Taking the Fear Out of Birth: Unwanted Interventions

Most pregnant women have at least some desire or hope to have a natural birth.  We want to know that we are capable of birthing our babies, like many of our ancestors. However, many women find themselves thrown into an unknown world full of fear with little knowledge of what is happening to their bodies. This unfamiliar experience leads to a lot of different fears, as we have been discussing over the last few months.

In the presence of normality, almost every woman can give birth naturally and intervention-free with the right education and support. Even women with high-risk pregnancies can give birth naturally if they are supported and monitored appropriately.  It is important, however, to be educated about the birth process, know in advance what the risks and benefits are of any treatment you may encounter, and know how to tell the difference between an “unwanted” intervention and an “unnecessary” intervention.

There is a difference between “unwanted” and “unnecessary” interventions.  I think what most women fear is actually unnecessary interventions, because we should be able to recognize, even though we may not want them, there is a time when interventions may become necessary to save the life of the mother and baby.  But how do we recognize the difference? Well, There are a few easy steps you and your support team (whether a husband, partner or doula) can take to ensure you are getting the information you need to distinguish between an unnecessary intervention and a necessary one. 

To make sure you know whether or not you are getting a unnecessary intervention, there is a series of questions that will allow you to recognize when a treatment is really necessary and to make informed decisions.  So let’s look at how you do this:

What is informed consent?  Informed consent means that you are given all of the information, both positive and negative, about any procedure that will allow you to make an educated decision. For example, if your practitioner suggests giving you Pitocin to speed up labor, they are required to tell you why they are suggesting this, what the risks and benefits are, what are the alternatives and also discuss what happens if you do nothing.

How do you give informed consent?  To give informed consent just use your BRAINS (I like this popular pneumonic device to help remember what to ask).

B – Benefits. What are the benefits of this procedure? Why are you recommending this procedure?  Why are you recommending this procedure? How do you see it helping the birth process.

R – Risks. What are the risks of this procedure? What are the effects on mommy and baby? How long will these effects last? What is the chance this procedure won’t work?

A – Alternatives. Are there any natural alternatives to this procedure? Are there any medical alternatives to this procedure? What haven’t we tried yet?

I – Intuition – What is your intuition telling you about the procedure? Do you trust that it is necessary, or is your mind and the knowledge you acquired previous to birth telling you to try something else?

N – Nothing.  What will happen if we do nothing?  What will happen if we wait?

S – ‘Scuse me? Can we have some time to talk about the procedure? It is necessary to have some time alone with just you and your partner to discuss the information and make the right decision for you and your baby.

Knowing this information will help you determine whether an intervention is necessary or unnecessary and you can feel confident that you won’t receive any interventions that you don’t need (or want).

Need to build your base of knowledge so you can make informed decisions during your birth? Register for our FREE pregnancy seminar coming up in March www.FamilyBirthSupportServices.com.

Wheat, Egg, & Dairy Free Pancakes (Daughter and Husband Approved!)

Better picture to come soon!

The experimentation continues. We learned recently that my daughter really likes pancakes (she gets them at day care) and since she was begging for them, I decided to experiment with recipes.

Well, here is what I came up with. I found a simple recipe for pancakes online and put in substitutes for wheat and eggs. First, I tried to use powdered egg replacer, which turned out fine, but ultimately we decided that using apple sauce was better. It made the batter a little sweeter.
*Note: This recipe uses almond milk and is not a no sugar recipe

Recipe:

1 cup Gigi's Everyday Gluten-Free Flour Blend (Gum Free)
1/4 cup sugar
1 tablespoon baking powder
1/4 teaspoon salt
1 cup almond milk (unsweetened)
1/4 cup of unsweetened apple sauce
1 tablespoon oil (works with vegetable or olive oil)

Combine dry ingredients and mix well. Then add wet ingredients, mix until moistened, but there will be some lumps. Heat griddle on medium heat until water bounces off of it. Cook pancakes until edges are dry and when the bubbles pop they do not fill back in.

You may have to cook the pancakes a little longer than you might expect, Most of the pancake should be filled with holes left by the bubbles. This will make it easier to flip.

Add toppings as desired and Enjoy!

