Tag Archives: Birth

Interview: Ricki Lake on giving birth, pregnancy and motherhood

Interview: Ricki Lake on giving birth, pregnancy and motherhood
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Ricki Lake never imagined that one of her more memorable film roles would involve giving birth in a bathtub. When the actress and former talk-show host delivered her son Owen six years ago, she recorded his home birth for posterity. She never envisioned the footage would be seen outside of her immediate family.

Fast forward to January, when Lake’s documentary, The Business of Being Born, premiered at the Tribeca Film Festival. The movie, which celebrates midwifery and natural birthing methods—while scrutinizing how some hospitals deliver maternal care—is Lake’s baby in every sense of the word. The film shows Lake birthing Owen at home with the help of a midwife. “There I was at 195 pounds, naked and giving birth to my son in the bathtub,” says Lake, who turns 40 this year. “I was hesitant at first to include the footage in the film. It’s very intimate but it’s also a beautiful moment.”

A labor of love

Lake had vastly different birthing experiences with her two sons. Milo, who is now 11, was born in a New York City hospital where Lake’s childbirth experience deviated from her birth plan. Although she had a midwife present, the hospital had certain protocols, and after a long labor she eventually had to be induced. Although she received exemplary care, Lake wondered if her son’s birth might have been different without all of the medical interventions. “I was in labor for almost 36 hours, tethered to an IV that was dispensing [the labor-inducing drug] Pitocin,” she says. “I didn’t feel as if I was in control of my body or that I had many choices.”

After reading the classic Spiritual Midwifery by midwife Ina May Gaskin, Lake decided to birth Owen at home, in water, surrounded by her midwife and family. “With my second son the delivery was nine hours long and I was entertaining friends and family at my home the next day,” says Lake.

Lake decided she had a story to tell as well as the background and resources needed to explore the notion of an ideal birth experience. She approached friend and director Abby Epstein with the idea of filming a documentary that would examine the politics and history of birthing in America, while also attempting to answer some tough questions, like why the U.S. spends twice as much per birth as any other industrialized country but still has high mortality rates for infants. Lake also asks, “Why are one in three women having C-sections? Are they really medically necessary?”

Lake wanted to advocate for the rights of expectant mothers and for better maternal care. So she bankrolled the project and served as its executive producer. To capture a variety of views and experiences, Lake and Epstein interviewed doctors, nurses, medical anthropologists and midwives while also following several women through their pregnancies and births.

Advocating choice

While some critics say the film advocates natural home births, Lake says her only goal was to educate pregnant women about their birthing options. “The film doesn’t advocate anything other than choices,” she says. “I’m not recommending that all women have a natural home birth or forego having an epidural.”

During her own pregnancies she grew tired of movies and television shows that depicted pregnant women lying in hospital beds screaming; she wanted the film to show birthing in a positive light. The film includes a number of women giving birth; these scenes have been praised for their mixture of delicacy and humor. “Books and movies can scare the hell out of pregnant women,” says Lake. “I want women to realize that giving birth isn’t an illness that needs to be numbed but rather a miraculous event that should be experienced.”

When Epstein learned she was pregnant during the filming, her experience also became part of the documentary. She originally opted to have a home birth, but after learning her baby was in a breech position, Epstein was admitted to a hospital where she delivered her son by Caesarean section.

Although the surgery was unexpected, both Epstein and Lake say the experience illustrated why women need to be educated about their options. “We don’t want women to feel bad if they have a C-section,” Lake says. “Our belief is that C-sections are fine as long as they are only performed to guarantee the health of the mother and baby. They shouldn’t be the first choice of delivery for healthy mothers.”

Celebrating midwives

Lake is especially passionate about the role of midwives in birth. She cites national research demonstrating that midwives achieve the same outcomes as physicians but with fewer disruptions to the natural process of birth. Midwives have also been shown to reduce Caesarean section rates by more than 50%, and their patients have significantly lower rates of episiotomies, induced labor and forceps births. Today’s certified nurse midwives are professional healthcare providers and registered nurses who have graduated from one of the advanced education programs accredited by the American College of Nurse Midwives.

