Trusted Information for Healthy Pregnancies
birth plan
Why a Page woman traveled 350 miles to Valley to have baby
Feb 16th
In order to deliver her baby the way she wanted, a woman said she would have to come to the Valley, 350 miles away from her home in Page.
Joy Szabo has four boys. Her first delivery was vaginal, her second a cesarean, her third a vaginal birth after cesarean or VBAC.
For her fourth... "I knew from the beginning that I wanted to deliver him vaginally, I had already had a successful VBAC and my doctor was on board with that," said Joy.
She planned to deliver at Banner's Page Hospital, until she learned the hospital would no longer allow VBAC births.
Joy spoke with the CEO.
“She told me she didn’t see any reason why I shouldn’t be able to deliver vaginally, but it wasn’t going to happen there. I needed to find some place else,” said Joy.
At this time Joy was entering her last trimester. She checked into it and home birth wasn’t an option. It’s illegal for a midwife to allow a woman to VBAC at home.
She would have to come to the Valley for a VBAC birth, 350 miles away from her Page home. With a husband and three young boys it wasn’t an easy task.
She was doing all this to avoid the risks that come along with a c-section surgery, but VBACs carry their own dangers. The biggest is the possible rupture of the C-section scar on the uterus.
OBGYN Dr. Roger Seymann has seen it and no longer handles VBACs because of it.
“Observing the horrendous outcome of opening the abdomen, seeing a baby in the belly, knowing this baby has a risk of neurologic damage, if it has in fact survived at all,” said Dr. Seymann.
Banner Hospitals say they don’t allow VBACs at their rural locations because they can’t provide the 24/7 care needed in case of a rupture.
Joy ended up delivering at Banner Gateway with a doula and a doctor that would work with her wishes.
Her doctor was Dr. Christine Brass of Mesa.
“I just carefully choose with the patient themselves you know who is going to be the best candidate for proceeding with a vaginal birth after cesarean,” said Dr. Brass.
She says there are plenty of factors that go into that consideration. Dr. Brass says women who had a c-section the first time because the baby was too big for their birth canal probably aren’t good candidates. A woman who has done a VBAC before, like Joy, is a great candidate.
Joy says she couldn’t be more happy with the outcome.
“There is an emotional side to delivering your own baby and being able to see what’s happening and participating in the process that really is valuable,” said Joy.
The ACOG guidelines recommend that both obstetrician and anesthesiologist need to be immediately available for elective VBAC in order to meet patient safety standards for laboring mothers and their infants.
Source
Birth planning leads to surprising increase in premature births
Feb 8th
The rising trend of expectant mothers being involved in every aspect of planning their births has had an unintended consequence - a rise in pre-term deliveries.
"It never would have occurred to me or anyone I knew to think you had any kind of control over when the baby would come out," said Laura Crawford, who gave birth more than a decade ago.
Crawford, producer of the Kentucky Educational Television documentary "Born too Soon," said the increasing incidence of what is called late pre-term births is among the topics explored in the film.
Prematurity rates in the nation have increased quietly over the past two decades, according to public health officials. The premature-birth rate in Kentucky is 15.2 percent, and it's rising faster than the national rate, which is 12.7 percent. Kentucky has one of the highest rates of pre-term births, trailing only Louisiana, Alabama, Mississippi and South Carolina.
Some of Kentucky's rise is related to some not-so surprising subjects, including the rate of maternal smoking (more than twice the national average), poverty and environment.
Other reasons are more surprising. They include the rise in scheduling births.
It's just within the last three or four years that the scope of the problem of late pre-term births - babies born between 34 and 36 weeks' gestation - has become apparent, said Dr. Ruth Shepherd, division director for maternal and child health in Kentucky's Department of Public Health. Roughly 10 percent of all babies born in Kentucky fall into the late pre-term category.
Ideally, she said, babies shouldn't be delivered before 39 weeks.
Often, there are legitimate reasons for early delivery, especially if the health of mother or child is at risk.