Wheat and Egg Free Banana Bread

So a few weeks ago my daughter was diagnosed with wheat and egg sensitivities, and so that means we have been welcomed into the new world of elimination dieting. While none of her sensitivities are life threatening (thank God!) or even very serious, we are still tying to be conscious of the amount of these products we give her. Therefore, I get to start experimenting with how to make some of our favorite dishes and treats wheat and egg free.

For today's experiment, I started with banana bread (we had a lot of too ripe bananas laying around so that seemed like the good place to start!). I am not much of a cook, but I do love baking, so I am trying to find ways to make very simple adjustments or substitutions to baked goods that won't change the flavor or consistency much and don't (hopefully) require too much trial and error.

Well, I am pleased to report that this experiment went very well! And here is how I did it:

First, I scoured the internet for information on how to make wheat (gluten) free flour. I know there are plenty of ready made options, but they are pretty expensive, so I thought I would save money combining the ingredients myself, which I did! I discovered Gluten-Free Gigi, who has some awesome information on her site on how to live and cook gluten-free.  I read her recommendations for gluten-free baking on this page, and then used her recipe for Gigi's Everyday Gluten-Free Flour Blend (gum free). I made a double batch of the the flour from Bob's Red Mill ingredients purchased at my local HyVee (but any supermarket that has gluten free items will have it, or you can order online). This recipe makes a create cup-to-cup replacement for regular flour.

The banana bread recipe I use is a traditional Betty Crocker recipe:

Traditional (Makes 1 loaf)                        Modified (Makes 1 loaf)
2 1/2 cups flour                                           2 1/2 cups Gigi's Everyday Gluten-Free Flour Blend
1 cup sugar                                                 1 cup sugar
2 1/2 teaspoons baking powder                  2 1/2 teaspoons baking powder
1 teaspoon salt                                            1 teaspoon salt
3 tablespoons oil                                         2 tablespoons oil (I used canola oil this time)
3/4 cup milk                                                3/4 cup milk (I subbed Almond Milk)
1 egg                                                           1/4 cup plain applesauce
1 cup of bananas (2 large bananas)            1 cup of bananas
1/4-1/2 cup chocolate chips (optional)       1/4-1/2 cup chocolate chips (optional)

Grease and flour (with flour substitute) a bread pan. Add dry ingredients and then wet ingredients to a mixing bowl. Beat ingredients with a mixer on medium speed until mixture is mostly smooth. Fold in chocolate chips at the very end. Pour into greased pan and bake at 350º for 60 minutes, or until a toothpick comes out mostly clean. I don't like to over cook anything, which helps keep it a little moist and since this recipe has no eggs, you don't have to worry about under cooking (just don't leave it doughy). Also, your bread pan will be very full, but that's okay, it won't overflow when you bake it.

The applesauce and flour substitutes worked perfectly. The bread turned out moist on the inside, with a nice crispy outside. I didn't detect any flavor difference from when I have made it previously and my daughter loved it! (And she is an extremely picky eater)

The Pomegranate: Simple ideas for a super food.

It's Pomegranate season! While I have always loved pomegranates (they are the perfect replacement if you love sweet and sour candies), I have never been brave enough to try and deal with one on my own. They are kind of intimidating. But these past couple of weeks we have been experimenting with different foods in our house and so I thought I would try it.  Well, guess what? It isn't as hard as it may seem. Just requires a few simple tricks.

There are lots of websites and videos that will show you how to open and de-seed a pomegranate, but this is the one I liked the most (click here). This site shows you how to get into the pomegranate and get the seeds out with relative ease and without losing too many of the little precious jewels. The key to easy pomegranate opening is to soak it in water and remove the seeds with your fingers while it is submerged. This loosens the seeds and makes them pop out quite nicely.

Seeds after they have been drained and rinsed.

So what is the big deal about the Pomegranate? Well apparently it is super rich in antioxidants, even more than cranberry juice or green tea and provides a number of health benefits. Pomegranates or pomegranate juice may help improve blood flow and keep plaque from developing in your arteries reducing your risk of heart disease and it could also help slow the growth of prostate cancer. While more research still needs to be done, even the possibilities make this little gem a must on your shopping list.