Midwives assist women in all types of birthing situations and facilities; Lake had midwives present for both of her sons’ births—even during her first son’s hospital birth. “I’m not anti-doctor or anti-hospital,” Lake says. “I think it’s important for women to know what the statistics and risks are—for both a natural home birth and a hospital one.”

Educating women

To date, the film has been well received. By April it had already been rented or reserved by 85,000 customers of the online movie company Netflix. Another 14,000 subscribers opted to watch the movie online. “We’ve had obstetricians tell us that the medical community is embracing our film as a very important tool,” says Lake. “Midwives have thanked us for promoting an awareness of their profession, and women are telling us that in some cases they have switched care providers and left the film with very different ideas about their birth plan.”

Lake and Epstein are continuing their journey to empower expectant mothers with a new book, Your Best Birth, slated to hit bookstores next spring. “The book covers everything from questions to ask a midwife to having a vaginal birth after Cesarean,” Lake says. “I am so excited about both the movie and the book. I truly feel that these projects give my life meaning.”

The book will also feature the experiences of other celebrities, including supermodel Cindy Crawford, who birthed her two children at home. “She was a fantastic person to interview,”
Lake says. “She was very open about both of her children’s births and how the experiences changed her.”

Lake says that being a mom has altered her own life for the better. She revels in watching her sons grow up. “Both boys saw the premiere of the documentary with me,” Lake says. “And Owen gave me a beautiful handmade card that said, ‘Thank you for letting me be born in our bathtub at home.’ ” And for that, says Lake, he is very welcome.

 

By Linda Childers
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How to Find the Best Birth Control Post-Pregnancy

How to Find the Best Birth Control Post-Pregnancy
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Although it might seem fair for it to be otherwise, the reality is that right after the birth of your baby you have no natural or special protection against conceiving another child.

During this time, it’s important for you to take in all of the factors affecting your birth control choices, including your recovery from birth, whether you had an incision, episiotomy or tear that needs healing, your energy level, infant care needs, and emotional readiness, before resuming sexual activity post-pregnancy.

This is a time for you and your partner to practice open and caring communication, especially as you adjust to life-changing roles with a baby in the house, as these stressors can affect your sexual relationship and intimacy. First, have a plan to make sure that you don’t resume sexual activity before you have taken appropriate precautions. Discuss how any of the following options might work best for you and your partner with your healthcare provider to make the best choice for your body and its health.

Oral contraceptives

Because pregnancy increases your risks for blood clots, and your body is recovering for several weeks post-birth, you can’t start on oral contraceptives immediately following your baby’s birth. Combination hormone pills can affect milk supply, so wait until your milk supply is well-established before resuming oral contraceptives. There are a lot of options to choose from so this requires a risks and benefits discussion with your healthcare provider to find which one would work best for you.

Diaphragm

Your body has changed through pregnancy so don’t be surprised to find that if you want to continue using a diaphragm, you’ll need to be remeasured for a proper and reliable fit. Pregnancy changes the shape of your cervix and vagina. You can do this at or after your six-week check-up.

Condoms

Condoms are often your best bet post-birth. And using water-based lubrication products may be helpful, particularly if you’re experiencing vaginal dryness after birth or while breastfeeding.

IUD

If you were an IUD fan before birth, you’ll have to wait until your body is entirely healed from delivery, typically 6 to 12 weeks, before this device can again be inserted into your uterus.

Breastfeeding

While breastfeeding does provide some postpartum protection, it’s only as reliable as you and your hormones are. You may ovulate before you menstruate so breastfeeding is not recommended as a birth control method. You can discuss the lactation amenorrhea method (LAM) if you are exclusively and frequently breastfeeding, and ask about adding a hormonal contraceptive to your regimen just to be safe.

