Vaginal Exams: Pregnancy & Labor

Are vaginal exams (also called pelvic exams, or cervical checks) necessary during pregnancy and labor? They can certainly be helpful at specific times, such as for being admitted to the hospital or birthing center when you're in labor, if you've gone past your due date, if an induction is needed, if there is a concern about labor progress, or perhaps a question of the baby's position during labor. What about checks during pregnancy, or during labor - when everything seems to be progressing normally, and the mother is fine and the baby is fine? This is your choice to make, based on the pros and cons, your care provider's recommendation, and your feelings, opinions, and intuition. More information on vaginal exams is below, from a few different sources. Read, be informed, and decide for yourself - based on you, not anyone else.

Evidence on Cervical Checks at the End of Pregnancy

Pelvic Exams Near Term: Benefit or Risk?

Vaginal Examinations: A Symptom of a Cervical-centric Birth Culture

Ina May Gaskin, by Timeline

This past fall I had the incredible opportunity to study at The Farm, the community where Ina May Gaskin and the Farm Midwives made their home, birthed they children, and their names as pioneers in the modern day American natural birth movement, delivering thousands of babies. All around the world, for centuries, women had been giving birth at home and naturally. By the time many of these midwives had come to have children, the maternal care system had become overly medicalized and severely limiting women's choices. Ina May Gaskin and the Farm Midwives gave women another safe option, and I am so grateful for their bravery, courage, and hard work in paving the way for women to have options in childbirth today. Check out the video below to learn more.

https://www.youtube.com/watch?v=y_qqxilWcb0

Birth Stories of All Kinds

For some birth stories, check out these websites below. They feature all kind of birth - at home, in the hospital, in a birthing center, with midwives and doctors, as well as natural births, births with pain medication, birth with interventions, and Cesarean births. Enjoy the beautiful variety!

Birth Becomes Her

The Birth Hour

Birth Without Fear

Tell Me a Good Birth Story

POSTBIRTH - An Acronym that Can Reduce Maternal Mortality and Morbidity in the Postpartum Period

POSTBIRTH - An Acronym that Can Reduce Maternal Mortality and Morbidity in the Postpartum Period

by Sharon Muza, BS, LCCE, FACCE, CD(DONA), BDT(DONA), CLE

Full text of the article can be found here.

Maternal mortality and morbidity in the United States are as high as they have ever been.  More people are dying from complications of pregnancy or childbirth than ever before.  61 percent of deaths related to childbirth occur in the postpartum period and most of those occur in the first 42 days after birth. The current estimated maternal mortality rate in the U.S. is 23.7/100,000 live births (MacDorman, Declercq, Cabral, & Morton, 2016).  

There is agreement that we must improve the way we care for people in the postpartum period if we want to be able to reduce the complications and deaths that occur after giving birth.  Part of this improvement lies in how warning signs information is provided to families after birth.  As it is not possible to identify who will have a postbirth complication, it is imperative that everyone receive information about concerns in the postpartum period that will need to be evaluated by a health care provider.  The postpartum nurse or mother-baby nurse is in a unique position to educate families on what to watch for postpartum.

Unfortunately, current research indicates that the information that postpartum nurses teach to new parents about warning signs is inconsistent and often inaccurate.  There is also evidence that many postpartum nurses are not aware of the major risks that face people after they give birth that can cause death or serious complications.  Families report being flooded with physical and emotional situations in the first days postpartum that make it difficult to take in important information accurately and clearly.   For these reasons, the postpartum discharge education RNs provide must be clear, concise, and accurate. When appropriately informed and educated, postpartum nurses are in an ideal position to improve postbirth outcomes, if they are given adequate time to share information with the new family.

A new study, Nursesʼ Knowledge and Teaching of Possible Postpartum Complications, published in MCN: The American Journal of Maternal/Child Nursing, examines postpartum nurses’ knowledge of maternal morbidity and mortality, and information they shared with women before discharge about identifying potential warning signs of postpartum complications. 

Almost half the postpartum nurses in the study were not aware that maternal mortality rates have increased.  Almost all (93%) of nurses knew that hemorrhage was one of the top three causes of death, but only 68% knew that hypertension was another, and barely 39% could identify infection as the third leading cause of death.