Increasingly, choices are made for reasons other than health. Delivery might be scheduled to coincide with grandparents' dates of arrival from out of town, or before Dad must ship out for Iraq.
There are several complicating factors, Crawford said. The documentary states that people tend to underestimate the impact of premature births, especially late pre-term births. They tend to overestimate how accurately a due date can be determined.
Shepherd said there can be real consequences. They can include immediate physical challenges, including underdeveloped lungs and long-term problems involving learning and behavioral disabilities, for example.
And even if a mother gets an ultrasound within the first 16 weeks - the best way to accurately determine the due date - the date can be off by two weeks either way.
Those two weeks can be crucial, she said.
"It's an issue of planning and control," she said. Planning is good. The Centers for Disease Control and Prevention recommends that mothers have a birth plan. But, Shepherd said, "you can take it too far if you don't pay attention to the science."
Source
Birth month determines who becomes a sports star
Feb 3rd
Do you have sports star dreams for your unborn child? Well, then plan the baby in such a way that he or she is born in the month of January, claims a researcher.
By studying the seasonal patterns of population health, senior research fellow Dr. Adrian Barnett from Queensland University of Technology's Institute of Health and Biomedical Innovation concluded that the month you were born in could influence your future health, fitness and sports ability.
The results of the study are published in the Springer book Analyzing Seasonal Health Data, by Barnett, co-authored by researcher Professor Annette Dobson from the University of Queensland.
To reach the conclusion, Barnett analyzed birthdays of professional Australian Football League (AFL) players and found a disproportionate number had their birthdays in the early months of the year, while many fewer were born in the later months, especially December.
The Australian school year begins in January. "Children who are taller have an obvious advantage when playing the football code of AFL," Dr. Barnett said. "If you were born in January, you have almost 12 months' growth ahead of your classmates born late in the year, so whether you were born on December 31stor January 1st could have a huge effect on your life."
Dr. Barnett found there were 33 percent more professional AFL players than expected with birthdays in January and 25 percent fewer in December. He said the results mirrored other international studies which found a link between being born near the start of school year and the chances of becoming a professional player in the sports of ice hockey, football, volleyball and basketball.
"Research in the UK shows those born at the start of the school year also do better academically and have more confidence," he said. "And with physical activity being so important, it could also mean smaller children get disheartened and play less sport. If smaller children are missing out on sporting activity then this has potentially serious consequences for their health in adulthood."
Source
A Natural Birth: Seamus’s Story
Jan 26th
My story starts back in 2006.
I have a history of miscarriage. I had two early losses before giving birth to Noah, but for some reason had thought it would not happen again.
We decided to start trying for another baby in December 2005, and got pregnant right away. However, this pregnancy sadly ended in a miscarriage at the end of January, a very traumatic loss.
Since this was my third loss, despite not being consecutive, I talked my GP into referring me to the hospital for further testing. I had a ton of blood taken for various different tests, however by the time my appointment came along to see the consultant to discuss my results I was already pregnant again, after suffering a chemical pregnancy the cycle before, it turned out this time the baby was going to stick. I had about 8 scans as they monitored my pregnancy very closely this time.
However, things were not to go completely smoothly, as at 16 weeks I consented to having the triple test done for Downs/Edwards syndrome/Spina Bifida, something I regret doing as I feel very strongly against abortion apart from in extreme medical circumstances. This test came back with an elevated risk for Downs Syndrome, at 1 in 200. (The risk for my age, 29, should have been 1 in 1000.) Due to my loss history I refused an amniocentesis. The risk for losing my baby was double the actual risk of it having Downs and I could not accept those odds. So I opted for a detailed scan instead. The scan showed no soft markers for Downs and confirmed what we already suspected was true, that I was carrying another little boy.
At 34 weeks, I had another scan which also showed no markers for Downs. The consultant tried to talk me into an amnio at that stage, which I refused, as I could see little point. She said,
Do you know what risk you are taking?
I felt that was completely ridiculous, as whatever abnormalities my child might have had, we would just deal with whatever came up. I would love my child no matter what and strongly believe that we got given what we can handle and no greater than that. My gut told me though that my child was healthy and I clung onto this.
