Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

Home Birth and Midwives in the News! June 24, 2009

Filed under: Birth/Inspirational Stories,In The News — NursingBirth @ 9:04 AM
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Today I read an article on www.journalgazette.net, the website for the newspaper The Journal Gazette based out of Fort Wayne, Indiana that really gave me the warm and fuzzies.  

 

The article is entitled For some, life begins at homeby Emma Downs and it tells the story of a local family that researched, planned, and ultimately had a positive and empowering home birth after a dis-empowering hospital birth with many interventions.  The article also touches on the growing demand for home births that some midwives are reporting in many communities and how for families that chose home birth, it is about personal responsibility and research and most importantly, informed choice.  I really liked this article as opposed to other articles I have read on home birth in other major media outlets because it just tells it like it is without over-sensationalizing it.  A GREAT read!

 

Thank you to Christina from the Massachusetts Friends of Midwives Blog for alerting me to this story!

 

Women’s First-trimester Working Conditions Impact Infant Birthweight June 22, 2009

Filed under: In The News — NursingBirth @ 10:12 AM
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A new study that will be published in the August 2009 edition of the American Journal of Public Health has found that high levels of job strain during early pregnancy are associated with reduced birthweight and an increased risk of delivering a small for gestational age (SGA) baby, especially if mothers work 32 or more hours per week.  The study included questionnaires from and conducted follow-up on 8266 pregnant women participating in the Amsterdam Born Children and Their Development study.

 

I find these findings particularly interesting because many mothers, if they have the luxury of being able to take some time off of work during their pregnancy, typically take the time off during the end of their third trimester.  The results of this study make me, and the authors, wonder if perhaps women who work in high strain jobs and/or work a long work week should consider reducing their hours or workload during the first trimester instead or as well.

 

Remember, the first trimester is the most critical time in a woman’s pregnancy.  Although at the end of the first three months the fetus is only about 4 inches long and weighs less than 1 ounce, that tiny little baby has already begun to form all of its major organs and nervous system, has a heartbeat, and already has formed its arms, fingers, legs, toes, hair, and buds for future teeth.

 

To check out the article’s abstract visit the American Journal of Public Health website.

 

To check out a summary of the article visit Medical News Today.

 

Super Comment!: Maternal Death in the U.S., or TOP TEN Ways to Reduce Your Risk For Complications in Pregnancy and Childbirth May 27, 2009

Filed under: In The News,Super Comments!,Top Ten Lists — NursingBirth @ 2:46 PM
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Dear NursingBirth,

I’m a huge fan of your blog! Please keep the awesome entries coming! I am learning so much. I am just a novice birth-junkie rather than a birth professional and so am anxious to eat up all the great information you’re giving out here.

Anyhow…. Our state treasurer’s wife (that’s here in Arizona) died today in childbirth, and their baby is said to be in grave condition. They’re not giving causes or reasons. Here’s the link:

http://www.azcentral.com/news/articles/2009/05/26/20090526treasurers-wife0526-ON.html

Can you think of occurrences in hospital-birth that would end up with a dead mother and a baby in really bad condition? I’d love to hear from someone who knows her stuff. The things that came to mind for me were amniotic fluid embolism, severe uterine rupture, and cesarean gone really wrong.

Keep up the amazing work!!!
Diana

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Dear Diana J.,

 

I just read the story you linked to and my heart goes out to that family.  Unfortunately the story you linked to did not go into any details, including the most important detail which is: Did the treasurer’s wife have a vaginal birth or a cesarean section, as the risks are significantly higher with a cesarean section.  I think your question is a good one and since this story has the potential to make national headlines, I think that it is an important enough question to put as its own post on my site.  I hope, however in posting about your question that moms out there who read my blog are not unnecessarily worried or upset that we are talking about maternal death as it is still a relatively RARE occurrence when you think about all the other causes of death in childbearing women. 

