Wednesday, December 30, 2009

Welcoming The Babies

In Bali, at the birth of each babe, the midwives and all in attendance would begin to sing this song.  As the babe was crowning, it was very important to begin singing.  I fumbled along but never really got the words stuck into my brain like I wanted them to be.  This time around, I want to sing along knowing both the words and their meaning.  The midwife did explain to me something along the lines of, "we are welcoming each babe.  telling them we recognize the god in them."

For me, seeing words spelled out really helps to understand a language.  If I spell your name, when we meet, I am likely to recall it!  So, seeing the song spelled out is helping me to memorize it.  I am so stoked to sing along this time.  Oh, wait!!!  I am tone deaf.  I don't know a beat or a rhythm.   All memebers of my immediate family have asked me to stop singing at one point.  It's true.  This holiday season, as I sang Ezra Jack Keats' version of "The Little Drummer Boy", my Ez asked me to "just read it, mom."  Now, what?  Sing anyway and ruin the otherwise melodic births of these precious babes?  Or just spell it in my head as I hum or mumble along inside pleasantly happy enough to finally KNOW the words.

The babes at Bumi Sehat hear these words being sung over them:

Om Bur Buvah Suvaha
Thath Savithur Varenyam
Bhargo Devasya Dhi-Mahi
Dhiyo Yonaha Prachodayat

What does it mean, you ask?  Well, I asked the same!  It means:

Oh God! Thou art the Giver of Life, Remover of pain and sorrow, The Bestower of happiness, Oh! Creator of the Universe, May we receive thy supreme sin- destroying light, May Thou guide our intellect in the right direction.

And, just for clarity, not every single babe hears these words first.  Why not?  It is tradition for the Muslim dads to whisper The Call to Prayer into their babe's right ear.  We are all quiet to honor this.  Everyone, including the dad, perhaps has been singing up until this point sometimes.  But, if we know the family is Muslim, all gets quiet for the dad to whisper.  I have seen it done with tears streaking down the dad's cheeks as he is so full of joy in welcoming his precious babe just as we, the birth attendants are.

Friday, December 25, 2009

Merry Christmas

 Today will be a fabulous day, one where my family celebrates the birth of a sweet babe.

If you are looking to get crafty today, this looks like a beautiful project to do.

Thursday, December 24, 2009

Matchings...Oops

First, let me share with you a blog post that makes me want to be a more consistent blogger and just a truer human mama person.  It's from my long-distance rockin' mama friend.  She even rocks in labor and birth, trust me, I was (HONORED TO BE) there to witness.

One of the bear's favorite books is Sandra Boynton's "Blue Hat, Green Hat" which ends in the word "oops". She reads it to herself on a daily basis now. One of her other favorite things (and e's, too) is to have matchings with her sister. Whether it is clothes, crayons, shoes or food portions, they both really like to have the same.


So, being a mama that really enjoys the visual imagery of Hanna Andersson dresses, I ordered them matching red snowflake dresses.  Now, I did not go to the official website to order them but rather spent time on ebay bidding frugally on matching reds.  The bear's came first and one for e came later.  If you know about Hanna, they are European sizing which my brain doesn't always compute.  So, the dress for e that came was a tad too big.  We laughed for a long time as she tried it on, already knowing it would fit Maggie better than ez.

Huge ole dress.  And, yes, the bear does have her dress on backwards and with a pair of pants that I put in the give away pile a week earlier.  Doesn't get much better.  We are awesome.

Somehow, the dress did get turned around but e never did get one in the right size.  Oops.  She really didn't seem to mind, at least.  Merry Christmas!  

Wednesday, December 23, 2009

Jumping Beans


In mid-air, she leaps from the ledge to the ground.  Why?  B/c it is just the right height to be jumped from, of course.


Getting sister in on it is the best part.  Even a sister dressed in silly ole boy clothes.  Yes, she is not two years old, yet and already loves wearing her boyfriend's shirt.  What's a mama to do?  Have him over for a slumber party, of course!  If they are going to get hitched one day, I have to start teaching him how to wait on her hand and foot like all good partners do for each other.

Love that they held hands through the whole jump.  Precious.

Then, they found an empty box and jumped into it for a while.


Until it needed to be transformed into a boat for lots more play.  Oh, happy evening.  

