How to Effectively Negotiate in the Hospital

I love this blog post from Lamaze! I highly recommend having a read through this concise and informative article, and if you have another minute, to browse their website. Lamaze has evolved and come a long way from what you may know as the "hee here hoo hoo hee hoo" exaggerated breathing for birth :)

6 Tips for Effective Hospital Negotiations  

 By Jessica English, CD(DONA), BDT(DONA), LCCE, FACCE, with commentary from Cara Terreri, CD(DONA), LCCE

Hopefully you're able to choose a birthplace that largely supports your goals for birth, but if that's not possible, here are some suggestions that might make negotiating easier.

>>Straight away, the author points out that the best and most effective way to get the birth you want is to choose a birthplace -- hospital, birth center, or home -- that supports your preferences and practices according to best evidence. Here's an excellent resource with tips for choosing the best birthplace for you.

1. Talk it out beforehand, and get it in writing. If something is particularly important to you, talk it over with your midwife or doctor at an office visit. 

>>This is where your birth plan comes in handy! Remember, a birth plan is not so you can "plan" your birth with a play-by-play script, but rather an exercise in learning about the many options available and stating the preferences that are most important to you and your partner. It's also the perfect tool to start conversations about choices with your care provider. Learn more about preparing a birth plan. 

2. You'll catch more flies with honey than vinegar. I suggest to my students that they are firm but very polite when working with the staff. Is continuous monitoring the policy at this hospital? Nurses, midwives and doctors are just people. A gentle approach is usually received much better than angry demands, and you're more likely to get what you want. 

>>This couldn't be more true. If you go in expecting a fight, you'll likely find one. But if you go in expecting to be treated with respect and be prepared to deal with it if you aren't, you'll put yourself in a much better frame of mind. If you've tried the "kill 'em with kindness" approach and it just isn't getting you anywhere, request a different nurse. The nurse assigned to you may be having a bad day, or perhaps your personalities don't mesh. It's ok to ask for someone else. 

3. Brainstorm. If you can get your nurse or provider working with you, they may start to take ownership of your ideas. Try asking for their help to brainstorm a problem. If they respond with reasons why something won't work, you can always throw out a phrase like, Let's try together. When people are part of the process they generally respond better than if you simply list your demands.

>>Generally speaking, nurses, doctors, and midwives are on your side -- they too want to see the safe and healthy birth of a baby, and they too want to make sure you have a good experience. Sometimes, though, they can lose sight of how their actions, words, or an intervention can impact your experience. If you can frame requests and questions as if you're in it together, you're more likely to work as a team, which benefits everyone. 

4. Bring a doula. An experienced doula has usually seen other families successfully negotiate in the hospital environment. She probably knows what's possible and may have some techniques for helping you get to yes.  

>>Doulas are invaluable when it comes to helping navigate the hospital maternity care experience. If you absolutely cannot or do not want to have a doula at your birth, consider taking a quality childbirth class, which will cover decision making communication tactics. A childbirth class is also important even if you do hire a doula, too. 

5. Don't stop at the first no. If you're asking for something outside routine hospital policy, the first answer you receive will probably be no. Expect that first no, and be pleasantly persistent, using all the techniques mentioned above. 

>>This is like how the squeaky wheel gets the grease -- except in this case, the super kind, team player gets what she wants in labor and birth. 

6. Remember, it's your body, your birth and your baby. If it comes down to the line, remember that no one can force you to do anything or accept any intervention that you do not want. Shared decision making requires your consent. It can be intimidating to have professionals in scrubs and white coats telling you to do something, but if there is no clear safety reason for the request, it is always your right to say simply and clearly, No. After all, it is your body, your birth and your baby.

>>One thing I always tell families is that health care professionals are working for you, not the other way around. When it comes to care in childbirth, you do have choices and rights. 

The Rise of the Birth Center

Unfortunately in the NYC/Brooklyn area, birthing center options are very limited. Hopefully, as the demand continues to increase, we will see more birthing center options for women. An excerpt is below from a recent article by CNN on the rise of birthing centers.

