First Day of the Conference, part 2.

On the first day one of the other sessions was, “Can VBAC’s Make A Comeback In The US?” by Dr. Eugene Declerq. (please understand these notes are not exact quotes)

*He asks “whats the link between research, evidence and practice? NONE. It’s about cultural practice. That is what is determining what the numbers are.”
*5 things you might not have known about contemporary VBAC’s:
1. Things are maybe not so bad for vbac’s. there is a tendency for vbacs to be under counted in vital statistics systems. *same is true for repeat cesareans. Because on the birth certificate there isn’t an option for vbac, only vaginal or cesarean. So technically the vbac counts as a vaginal. This changes how the numbers are reported. Alabama ranked number 4 in the lowest vbac rates.
2. The falling rates of VBAC have nothing to do with maternal risks. Simply having had a prior cesarean is the only indicator.
3. The relationship between vbacs and primary cesareans. The debate over vbacs is not extinct from the debate. Increasing the VBAC rate will likely be related to decreasing the primary rate. (primary=first time cesarean).
4. Is there a trend toward home VBACs? Yes.
5. Things will get better for vbac’s. How much worse can they get? (sadly, this is true) NIH meeting, new ACOG guidelines.
*NIH reports that mortality is higher in ERCD (elected repeat cesarean delivery).
*Uterine rupture: 325/100k women undergoing TOLAC (trial of labor after cesarean)
ERCD-26/100k (Risk increases with the number of prior cesareans). (can’t find the year or study name on this one.. although I think it was in the green journal).
Interestingly enough this session was a tad bit depressing. Because what would have to change is first, how vbacs are reported, but also this has a lot to do with cultural practice and if a doctor has had an adverse outcome or not. Also, the insurance companies and malpractice insurances are going to have to reform before you see more acceptance of VBAC’s. Even though ACOG made some recommendations that were to be a help to those wanting a TOLAC, they still made recommendations (in their own Level C.. based on “expert opinion” not RCT’s) that are not based on the evidence (RCT’s). So at the end of the day the hope is that things get better because, how could they get worse? Oy.

Here is a video that Dr. Declerq has done on “Birth by the numbers.”

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First Day of the Conference, part 1.

Yesterday’s session Highlights:

“Third and Fourth Stage of Labor: Usual Practices under Heavy Criticism”- AND “How Normal is Birth Today?”-Penny Simkin.
*When physicians are making policy for their practices, generally it has an “order” to it.
1.RCT’s (Random controlled studies)
2. Observational Studies
3. Expert Opinion
Those are the scientifically “accepted” method of deciding what practices you do. But someone came up with a fourth criteria that seems to be jumping on the list:
4. Adverse outcome. And sometimes, even if the RCT’s and science supports a particular practice, if a doctor sees an adverse outcome they will ban it from their practice all together.
(EX: if there is a 1% chance of uterine rupture, and they will ban VBACS all together. Rather than accepting that the opposite is true-per the same study- that there is a 99% chance that you won’t experience a uterine rupture).
*Daddy Skin to skin- even 15 minutes in the first 24 hours: promotes protectiveness, more likely to call the baby by name (instead of “it” or “the baby.”), better understanding of babies cues and promotes closeness toward the baby.
ONLY 6% of ALL births have “NO complication” according to the 2011 review of Insurance billing records of 2008. There is a high incentive to bill more instead to promote health or prevention.
*In the 94% reported as complication here is a breakdown of some by definition: “complicating conditions high rates of minor or modifiable risk factors and preventable complications”- Nukal cord 18%, maternal age12%, prolonged pregnancy-12%
*High prevalence of diagnoses based on unreliable screening tests or subjective clinical judgment – gestational diabetes-17%, abnormal fetal heart tones-17% (meaning these are diagnoses based on interpretation.. different doctors can look at the same EFM strip and make different diagnoses).
*the high % of “complications” were caused by overuse of questionable medical procedures (induction, c/s, episiotomy)
*Payment tied to number or procedures-incentive to dx high risk & disincentive to promote health and prevention
*our current maternity payment and reporting system causes misleading and inflated views of risks of childbearing. See this link for more info http://transform.childbirthconnection.org/blueprint


FOR THE DOULA:

* Even telling a mom, “you’re breathing too fast,” “keep those sounds low”. . she may feel shame “Oh I’m not doing it ‘right’.” . we must be careful not to do that. Rather word it “with the next one try this..” We are doing everything we can to help the flow of oxytocin and shame will cut it off. Yes, there are times where we do have to ask mom to give a little more effort (ex: pushing) but we must know how to communicate that positively).