The joy on both of our faces and the loving hold.  And most of all, the plastic kids headband (bought for holding pig ears in place at halloween) that gets put on me practically every day when I pick it up off the floor-couch-counter-desk-stairs-table and don't have enough hands to lug it to the bathroom drawer where it "belongs". 

Tuesday, December 22, 2009

While You Were Sleeping





This must have happened in that marvelous time when I sleep in while Glammi takes care of my girls.  Love it.

They are all so happy just doing this!

Monday, December 21, 2009

Saturday, December 19, 2009

Celebrating Advent with my Mom


We go this book last year about Little Bear, which introduces a new character each day who is following the star.  One day, I would love to create my own calender to go along with the story line.


Granny Jenny rode the train down to see us for a few days.  We were grateful to spend time with her and to not have to make a trip up to Richmond right now with all the other travel we have coming up.  And, yes, that is the shrek advent page in the aforementioned book.


We should all be so excited about a toothbrush and some xylitol, eh?



Where we burn off some steam before bath, bed and beyond.


My sister sent a stuffed christmas bear to each of the girls.



Snuggling with her eza girl.

Wednesday, December 16, 2009

a lil tree

The girls and hubby picked out a tree while i was at a midwifery workshop.  It's a precious little one. 

Sometimes the bear is a huge fan of takings pics and other times (like in this pic), not so much.

We've gotten live trees in the past but this year, they chose to get a cut one.  It's decorated with ornaments from each year of our family's life together and quite a few from my childhood.  I have a handful of ornaments from 1985; must have been a good year for me.
As embarrassing as this is, the girls are enthralled by Shrek The Halls.  It's a book that I got when E had a huge crush on Shrek from watching all 3 movies in Bali while I was busy having morning sickness and being horizontal on the floor beside her.  She laughed hysterically at the movies.  It's been a while since she saw them and the Bear doesn't really watch movies before getting bored and bouncing around.  But, this book makes them giggle still.

This is usually our nature table.  Not a whole lot of nature perhaps right now.  We light a small candle with each week of advent.

Wednesday, December 9, 2009

EFM Response

Jackie says here:

"It turns out that there are indeed Prospective Randomized Controlled Trials done on EFM that go all the way back to the ’80s. By 1987 there were 8 or so of those “gold standard” trials published in authoritative journals in the US and Europe, including one from ‘86, in the British Medical Journal, comparing EFM with intermittent listening, and all the studies were summarized in the Lancet, December 12, 1987 (the intermittent listening was done with fetascope or Doppler, and differences between those two methods were not distinguished).

This meta-analysis showed unequivocal results, since all the studies came to the SAME CONCLUSION: EFM has only one constant and significant statistical effect: it increases the rate of cesarean section. The studies showed that there was no beneficial effect on fetal health, or on fetal outcomes. NONE. It does not identify more babies at risk than intermittent listening, or identify and save babies from CP, or turn compromised babies into healthy ones or save baby’s lives any more than simple intermittent listening. Therefore, the ratio of benefit-to-risk was negative in that it caused an increase in c-section without any benefit to mother or baby.

Yet today and every day, EFM machines churn away in every L&D, and no laboring mother is ever told that it’s just fine to have someone just listen to her baby’s heart rate every half-hour, or that she can request, and indeed insist, that she have intermittent monitoring. And of course, no one ever tells her that if she stays connected to the monitor, her chances of c-section go up. Even more distressing is the fact that no matter how ACOG re-analyzes and renames and re-categorizes FHR monitoring, as in the new practice bulletin, they will never come out and say.”Don’t use continuous monitoring because it has proven negative consequences”…that pesky increase in the rate of cesareans.

Here’s a really upsetting study published in the American Journal of Obstetrics and Gynecology that the Times will never mention: since obstetricians really couldn’t believe that observing every fetal heartbeat on a strip isn’t helping the health of babies, they thought that more training in interpretation of the monitor tracings would be the answer. So a study was done to find out if special training for obstetricians and perinatologists could reliably identify babies in trouble by using continuous monitoring. Here’s the citation in case you want to check it out: “Intrapartum nonreassuring fetal heart rate tracing and prediction of adverse outcomes: Interobserver variability”. American Journal of Obstetrics and Gynecology, doi 10.1016/j.ajog.2008.06.027[Abstract]. And here’s the conclusion of that study: even special extra training of experienced maternal-fetal medical professionals does not help predict or identify which babies would be compromised. It’s not just that they disagree because training is useless or because experts can disagree…it’s that they disagree because EFM is useless… or, as the researchers state: “intrapartum FHR (EFM) monitoring is not a useful diagnostic test…” If the effect of a procedure is neither neutral nor beneficial, if it has indeed been shown to have risk, i.e., lead to increased, and by implication, unnecessary c-section, how can the use of EFM on every woman every day in this country have any ethical justification.