So what do you do with a pomegranate once you get the seeds out? I have found that pomegranates make a great addition to just about anything you would want to put fruit on (this is if you don't just want to eat them plain, which is also delicious). It makes a great addition to a fruit salad as well as lettuce salad. Here is a couple of my favorite ways to use them.

1. Add it to yogurt.
        For this I used Kalona's organic vanilla yogurt and gluten free granola mixed with pomegranate seeds and raspberries. You can mix to your own proportions, but I usually follow the recommended serving sizes.

2. Add to a salad.
        Here I used sweet, organic baby greens and topped them with pomegranate seeds, green peppers, feta and almonds (you could do whole, slivered or even candied to add sweetness).  I topped it all with my favorite sweet apple cider vinaigrette.
                     
                   Sweet Apple Cider Vinaigrette
                       1/2 c. sugar (you can replace the sugar with Stevia if you want lower calorie but still sweet)
                       1 T poppy seeds
                       1/2 tsp Worchestshire sauce
                       1/4 c. cider vinegar
                       2 T sesame seeds
                       1 1/2 tsp minced onion
                       1/2 tsp paprika
                       1/2 c. salad oil
                          Mix all ingredients in a container.  Mix or shake well and add to salad.

This fruit is so versatile, though, you can pretty much do whatever you want or think might be good, so try experimenting!

Taking the Fear Out of Birth: Facing the Unknown

Taking the Fear Out of Birth: Facing the Unknown

By Amy Wehner, childbirth educator and doula (wwww.familybirthsupportservices.com)

Childbirth is different from any other experience because each woman just doesn’t know how it will turn out for her. When we get pregnant, especially for the first time, we hear lots of stories about different births, some good, some bad, and we start to worry about how our birth will go. The reality is that there is no way to know 100% what will happen during birth because every woman, pregnancy and baby is different. However, there are many ways a woman can prepare herself for birth and make the unknown known. Here are some steps you can take to help overcome the fear of the unknown.

First, get educated. If this is your first pregnancy, you have already spent a lot of time researching parenting, cribs, bouncers, toys, and car seats, but have you researched birth? The best way to prepare is to learn about natural birth, how the body is supposed to work in pregnancy and labor, what is normal during labor and how to react to the normal process. In order to do this, you can take a childbirth education course that teaches natural birth, watch videos on YouTube (search “natural childbirth” or “Bradley birth” to see examples of normal birth), and read research online (try www.evidencebasedbirth.com). One caveat, If you research online, make sure you are looking at your sources, a blog may be very subjective and not based on actual research, and other health resources may be biased in other ways, so read different articles from various sources.

You will also want to educate yourself about your options in birth and the real risks. Fear of the unknown may actually be attributed to your fear of specific aspects of birth, like pain, complications, medications, and making decisions. So, ask yourself, where is my fear really coming from and then learn about the realities of those fears. We will be addressing some of these in future articles, but many of the fears that arise stem from a lack of understanding about the realities of childbirth. A proper childbirth education course will teach you about these realities and how to ask the right questions to get the information you need.

Second, build a good support team, talk to them about your wishes for your birth, and make a plan. After you research, you will have a better idea of what you want for your birth experience. The next step is to decide who you want to support you. Choose an OB, doctor, or midwife that fully supports your wishes and gives you answers to the questions you have without hesitation.  Next, consider who you want to support you in labor: your husband? Partner? Mother? Doula? Or combination of these? Make sure they attend childbirth classes with you and are educated about natural birth, the normal progression of labor, ways to support you during labor, and the real risks of childbirth so they can help you make the right decisions during labor. You want to make sure that anyone you ask to be on your team can be with you through the entire labor so you are constantly supported.

Third, communicate and practice.  Talk to your support people about your fears. Communicate with your partner about your desires for your birth.  Discuss the pros and cons of all treatments that you may encounter during labor. Practice and discuss different labor scenarios and what you would do in each situation. Doing this will give you the opportunity to address many of the unknown aspects of labor and give you a plan.