We started to plan the delivery, our local hospital had recently upgraded their birthing pool so that mothers could actually give birth in it rather than just laboring in it and then getting out before the birth itself. I fully intended on using this pool, especially after researching it and finding out that a warm bath is the second most effective form of pain relief after an epidural!
I had an epidural with Noah’s birth which had not taken properly (just down one side) and I had some horrible side effects (nausea and shaking). I was determined not to have one this time.
A good family friend of ours, Joana, is a midwife and had delivered Noah, we had her on call whenever I went into labor, although she would need some assistance as this would be her first waterbirth.
At 39 weeks, 4 days, I woke up to mild contractions, timed them as coming every 10 minutes.
As the day wore on though, they did not intensify, or get any closer together. By the time Gary got home from work I was getting very frustrated and at that point not even bothered if they stopped, I just wanted SOMETHING to happen or let me get some rest. At 9 p.m., I decided to try and get some sleep so went to bed. It was difficult as I was woken with every contraction, but I was determined I would need some sleep if I was going to have any energy to deal with labor.
Somehow I managed to get to sleep and the next thing I knew, it was 1 a.m. and I awoke having a very intense contraction. I lay there timing them again, and noticed they were coming about 3 minutes apart and lasting about 50 seconds each. I woke DH and we both got up, rang the in-laws. I got dressed and headed over to the hospital. I rang Joana on the way over.
At this point my contrax were 3 min apart, but every now and again I would have an extra one in between; they were painful but manageable. When we got there they had the pool all ready for me and they checked me before I hopped in. Joana was shocked to find I was already 9cm dilated – so I had already gone through most of labour at home!
I got into the tub and as soon as I hit the water I hit transition and started to lose it. Seconds after, I felt a huge pop and my waters broke. (Great timing!) I managed to focus on the contractions, which were getting really intense.
About 10 mins after I started to feel the urge to push, my body just took over – this part always freaks me out, how the body just does things with no input.
With my last labor, the pushing had been very, very difficult, as I was on my back wired up to machines after having an epidural, and it took over 2 hours to get him out.
This time though, I was able to get right into a good position and let gravity help me. Still, I was nervous. I also tore badly last time and was worried about it happening again.
In the end though I just realized the faster I get him out the sooner the pain is over and just pushed along with my body. I knew he was coming soon. I could feel the infamous “ring of fire”.
Joana called the other midwife in. They got me to squat right in the center of the pool as low as I could and as he came out, they told me not to touch his head, as it might stimulate him to breathe. His head popped out and very soon after the rest of his body.
When they told me the time was right I brought him up to the surface and laid him on my chest. I remember thinking how soft his skin was and what a big boy! He didn’t even cry and soon pinked right up nicely.
Seamus weighed on at 8lbs, 4oz, born at 4.50am (45 minutes after reaching the hospital) on the 24th February 2007. Perfectly healthy.
Written by Claire Louise. Read more details of the story here.
Father’s presence at birth seems to have little effect
Dec 29th
A father's presence during childbirth seems to have neither a positive nor negative effect on the process, according to a study by a Germany medical society.
Achim Woeckel of the DGGG (German Association for Gynaecology and Birth Aid) said studies of childbirths showed that a partner's presence had little impact on the length of labor, the need for painkillers or the likelihood of medical intervention. At the same time, the father's presence had no correlation with the rate of complications.
But Woeckel says it might help for fathers to attend men-only courses - not couple's child preparation courses. Doing so can have positive effects for the couple's happiness, since fathers might pose questions in such sessions that they wouldn't when their partner is around.
Attending such a course also means fathers tend to have a more positive memory of the birth experience. Properly prepared men are more comfortable in their role. They know that, in the delivery room, their job is not to provide guidance or do work, but simply to be there and trust in the medical staff to do their job.
Additionally, men should exercise their right not to be in the delivery room, if they so choose, says Klaus Vetter of the DGGG.
'A woman in labor does not need an uncertain or nervous partner around,' he said.