"There are nearly 4 million births a year in the United States and 98% still arrive in hospitals, but the increase in birth centers run by midwives has obstetricians, health insurers and hospitals taking notice. The number of babies born annually in birth centers has jumped 56% since 2007 to about 16,000, while total U.S. births have dropped nearly 10% in the same time, according to federal data."

Read the full article here: Not a Hospital, Not a Home Birth: The Rise of the Birth Center.

The Big Baby Myth

I often hear care providers telling women that they recommend and induction or a C-section or other intervention if it's suspected that they have a "big baby." Here are two great articles that take a researched and balanced approach to the Big Baby phenomena.

Evidence-based Care for Suspected Big Babies

Babies Declared "Too Big" In Utero Are Often Smaller Than Doctors Predict, Any Why That's A Problem

Monitoring Your Baby's Heart Rate During Labor

A few informative articles on electronic fetal monitoring (EFM) that I encourage all pregnant women to read. 

Evidence Based Fetal Monitoring

The Most Common Childbirth Practice Is Unnecessary and Dangerous

Monitoring Your Baby's Heart Rate During Labor

How Doulas Impact C-Section Rates

"The presence of a doula at birth was linked to an almost 60 percent reduction in women's odds of having a C-section, and 80 percent lower odds of having a nonmedically indicated C-section compared with women who had no doula. (Overall, 10 percent of the women in the survey said they had no clear medical need for a cesarean delivery, yet delivered via C-section anyway.) 

Women with doulas also had significantly lower odds of having a C-section -- both for clear medical reasons and otherwise -- than those who wanted a doula but did not have one.

"What our study showed is that [lower odds of a C-section] don't come with wanting a doula; it's having a doula that is actually associated with important and substantial risk reductions," Kozhimannil said."

Read the full text of the article here.

Every mother needs a midwife, and some women need a doctor, too.

An excellent article that puts midwifery in context, including a cross cultural examination of midwifery. How did we get to where we are now? Call (back) the midwife!

Read the full article here.

Placenta Research is Underway!

The full text of the article is below, and is from the University of Nevada. The original article can be found here.

Moms-to-be, stay tuned. You may want to add "cook placenta" next to "stock up on diapers and onesies" to your list of things to remember when having a baby.

Placenta eating may seem like a farfetched trend but a growing number of women are doing this across North America and even in Southern Nevada, according to a new survey conducted by UNLV anthropologists.

Daniel Benyshek, a UNLV medical anthropologist, and Sharon Young, a doctoral student of anthropology, asked 189 women who consumed their placentas after childbirth why they did it, how they preferred to have the placenta prepared, and if they would do it again. The results were published online Feb. 27, 2013 in the journal Ecology, Food and Nutrition. 

The survey found most women who participated in the practice, called placentophagy, were American, Caucasian, married, middle class, and college-educated and were more likely to give birth at home.

Overall, 76 percent of participants said they had very positive experiences. The most commonly reported negative aspect of placentophagy was the placenta's appeal -- the taste or smell of it was simply kind of icky. But most reported positive placentophagy experiences.

What these moms are doing very well may be something new for humans, said Benyshek. While nearly all non-human primates and mammal mothers are known to eat the placenta after giving birth, there is very little evidence for it among human mothers. In fact, a published 2010 study by Young and Benyshek did not find any evidence of human maternal placentophagy as a traditional cultural practice among a sample of 179 societies around the globe.

Placenta consumption by humans other than the mother, however, has been recorded among a handful of cultures for various medicinal purposes, and it is used in some traditional Chinese remedies, he said.

Because the placenta transfers essential nutrients from mother to baby, placentophagy advocates suggest that the placenta would have the same benefits to the mother post-childbirth. Participants reported that they believe the benefits include treatment of post-partum symptoms, increased lactation, and a better mood.

While science knows much about the hormonal and nutritional components of the human placenta tissue, almost nothing is known about the biological effects of its consumption. Benyshek notes, however, that there is a hunger for remedies to treat post-partum effects.

Benyshek is now researching the public health implications, the likely course of placentophagy throughout human evolution, whether placentas can treat mood disorders and hormonal imbalances, and any potential risks.