Finally, trust your body and your baby.  Women have been birthing for millennia and for most of that time completely naturally.  Your body was designed to know exactly what to do to during labor. Trusting in that power is the most important step to getting over that last hurdle of the unknown. Once you have done these things you will find that you have made many of the “unknown” aspects of labor “known” and you can move forward with confidence instead of fear.

For more information on education and support contact info@familybirthsupportservices.com.

Taking the Fear Out of Birth: Loss of Privacy/Modesty

I would like to welcome today guest writer Kylie Saari.  When I moved back to southern Minnesota, I was very fortunate to come into contact with her as a fellow birth worker.  Since then, we have been working together to provide many of the new opportunities and resources for pregnant women in the Fairmont area.  Together, we are writing the Taking the Fear Out of Birth column for the Photo Press we will be sharing that with all of my readers.  This is an excellent column on the fear of "Loss of Privacy/Modesty" that appeared in the Fairmont Photo Press two weeks ago.  Enjoy!

Taking the Fear Out of Birth: Loss of Privacy/Modesty

by Kylie Saari, birth doula, Family Birth Support Services

Over the years, the concern for privacy in the medical fields has lead hospitals to create private labor and delivery rooms and wards so quiet, it is often difficult to know if there are any other women on the floor. Nurses and doctors knock before they enter a room, and ask permission before performing any procedures.

Despite the focus on patient privacy, many pregnant women continue to list the fear of a loss of privacy and the loss of modesty as one of their biggest concerns about labor, specifically the fear of being undressed in front of strangers or losing control of their bodies.

In an uncomplicated birth, a baby exits the mother from an area she typically keeps covered, so it is unsurprising this could cause a bit of alarm, especially for first-time moms. Another reason laboring moms tend to shed their clothing during labor is simply because their bodies are working hard, and as with any strenuous exercise, they get hot. It can be unsettling to women when they hear other moms recall birth stories saying they didn’t even think about their state of undress, and if they had thought about it, they wouldn’t have cared. It can be frightening to think of yourself acting in a different way than you would in a “normal” situation.

Despite widespread concern of pregnant women on this issue, few moms report feelings of humiliation or embarrassment following birth. In fact, there is at least one childbirth preparation method that teaches labor coaches to watch for the changes to laboring mom’s level of modesty. As her cervix dilates and she moves toward transition, the period of labor before she begins pushing, her level of modesty decreases. I have attended moms in five different hospital systems, and have never met a mom who recalled feeling embarrassed about what she was wearing during labor. Her body is completely focused on the task at hand, and those attending the birth are unlikely to be phased by it.

Still, there are ways to for mom to keep covered during labor. It isn’t unusual to find moms in labor wearing sports bras to keep themselves covered up top, even if their lower half needs to be exposed. Hospital gowns and robes, while not particularly stylish, keep do a fairly good job of keeping mom covered, especially when she is out walking the halls during a particularly long labor. There are even specifically made labor gowns available for purchase online.

Labor gowns typically look like a cross between a sundress and a nightgown, with halter straps that can be untied for breastfeeding, low cut back to facilitate an epidural, and two front slits to accommodate external monitors. The dresses range in cost from $25 - $150, and while I have concerns about the emphasis some of the websites put on making sure mom is pretty during labor and the idea of capitalizing on someone’s fear, the dresses themselves seem like a reasonable alternative to a hospital gown if a woman is set on it.

As for “losing control”, it is important to remember that the pregnant woman’s body should be in control of labor - not necessarily her mind. In unmedicated births, body changes, both chemical and physical, work in concert, without much higher level thinking involved. Learning to surrender to labor, to trust that the body knows what it is doing, will do wonders toward shortening labor, relieving pain, and smoothly delivering a baby. If a woman and her labor support person understand the changes in labor, and know what to expect, it is unlikely she will be embarrassed in the process.

For more information on the stages of labor and how to prepare for birth, contact, Kylie Saari at familybirthsupport@hotmail.com, or Amy Wehner at amywehner30@gmail.com.

Taking the Fear Out of Birth: Not Getting to the Hospital

My friend Kylie of Family Birth Support and I (Amy of AKFW Childbirth Services) have started a new column in one of our local papers called "Taking the Fear Out of Birth."  Since this particular paper is not online, I will also be posting our articles here to share with the the internet community.