Folic Acid/Folate in Pregnancy: New Research on Potential Risks

Folic Acid (otherwise known as Folate, in it's non-synthetic form) : we know it's important for a developing fetus, but should everyone be taking folate?? This article contains groundbreaking information on folic acid and an uncommon, but not rare, genetic condition.

"There’s no solid consensus, but some reports state that anywhere from 10 to 15 percent of Caucasians and more than 25 percent of Hispanics are unable to metabolize folic acid. Called methylenetetrahydrofolate reductase, or MTHFR for short, this defect refers to the MTHFR gene, which produces the enzyme responsible for converting synthetic folic acid (what’s found in prenatal vitamins and fortified grains) to methylated folate (the metabolized nutrient that protects against NTDs)."

Read the full article here.

Why delay cord clamping?

Science and Sensibility, the research blog from Lamaze, has an excellently evidence based article on the practice of delayed cord clamping. The article is structured by listing objections, which is a great way to go about learning the benefits, as well as to be prepared to answer to someone's concerns about this practice. Delayed cord clamping is becoming so much better understood and common place. Many Ob and midwife practices in Brooklyn and NYC do this as a matter of protocol. 

Read the full article here. 

Mothering The Mother: Postpartum Support for Women

During prenatal sessions with my doula clients, I always make a point to discuss postpartum plans. In the way in which every woman usually has some sort of birth preferences (hospital birth, home birth, birthing center birth, midwife, doctor or OB, natural birth, epidural birth, and so forth...) it is important to develop some ideas around what the plan is for postpartum care. 

Some of the questions I encourage my pregnant couples to ask themselves are: what is our sleeping arrangement and what are our beliefs in infant sleep? Where is our healthy food coming from? Who's around if we need support? Would we like a postpartum doula? How much time can we take off? Who is in charge of feeding? Who is in charge of feeding? Who will do the laundry and the chores?

Mothering the Mother: New Mothers Need a Focused Period of Rest and Recovery

An excerpt:

The postpartum period is considered to be the roughly six-week period when a woman recovers from the magnitude of pregnancy and birth. It is also the wild, messy, tender, achy, exhilarating time when a woman begins the process of shedding one way of being for an entirely new identity. It is a fleeting, essential moment, a powerful pause before the full initiation of the next chapter of her life. But in a society that encourages a new mother to "bounce back," right after birth, a woman is pushed to do the opposite of resting and recovering; she is encouraged to get back to a version of her body and her life that is gone forever. She has been forever transformed by the profound act of making another human being and requires care and attention before hurtling forward.

From Spinning Babies... The Sacrotuberous Ligament: Key to Unlocking a Long Labor

This article is definitely worth a read if you are pregnant and preparing for labor. And especially if you are interested in anatomy! According to the article, it may be particularly applicable if any of the following are present:

• A long and difficult labor in which normal remedies (Rebozo Sifting, Position Changes, Spinning Babies Maneuvers) are not fully effective

• Persistently malpositioned baby

• Highly athletic mother (especially those who are highly athletic into their pregnancy)

• History of any trauma in which the ligaments of the pelvis could have been affected (accidents, falls, etc.)

• A visible Pelvic Upslip: One (usually left) iliac crest superior to the other, one leg (usually left) functionally shorter than the other.

NYC's Newest Birthing Center at LOMA

Finally, earlier this year, New York City unveiled a new in-hospital birthing center. Until recently, our only in-hospital birthing center was the Birthing Center at Mt. Sinai West (formerly known as St. Luke's Roosevelt). As of this winter, women have another in-hospital birthing center option: The Birthing Center at New York Presbyterian/ Lower Manhattan Hospital. I had the pleasure of attending a birth there as a doula just a few weeks ago, and the facilities are beautiful! (Not to mention the birth, too, of course!!)

Hopefully this trend will continue in NYC. There are so many women looking for low intervention birth settings, with the option to labor in a tub amongst other great options available in the birthing center. NYC residents also have the option to give birth at the Brooklyn Birthing Center, an out-of-hospital freestanding birthing center, and New York City's only independent birthing center.

Read more about the opening of Lower Manhattan's Birthing Center here.

Home Birth: The Latest Article with Some Statistics

If you haven't come across it before, Lamaze's blog, Science and Sensibility, is a great way to stay up to date on recent studies and new information in the maternal/perinatal health world. I recently came across this article and wanted to share it.