He's also analyzing the nutritional, hormonal, and chemical components of placenta in its various preparations. Benyshek has partnered with Jodi Selander, a specialist in placenta encapsulation and education in Southern Nevada. She is preparing the placentas for experiments and also helped connect the researchers with survey participants.

The placenta can be consumed cooked or raw, but most women in the survey consumed it in the easier-to-digest capsule form. In this preparation, a cooked or uncooked placenta is dehydrated (it will look like a dried mushroom). It is pulverized (Benyshek's lab uses a Magic Bullet blender for this) until it resembles cumin powder and encapsulated in a gelatin-coated pill and then consumed daily over a two- or three-week period.

"Our survey participants generally reported some type of perceived benefit from the practice, felt that their postpartum experience with placentophagy was a positive one, and overwhelmingly indicated that they would engage in placentophagy again after subsequent pregnancies," the authors write.

About the study:

• 189 females over the age of 18, average participant age was 31
• Participants were recruited through social media sites and message boards with assistance from Jodi Selander, a placenta encapsulation specialist in Southern Nevada
• Women who had ingested their placenta after birth of at least one child were included in the survey
• The survey was conducted between October and November of 2010
• 91 percent from the U.S.
• 93 percent Caucasian
• 90 percent married
• 58 percent with income over $50,000 a year

According to the survey, the top three positive effects of placentophagy were:

• Improved mood
• Increased energy
• Improved lactation

According to the survey, the top three negative side effects of placentophagy were:

• Unpleasant burping
• Headaches
• Unappealing taste or smell

Fact or Myth? Bacteria & Heavy Metals in the Placenta

We should begin with talking about how the placenta works and some of its roles to the mother and fetus.  The placenta is often referred to as a filter; this isn’t an ideal term for the placenta considering its function in the body. As consumers we use filters in daily life to remove unwanted particles and toxins then throwing them into the trash once they have reached capacity.  The placenta does not function as a filter in this sense, a more suitable way of viewing it would be as a gatekeeper between the mother and fetus.  The placenta’s job is to keep the maternal and fetal blood separate, at the same time allowing nutrients to pass to the fetus, gas exchange to occur, and allowing waste from the fetus to pass through to the mother.  The placenta does prevent some toxins from passing through to the fetus but they are not stored in the placenta.  Toxins in the body and waste from the fetus are processed by the mother’s liver and kidneys for elimination. 

Read the full article here.

Mothers facing C-sections look to vaginal 'seeding' to boost their babies' health

"Dominguez-Bello, a microbiologist from NYU, has been studying the microbiome for several years. For the past three she’s been trying to determine if C-section babies can reap the benefits of a vaginal birth through the process of seeding with gauze that’s been incubated in its mother’s vagina. So far, the results are very promising."

The Most Common Intervention in Hospital Childbirth is not Evidence Based

"Electronic fetal monitoring—which also includes external monitoring, in which an ultrasound transducer is placed on the mother's stomach—is supposed to prevent deaths by alerting the doctor to complications that would require an emergency Cesarean or vacuum extraction. Which sounds logical enough: The more you monitor the baby, the more likely you are to catch problems instantly. But study after study has proven that EFM is not logical at all, as it provides no benefit to most patients and creates more problems than it catches."

You can read the full article here.

Stop Telling Women that Birth Plans are Pointless

Excerpt from this great article by Milli Hill:

Yes, birth is unpredictable, but don't let that fool you into thinking the whole thing is just pot luck. There are elements that you can include in your birth plan that will maximise your chances of having a positive experience. They won't be a cast iron guarantee (remember that bit about how life sucks?). But they will maximise your chances.

Birth plans are not just idyllic wish lists lit by pretty tea-lights and trimmed with home-made bunting. A birth plan is a chance to take a detailed look at the huge amount of choices and options available to you, to consider the many ways birth might unfold, and to really make sure your voice is heard in the labour room. "Don't offer me pain relief unless I ask for it." "Keep voices and lights low" "Delay cord clamping" "I don't want V.E's" "Immediate skin to skin" "Husband with me in theatre" "Yes / No to Vitamin K", the list of options is endless and worthy of a great deal of time and consideration. Read the article in its entirety here.