 

Let’s put it into perspective.  As the Arizona Central story stated, “In late 2007, the National Center for Health Statistics, part of the U.S. Centers for Disease Control and Prevention, released a report showing that there were 13 maternal deaths per 100,000 live births in 2004 in the United States.” And since in 2004 there were 4.1 million births in the United States, if you do the math that would make about 533 maternal deaths in 2004.  And don’t get me wrong…that’s 533 deaths to many for sure!  However take a look at this chart published by the Center for Disease Control (CDC) entitled: Leading Causes of Death by Age Group, All Females- United States, 2004.  It shows the following:

 

Leading Causes of Death for 15-19 year old Females, 2004:

1)      Unintentional Injury (51.7%), 2) Suicide (8.8%), 3) Homicide (7.5%), 4) Cancer (7.3%), 5) Heart Disease (3.1%), 6) Birth Defects (2.8%), 7) Pregnancy Complications (0.9%)

 

Leading Causes of Death for 20-24 year old Females, 2004:

1) Unintentional Injuries (40.5%), 2) Homicide (8.4%), 3) Cancer (8.0%), 4) Suicide (7.6%), 5) Heart Disease (4.6%), 5) Pregnancy Complications (2.7%), 6) Birth Defects (1.9%), 7) HIV disease/Stroke (1.4%).

 

Leading Causes of Death for 25-34 year old Females, 2004:

1) Unintentional Injuries (25.3%), 2) Cancer (15.1%), 3) Heart Disease (8.2%), 4) Suicide (7.5%), 5) Homicide (5.8%), 6) HIV disease (4.4%), 7) Pregnancy Complications (2.3%).

 

And for women ages 35-44 years old, pregnancy complications don’t even crack the top 10. 

 

Okay so if you are a pregnant mom please know that dying of pregnancy/childbirth related complications is rare and I don’t want to completely freak you out.  But there is something very disturbing about the United States maternal mortality statistics which shocks most people when they hear it….

 

The United States ranks 42nd in the WORLD for maternal mortality rates, with 1 in 4,800 women dying from pregnancy complications in the U.S. in 2007.  That means that 41 countries other countries in the world have BETTER maternal mortality rates than the United States!

 

Many of our practices and current situations in this country, including our obsession with medically unnecessary labor induction, our over-medicalized maternity care system, the practice of defensive as opposed to evidenced-based medicine, the lack of a universal health care system, large differences in health disparities among different racial/socioeconomic groups, the obesity epidemic, and our skyrocketing cesarean section rate greatly contribute to our country’s maternal death rate. 

 

So what exactly is defined as “maternal death.”  According to the World Health Organization, “A maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.”  Therefore a death of a woman that died from complications arising from a cesarean section a month after she had the baby would be counted in the maternal death statistics where a pregnant woman who died in a car accident or murdered during a domestic violence dispute would not. 

 

Okay, but you are probably thinking Why?  Why are so many women dying in childbirth in an industrialized, developed country like the United States at a much higher rate than other industrialized, developed countries like Japan, many countries in Europe, or Australia? 

 

Ina May Gaskin, midwife and founder of the Safe Motherhood Quilt Project, gives us some insight into the situation in her book Spiritual Midwifery, page 455, written in 2002:

 

“According to the CDC, there has been no improvement in the U.S. death rate (which is nearly twice as high as Canada’s) since 1982.  Sadly, the CDC estimates that the true death rate is as much as three times higher than that which is reported and that half of all the reported deaths could have been prevented through early diagnosis and good care.  Given the situation it makes sense for women to avoid unnecessary surgery while pregnant or in labor.  Women double or triple their risk of dying when they have an unnecessary cesarean.  Medical mistakes do happen, even to people who are well informed about their possibility.”

 

Also Ina May’s Safe Motherhood Quilt Project website also links to a Maternal Mortality in the USA Fact Sheet that is worth checking out!

 

The 2008 documentary Orgasmic Birth (which I highly recommend renting) has a 20- minute movie clip as part of the “special features” section of the DVD that provides some eye opening statistics about maternal and infant mortality rates in the United States as compared to other industrialized countries around the world.  In this short movie clip, entitled Birth By The Numbers, Eugene R. Declercq, PhD, Professor of Maternal and Child Health, Boston University School of Public Health, presents the sobering statistics of birth in the United States today.  It is a MUST WATCH CLIP for anyone who is or cares about a mother.