Seeding the Microbiome

This is a relatively new phenomena that has come up in the birth world as more and more research on the significance of gut health and our microbiomes has emerged. In birth, this applies in particular to a vaginal vs. Cesarean birth. During a vaginal birth, the baby is colonized, or "seeded" with bacteria from the mother's vagina, which leads to long term health benefits; in a Cesarean birth, the baby does not have the same bacterial colonization opportunity. It is because of this that some women are looking to simulate this process at the time of a Cesarean.

We are just now beginning to understand that many modern day health conditions, such as colon cancer, Autism, and mental health (just to name a few) are likely affected by the balance, or lack of balance, in good and bad bacteria in our bodies. Think of the recent surge in the understanding and promotion of probiotics, our understanding of antibiotics, and the fermented food movement. 

The recent documentary "Microbirth" focuses on bacterial health in birth, as well as some recent articles below. You can also check them out to understand how some women are choosing to take vaginal seeding into their own hands in the event of a Cesarean.

https://www.scienceandsensibility.org/p/bl/et/blogid=2&blogaid=825

http://www.positivebirthmovement.org/pbm-blog/category/gauze-seeding

http://www.mostlymicrobes.com/vaginal-seeding/

Essential Oils in Pregnancy, Birth, and for Your Baby

I recently attended a workshop on Essential Oils in Pregnancy and Birth. Big inhale, exhale... there are some great scents that can be used for a variety of ailments, concerns, and comforts. Some are quite powerful! So, what's the right way to use them? Read on for some more info.

https://www.youngliving.com/blog/pregnancy-and-essential-oils-a-guest-post-by-dr-lindsey-elmore/

http://doterrablog.com/ask-dr-hill-pregnancy-doses-and-zendocrine-supplements/

http://www.theessentialmidwife.com/

Birth Matters.

I love this article! Read the full text here.

Excerpt below:

"The problem with saying “It doesn’t matter how you give birth” is that if women take that to heart, they may not take the time to educate themselves on their choices or vet potential providers to find the right fit since the birth process doesn’t really matter anyway. Empowerment starts with women educating themselves on the childbirth process and understanding that they are the drivers of that process. Birth attendants are primarily experienced navigators who know what to do if inclement weather hits or if the car breaks down. They should not take the wheel unless there is truly no other choice.

Childbirth is the likely the hardest, most overwhelming thing a woman will ever do, so of course those experiences matter. If you walk away from your birth feeling powerless, that’s important. No matter how your baby ultimately enters the world, how you experience birth and how empowered you feel throughout the process does matter. Let’s stop telling women that it doesn’t."

Partners & Doulas: What you need to know

You've chosen your doctor or your midwife; you've decided on the hospital, the birthing center, or giving birth at home; you've decided on a natural birth or that you'll use pain medication or maybe something in between; you have a list of baby names; you have the baby gear list... so what's missing? Your doula, of course! For some couples, whether or not to hire a doula is not an easy choice. One of the main concerns I hear from couples - especially those who are planning to have a natural birth with full support of their partner - is that they wonder if a doula is really necessary. Completely valid question. Below is an article that gives you some perspective on the Doula and the Dad - although  prefer to use the term " birth partner" as there's not always a dad in every birthing couple!

Excerpt:

"But doulas aren't there only for moms-to-be. They also play a key role in helping their partners, offering them invaluable emotional and practical support during the overwhelming experience of childbirth. "I see myself as having many roles, fitting in where I am needed, lifting up and supporting the partner in order for them to support the laboring mom," says Zoe Etkin, a birth and postpartum doula and women's sexual health coach in Los Angeles. "Looking back on the birth, I hope they will both remember how connected they were, and I will just fade into the background. Although I believe my role is important, it's ultimately about the birthing couple."

Even so, it's common for dads-to-be to worry that having a doula during delivery might push them out of the main labor support role. Doulas insist that couldn't be further from the truth. "I'm there to accentuate their involvement, not to take their place," explains Gena Kirby, a doula of 10 years, childbirth educator, and host of Progressive Parenting radio. "Partners have taught me so much over the years about different ways to approach different personalities and births."

Full article here.

6 Steps for a Healthy Birth

These 6 principals by Lamaze are great way to set yourself up for a healthy birth. Take a look at this quick and easy-to-understand video below.