Tubal ligation

If you’ve completed your family, you may want to consider tubal ligation, which is a surgical, sterilization procedure, often done during a c-section or while still in the hospital after delivery. It’s not without risks, and it should be considered a permanent decision that’s made only when you’re certain you don’t want more children. It shouldn’t be taken lightly in the context of relationship issues, economic circumstances, or input from others. If you’re on Medicaid, federal law requires that your consent papers be signed well in advance of your delivery, so discuss this in a timely manner with your care provider.

By Carolyn J. Lee, PhD, CNE, RN

Carolyn J. Lee, PhD, CNE, RN, is a nurse expert adviser to Healthy Mom&Baby.

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Birth With A Midwife

Birth With A Midwife
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Birthing with a midwife is becoming more popular among women seeking fewer medical interventions and a supportive approach to prenatal care, labor and birth.

With a midwife, if you’re having a healthy pregnancy without significant medical complications, you’re more likely to avoid risky interventions, such as labor induction and cesarean birth, and have your baby born through vaginal birth, says Holly Powell Kennedy, CNM, PhD, FACNM, FAAN, president of the American College of Nurse-Midwives (ACNM). You’re also more likely to breastfeed your baby with midwifery care.

Midwives believe women can trust their bodies to birth successfully with little or no intervention.

What to Expect

Midwife is old English for “with women.” During pregnancy, expect very individualized care from your midwife from your first prenatal appointment through baby’s first month of life, or longer.

In fact, midwives spend twice as much time, on average, with pregnant women and their partners than do physicians.

Midwives value this time with you and your partner to develop the close relationship that will empower your collaboration. Last year, a nationwide survey showed women who receive care from midwives rated their satisfaction 91%-95%.

Many midwifery practices offer the CenteringPregnancy prenatal program, in which you receive both individual care from your midwife but also participate in a small group with 8-12 other women of similar gestational ages for group sharing, education and support.

When it comes to birthing, your midwife will stay with you throughout labor and birth, providing support and care, and continue this care postpartum. You’ll have a broader variety of pain relief choices, including epidural, massage, relaxation, laboring and birthing in water, among other options.

If baby arrives healthy, you can hold her skin-to-skin immediately after birth. This helps baby stabilize her blood sugar and body temperatures faster, and start breastfeeding in that first hour post-birth.

Choose a Midwife

Certified nurse midwives (CNMs) practice in all 50 states and in every healthcare setting, from hospitals and clinics to birthing centers and with home births.

Midwives provide women’s health care across the lifespan, including pregnancy care, from your first period to menopause and beyond—just like physicians. ACNM recommends getting care from a midwife who has graduated from an accredited midwifery program and who is licensed to practice in her state. Find a midwife at MyMidwife.org

Reduce Your Risks

Research shows birthing with a midwife definitely has its advantages, including:

  • Lowest risk of cesarean (6.1% compared to 33% nationally with other providers).
  • Greater chance of having vaginal birth (81%) compared to doctors (63%).
  • Lowest rates of interventions like labor induction.
  • Highest rates of breastfeeding, including starting and sustaining.
  • Highest patient satisfaction scores.

Summary of Research on Midwifery Practice in the US (2012), ACNM

By Joanne Goldbort, PhD, MSN, RN

Joanne Goldbort, PhD, MSN, RN, is an assistant professor in the College of Nursing at Michigan State University and an expert nurse adviser to Healthy Mom&Baby.

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Diflucan May Be Associated With Birth Defects

Diflucan May Be Associated With Birth Defects
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Diflucan may be linked to birth defects

The FDA are advising that a drug used to treat yeast infections of the vagina, mouth, throat, esophagus and other organs may cause birth defects.

Treatment with chronic, high doses (400-800mg/day) of Diflucan (fluconazole) during the first trimester of pregnancy may be associated with a rare and distinct set of birth defects in infants.

This risk does not appear to be associated with a single, low dose of Diflucan 150mg to treat vaginal yeast infection (candidiasis).

