Belly Up

* bellies * birth * babies * breastfeeding *

Tuesday, December 3, 2013

Best Doula and Birth Stories - vote for me!
I started writing this blog to have a resource to send my clients to after I noticed that I was getting the same questions come up frequently.  I still do this all the time and it is interesting to see that the posts I most often direct clients to are also the ones that receive the most hits from google.  Seems that pregnant ladies everywhere wonder about similar things!  I have to admit with 4 kids of my own and having attended over 45 births a year for the last few years, I have not had the time, or really the energy, to add much to this blog recently.  However, if you love reading about birth, feel free to check out my actual doula website where I blog a bit about every birth I attend.  There are lots and lots of birth stories of all types if you are looking for encouragement or inspiration.

Best Doula, Dallas Child Magazine
If you have enjoyed reading my blog either here on my doula site....I would love to have your vote for Best Doula North Texas from Dallas Child Magazine.  I won this award last year and I admit, it was a pretty cool honor.  So, if you happen to see this before December 15th, 2013 then you can go here to vote for me (or someone else):


Happy Birthing!

Monday, July 8, 2013

It's The Law - Eye Ointment for All Babies

Texas State Rule 97.136 Prophylaxis against Ophthalmia Neonatorum 
(a) A physician, nurse or midwife or other person in attendance at a childbirth shall apply or cause to be applied, to the child's eyes a 0.5% ointment in each eye within two hours after birth.  If this ointment is not available due to the disruption in the distribution or manufacturing, a physician, nurse or midwife or other person subject to this section shall apply or cause to be applied to the child's eyes and alternative treatment included in guidance issued by the Department of State Health Services or the Center for Disease Control and Prevention.
(b) Failure to perform is a Class B misdemeanor under the Texas Health and Safety Code. 

Did you know that every baby in Texas is treated for an STD within hours of their birth?  Ophthalmia neonatorum (ON) is a conjunctivitis (ie type of pink eye) that can be contracted during vaginal birth. The two main causes of ON are chlamydia or gonorrhea. ON is NOT caused by Hep B, Step B or HIV.  If the mother does not have chlamydia or gonorrhea, then the newborn cannot contract it.   While ON can potentially lead to blindness (and that was a common problem before the advent of antibiotics), ON is treatable and blindness would only occur if an infected newborn did not receive antibiotics.  In most states though, antibiotics in the form of eye ointment or drops are administered prophylactically to avoid an initial infection on every single baby that is born regardless of the mother’s chlamydia or gonorrhea status. 

It's the Law
The Texas state law as seen above requires that every baby have the antibiotic erythromycin within 2 hours of birth and the law is written so that it is a misdemeanor for the care provider to not to so (though there are provisions for midwives that I have not listed).  In practice, many hospitals provide a waiver for parents to opt out as patients should always have the right to decline any medical care that they choose.  However, a number of big hospitals do not have any opt out and those hospitals typically call CPS if mom and dad decline and often will administer the ointment against a parent's wishes. 
Why would a parent even want to decline the treatment?  There could be any of a number of reasons.  The ointment is irritating to some babies eyes, most babies are taken to the warmer for the administration of the ointment so baby is taken away from mom during the initial bonding period and the ointment may then also interfere with the baby's sight during that time.  However the most common reason may be that most parents do not want to give unnecessary medication to their children and from a societal perspective the use of unnecessary antibiotics contributes to the growing problem of antibiotic resistance.  Even C-section babies are required to get the medication and, particularly if their amniotic sac was intact prior to surgery, there is almost no likelihood of an infant acquiring an ON infection - even if mom is positive for Chlamydia or Gonorrhea.  Given the numbers of babies being born surgically, that means just by method of birth alone, upwards of 60% of babies are receiving unnecessary antibiotics within moments of their arrival.  That's quite a welcome! 
So where does that leave expecting parents? 

  • Decide if this is an important issue for you.  Ask your care provider when you were last tested for gonorrhea or chlamydia and honestly assess what your risk is of having acquired one since that test.  Find out your hospital's policy on opting out of the eye ointment.

  • If the hospital does not have a waiver,  you may ask to have the ointment administered while you are holding your baby and bring a soft cloth to wipe your baby's eyes.  Even if you want the ointment, it is still wise to ask if the procedure can be done while you are holding baby.  This will keep your bonding time from being interrupted.

  • Decline the ointment with either a waiver or be willing to have CPS give you a call.  (I have had clients where this happened and CPS was totally cool about it, but no promises that will always be the case.)

Monday, June 24, 2013

"Let Me Tell You My Story"

Hey doula!  Let me tell you my story!
When in the course of conversation it comes up that I am a doula I sometimes get the response of  "you do what?" or "what the heck is a doula", but more commonly I get told birth stories...lots of birth stories!  I have heard literally thousands of birth stories from friends, strangers and other women after they hear I support laboring moms.  Some of these moms have fabulous stories, some very scary ones.  Some are recent experiences and some were decades ago.  Women remember their births and most want to share the special tale of how their child arrived.  I listen to them all and hopefully nod and smile in all the appropriate ways. 

I really do love hearing the stories.  When I hear comments like, "my C-section was necessary" or "my labor was really, really, really hard so I had to get an epidural".  I hopefully also nod and smile in the appropriate ways and let these mom's know that I think their story is important.  I wasn't there and they are not asking me anything, really just looking for acknowledgement of their choices, their experience and perhaps my approval, which of course they don't need.

However, I recently had a acquaintance talk to me about her upcoming delivery which was going to be an elective repeat C-section. She told me this was the only option available to her. I try very hard to listen to everyone and support the choices they make and only offer suggestions if asked, but this time I found myself unable to just nod and smile.  I looked right at her and told her (very nicely!) that she knew she had other options.  There are many OBs in our area that would help her have a VBAC and we had even had that conversation previously.  It wasn't that she didn't HAVE options, it was that she had already CHOSEN her option.  And that's OK.  It is OK to choose an option that I would not....however it is not OK to say you have no options to justify your choice. 

Empowered birth and informed decision making is about knowing your options, and deciding what is best for your situation and then owning that choice.  It is even a valid choice to hand over all decisions to someone else - be it an OB or your in-laws or your hubby (all of which I have seen).  It just isn't OK to say you didn't have choices when in most case you do.  From the choice of care provider, to birth location to when and how to deliver, there are lots of options and almost none are irreversible until the baby is out.  (Obviously a mom giving birth to say triplets has many less options than other moms, but even then she has some choices and can feel empowered in making them.)

I often work with moms who are planning a birth that is going to be hard to pull off with their
Informed choices, amazing births
chosen providers.  Now I admit, changing providers late in the game is less fun than starting with a great one, but it isn't that hard either.  One of my most memorable examples of this is a couple who wanted a VBAC.  At 41 weeks her provider scheduled a C-section and said her time was up.  They had a choice.  One choice was to have repeat surgery, the other was not to.  In this case, mom made an appointment with a new OB and didn't show up for her surgery.  The same day her surgery was scheduled she met with that other OB and at 41 weeks and 2 days she had a beautiful all natural VBAC.  That happy ending does not mean though that if she had decided to trust the first OB that she had run out of options.  It would have meant that she had chosen to have her baby via C-section.

When it comes to birth, know your options so you can make informed decisions.  Or maybe even  make a choice to not explore your options (though that is obviously not what I recommend!).  Just know that choosing not to explore your options is in and of itself is a choice.  Empowerment in birth does not come from having a perfect labor, it comes from a couple making the choices that are best for themselves and their baby and being proud of how and why those choices were made.