 

Also, here are some articles from mainstream news sources published in response to the 2007 maternal mortality rankings that provide some insight:

 

1) More U.S. women dying in childbirth: Death rate highest in decades; obesity and C-sections may be the cause  Associated Press, August 24, 2007

2) Maternal Mortality Shames Superpower U.S.  Inter Press Service, October 13, 2007

3) U.S. ranks 41st in maternal mortality  Seattle Post-Intelligencer, October 12, 2007 

 

A flyer published by the medical journal The Lancet in 2006 entitled Causes of Maternal Death: A Systematic Review ranks the top 9 causes of maternal death related to pregnancy/childbirth complications in DEVELOPED countries as the following:

1) Other Direct Causes (21.3%), complication of the pregnancy, delivery, or their management which includes (among other things):

            -Anesthesia Complications* (responsible for about 3% of all maternal deaths by itself and includes:    management of the difficult airway in obstetric patient, aspiration of gastric contents under general anesthesia, local anesthetic toxicity, and high spinal or epidural block which paralyzes the breathing muscles of mother).

2) Hypertensive Disorders (16.1%), includes (among other things):

            -Preeclampsia

            -Eclampsia*

            -HELLP Syndrome*

3) Embolism (14.9%), includes (among other things):

            -Pulmonary Embolism (typically a complication seen post-op surgery)

-Deep Vein Thrombosis (DVT) (more likely to develop for women on bed rest or post-op surgery

- Amniotic Fluid Embolism (rare and more appropriately known as Anaphylactic Syndrome of Pregnancy)*

4) Other Indirect Causes of Death (14.4%), pregnancy-related death in a patient with a preexisting or newly developed health problem like cardiovascular disease, seizure disorder, respiratory disorder, diabetes, kidney disorder, liver disorder, obesity, etc.

5) Hemorrhage (13.4%), includes (among other things):

  – Obstetrical Hemorrhage (most common causes being uterine atony, trauma, retained placenta, and coagulopathy)

  – Placenta Previa*

            – Placenta Accreta, Increta & Percreta

            – Placental Abruption*

            – True Uterine Rupture*

6) Abortion (8.2%)

7) Ectopic Pregnancy (4.9%)

8.) Unclassified Death (4.8%)

9) Sepsis Infection* (2.1%)  (most likely to occur post-operatively but can occur post-partum or antepartum)

 

*Comes to mind for me as having the potential to cause a critical illness or death for baby as well.

**Please note mothers undergoing cesarean surgery, especially repeat caesarean surgery are MORE at risk for anesthesia complications, pulmonary embolism, obstetrical hemorrhage, placenta previa, placenta accreta, and sepsis/infection than moms undergoing a vaginal birth.**

 

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You are probably thinking, “So what does all of this mean for me?” “How can I reduce my risk?”  Both are GREAT questions.  It is important to remember that I am not claiming that 100% of maternal deaths are preventable or even foreseeable.  No one is.  I also do not want anyone to get the impression that I am blaming mothers or putting unrealistic pressures on mothers to control things that are sometimes just happenings that are an unfortunate and very sad part of life.  For example, who could have predicted a fatal postpartum hemorrhage for a healthy mom after a normal uncomplicated unmedicated singleton vaginal birth?  No one could!  But what about a mom who experienced a fatal postpartum hemorrhage after elective cesarean surgery….well that one doesn’t sit so well with me!   And which do you think is more likely?  If you guessed the latter you are correct…by at least 4 times as much! 

 

So how does a mother reduce her risk of maternal morbidity and mortality related to pregnancy and childbirth complications?  The following is a short list you might want to keep in mind.  (Not surprisingly, many relate back to avoiding unnecessary surgery.)

 

TOP TEN Ways to Reduce Your Risk For Complications in Pregnancy and Childbirth:

1)      Obtain good and thorough prenatal care, keeping all of your appointments, preferably beginning in your first trimester.

 

2)      Make a conscious effort to eat a well balanced diet during conception and pregnancy that includes adequate amounts of fresh fruits and vegetables, healthy fats, and protein.  There are a variety of prenatal nutrition books out there as well as many childbirth books that have a section on prenatal nutrition.  If you don’t have one buy one or borrow one from the library!!

 

3)      If you don’t exercise, start!  Many gyms, community centers, and YMCAs offer low-impact, pregnancy-friendly classes for expectant moms.  Even a 30 minute walk three times a week will do!

 

4)      If you suffer from a chronic disease or illness or are obese, it is important to know that making appointments with health care providers and specialists that can help you to manage your disease and lose weight in a healthy way before and during pregnancy can ultimately help you to reduce your risk of life threatening complications during pregnancy and childbirth.

