Monday, June 17, 2013

Standard of {Your} Care

The Stir on  cafemom came out with this article you can read below and I desperately wanted to leave a comment but what I had to say was too long. I felt this warranted a blog post! 

There is a term often used in our society that I have come to question. That term is "Standard of Care"
Initially, I think of my care provider taking this approach to care for me in the best way s/he knows how for my situation. What this term really means is, 'this is the problem, this is the solution' across the board.
 Pregnancy and birth are such intimate times and each woman and baby so unique; is this really the kind of care you want to receive. Standard not being what's best for you and yours but what's most commonly used (not necessarily evidence based or the best) throughout America.
I urge you, don't accept merely the "standard of care" but strive to discover what is best for you, as an individual, in your personal life and circumstance, creating the standard for your care.
Be empowered with informed choice and refusal

I have two overused and unnecessary pregnancy procedures to add to this list by Michelle Zipp- vaginal exams and IV fluids. 

Most importantly vaginal exams. They are not necessary in pregnancy or labor and can lead to the overused, and often inappropriate, diagnosis of "failure to progress" in labor. In pregnancy, many women think they need to know if "they're getting close" by vaginal exams as they near their due date. Getting a vaginal exam does not predict when you'll go in to labor. As a birth doula, I've had clients be at 2cm for weeks before labor starts and clients who weren't "showing any progress" go into labor the next day. I put "showing progress" in parenthesis because there is so much more going on in labor than a cervix is telling and the cervix dilation is the last thing to happen. In labor, not only is your body preparing to open and birth your baby, but the baby is preparing as well; it's an delicate dance, best left undisturbed. Maryn Lyster describes birth as "being, not doing."

Now along those lines of the position of baby- I've read a lot of comments in the original article of fetal monitoring and fear!!! We don't have to have the electronic fetal monitors and not having them should not create fear.  A hand help doppler or fetoscope works just as well. For years and into this day and age, women safely deliver babies at home without these efm's. Not only can electronic fetal monitors can be read wrong but they also restrict your mobility. Did you know that your position can also affect baby's heart rate? For example, if you're lying on your back, which you are doing quite often when on the monitors, you can be compressing the baby's cord which can cause a dip in the heart rate. Too often, unnecessary panic and cesareans are caused by these monitors. Before panicking, try changing positions. Also consider and internal monitor if you're being faced with a cesarean. Also consider, are you being directed to push and doing so on your back? 

This brings me back to the vaginal exams. Pushing should be left to the experts- the laboring mother. If you have the urge to push, you're care provider or nurse may want to make sure you're fully dilated- whether you allow this or not is up to you, but if you have the urge, you have the urge and if you don't, you don't! Quite often while attending births as a doula, I see [too] frequent vaginal exams during labor and then mother reaches 10cm and she's given "permission" or sometimes directed to push before she has the urge. As I said earlier, there is so much more going on than cervical dilation, including the position of the baby. Perhaps, though mom may be fully dilated, the baby is not in the most optimal positioning for pushing or perhaps she's lucky enough that her body is allowing a break before the 2nd stage. Going ahead and pushing on command could have a negative affect on baby and make it harder for mom, when she could be enjoying this nice break or using this time to re-position herself or work with her doula or partner, trying rebozo sifting or other methods of encouraging the baby to get into position.

IV's - when and why?

IV fluids are needed if you plan on or need an epidural. The hospital will administer fluids, via and IV, to help reduce the likelihood of your blood pressure dropping too low upon administration of the epidural or spinal block. IV's are also used to administer medications such as pitocin or narcotics.

If you don't plan on any of these interventions and are low risk, you don't need the IV. The hospital will encourage you to have a heplock, "just in case" but think about it- Getting the heplock is not going to administer the fluids, that you probably don't want any way, it's just there. So, it doesn't have a head start on much "just in case" and if you're trusting the hospital to be a safe place for the birth of your baby, I hope you trust the skill of the personnel enough to place an IV should the medical need arise.

Use your best judgement; do what's right for your body and your baby, know your options, be prepared for your birth- don't skimp on the childbirth education. The conclusion of all of this is to trust birth and to trust your body. Too often these "standard of care" medical procedures cause the very problem you'd like to avoid. If you are low risk, a low intervention birth is probably in your best interest. 

How will you be empowered on this Journey of Life?

Thursday, June 13, 2013

Don't Hate, Let's Educate -part one

I try not to judge other parents, I really try. I've heard another mother say, it doesn't matter what she does as long as it doesn't affect my kids; but if you think about it, what each of us does affects the other. Regardless, I don't judge you for the choices you make regarding your children; you parent your way, I'll parent mine. We all make the best choices we can for our families and I respect that in each of us. What I judge is ignorance. Nothing bothers me more than an uneducated decision or a decision made without thoughtfulness.

