From the Archives: Writing a Birth Plan

how-to-write-a-birth-plan

The subject of using online birth plans came up last night, so I wanted to distill my advice here on the blog. Turns out, I wrote about it 4.5 years ago. Ha! Ah well, it’s still good advice.

-Veronica

Originally published February 7th, 2012:

First of, let me say this:  I know you can’t plan your birth.  You can’t decide it’ll last only 20 minutes, or that you’ll only push twice.  Do you know this?  I hope you know this.  Rather, a birth plan is a tool that should be used by a mother to sort out her options and to communicate those preferences to her care provider.  While she can not plan what will happen, she can give a good amount of thought to how she will handle what happens.  Also?  I believe very, very much that it’s something that should be done no matter the place of birth.  Even moms planning home births need to think about what they want or don’t want.  So, after giving much thought over the last couple of days as to what makes a birth plan good, and what can make it very, very bad, I give you the following advice:

DON’T: Go to a website that “writes” a birth plan for you by having you check off a couple of boxes that sounds good.  Why?  Well, it comes across that you put very little thought into writing your birth plan.  Also, you can end up “choosing” things that are not even an issue at your desired birth place (like saying you don’t want to be told what to wear during labor at a home birth).  However, if you feel completely stuck, you can check out one of those websites for some ideas, just make sure you rewrite things in your own words.

DO: start with an introductory couple of sentences. Think along the lines of: This is my second birth.  My first birth was very long, and very difficult, with many things that felt like I was not listened to.  I am hoping for a much calmer, more supported birth. Or whatever fits your specific situation.  Make it short, to the point, and applicable to this birth. It will help the people who are part of your birth team know very quickly what you are looking for, which means that (hopefully) they will be supportive of where you are physically and emotionally, not where they think you should be.

DON’T introduce anyone and everyone in your life in the birth plan.  A birth plan is not an autobiography.  Please don’t use it  to introduce the nursing staff to your cats, or your turtles, or your childhood home that you haven’t been to in 25 years.  And for goodness sakes– no pictures of these things!

DO keep the information relevant.  If there is something about your medical history that is relevant to this specific labor and birth, include it.  Yes, it’s in your chart…somewhere.  But save everyone a headache and confusion and include that important information right at the top of your birth plan. Have you already met with an anesthesiologist and found out that you are not, for a specific reason, a candidate for an epidural?  Include that!  Is the father of the baby not participating in the birth because of religious or cultural reasons?  Include that! Trust me, it will save so much time and frustration of everyone is, almost literally, on the same page.

DON’T make your birth plan more than a page long, two at the most.  Very important information gets lost in long birth plans, and it can seem like not much actual thought went into writing the plan.

DO make sure only time-specific information is in the plan.  Don’t bring a plan to the hospital that talks about laboring at home (or how long you’ll wait before calling your midwife for a home birth). You do need to think about things like that, but it can end up burying the more relevant information.

DO write out a really long plan, if you feel you need to.  You can include things like how long you want to labor until calling your doula, or at what point you want to o to the hospital, or fill up your birth tub at home–whatever.  But then sit down with someone and go through that list with a very critical eye, and think, “What will people need to know at the time?” Then start to cut things out, leaving a shorter version.

DON’T list things that are not done at your chosen place for giving birth. If they don’t do routine IVs, don’t say, “I do not want a routine IV.” On the flip side, be reasonable.  Don’t list things that just CAN NOT happen, like, “If I have an epidural, I do not want an IV.”

DO take good, comprehensive childbirth classes so you can understand all of your options and help you understand how to avoid those things you do not want.  So, for instance, if you don’t understand why IVs might be used, you might need a class.  If you were never told the many different ways an induction might be done, you need a better class.  This might ruffle a feather or two, but knowing about something doesn’t mean it’ll happen.  Ignorance IS NOT bliss.  Hopefully there are things you’ll never need to go through, but knowing about them, just in case, is always a good idea.

And finally:

DON’T assume that writing something down means that it will be so.  Make sure that your care provider (and, since most people see a group practice, ALL the possible providers) will take the time to listen and respect your voice.  There is nothing sadder to me than telling families prenatally to address specific things with a care provider, only to watch those parents find out that  Midwife X won’t allow it, or Doctor Y doesn’t believe in it while mom is in labor.  Yes, you are the patient, but birth time should not be battle time, and if there are options, find the very best care provider to fit what you want.  And yes, it is worth it.

Quickly, in my opinion, what should a birth plan touch on?

  • support people
  • environment
  • comfort measures
  • labor positions/ tools
  • medication preferences
  • pushing and birth positions
  • newborn procedures (right after birth and the few days after birth)
  • post-birth maternal procedures

I’m sure I missed a thing or two (or three).  What do you think?  What tips would you add?  What else do you think is a MUST INCLUDE?  Add it in the comments below!

Warmly,

Veronica

Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

The Allina strike will put birthing families in grave danger

I have been blogging for almost exactly 5 years in this space, and maternity care outcomes and transparency hold a special place in my heart. I don’t know if anyone gets as excited as I do when new info comes out. After a lot of thought over the weekend, I am posting this. Buckle in.