 

5)      Consider hiring a birth attendant that practices a midwifery model of care.

 

6)      Do NOT agree to a medically unnecessary labor induction.

 

7)      Do NOT agree to a medically unnecessary or elective cesarean section.

 

8)      If you have a history of a cesarean section, seriously consider a vaginal birth after cesarean section (VBAC) if you have no reoccurring or new reasons or medical indications for a repeat cesarean.  If necessary switch to a birth attendant that supports VBAC and has the cesarean statistics to prove it.

 

9)      Seriously consider avoiding interventions in labor that evidenced-based research have shown could increase your risk of a cesarean section, fetal distress, and infection including early amniotomy (breaking of waters), accepting pitocin to stimulate or augment contractions without trying other more natural methods for augmenting labor first, going to the hospital during very early labor, accepting continuous external fetal monitoring as opposed to intermittent auscultation for a normal healthy labor and a normal, reactive, and reassuring fetal heart rate pattern, and requesting an epidural or narcotic pain medication (especially in early labor) before trying all methods of non-pharmacological pain management techniques first.  (Check out my post: Top 8 Ways to Have an Unnecessary Cesarean Section)

 

10)   Empower yourself to make safe, healthy decisions regarding your pregnancy, your labor, your birth, and your baby by doing your own research!!  (Check out my post: Birth Resources EVERY Woman Should Know About).

 

More Risks for Baby With Repeat C-Sections May 24, 2009

Filed under: In The News — NursingBirth @ 9:25 AM
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A new study entitled Neonatal Outcomes After Elective Cesarean Delivery published in the June issue of Obstetrics & Gynecology (aka “The Green Journal” published by American College of Obstetrics & Gynecology (ACOG)) concluded that:

 

“In comparison with vaginal birth after cesarean, neonates born after elective repeat cesarean delivery have significantly higher rates of respiratory morbidity and NICU-admission and longer length of hospital stay.”

 

The journal article begins with the following introduction:

 

“In 2006, the United States cesarean delivery rate of 31.1% was at an all-time high, making cesarean delivery the most common surgical procedure performed in American women.  This high rate of cesarean delivery is attributed to the rise in primary cesarean delivery rates from 14.6% in 1996 to 20.3% in 2005, an increase of 60%.   With the rates of vaginal births after cesarean delivery (VBAC) at an all-time low of 7.9% in 2005, women who have a primary cesarean delivery have a greater than 90% chance of having a repeat cesarean delivery, only serving to increase the overall cesarean delivery rate.   Almost one half of cesarean deliveries, a rate of 15%, are done electively, before the onset of labor.”

 

This study found that neonates born by intended cesarean delivery were more prone to NICU admission for:

 

1)      hypoglycemia (low blood sugar),

2)      needing higher rates of oxygen supplementation,

3)      needing intubation/ventilator support

 

This study’s findings were consistent with the multiple studies previously done that documented respiratory morbidity in neonates born after elective repeat cesarean delivery, particularly with an increase in:

 

1)      respiratory distress syndrome,

2)      transient tachypnea of the newborn,

3)      persistent pulmonary hypertension,

4)      need for supplemental oxygen

5)      respiratory morbidity related to failure to clear fetal lung fluid related to birth without benefit of labor

 

The authors write:

 

“While the common perception is that conditions such as transient tachypnea of the newborn are benign, self-limiting illnesses, several studies indicate that neonates with such conditions can progress to severe respiratory failure, leading to the need for extracorporeal membrane oxygenation or death.”

 

This study really hits home for me since I had to scrub three, count them, THREE primary elective cesarean sections the other week, all attended by the same physician, for the most outrageous and bogus reasons EVER!  Stay tuned….More on elective primary cesarean section to come!

 

To read the full text of this study click here.

 

To read the Health Day newspaper article on this study check out Yahoo! News.

To learn more about Vaginal Birth After Cesarean (VBAC) and the risks of Repeat Cesarean Section, please visit ICAN’s website.

 

Special THANKS to The Feminist Breeder for alerting me to this study!

 

Research Shows TENS Unit Can Ease Labor Pain May 15, 2009

Filed under: In The News — NursingBirth @ 10:43 AM
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It’s been waaaaaaaaaaay too long since I have posted!  It’s been really crazy busy at work and I’ve had to work some overtime to help out.  But I’m back in the saddle again!  So here it goes!

