormal with violent contractions that can damage the uterus and pelvic floor. The only reason women agree to such induction is because they are not told the truth about the drugs, for example that Pitocin (oxytocin), a drug used for decades to induce labour, doubles the chance the woman will have urinary incontinence in the future. By withholding such facts doctors seduce to induce.

Induction with drugs is not the only aggressive, invasive intervention that is frequently used in vaginal birth and is associated with damage to the urinary system, pelvic floor and rectal areas. Episiotomy has been scientifically shown to result in more pelvic floor damage than a natural tear. When an effort was made in the 1980s to reduce caesarean section in the United States, the rate of using forceps or vacuum extractor to pull the baby out went up—some doctors just can’t stop doing invasive interventions. And there is good data that using forceps or vacuum to pull the baby out has more risk of pelvic floor damage than any other form of birth.

Obstetricians have turned birth into a surgical procedure and done damage to women’s bodies and now suggest the solution is to promote yet even more radical and aggressive surgery; caesarean section. The solution is less unnecessary invasive surgical procedures during birth, not more.

[Re: the Midwifery Today E-News article, Issue 3:23]: The two obstetricians tried to say that vaginal birth can damage a woman, but they never pointed out the ways in which caesarean section can do harm not only to the woman but to the baby as well. The following excerpt from my article “Choosing Caesarean Section” in The Lancet of November 11, 2000, reviews some of the dangers associated with caesarean section, the alternative to vaginal birth that some doctors are trying to promote:

‘In addition to the increased risk the woman will die with an elective caesarean section, there are other risks for the woman including the usual morbidity associated with any major abdominal surgical procedure—anaesthesia accidents, damage to blood vessels, accidental extension of the uterine incision, damage to the urinary bladder and other abdominal organs.1 Some of these risks are common: 20% of women develop fever after caesarean section, most due to iatrogenic infections requiring diagnostic fever evaluation for both woman and baby.1

There are also risks women carry to subsequent pregnancies due to scarring of the uterus including decreased fertility, increased miscarriage, increased ectopic pregnancy, increased placenta abruptio, increased placenta previa.1,2, 3 Recently in the United States the widespread use of the unapproved drug misoprostol (Cytotec) for labour induction has created a new risk of caesarean section in subsequent pregnancies. Women attempting VBAC (Vaginal Birth After Ceasarean) who are given misoprostol have a rate of uterine rupture of 5.6% compared with a rupture rate of 0.2% for women attempting VBAC not given misoprostol, a 28-fold increase in risk of uterine rupture.4 For women choosing caesarean section, all of these risks exist in all of their subsequent pregnancies even if the original caesarean section was not an emergency. The increased risks of ectopic pregnancy, abruptio placenta, placenta previa and ruptured uterus are all life threatening to both woman and baby.

For whatever reasons women choose caesarean section, very few are clearly informed about foetal risks. In an emergency caesarean section where the baby has developed a problem during the labour, the risks to the baby of doing the caesarean section will likely be outweighed by the risks to the baby of not doing it. In an elective caesarean section where the baby is not in trouble, the risks to the baby from doing a caesarean section still exist, meaning the woman who chooses caesarean section puts her baby in unnecessary danger. That some women are choosing caesarean section strongly suggests women are not told these scientific facts.

The first danger to the baby during caesarean section is the 1.9% chance the surgeon’s knife will accidentally lacerate the foetus (6.0% when there is a non-vertex foetal position). (5) Obstetricians may be less aware of this risk — in one study only one of the 17 documented foetal lacerations was recorded by the obstetrician doing the surgery.5 A much more serious risk to babies born by caesarean section is respiratory distress. Many reports in the scientific literature document the caesarean section procedure per se is a potent risk factor for respiratory distress syndrome (RDS) in preterm infants and for other forms of respiratory distress in mature infants.1 RDS is a major cause of neonatal mortality. The risk of newborn RDS is greatly reduced if the woman is allowed to go into labour prior to the caesarean section. Another serious risk to the baby born by caesarean section is iatrogenic prematurity (the baby is premature because the caesarean section was performed too early). Even with repeated ultrasound scans, the standard deviation for estimating gestational age is large, creating errors in judging when to do an elective caesarean section. Doing the elective caesarean section after the woman goes into spontaneous labour would markedly reduce this risk as well. A vast literature documents the increased mortality and morbidity, including neurological disability, associated with premature birth.’