The Allina nurse strike saga continues. In June, the nurses went on a 7 day strike. Back then, I had concerns about the safety of giving birth with replacement nurses. Now that a strike date of September 5th at 7am has been set, and after careful consideration, I can’t say this without enough emphasis: DO NOT HAVE YOUR BABY AT AN ALLINA HOSPITAL DURING THE STRIKE. CHANGE PROVIDERS AND/OR PLACE OF BIRTH NOW!!!!!

I may not make any friends with the system’s physicians or administration, but the evidence is more than circumstantial to back up my warnings. While I understand the political forces at stake with public opinion of unions in general, staffing ratios and staff safety are always issues at Allina. And in fact, the National Labor Relations Board ruled that the Minnesota Nurses Association’s complaints about unfair labor practices were with merit.

Historically, Allina’s hospitals have had some of the highest cesarean rates in the Twin Cities Metro Area. Recently, a change was made and births are no longer done at Unity Hospital, but in 2014, the c-section rate for Abbott Northwestern was 30.2%, it was 28.3% at Mercy Hospital, and 30.4% at United Hospital; all of these are above the state average of 26.9%. In 2014, 11,207 births occurred at Abbott, United, Mercy, and Unity–an average of 217 per week. With such high volume, Staffing problems will hit maternity services hard. Lactation services are sure to be hit hard as well, as union IBCLC RNs will also be on strike, so moms will have a very hard time getting appropriate breastfeeding help.

The last strike, which was limited to 7 days, cost Allina $20 million. On social media pages, nurses from other parts of the country are posting information they’ve received from staffing agencies recruiting workers to fill in for the striking nurses. Replacement nurses are being offered $6,900 per week and are not required to be licensed to practice in Minnesota. Additionally, because of such a high cost to replace nurses and because of the very large number of striking nurses (4,800), there is absolutely no way that Allina’s hospitals will have adequate staffing– in fact, only 1,400 nurses were brought in during the strike in June. A hospital system with a whopping 71% reduction in nursing staff is without a doubt incapable of providing safe care. While this creates a dangerous situation for all of the hospital units, because safe staffing ratios are so high– 1:1 nurse to patient ratios during labor and birth, and 1:3 nurse to patient ratios postpartum, there’s no doubt that having less than 1/3 the normal number of nurses will put mothers and babies in grave danger.

Very specifically, replacement nurses can’t provide appropriate care in the “Mother Baby Centers” of Allina hospital because:

  • Nurses will be much slower at charting in a system that they aren’t familiar with. Even if the nurses are familiar with EPIC, the most common EHR in our area, each organization has their own unique configuration. In births, charting is extensive– many, many things need to be documented in real time, taking away the nurses’ ability to provide patient care.
  • Maternity Care practices in our area are very different from those in other parts of the country. We tend to have better outcomes than in other parts of the US–meaning the replacement nurses will probably be used to maternity care practices that are considered outdated or unsafe. So, for instance, while Allina hospitals have Nitrous Oxide as an analgesic option for birth, it’s still rarely used outside of our metro area. Because the replacement nurses won’t have the training needed to provide Nitrous, parents will very likely find that options they expected to be available aren’t.
  • Patients with high-risk pregnancies are very likely to have replacement nurses that lack the higher training needed to keep medically fragile conditions under control.
  • Staff morale in hospitals during strikes always takes a major hit, distracting from the real need-providing patient care.
  • Even if the nurses were perfectly trained to work as Labor and delivery and postpartum nurses, even if they knew exactly how to use the Electronic Health Record System– In no way, shape, or form will there be nearly enough nurses to provide safe care.

When I previously wrote about my concerns, I wasn’t sure what birthing mothers would end up experiencing. However, last week, I made contact with one mother who gave me permission to share her story. Her name is Lisa, and her story follows:

I planned birth at Abbott due to VBAC.  I was aware of the strike and very concerned that I would go into labor during that time, but I was planning to birth with my midwife and with my doula and I was reassured that I have nothing to worry about. In fact I’m going to say what no one said to me when I was worried about the strike: RUN! I know everyone might not agree with that, but I speak from personal experience. I moved back from Alabama so that I could receive the care we’re accustomed to here in MN, and I still ended up with nurses from states where I would never give birth.  My due date was 6/19.  Same day as the strike. Water broke 6/16.  Labor never started so I went in 6/18 at 4am for Pitocin.

24 hours later [early in the morning of June 19th, the day of the strike], I’m laboring hard on Pitocin. I have a wonderful supportive Allina nurse. The best nurse I’ve ever had, but there’s a tension in the room so thick that you could cut it with a knife. We all know she has to go home at 7am, when her shift ends and the strike begins. In just 3 more hours. It was awkward. There was an elephant in the room. I considered asking her if she would stay with me but that seemed awkward and inappropriate.

So 7am came and she said “I’m sorry, I have to go now. ”

After that I had a stream of nurses. “I’m you nurse now. ..no I’m your nurse now. No I’m your nurse again.” I was in the shower and they kept interrupting me. I had a doula and a very supportive husband. I just wanted some privacy at this point, I wasn’t asking for extra support.