Don't Hate, Let's Educate!  In this series, I'm going to cover what I feel are the top controversial decisions we must make for our children- sometimes I see parents make these decisions with great care, other times I see thoughtless choices, often influenced by our media. With a great deal of access to social media, television shows, tabloids and more, we are such a misinformed culture!

Stop the Mommy Wars is derived from the concept that the only choices we have control over are our own. What another mom chooses is her decision – who are we to judge that?  We are each free to make our own decisions and we should support another mother in her own decisions, creating a stronger community.  While I fully believe this is an excellent idea to stop the growing trend of pop culture pitting moms against each other, I also feel we have other battles placed in front of us that must be confronted. So should we fight one another, insisting that each person is in the right? No: Don't Hate, Let's Educate.


If you don't vaccinate, I must. I will say it- vaccinations are why devastating diseases like polio and rubella are no longer prevalent. Does this mean I'm pro-vaccination? Not really, I'm terrified of them! I cringe every time I take my child to get vaccinated. We don't get all of them; I do my research and take my 'risks' accordingly. The problem I have, is all the crap they put in these vaccinations! I'm sure a lot of parents have an issue with this. Another disconcerting factor of vaccinations is the number of diseases we are now attacking. What every happened to chicken pox parties? What's with the rise in childhood shingles? Perhaps it's along the lines of our sudden phobia of illness. In the 1950's we vaccinated for 5 major diseases. Today we vaccinate for 14 and have combo shots to boot! Learn more in the Vaccine Education Center of The Children's Hospital of Philadelphia. Parents who weren't vaccinated as children take claim to being the healthiest people they know. Some parents vaccinate their children and claim no ill effects, while others are sure their child has suffered traumatic reactions to one or a combination of vaccinations. So what's a parent to do.  Should I shout from the roof tops that I am right and you are wrong? No, I won't do that. I will make the best choices for my family and you for yours. All I ask is that you know- know what's in them, understand what they are striving to prevent, know the risks of vaccinating and the risks of not vaccinating. Perhaps you'd consider Homeoprophylaxis? Science-Based Medicine argues that due to the law of dilutions, "homeopaths use nosodes as their vehicle for imaginary vaccinations." You decide but please respect the decision of other parents. Don't hate, let's educate!

Formula vs Breastfeeding

A very small percentage of mothers actually can't breastfeed, a very small percentage. So is it fair for me to judge a mother who chooses to formula feed her baby just because? Probably not. But considering what I said before, "as long as your choices don't affect my kids", maybe it is fair to judge. Or in the very least, I can just be angry at what that child was deprived of. I know, s/he's your child, so why should I be angry? Because formula fed children get sick more than breastfed children- can you say school house germs!? (Check out this blog post by The Alpha Parent and scroll down to numbers 9 & 10) In general, babies who are formula fed are hospitalized more and have more health concerns, including asthma, ear infections, meningitis. All of this affects me and my child, not to mention I find our rising obesity epidemic offensive. The CDC says
Improving the health of mothers and their children is a primary goal of the Centers for Disease Control and Prevention (CDC). Protecting, promoting, and supporting breastfeeding, with its many known benefits for infants, children, and mothers, is a key strategy toward this goal.
Photo courtesy of Proud to Announce Photograhy
So there you have it! Improving breastfeeding rates is a major goal we are working towards because it does matter and no child should be deprived the benefits of breastfeeding due to an uneducated or selfish decision to formula feed.  [I breastfeed for selfish reasons! and of course for the benefit of my child.] I am coming to realize that my anger is not towards another mother who chooses not to breastfeed but at our culture. So many mothers turn to formula in response to media or fear of social judgment or because they aren't given enough support. I can't fully agree with that last reasoning because the support is there- you just have to look for it. So perhaps, support like La Leche League is overrun and hidden by all those campaigns funded by the formula companies. Formula is no longer being used as it was intended to be used; formula companies got greedy and lactation consultants got ignored for a quick fix solution. I urge you, consider what formula really is and what it was intended for- those few circumstances where a baby couldn't breastfeed- and consider what breasts are really intended for. It is my hope that we all make the best decisions for our babies and given the information it's no secret what that is. Perhaps, like this parent, breast is not best for your family. You deserve respect for your informed choice, despite any disagreement. Don't hate, let's educate.

Fun Fact:

Breastfeeding ensures that vaccinations work properly.

These are just two of the many decisions we'll make as parents on the Journey of Life. 
For more in this series, follow the Journey of Life by email.
Next in Don't Hate, Let's Educate: Birth

Do you vaccinate? Do you cling to breast or bottle? Do you support other mothers whose decisions may differ from you own? I'd love to hear your thoughts.

Monday, June 10, 2013

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Jennifer Valencia | Labor & Postpartum Doula | 928.300.1337


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