ACOG says, in Practice Bulletin #76, “Despite its widespread use, there is controversy about the efficacy of EFM. Moreover, there is evidence that the use of EFM increases the rate of cesarean and operative vaginal deliveries. Given that the available data do not clearly support the use of EFM over intermittent ausculation, either option is acceptable in a patient without complications.” (Obstetrics and Gynecology, Intrapartum Fetal Heart-Rate Monitoring 106 (6), 1463-1561.) They can remove what they like from their own prior literature, but Amy is correct in that they cannot erase the studies already out there for years. Is it ethical for ACOG even to call EFM an “acceptable option”? ACOG wants everyone “to be on the same page”? Maybe intermittent listening is the page all should be on!! Let’s not even begin to talk about “defensive” medical practices!"

Tuesday, December 8, 2009

ACOG Issues New Practice Bulletin on Continuous Electronic Fetal Monitoring

From Our Bodies, Ourselves:
July 9, 2009

ACOG Issues New Practice Bulletin on Continuous Electronic Fetal Monitoring

This is going to be a long one, readers, so sit tight!
The American College of Obstetricians and Gynecologists (ACOG) has issued a new practice bulletin on continuous electronic fetal monitoring in labor. Given how thoroughly this practice has been embraced by obstetricians – it was used in more than 85% of births in 2002, up from 45% in 1980 – some readers may be surprised by the bulletin’s strong statements about potential harms of and lack of evidence supporting its use.
Continuous electronic fetal monitoring (cEFM) was introduced in the early 1970s in the hopes of reducing certain complications such as cerebral palsy or fetal death, which were believed to occur because the fetus wasn’t getting enough oxygen. However, these expected benefits were not demonstrated prior to cEFM becoming nearly ubiquitous in obstetrics. As a New York Times piece on the bulletin points out: “Continuous monitoring became a standard obstetrical procedure before studies could show if the benefits outweighed the risks, and without clear-cut guidelines on how doctors should interpret the findings.”
The authors of the ACOG bulletin explain that – in weighing the evidence now – the efficacy of cEFM should be “judged by its ability to decrease complications, such as neonatal seizures, cerebral palsy, or intrapartum fetal death, while minimizing the need for unnecessary obstetric interventions, such as operative vaginal delivery or cesarean delivery.” [emphasis added]
Because there are no randomized trials comparing cEFM with other monitoring methods, the benefits “are gauged from reports comparing it with intermittent auscultation” [periodic listening via stethoscope].
The report states that cEFM does not reduce the risk of perinatal mortality or of cerebral palsy. It is thought to reduce the risk of neonatal seizures by about 50%; these seizures are estimated to occur in about 1 in 500 neonates, with a good prognosis for most patients. On the risk side,  the authors very clearly note that cEFM increases the risk of c-section, and the risk of vacuum and forceps operative delivery.
Given these findings – though with a caveat that current practices for frequency of monitoring may make it logistically difficult under some current models of labor management and hospital staffing – the bulletin states:
Given that the available data do not show a clear benefit for the use of EFM over intermittent auscultation, either option is acceptable in a patient without complications.
The old practice bulletin has already been withdrawn, so it’s difficult to compare exact changes, but an ACOG press release explains that “One notable update in the guidelines is the three-tier classification system for FHR tracings (print-outs of the fetal heart rate).” The authors defined three categories of tracings with specific clinical criteria for each; they are normal (no action required), indeterminate (further evaluation and surveillance needed), and abnormal (requiring prompt evaluation).
Interestingly, the guideline does not recommend immediate cesarean section for the Category III tracings. Instead, it indicates that initial evaluation and treatment may include discontinuation of labor stimulating drugs, cervical exam to check for things like umbilical cord prolapse, changing the woman’s position, monitoring her blood pressure, and assessment of uterine contractions. They further explain that “If a Category III tracing does not resolve with these measures, delivery should be undertaken.”
The authors also explain that “Our goal with the ACOG guidelines was to define existing terminology and narrow definitions and categories so that everyone is on the same page.” This may be necessary in part because providers may often interpret fetal monitor strips very differently from one another, as evidenced here:
For example, when four obstetricians examined 50 cardiotocograms, they agreed in only 22% of the cases. Two months later, during the second review of the same 50 tracings, the clinicians interpreted 21% of the tracings differently than they did during the first evaluation. In another study, five obstetricians independently interpreted 150 cardiotocograms. The obstetricians interpreted the tracings similarly in 29% of the cases, suggesting poor interobserver reliability.
Continuous fetal monitoring may have become commonly used in part because clinicians hoped to avoid malpractice judgments. If there is little agreement between clinicians looking at these tracings, and little evidence of fetal benefit, however, that rationale may need to be discarded. The NY Times piece points out that “Monitoring results are widely used by lawyers to bolster malpractice cases of spurious merit” – in other words, a technique that clinicians have widely adopted with the hope that it would protect them and their patients may instead have a negative effect on their careers, finances, and (last but not least) patients.
Overall, the practice bulletin agrees pretty well with what advocates (including OBOS) have been saying for some time, by addressing reducing women’s exposure to unnecessary procedures, clearly outlining the risks and lack of many assumed benefits of continuous EFM, suggesting that the high tech option isn’t always better, acknowledging that providers may err and vary, and providing the possibility of initial measures that don’t involve going straight to c-section. It’s too early to tell what the response to this ACOG bulletin might be (and further refinements are expected next year), but we’ll certainly keep an eye out for commentary – please leave yours in the comments.