 

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Medical News Todayrecently published a press release citing a 2009 review by the Cochrane Collaboration that concluded that women should have the option of using transcutaneous electrical nerve stimulation (TENS) as a non-pharmacological method of pain management in labor.

 

The full report can be found on the Cochrane Collaboration’s website.  The summary reads:

“TENS is a device which emits low voltage currents which has been used for pain relief in labour. The way that TENS acts to relieve pain is not well understood. The electrical pulses are thought to stimulate nerve pathways in the spinal cord which block the transmission of pain. In labour, the electrodes from the TENS machine are usually attached to the lower back (and women themselves control the electrical currents using a hand-held device) but TENS can also be applied to acupuncture points or directly to the head. The purpose of the review was to see whether TENS is effective in relieving pain in labour. The review includes 19 studies with a total of 1671 women. Fifteen studies examined TENS applied to the back, two to acupuncture points and two to the cranium (head). Results show that pain scores were similar in women using TENS and in control groups. There was some evidence that women using TENS were less likely to rate their pain as severe but results were not consistent. Many women said they would be willing to use TENS again in a future labour. TENS did not seem have an effect on the length of labour, interventions in labour, or the wellbeing of mothers and babies. It is not known whether TENS would help women to manage pain at home in early labour. Although it is not clear that it reduces pain, women should have the choice of using TENS in labour if they think it will be helpful.”

 

I think the findings of this study are interesting.  I certainly support pain management techniques in labor that 1) are non-pharmacological, 2) do no harm to mother or baby or to the progress of labor, and 3) increase a mother’s feeling of control during her labor.  So it seems like the use of a TENS unit could be really helpful to some moms.  On the other hand I have never had any experience with a TENS unit, either personally or via any of the moms I have taken care of, so I have little knowledge about it. 

 

Since I have little knowledge on the subject I naturally did an Internet search to learn more.  If you are interested in using a TENS unit for pain management in labor please check out one of these websites:

 

1) Transcutaneous Electrical Nerve Stimulation (TENS) for Labor Pain Relief   By Robin Elise Weiss, LCCE

2) How to Use a Portable TENS Unit for Labor  By eHow Health Editor

 

Here are some quick facts about TENS units to get you started:

 

1) DO learn how to use a TENS unit before labor from a trained professional.  (This can usually be done by a trained doctor, midwife, or physical therapist.)

 

2) DO continue to move with your TENS unit on!  (A TENS unit does not keep you from moving around or assuming various labor positions.)

 

3) DO use a TENS unit beginning early in labor and if you have back pain/back labor.  (Studies have shown that it is most effective in these situations).

 

4) DO NOT use a TENS unit while you are in a tub or shower.  (Although a TENS unit can be used during times when you are not in the water.)

 

5) DO turn up the frequency of the nerve simulations to help with the pain of contractions or push a button to give you a “boost” as needed during labor, then turn down during periods of rest.

 

6) DO try turning the TENS unit off and seeing how your contractions feel if you feel the TENS unit isn’t helping.  (You may find the TENS unit is actually helping!)

 

7) DO learn about, read about, and practice other non-pharmacological pain management techniques for labor even if you are planning on using a TENS unit including: warm water showers/bath/jacuzzi, back massage, leg massage, counter pressure, various labor positions, birthing ball, squat bar, birthing stool, visualization, affirmations, music therapy, aromatherapy, walking, warm packs, breathing & relaxation techniques, doula support, and most importantly, loving undivided attention and care from supportive labor companions.

 

Recommended Reading:  The Birth Partner, Third Edition: A Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions  by Penny Simkin

 

Penny Simkin’s book is a MUST read for any woman or labor companion preparing for childbirth (EVEN women who are planning on using pharmacological pain management options including epidural and IV pain medications should read this book!!!)  On page 150-151 Penny describes how to use a TENS unit in labor. 

 

Are you looking to rent a TENS unit for your labor?  Please check out www.babycaretens.com

 

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Have any of you ever used a TENS unit for pain management in labor?  I’d love to hear how it worked for you!