Diflucan is also used in patients who are likely to contract yeast infected because they are being treated with chemotherapy or radiation therapy before bone marrow transplant. Diflucan is also used to treat meningitis caused by a certain type of fungus.

Patients should notify their healthcare professionals if they are or become pregnant while taking fluconazole. If a patient uses fluconazole during pregnancy, the patient should be informed of the potential risk to the fetus.

Also see: Folic acid helps prevent birth defects

By AWHONN Editorial Staff

The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) promotes the health of women and newborns.

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Choose Your Birth Environment

Choose Your Birth Environment
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You have choices when it comes to birthing your baby—consider the options and decide what’s best for you!

As soon as you become pregnant (or even before you conceive), explore your options and decide what type of care provider you want to guide and support your pregnancy journey. Find providers you can connect with and trust, who will be there to assist in the labor and birth processes. Don’t be afraid to ask questions and arrange facility tours as you explore the best place to safely birth your baby.

98% of women in the US birth in a hospital even though there are birthing center and home birth options. In choosing your provider, you’re also inadvertently choosing where you will birth by where your provider practices. For example, if you choose a certified nurse midwife (CNM) for your pregnancy care, typically midwives can care for you at a hospital or a birthing center—and some do home births as well. Most physicians are primarily hospital-based.

Hospitals

Most American women’s birth environment is in a hospital, attended by either a board-certified physician or a certified nurse midwife and usually 2 registered nurses: 1 caring for you and 1 for your baby. If you have a high-risk pregnancy, a NICU team may also be there for support.

You’ll be able to have your partner or other support people, including a doula, with you. Typically, you would labor in a hospital room on what’s called an LDR (labor, delivery, recovery) unit; once baby is born, you would move to the mother/baby unit—sometimes called the postpartum area until you’re ready to go home. For normal birth, you would stay in the hospital up to 48 hours, and up to 72 hours for cesarean.

Expect baby to room in with you; newborn testing or screening can typically be done at your bedside. If baby has to go to a different part of the hospital, ask anyone preparing to move your newborn for their hospital photo ID. You can also have your partner or a support person accompany baby for any procedures or screens apart from you.

Birth Centers

Birth centers are typically operated by either certified nurse midwives or certified professional midwives. Research shows this is a great choice if your pregnancy is progressing normally and without any elevated risks; it’s your best choice if you’re having a healthy pregnancy and want a natural birth without electronic fetal monitoring, intravenous fluids or pain relief drugs.

CNMs are trained to identify any risks during your pregnancy and refer you to an obstetrician or perinatal specialist, if necessary. Birthing centers aren’t typically options for moms carrying multiple babies or who are experiencing high-risk complications such as high blood pressure, which could lead to a condition called preeclampsia. If at any time there is an emergency during labor and birth, you would be transferred from the birth center to the nearest hospital via ambulance.

In a freestanding birth center, you’ll find a more home-like environment. You’re typically in a private bedroom like you would have at home, you wear your own clothing, can have as many support persons as desired including a doula, and you’re not restricted to bed. You can eat light foods and drink fluids; there may also be options for laboring and birthing in water. Your midwife will use a handheld Doppler to periodically check your baby’s heart rate in lieu of continuous fetal monitoring.

You and your partner will actively participate in the labor and birth processes, supported by your midwife and their assistants. Length of stay in this setting is about 6-8 hours, but that doesn’t mean the care ends there. Your midwife will follow up with you in person and by phone in the coming days.

Some hospitals also operate birth centers for moms who want a more home-like birth; still there may be more medical intervention depending on their policies and procedures. To be considered true birth centers, they must meet certain standards for independence and must be separate from the hospital’s labor and delivery unit. Certified nurse midwives typically staff these centers with a separate nursing staff. Like a freestanding birth center, you’ll need to have a low-risk pregnancy to birth in this environment with plans to forego any drugs for pain.

In either type of birth center, the midwives and nurses are well educated on various birthing options and positions, such as standing or squatting, and can offer many different types of comfort measures such as hydrotherapy, birthing balls and relaxation techniques.

