Posts from the ‘clinical topics’ Category
August 25th, 2012
A new mother is five days postpartum. Her milk has come in, but the baby just cannot seem to latch well. She wants to nurse but is fussy at the breast. She is hungry because she hasn’t had a really good feeds yet. Mom is exhausted and frustrated. After a few more days, everyone is overwhelmed and no one knows how to help the nursing go any better. Mom takes baby in to the pediatrician/midwife/nurse-practitioner…
The trouble is, most care providers are only familiar with the classic tongue-tie. Lip-ties and posterior tongue-ties are similar structural obstacles to nursing that are typically overlooked by most of us midwives, pediatricians, even lactation consultants because we simply aren’t aware of them; We were never taught to look for them.
Unlike my son who nursed voraciously (and hourly), my daughter had a loose and lazy latch, and only nursed for short spurts as a newborn. I checked under her tongue to see if she was tongue-tied, and she wasn’t. She did eventually learn to latch well enough to get enough milk to feel satisfied and gain weight — albeit slowly. Looking back on those first six months, I was so sleep deprived and busy trying to stay connected to my three year-old that it hadn’t occurred to me that she might have some other structural or oral-motor problem contributing to her poor latch.
July 27th, 2011
If I hadn’t already felt like a pawn in the eyes of the pharmaceutical industry — another warm body off of which to profit — I sure do today. Drug manufacturers are educating women about yet another new condition it can cure: too many periods. I discovered the new condition on the back of the May/June issue of ”Nurse Practitioner World News” sticking out of my mailbox. An advertisement for Seasonique™, an oral contraceptive offering “fewer periods, and now more savings, ” proudly displays a vibrant, healthy, happy, Patagonia-clad woman is enjoying a fresh walk down the beach. She is walking in confidence — period free!
May 30th, 2011
Your baby has just been born. Would you let someone draw their blood and remove 30% of their blood volume?
I became a midwife before I birthed my own babies. People often ask me how my practice changed after I became a mother and gave birth. All midwives advocate for the needs of babies, but giving birth to my own baby afforded me a more direct and visceral connection to the baby’s birth experience than I had previously known (among other things!). I am more deeply attuned to how the both mother and baby experience labor, birth and the hours after birth — physiologically and emotionally; From their passage out of the pelvis (or abdomen) to their first moments touching, hearing and smelling each other, it is a sacred and biologically unique time.
Harmful cord clamping practices are one of the first interventions experienced by most babies born in the US. (Sometimes they are also needlessly bulb-suctioned or removed from their mother). Cutting the umbilical cord within seconds of the birth, also known as premature or early cord clamping, is a routine practice of hospital births attended by physicians. It is another intervention that has become so second-nature to physicians, and has gone largely unchallenged in the delivery room.
March 5th, 2011
Imagine a woman in labor at the hospital. How she is moving? Where is she in the room? What is she doing? Probably you see a woman lying down in the bed, wearing a hospital gown, hooked up to various monitors, straps and tubes.
In some high-risk labors these procedures may truly be necessary for the safety of moms and babies (or for women using epidural medications). Most healthy low-risk women do not need to be hooked up to anything in order to safely birth a baby. Imagine how different hospital birth would be if most women could move around as they pleased without any sensors or straps attached to them. Imagine women moving instinctively, following their own inner rhythm and positioning themselves in ways that made their bodies feel powerful, relaxed, and productive.
June 10th, 2010
I recently attended a planned hospital birth of a client who transferred out of my care shortly before her birth. We transferred her care to our small, local, natural birth-friendly hospital. A gracious family practice physician took over her care. Two of my client’s main hopes for her birth were delayed cord clamping (of at least a minute or two), and to receive her baby immediately from the hands of the doctor. The doctor and I discussed the mother’s wishes more than once while she labored, and she was amenable to both. I had such high hopes for this baby’s entrance; We were going to have a somewhat physiological experience here!