 

Stand And Deliver! Research Shows Upright Labor Positions Reduce Pain, Speed Birth April 15, 2009

Filed under: In The News — NursingBirth @ 9:37 AM
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As if we all didn’t already know this!  :)

 

Medical News Today posted a story on a new study published in the latest issue of The Cochrane Library which found that women who walk, sit, kneel or otherwise avoid lying in bed during early labor can shorten the first stage of labor by about an hour and are also 17 percent less likely to seek pain relief through epidural analgesia.  On the whole, the review examined 21 studies totaling 3,706 births.  After reviewing the research the authors’ concluded, “Women should be encouraged to take up whatever position they find most comfortable in the first stage of labour.”

 

The Cochrane Collaboration is an international organization that evaluates medical research by performing systematic reviews and drawing evidence-based conclusions about medical practice after considering both the content and quality of existing medical studies on a particular topic.

 

I would probably bet money on the fact that every savvy birth junkie or mom reading this blog already knows this J.  I just love when the research supports what midwives and mothers have instinctually known for centuries!!

 

So get up and move girl!!  Beware of any intervention that restricts your movement and, YES, this includes unnecessary and elective inductions.  This is the #1 reason women end up with all the needless and risky interventions in the first place.  The LESS unnecessary interventions the MORE you will be able to move!

 

Breast Milk: A Lifesaver for Premature Babies April 13, 2009

Filed under: In The News — NursingBirth @ 9:17 AM
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Finally!!  A positive story about breastfeeding in the news J!  I think my heart will be able to rest a bit easier now. 

 

On April 10, 2009, the CBS Evening News aired a story about the importance of mother’s milk for premature babies.  The story and video entitled, UCSD Doctors Say Breast Milk Can Mean Difference Between Life And Death For Premature Babies, can be viewed on the CBS news website as well.  

 

What stunned me the most about the story was the statistics: One huge difference the breastfeeding promotion program at UC San Diego Medical Center’s NICU has made is a significant decrease in one life-threatening gastrointestinal infection called necrotizing enterocolitis (NEC). Of the half million premature babies born every year, between 5-10 percent of them develop NEC and a third of those who develop it will die.  The best part is that before UCSD started their breastfeeding promotion program, the rate of NEC in this hospital was 5.8 percent.  But last year it had fallen to less than 1 percent!

 

 

 

 

 

CDC Scientists Find Rocket Fuel Chemical In Infant Formula April 4, 2009

Filed under: In The News — NursingBirth @ 10:31 AM
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I feel like I have been on a breastfeeding support and advocacy kick lately.  I am currently in the process of obtaining my certification to be a Certified Lactation Educator through the Childbirth and Postpartum Professional Association (CAPPA), have recently been reading a lot of breastfeeding books, and have passionately blogged against “The Case Against Breastfeeding”  (see: Why The Today Show Hurts America (or, Battling The Case Against Breastfeeding).

 

So you can imagine how an article entitled Powdered Cow’s Milk Formula Contains Thyroid Toxin recently published on the Environmental Working Group’s website would have caught my eye.

 

The article states that researchers from the U.S. Centers for Disease Control and Prevention (CDC) have reported that 15 brands of powdered infant formula are contaminated with perchlorate (a rocket fuel component detected in drinking water in 28 states and territories) and that two most contaminated brands, made from cow’s milk, accounted for 87 percent of the U.S. powdered formula market in 2000.

 

What is even more disturbing is that the report states that the CDC team cautioned that mixing perchlorate-tainted formula powder with tap water containing “even minimal amounts” of the chemical could increase the resulting mixture’s toxin content above the level the Environmental Protection Agency (EPA) has deemed “safe”.  Other scientists challenge the EPA’s current “safe” level, believing that it is too high to adequately protect public health.

 

If this isn’t yet another reason we need to continue to increase the support in our maternity care system and in our communities for new mothers to initiate and continue successful breastfeeding with their newborns and infants, I don’t know what is!

 

My (Aggravated) Response to “Ban the Breast Pump” April 3, 2009

Filed under: In The News,Ramblings,Reviews & Commentary — NursingBirth @ 2:21 PM
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Hanna Rosin’s done it again.  It was bad enough that she was even published never mind the fact that she was actually invited onto NBC’s Today show.  But now there are journalists out there seriously supporting her cockamamie ideas and poor research by writing about her in major news papers!  Oh give me a break!

 

Case in point: April 2nd’s edition of The New York Times.  Gracing the opinion page, an article entitled “Ban the Breast Pump” by Judith Warner, author of the 2005 book “Perfect Madness: Motherhood in the Age of Anxiety.”  Oh brother… this should be good. 