Homes

A small percentage (<1%) of American women have home births, typically attended by a midwife. A home birth for the low-risk woman allows more control over the environment—it is your home, after all! You and your partner create your birthing environment and experience as you desire. Your midwife will help you determine how to set up the room for the birth and will bring all the necessary items to safely bring your baby into the world.

Though a home birth environment is more common in other parts of the world, birth is considered more of a medical event in America. As such, the American Congress of Obstetricians and Gynecologists (ACOG) recommends that births take place in a hospital or birth center that meets required standards.  However, ACOG also states that women have the right to make medically informed decisions about birth, and they support care by certified nurse-midwives.

By Joanne Goldbort, PhD, MSN, RN

Joanne Goldbort, PhD, MSN, RN, is an assistant professor in the College of Nursing at Michigan State University and an expert nurse adviser to Healthy Mom&Baby.

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Tips on Preventing Preterm Birth

Tips on Preventing Preterm Birth
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Did you know that any baby born before 37 weeks of pregnancy is considered preterm? A typical pregnancy is 40 gestational weeks, with day one of week one being the first day of your last menstrual period.

If you give birth to a preterm infant, your baby may experience a host of problems that may require admission to the neonatal intensive care unit (NICU). Often, the severity of the problems depends on how many weeks too early they were born.

The earlier a baby is born, the more immediate and long-term health problems they are likely to have, such as respiratory, digestive, brain, and developmental delays.

Prematurity causes babies to struggle with regulating their temperature and blood sugar (glucose) or can cause babies to have to be on a ventilator for respiratory distress. Birthing a baby preterm is typically stressful and devastating for parents.

If born premature, your baby would need close observation ranging from a few hours to weeks in the neonatal intensive care unit with continued, close follow-up after discharge for many months.

Preventing prematurity

So, what can you do to keep your baby from being born too early? While researchers have recently identified key hormonal changes that may unlock clues as to why some babies are born early, there’s still no way to predict which pregnancies end in preterm birth.

There are, however, things you can do to reduce your risks of experiencing preterm labor and birth, plus warning signs that can help you seek early and necessary treatment that you can watch for and relay to your healthcare provider to help prevent a preterm birth.

Remember

What women sometimes think of as the normal aches and pains of pregnancy can be warning signs of preterm labor or birth. Why not get these symptoms checked out to make sure that you’re not in early labor? If something doesn’t feel right, call your healthcare provider. Or go to the hospital if the symptoms don’t go away after drinking a couple glasses of water or juice and resting for an hour on your left side.

You know your body better than anyone. If something’s not right, seek medical attention. There are no limits to doing what’s best for you and your baby – even if it means several trips to your provider’s office or the hospital to make sure that you’re not in early labor.

Preterm labor or birth warning signs

  • Contractions: place your hand on top of your belly and it will feel like a hard ball tightening in a pattern every 10 minutes or more often
  • Watery or bloody vaginal discharge
  • Pelvic pressure that feels like the baby is pushing down
  • Menstrual-like cramps
  • A low, dull backache
  • A general sense that something ‘just doesn’t feel right,’ especially when coupled with abdominal cramps and diarrhea

Physical risks

You have little control over the physical risks related to preterm birth:

  • History of a previous preterm birth
  • Being pregnant with multiples (twins, triplets, etc.)
  • Having an abnormal cervix or uterus

Lifestyle risks

But you can control the known lifestyle factors related to preterm birth by doing the following:

  • Start and continue prenatal care early in your pregnancy
  • Quit smoking or using tobacco if you do
  • Avoid alcohol or illicit drugs
  • Seek help if you’re in a violent or abusive relationship
  • Reduce your stress
  • Ask for help in taking care of your other children or your household
  • Find time to sit or recline if you work long hours on your feet
By Joanne Goldbort, PhD, MSN, RN

Joanne Goldbort, PhD, MSN, RN, is an assistant professor in the College of Nursing at Michigan State University and an expert nurse adviser to Healthy Mom&Baby.

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