After a few pushes baby comes out, pink and happy, and I’m watching, waiting…… still waiting for baby to be in mom’s arms. The doctor holds the baby down by the mother’s thighs, taking ample time to do unusual and unnecessary things. First, she bulbed the vigorous baby four or five times, then leisurely picked up a piece of gauze and slowly wiped the baby’s face. The energy shifted in the room from pure joy and excitement to mistrust and anger. She had previously agreed to give the baby immediately to the mother and now she was stalling. We were all very confused. What was she doing?
Meanwhile the mother was pleading desperately to have her baby: “Please, pleeeease, give me my baby.” I will never forget the sound of this mother begging to hold her baby. It caused me visceral pain. Every second of it broke my heart. I pray I will never again be in a situation where I, or anyone else, would withhold a newly born baby from her pleading mother.
After mother and baby were settled and nursing I seized a brief moment to talk to the doctor in the hallway. I asked her why she did not honor the mother’s desire to immediately hold her baby, as she had previously agreed to. She stated that she did honor the mother’s request to immediately receive her baby (“immediately is often a relative in the hospital), but that she also was attempting to honor her request for delayed cord clamping — requests that, in her mind, were mutually exclusive. She argued that she could not give the baby to the mother while the cord was intact because the baby’s blood would back flow into the placenta. In her mind, the delayed clamping needed to happen first, then the mother could have her baby. The two things could not happen simultaneously. We all know that thousands of babies are placed on their mother’s bellies every day, and probably have been since humans started having babies, but somehow the rules have changed.
I was stumped. Of all the bizarre medical model theories and logic I’ve encountered, this one was new to me. Typically physicians oppose delayed cord clamping because they believe the baby will receive too much of his or her own blood volume through the cord. This doctor was afraid that baby would not receive enough of her own blood because it would back-flow into the placenta if the baby was on the mother’s abdomen.
After debriefing with some of my peers I discovered that fears about blood draining out of the baby is not uncommon. But since the medical community largely opposes ‘delayed cord clamping,’ the question about where the baby should be while waiting to cut the cord rarely comes up in OB-attended births.
To be fair, there is some logic in the belief the blood will backflow out of the baby. If a woman gives birth and someone holds the baby up two feet above the mother’s body for any length of time, yes, common sense tells us the force of gravity will encourage blood flow downward, away from the baby. However, there are two problems with application of this logic. First, suspending the baby above the mother should never happen. There is no valid reason to suspend a baby feet above her mother moments after birth. You may have seen this in birth scenes from the 80′s, but this is not an appropriate or even reasonable practice. Second, we now know that a complex feedback process determines when the cord vessels close and thereby minimizing blood flow out of the baby and maximizing blood flow into the baby. It has very little to do with the position of the baby in relationship to the placenta.
Nature came up with a perfect design here. We can’t outsmart this one. Keeping the baby at the level of the mother’s abdomen is practical, normal, and biologically best. Fortunately for babies born in the hospital , some contemporary evidence-based OBs are coming around to accepting what midwives and mothers have long known: leaving the cord intact allows the baby to receive her full blood volume along with all the stem cells, red blood cells, oxygen, immune-boosting antibodies, and whatever other undiscovered life-giving properties our blood supplies.
June 10th, 2010
An OB candidly shares her remarkable journey though three inductions, two cesareans, two vacuum assisted births, and one unplanned VBAC. Now a VBAC advocate, she shared her story on her blog:
My Surprise VBAC
“Needless to say, like most OB residents, my experience with normal, low-risk physiological birth was minimal……..Reflecting back over my journey, I see how much the field of obstetrics has managed to contribute and sometimes outright cause complications, all the while assuming they are just keeping everyone safer. And I see how much fear has overtaken the natural birthing process. I’ve said before that shows like Deliver Me, A Baby Story, and Birth Day should be renamed “Fear Factor” because they play on a woman’s often natural concerns about the birth by portraying the whole process as highly dramatic, with a woman strapped down and hooked up…..”