 

Warner begins the article by quoting Rosin in a recent four-part controversial podcast conversation she has filmed with three of her gal pals.  The main target, among a host of other things, is the breast pump.  Quoting Rosin, “That was my least favorite thing I ever did in my whole life.  Who could blame [your husband] for never wanting to sleep with you again?”

 

Oh jeeze, and here Warner goes… This is what she had to say in regards to watching Rosin’s podcast and reading her Atlantic article, “Hallelujah, I all but shouted at the computer, desperate to join in the conversation with these newfound sure-to-be best friends.  Rosin’s article, based upon a review of the relevant medical literature and some physician interviews, makes the case that the health claims about breast milk have been greatly overstated.  Why have we made such a fetish of breast milk when there’s no evidence to prove whether, as Rosin puts it in the Atlantic video, ‘what’s key about breast feeding is the milk or the act of breast-feeding’?”

 

If all of this is not infuriating enough, Warner decides to end her article with the following “take that” to every nursing mother out there who for one reason or another, desires to, has to, and likes to use a breast pump:

 

“In fact, I hope that some day, not too long in the future, books on women’s history will feature photos of breast pumps to illustrate what it was like back in the day when mothers were consistently given the shaft. Future generations of female college students will gaze upon the pumps, aghast.  ‘Did you actually use one of those?’ they’ll ask their mothers, in horror.  And the moms, with a shudder, will proudly say no.”

 

Of course I am not so naïve to think that there aren’t some women out there that don’t particularly enjoy, maybe even hate, using a breast pump.  I can remember my best friend telling me stories about when she was pumping for her premature twin girls when they were in the NICU.  She told me that it was very important for her to provide the girls with her breast milk since they were so premature, the gift, she said, of added germ fighting power she knew only she could provide for them.  But a month was her limit and she has said to me how she does not miss “milking” herself and how hard it was to “warm up” to a breast pump when she was so sad her babies were not at home with her.  I can totally understand her feelings.

 

On the other hand, I remember my mom pumping breastmilk for my three brothers and sisters before working evenings as a waitress while I was growing up.  So I called her up today and asked her how pumping made her feel.  “It didn’t much bother me,” she said, “It actually was pretty quick when I used to do it and I was lucky enough that I only missed one feeding being at work.  But if I didn’t have that pump, boy, that would have made things more difficult.”

 

First of all, it really boggles my mind that Warner can write, “Why do we, as women, accept all the guilt and pressure about breast-feeding that comes our way instead of standing up for what we need in order, in the broadest possible sense, to nourish and sustain ourselves and our families?” and yet be SO BLIND to the reality that there are hundreds of thousands of mothers in this country and in the world that DO NOT believe that breastfeeding is a burden, plaguing their marriage and self esteem, and hurting their independence and career!  That she can be so PIG HEADED to oversee how, for many families, breastfeeding is the ONLY way they CAN or CHOOSE to nourish and sustain themselves?!  And NEWSFLASH!  The real truth is that there are many mothers out there that breastfeed, not because they feel guilt if they don’t or feel societal pressures to do it, but that it is the best choice for them and their families.  Rosin & Warner’s stance falsely gives their readers the impression that all of the breastfeeding moms out there are just waiting for someone to give them an “out.”  How ignorant!

 

The following is an incomplete list of reasons that a mother might NEED, CHOOSE, or WANT to express their breast milk with a breast pump:

1)     Their own milk supply is higher than their baby’s needs and not pumping causes their breasts to become uncomfortably full

2)     Their own milk supply is less than their baby’s needs and pumping is required to build up a bigger milk supply (the physiology is: the more a mother breastfeeds or pumps, the more milk she will make)

3)     Breastfeeding must be delayed after the birth of a premature baby or sick baby that does not yet have the ability to coordinate a suck and swallow motion and therefore must be fed via gavage feeding (tube in stomach) and not pumping would render the mother with out an adequate milk supply to start breastfeeding when the child is ready.  Not to mention the proven evidence of how beneficial breastmilk is for a premature baby.

4)     The mother must be away from the child at some point of the day/week (for example, when she returns to work), and wishes to provide the baby with breast milk via bottle feeding when she is unavailable.  Pumping also allows the woman to keep her milk supply adequate especially if she works full time or long shifts.