*Pushing-If she is squatting.. she should not be doing the hard bearing down counting to 10. Sometimes we do have to ask for her to give some more effort if the baby is malpositioned. But there is enough pressure on her perineum that she does not need to force it. Let the baby rock back and forth, in and out of the “crowning”.. good for babies head and for stretching moms muscle.

*Penny Simkin does not like the words “tear or rip” and prefers to re-frame it as a “tissue separation.”

*We know that intravenous hydration may lead to: inconvenience and discomfort to mother, fluid overload, hyponatremia (loss of sodium= foot and hand swelling that can last for days), mother feeling deprived of basic comfort. But there is a CAUTION: too much oral fluid can lead to fluid overload and hyponatremia as well (Moem Study). We can trust the mom on whether she wants to drink or not. Don’t “make” her, suggest it to her.

*Penny Simkin loves epidurals for exhaustion. For the mom that has labored over 24 hours. (if they are exhausted). Because the epidural keeps a mind/body split. When the mind is out of it for labor, the epidural allows her to relax and frees her up to labor (especially during exhaustion).

Anything interesting to you??


"Is my baby getting enough milk?"

Have you ever wondered or been concerned about whether your baby is getting enough milk?

If so, here is a great visual to show that there really is no reason to worry..

Notice the shooter marble in the bottle? If you aren’t familiar with this type of bottle it is a very small 2 oz bottle.

The ball represents the size of your newborns belly until day 10.

So, yes, the colostrum is enough.

17th Annual DONA conference, in Boston!

So on Tuesday I am headed to Boston for my first DONA conference. Before the three day joy ride of wonderful “all things birth/doula related” I have two days of training (to begin my journey) to become a childbirth educator with Lamaze. I thought I’d let you in on the sessions I am sitting in on. Some were “general sessions” that are for everyone.. and some were ones that I picked to attend.

Third and Fourth Stages of Labor: Usual Practices under Heavy Criticism (general)
Presented by Penny Simkin, PT, CD(DONA)
The third and fourth stages of labor are the areas where changes are coming most rapidly. Almost everything that is currently done is being found to be harmful and the evidence is piling up on these routines and practices.

How Normal is Birth Today? (elective session)

Presented by Penny Simkin, PT, CD(DONA)
Examine the scientific evidence on common maternity care practices and discuss the doula’s role within and outside the birthing room.

Childbirth in 2011: Doula Practice in a World of Increasing Cesareans and Home Birth (general session)

Presented by Eugene Declercq, PhD, MBA, MS
In this session, participants will gain detailed knowledge about the state of maternity care in the US, how current practice patterns impact women’s birth experiences and how the doula can play a role in the future of birth.

Can VBACs Make a Comeback in the US? (elective session)

Presented by Eugene Declercq, PhD, MBA, MS
Cesarean rates continue to climb in the United States and many women who have cesareans with their first babies go on to have repeats with their subsequent babies. Whatever happened to VBAC?

Anesthetic/Epidural Medications and Their Impact on Breastfeeding (general)
Presented by Thomas W. Hale, RPh, PhD
Learn how drugs are transmitted to the fetus and the consequences of prenatal medications in the early days after birth.

Research Update for Doulas (elective)

Presented by Patricia Predmore, BSN, LCCE, FACCE, ICCE, CD(DONA), CLEC
What is the latest information available from the research? Join us for a guided tour through the latest.

What in the World is Belly Mapping? (general)
Presented by Gail Tully, BS, CPM, CD(DONA)
Learn how belly mapping can help an expectant mother get to know her baby better and, along the way, help the doula get to know her client.

You Can’t Do That Here: Protecting Breastfeeding as a Civil Right (elective)

Presented by Jake Aryeh Marcus, J.D.
Every doula wants to support mothers in their breastfeeding relationships as they have during birth. But today’s mothers must preserve their breastfeeding relationships in a culture that discriminates against breastfeeding in public and in the workplace. This session will review U.S. law concerning breastfeeding. Attendees will learn how and when breastfeeding is a civil right, what legal protections exist for breastfeeding women and how to support breastfeeding women when they need legal help.

The WHO Code: Why Doulas Have to Care (general)
Presented by Marsha Walker, RN, IBCLC
The World Health Organization’s International Code on the Marketing of Breastmilk Substitutes has been in place for more than 30 years. Learn why it impacts your doula practice.

Breastfeeding Made Simple for Doulas (general)

Presented by Kathleen Kendall-Tackett, PhD, IBCLC
The Seven Natural Laws of Breastfeeding—updated! How you can use them in your doula practice.



I am hoping to do mini updates while at the conference to share some bullet points for all of you to enjoy. If you like to drink the birth kool-aid like I do. 😉