Source
Tips for Avoiding an Unwanted C-Section
Dec 17th
Not every mother wants to avoid a C-section -- in fact, some request them -- but if you do, here are some tips for what to ask your doctor (or midwife) in the delivery room if the suggestion is made that it's time to give up on a vaginal birth and head to the operating room.
"Doctor, is this an emergency, or do we have time to talk?"
Sometimes you need a C-section to save your life, your baby's life, or both. In those cases, there's no room for discussion.
Delivery room emergencies include excessive bleeding, a breech position where the baby is headed out foot-first, or when the baby has certain heart rate problems.
"Doctor, what would happen if we waited an hour or two?"
The vast majority of the time, when your doctor or midwife tells you it's time for a C-section, it's not an emergency.
In many cases, women just need more time to labor. In fact, the No. 1 reason for a C-section is "failure to progress" during labor. If that's what we're talking about, then it's not an emergency.
"Doctor, are you sure the baby is too big for me to deliver?"
Sometimes parents are told a baby is too big to deliver vaginally. Dr. Ware Branch, medical director of women and newborns clinical program at Intermountain Healthcare in Utah, says parents should ask whether a C-section is absolutely necessary, especially if labor hasn't advanced very far.
"If it was my wife in labor and she's three or four centimeters dilated and the obstetrician says the baby's head is too big and she can't deliver him, I'd say, 'Nonsense, she hasn't really had a trial of labor, doctor.' "
"Doctor, is there something else I can try before having a C-section?"
Antunes, a spokeswoman for DONA International, which certifies doulas, says there may be options such as maneuvers like the one she used on Ste. Marie to get a slow labor moving.
"Doctor, can we talk more about the baby's heart rate?"
If you're told you need a C-section because of the baby's heart rate, try to get your doctor or midwife to be as specific as possible.
Some heart-rate problems mean a C-section is necessary immediately, but other types of heart-rate issues are not nearly as serious, and you may be able to labor longer.
"This is a very gray area," says Debbie Levy, a certified nurse midwife in Marietta, Georgia. "It takes years to learn how to read fetal heart tones, and it's not an exact science."
Levy says it can be difficult to ask these questions when the person delivering your baby says it's time for a C-section, especially since mom and dad are often exhausted.
"This is a very tough discussion to have in the delivery room," she says. "You're vulnerable, because you're talking about your baby's well-being."
But she says as long as it's not an emergency, you should have these delivery room conversations with your doctor or midwife.
"You shouldn't be afraid to speak up and say you'd like to try to labor longer," she says.
Pregnant Women Unaware of How Long Pregnancy Should Last
Nov 20th
Recent reports show that the rate of preterm deliveries continues to climb in the United States. Now, a new study suggests one reason why: Many women are confused about what constitutes a full-term birth in the first place.
About one-quarter of new mothers surveyed in the study considered a baby born at 34 to 36 weeks of gestation to be full term, while slightly more than half of women considered 37 to 38 weeks full term.
Though technically speaking, preterm births are babies born prior to 37 weeks, 39 to 40 weeks is optimal, according to the researchers.
Many women interviewed were also unaware that babies born even a little bit premature are at a higher risk of serious health problems compared to babies born at term, the new survey shows.
Misconceptions about what constitutes full gestation and how soon it's safe to schedule an elective induction or cesarean delivery are contributing to increasing numbers of premature births in the United States, said lead study author Dr. Robert L. Goldenberg, professor of obstetrics and director of research at Drexel University College of Medicine in Philadelphia.
The study, which included 650 first-time mothers ages 21 to 45 from around the nation who had health insurance, is in the December issue of Obstetrics & Gynecology.
When asked, "What is the earliest point in pregnancy that it is safe to deliver the baby, should there not be other medical complications requiring early delivery?", more than half chose 34 to 36 weeks, 41 percent chose 37 to 38 weeks and less than 8 percent chose 39 to 40 weeks.