5)     The father desires to participate in feeding the baby and both parents desire that the feeding provided still be breastmilk

6)     The mother would like to build up a supply of milk that can be frozen and used during a night out or in any situation where the mother might have to be away from the infant.

7)     The mother is experiencing engorgement after delivery causing the mother’s nipples to become flat and the skin on her breasts to become taut, making it difficult for the baby to latch on properly.  The temporary expression of milk with the aid of a breast pump can soften the areola so that the baby can latch on properly and hence, remedy a situation that could potentially threaten the mother’s confidence in her breastfeeding ability.

 

So as far as banning the breast pump goes, I think that it is one of the most judgmental, unsupportive, ignorant, selfish, and detrimental suggestions to come out of this whole “The Case Against Breastfeeding” debacle.  And articles like Warner’s are only the beginning. 

(See: Why The Today Show Hurts America (or, Battling The Case Against Breastfeeding)

 

Study Finds That Memory of Labor Pain Is Influenced By A Woman’s Childbirth Experience March 30, 2009

Filed under: In The News — NursingBirth @ 9:22 AM
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A study recently published in the March 2009 issue of BJOG: An International Journal of Obstetrics and Gynaecology has found that for about half of women who give birth, memories of the intensity of labor pain decline over time, for some women, their recollection of pain does not seem to diminish, and for a minority of women, their memory of pain increases with time.

 

I could not access the original study online but I did find an article published by Reuters Health Stories that summarizes the study.

 

As a labor & delivery nurse, I have heard many a time a mom in the throws of her second, third, or forth labor yell out, “I don’t remember it hurting this much last time!!”  It doesn’t matter if “last time” was 18 months ago or 18 years ago, anecdotally I personally have found that women do tend to “forget” the pain of childbirth.  It is interesting that this study did find that for about 50% of women, this is true.

 

But what I found most interesting about this study were the following two things:

 

#1) The study found that a woman’s labor experience (positive vs. negative) was an influential factor. The study found that women who reported labor as a positive experience 2 months after childbirth had the lowest pain scores, and their memory of the intensity of pain had declined by 1 year and 5 years after giving birth.  However, the memory of labor pain did not decline during the observation period for women with a negative overall experience of childbirth.

 

#2) The researchers found that women who had epidural analgesia remembered pain as more intense than women who did not have an epidural, suggestive of these women remembering “peak pain.”

 

Reading this article reminded me of the book Birthing From Within by Pam England, CNM, MA.  In her book, England writes a lot about a woman’s prior labor/birth experience and how much it can affect her future pregnancies and labor/birth experiences…especially the negative ones.  She writes about how important it is for a woman’s birth preparation and prenatal care to not just include learning about tests and birth technologies, but to include talking and exploring a woman’s hopes, secret fears, unresolved grief, self-doubts, and visions of birth.  England’s “Birthing From Within” classes use birth art as one way to achieve these objectives. 

 

Regarding epidurals (and again, anecdotally speaking) there have been many times in my practice as a labor & delivery nurse that an epidural doesn’t provide the mother with the relief she was seeking.  The epidural could be one sided, there could be a “window” of pain, or it could provide no relief at all.  It had always seemed to me that if the epidural never worked or more so if it worked for only a while and then wore off, that the women seemed to have less ability to cope with the pain for a variety of reasons.  In an article for Mothering Magazine entitled Epidurals: risks and concerns for mother and baby author Dr. Sarah J. Buckley MD writes:

 

“Beta-endorphin is the stress hormone that builds up in a natural labor to help the laboring woman to transcend pain. Beta-endorphin is also associated with the altered state of consciousness that is normal in labor. Being “on another planet,” as some describe it, helps the mother-to-be to work instinctively with her body and her baby, often using movement and sounds. Epidurals reduce the laboring woman’s release of beta-endorphin. 

 

Obstetric care providers have assumed that control of pain is the foremost concern of laboring women, and that effective pain relief will ensure a positive birth experience. In fact, there is evidence that the opposite may be true. Several studies have shown that women who use no labor medication are the most satisfied with their birth experience at the time, at six weeks, and at one year after the birth.  In a UK survey of 1,000 women, those who had used epidurals reported the highest levels of pain relief but the lowest levels of satisfaction with the birth, probably because of the higher rates of intervention.”

 

Certainly some food for thought… 

 

 
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