Monday, December 7, 2009

Cesarean Section Birth

Risks of Cesarean Section



When a cesarean is done, the risks and benefits of the procedure need to be weighed. This includes looking at the added benefits and risks of doing a cesarean or of birthing the child vaginally. Sometimes the benefits of the cesarean will outweigh the risks, and sometime the vaginal birth benefits will outweigh the risks of the cesarean.
People were asking what the additional risk of the cesarean were. I am condensing the following list from the book Mayo Clinic: Complete Book of Pregnancy & Baby's First Year. If you have any questions feel free to write me at: pregnancy.guide@about.com Robin Elise Weiss, ICCE, CD(DONA)
http://pregnancy.about.com/



Cesarean birth is major surgery, and, as with other surgical procedures, risks are involved. The estimated risk of a woman dying after a cesarean birth is less than one in 2,500 (the risk of death after a vaginal birth is less than one in 10,000). These are estimated risks for a large population of women. Individual medical conditions such as some heart problems may make the risk of vaginal birth higher than cesarean birth. Other risks for the mother include the following:

  • Infection. The uterus or nearby pelvic organs such as the bladder or kidneys can become infected.
  • Increased blood loss. Blood loss on the average is about twice as much with cesarean birth as with vaginal birth. However, blood transfusions are rarely needed during a cesarean.
  • Decreased bowel function. The bowel sometimes slows down for several days after surgery, resulting in distention, bloating and discomfort.
  • Respiratory complications. General anesthesia can sometimes lead to pneumonia.
  • Longer hospital stay and recovery time. Three to five days in the hospital is the common length of stay, whereas it is less than one to three days for a vaginal birth.
  • Reactions to anesthesia. The mother's health could be endangered by unexpected responses (such as blood pressure that drops quickly) to anesthesia or other medications during the surgery.
  • Risk of additional surgeries. For example, hysterectomy, bladder repair, etc.
In cesarean birth, the possible risks to the baby include the following:

  • Premature birth. If the due date was not accurately calculated, the baby could be delivered too early.
  • Breathing problems. Babies born by cesarean are more likely to develop breathing problems such as transient tachypnea (abnormally fast breathing during the first few days after birth).
  • Low Apgar scores. Babies born by cesarean sometimes have low Apgar scores. The low score can be an effect of the anesthesia and cesarean birth, or the baby may have been in distress to begin with. Or perhaps the baby was not stimulated as he or she would have been by vaginal birth.
  • Fetal injury. Although rare, the surgeon can accidentally nick the baby while making the uterine incision.

Copyright © 1994 - 1998 by Childbirth.org All rights reserved.