The first article in this series is on "Not Getting to the Hospital."  Enjoy!

Taking the fear out of birth: Not getting to the hospital.

By Amy Wehner, childbirth educator (www.akfw.net)

It’s an exciting movie scenario isn’t it?  A very pregnant woman in labor rushing out of a public place or in a car wondering if she will make it to the hospital?  Turns out, many women (and men) are afraid of this; they just won’t make it to the hospital in time to have the baby.  Fortunately, this isn’t the worst scenario for childbirth, and the likelihood of it happening is pretty low.  In the US in 2009, only 0.9 percent of births (about 40,000) happened outside of the hospital, this includes planned and unplanned births. Of those, only 6% (2,400) didn’t occur at home or in a birth center or hospital[1], which means you have about a 1/2000 of finding yourself in an emergency situation.

However, since it is preferable to have your baby with a trained medical professional near by, let’s talk about what you should do to lower your risk of an emergency childbirth and what to do if it does happen.

First, prepare for situations like this by taking a childbirth education class.  Look for a class that teaches both you and your partner about normal, healthy pregnancy and labor and how to deal with the unexpected.  Practicing labor can help you both to talk about what you would do if the unexpected arises.  Understanding what normal labor looks like will help you judge better when it is time to get to the hospital.

Second, having an additional birth professional, like a doula, can give you extra peace of mind in an emergency.  A doula supports you through the entire labor and is available to you before you go to the hospital.  She helps support your partner in many ways so that he can attend to your needs.  She can also call 911 and help coach you through emergency labor.

Third, it’s unlikely you won’t know you are in labor in advance (more likely with your second or third child, but still not great).  The biggest problem here would be your distance from the hospital.  To plan for this, you can compensate by leaving a little earlier than recommended.  The most common recommendation for leaving for your birthing facility is the 4-1-1 rule, contractions 4 minutes apart, lasting for 1 minute for the duration of1 hour.  You can adjust this as needed to give you time to get to the hospital.  One caveat: if you are like me, your contractions may not be regular, varying in length and time.  In this case, call your doctor, earlier rather than later, to get their recommendation.

Now, if you do find yourself an emergency birth situation, here’s what to do [2]:

1.     Don’t Panic. Childbirth is completely normal and natural.

2.     Call 911 from the nearest available phone.

3.     Stop, in a safe place and prepare.  Find any blankets, sheets or t-shirts you can, place under mom and over baby when born.  Stay where you are and wait for the ambulance.

4.     Let nature be your guide, do not give mother any medications, or alter her state or the baby’s at any time.  Let baby and afterbirth come naturally without assistance.

5.     Catch! Dads, that’s it! Don’t pull, tug or turn the baby to help. Place your hands under the head and allow the baby to fall into your hands gently.  Be prepared for it to be a little slippery at first!

6.     Put baby skin-to-skin with mommy immediately. Have her try to breastfeed, which helps pass the placenta and reduces risk of hemorrhage.  It’s also the best way to keep baby warm. Put baby directly in contact with mom’s skin and cover both.

7.     Do NOT cut, tug, or pull the umbilical cord.  Let the placenta come naturally and gather it and umbilical cord in blanket with baby.

8.     Finally, cheer up!  If this does happen to you, now you know what to do and you will have had a great natural birth and a fun story to tell for years.

For more information contact Amy Wehner at amywehner30@gmail.com, or Kylie Saari at familybirthsupport@hotmail.com.

Next time: Taking the Fear Out of Birth: Loss of Privacy/Modesty

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[1] MacDorman, M., Matthews, T.J., Declerq, E. (2012). Home births in the United States, 1990-2009. NCHS Data Brief, (84), Center for Disease Control and Prevention. http://www.cdc.gov/nchs/data/databriefs/db84.pdf

[2] Adapted for non-medical professionals from the Federation of American Scientists bulletin, Emergency Childbirth. http://www.fas.org/irp/doddir/milmed/childbirth.pdf

Article Reference:

Wehner, A. (June 26, 2013). Taking the fear out of birth: Not getting to the hospital. The Fairmont PhotoPress, 50(7), 4.