So beware. Surgeons try to sell surgery. Never forget that obstetricians are, after all, surgeons. Women must be extremely cautious in the face of this hard sell and get the facts from those who do not have a vested interest in surgery.


Thanks to Leila McCracken and www.birthlove.com

For more about Dr. Wagner.

1. Wagner M, 1994. Pursuing the Birth Machine: The Search for Appropriate Birth Technology, Sydney, Australia: ACE Graphics.
2. Enkin M, Keirse M, Renfrew M, Neilson J, 1995. A Guide to Effective Care in Pregnancy and Childbirth, 2nd ed, Oxford University Press.
3. Goer, H, 1999. The Thinking Woman’s Guide to a Better Birth. Putnam, New York: Penguin.
4. Plaut M, Schwartz M, Lubarsky S, 1999. “Uterine rupture associated with the use of misoprostol in the gravid patient with a previous caesarean section,” Am J Obstet Gyn 180:1535-42.
5. Smith J, Hernandez C, Wax J, 1997. “Fetal laceration injury at cesarean delivery,” Obstet & Gynecol 90:344-6.


First published in byronchild/Kindred, issue 1, March 02

Childbirth Film Screenings in Bangalore

The Bangalore Birth Network and Vikalp Bengaluru (Films for Freedom) cordially invite you to

BEING BORN:
FILMS FROM AROUND THE WORLD

Saturday, 2 February, 2008, 6:30 pm
Birth in the Squatting Position (10 mins, Brazil)
Born at Home (60 mins, India)

Sunday, 3 February, 2008, 3:00 pm
Birth Day (10 mins, Mexico)
The Business of Being Born (83 mins, USA)

Note: All films are in English or have English subtitles.
All films show actual births and are graphic.

Nani Cinema, Centre for Film and Drama
5th Floor, Sona Towers, 71 Millers Road
Bangalore 560052

***PLEASE FORWARD WIDELY***


THE BUSINESS OF BEING BORN

Birth is a miracle, a rite of passage, a natural part of life. But birth is also big business.

Compelled to explore the subject after the delivery of her first child, actress Ricki Lake recruits filmmaker Abby Epstein to question the way American women have babies.

Epstein gains access to several pregnant New York City women as they weigh their options. Some of these women are or will become clients of Cara Muhlhahn, a charismatic midwife who, between birth events, shares both memories and footage of her own birth experience.

Footage of women having babies punctuates THE BUSINESS OF BEING BORN. Each experience is unique; all are equally beautiful and equally surprising. Giving birth is clearly the most physically challenging event these women have ever gone through, but it is also the most emotionally rewarding.

Along the way, Epstein conducts interviews with a number of obstetricians, experts and advocates about the history, culture and economics of childbirth. The film's fundamental question: should most births be viewed as a natural life process, or should every delivery be treated as a potential medical emergency?

As Epstein uncovers some surprising answers, her own pregnancy adds a very personal dimension to THE BUSINESS OF BEING BORN, a must-see movie for anyone even thinking about having a baby.

BORN AT HOME

Born at Home observes indigenous birth practices and practitioners in parts of India (rural Rajasthan, Bihar, and the urban working class area of Jahangirpuri in Delhi). Poised between social reality and the eternal mystery of childbearing, the film poses a critical question. When dais or midwives are known to handle about 50% of births in India, why does the state not recognise the inherited and low-cost skills of the almost one million traditional practitioners in the country? Natural birth clinics and home births are increasing in numbers in the west, but our brand of progress continues to undermine our vast and centuries-old knowledge base. There are innumerable instances where modernity has only served to reinforce prejudices. The film presents an intricate delineation of the figure of the dai who is almost always a low-caste, poor woman. Unlike medical science to whose life-saving power the best of dais pay homage, indigenous birth methods are holistic, conceiving of childbirth not as pathology but continuation of organic life. Gender and class issues are juxtaposed with images of the post-partum massage, the ritual bath, and finally the miracle of an actual birth. Mind-body, earth-cosmos become one unified whole when, negotiating the nether world of pain and labour, a new life thrusts it way up into the sun. The dai's hands are experienced and empathetic as she guides the process.

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. For more information or to join the network, contact Paige at nycdoula@gmail.com.