However, experts warn that any delivery short of 39 weeks puts a baby at higher risk of respiratory distress, sepsis (blood infection) and needing to be placed in the neonatal intensive care unit, according to background information in the study. Only one-quarter of new moms realized 39 to 40 weeks was safest.
Technically, the World Health Organization and other major medical organizations define preterm births as babies born before 37 weeks. But that definition was developed some 50 years ago and is outdated, said Dr. Alan Fleischman, medical director for the March of Dimes.
More recently, studies have shown that babies born even a bit too early -- at 37 or 38 weeks -- have a greater chance of chronic respiratory disease and learning disorders than children born at 39 weeks or later.
Babies born between 34 and 37 weeks are six times more likely to die during their first week or life and three times more likely to die during their first year than babies born at 39 or 40 weeks, Fleishman added.
In many situations, there is probably some medical reason for choosing to deliver early -- perhaps the mother has slightly elevated blood pressure, for example, Goldenberg said.
"I call them semi-electives," Goldenberg said. "I believe over the last 15 or 20 years, the practice is evolving to deliver those babies earlier and earlier when there is no evidence of benefits."
TV shows and news reports about very premature babies that survive may also be fueling misconceptions, Goldenberg said. Some women are left with the impression that if babies born before 30 weeks can survive, infants that are just a little bit premature should have no problems.
The last few weeks of gestation are critical to fetal development. All of the organs continue to mature in preparation for moving from the womb to the outside world, Fleischman explained. Between 35 and 40 weeks, the fetal brain grows by about 50 percent.
Source
Financing a Pregnancy with No Health Insurance
Nov 6th
First, fill out a questionnaire at govbenefits.gov to see if you're eligible for any government benefits.
Pregnant women can use federally funded health centers that permit you to pay what you can afford, based on your income. They can provide complete care when you're pregnant as well as a host of other health services. To find one in your area, type in your address at www.findahealthcenter.hrsa.gov.
Medicaid is a federally funded state-run program that may help low-income families. The Kaiser Family Foundation provides an excellent database detailing what Medicaid may cover, at http://medicaidbenefits.kff.org/. Just click on your state. Unfortunately, a spokesman for the Centers for Medicare and Medicaid Services confirms there is no centralized federal database to provide pregnant women information on where to go either at local or state levels for Medicaid services.
Each state has a "Women Infants and Children" program, which provides nutritious foods, nutrition education and referrals to health and other social services. Administered by the USDA Food & Nutrition Service, this program covers low income, pregnant, postpartum and breast-feeding women, and children up to age 5 who are at nutrition risk. A household of four would qualify if its annual income is less than $40,793, according to the USDA Food & Nutrition Services. For more information, go to www.fns.usda.gov/wic. Be sure also to examine other federally sponsored nutritional programs located near the bottom of that same web page.
For information on prenatal services in your community, call 1-800-311-BABY. For information in Spanish: 1-800-504-7081.
The State Children's Health Insurance Program may help children of families who make too much to qualify for Medicaid but can't afford private health. Go to www.insurekidsnow.gov or call 1-877-543-7669.
Indian Health Service provides public health care services to American Indians and Alaskan natives as well as non-Indian women who are pregnant with an eligible Indian's child. Contact www.ihs.gov.
Some labor unions, professional clubs, associations and organizations offer private group plans to members, which may be lower-cost.
Other options:
- Talk to your hospital about a payment plan. Negotiate fiercely and try to obtain a list of all fees and necessary services in advance.
- A birthing center. This may cost $3,000 to $4,000, compared with $10,000 for a hospital. But consider this only if you are perfectly healthy and expect no complications. Find whether the center is properly licensed in your state and check staff credentials. You can search for a birthing center at www.birthcenters.org.
- Consider a midwife. Midwives charge less than one-third for their services compared with regular hospital care, and many prefer the personal touch and the natural nature of childbirth through a midwife. Ask your doctor or hospital for referrals. You also can search a data base at the American College of Nurse-Midwives at www.midwife.org. But shop around and carefully evaluate credentials, built-in safeguards, cleanliness and what insurance exists on the facility and/or midwife in the event of a problem.