At another point I had nurses just standing around me with their arms crossed. Just watching me. Like they had never seen a woman labor before. Like I was a fucking zoo animal!!!!

At another point, one nurse was giving another nurse a tour of the room. “Here’s the warming station…” and then the two of them stand in front of the computer and discuss how the medical system works. I just hear whispering and taping on the keyboard. I’m butt ass naked, standing at the foot of my bed, huffing nitrous every 2 minutes for 90 seconds. I can barely speak. I’ve been at this for 30 hours. I wave my hand at them “They need to go. They’re distracting me.” I’m begging/irritated. My midwife then shooed them away.

This still pisses me off. I shouldn’t have to protect my own birth space like this. My midwife was there and my doula and my husband. But no one said anything. I had to ask them to leave.

It’s no surprise that soon after this I lost my ability to handle my Pitocin induced contractions. I asked for an epidural. Then my contractions went to 18 minutes apart and I ended up with a cesarean, again. Cesarean was 6/19 at 6pm.

They surgery itself had some parts that were less than what I would expect from Abbott and my post surgery care was grossly negligent.

I actually had to page my midwife on call during the overnight hours.  When the baby was born (unplanned cesarean ) we were told he could stay with us but would need to have his temp closely monitored due to prolonged rupture of membranes.  But they never checked his temperature the entire night.  Nor did they check my bleeding on the night shift.  It literally felt like everyone had left the hospital,  apocalypse. When she [the midwife] called me back I told her that I wanted to transfer with my baby to another hospital because no one was taking care of us. I paged her just after 7 am.  I knew I was supposed to have a new nurse and still no one had come to check on me or the baby.   I told her I was scared because we weren’t being monitored  and wanted us to be transferred to another hospital,  by ambulance if necessary.  She said “hold tight,  I’ll see what I can do and I’ll call you back.”

It’s my belief that when she hung up with me she called up there to the hospital and raised hell, because within a few minutes I has my day nurse and the charge nurse there.  They helped me clean up the blood that was dried from my waist down, changed my sheets and got me some food.  And filled out the white board.  There was definitely a turnaround of my care at that point.  My midwife called me back about 8am on June 20 and asked if I still wanted a transfer,  and  told me she could make it happen.  At that point I said we had a new nurse and I  felt safe again.  I told her we would stay.

Hiring a doula won’t be enough. Every single birthing family  with babies due in the next month needs to change plans on where to give birth, which likely will result in also changing providers, and they need to do it NOW. Changing is easy– I’ve outlined the process before. If you’re late in the game, you may need to change to a Family Med Provider who does OB care or an OB group. If you need help sorting your options, I’m happy to help. Call or email me– 651-200-3343 or veronica@babylovemn.com.

And Allina union nurses? I have your back. Allina’s C-suite? You are putting people at risk with your ongoing actions, and you need to be ashamed of yourselves.

Veronica

Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

About that Alabama birth settlement…

Last week, a mom in Alabama was awarded $16 million by a jury to compensate her for damage; they found the hospital “violated the standard of care for labor and delivery and participated in reckless misrepresentation of fact.” Evidently, the hospital had a pattern of what the jury described as “Bait and switch”. Of note was that they hospital’s advertising touted waterbirth until At least July of 2015, even though water birth had been banned since January of 2013.

Waterbirth bans happen. In April of 2014 in response to one of the dumbest, most illogical opinions ever published in the American Journal of Obstetrics and Gynecology, Allina hospitals banned waterbirths. At the time, I blogged about the controversy, writing,

Rebecca Dekker over at Evidence Based Birth does a really good job talking about the evidence to support (or not support) the practice of allowing women to labor in a tub and to give birth in the tub. I’m not going to reinvent the wheel, so go read it on her website. The upshot? This isn’t an easy thing to study due to logistics and ethical standards, but it has been studied. It’s been studied enough that the practice is considered safe throughout much of Europe. And guess what? Their water works the same there as it does here.

So, here’s the problem: According to an archived copy of The MotherBaby Center’s (really just Abbot Northwestern, an Allina Hospital) website from June 6th, 2014, waterbirth was still an option.

Waterbirth

Despite the fact that there was ample media coverage of the waterbirth ban, this page is, essentially, the very same bait and switch that the Alabama hospital was sued over. Waterbirth is being actively marketed, but it is not available.

This is not OK. It isn’t OK in Alabama, and it isn’t OK here.

While it’s true that Alabama ranks as one of the worst states in which to give birth in the US, with very poor outcomes for both moms and babies, cases like what this mom experienced happen all the time. As a doula, I have witnessed obstetric violence. I have been in the room as OBs told moms that if they didn’t comply, their babies would die. I have seen moms get episiotomies even though they explicitly stated that they did not consent. Some of these cases happened at hospitals that otherwise had good cesarean rates. Many of these actually happened while a patient was under the care of Nurse Midwives. Backlash from the medical community in response to last week’s verdict was severe; some doctors claimed that this verdict was not actually a victory for birthing families, but that hospitals would respond by caring even less about what her patients wanted and refusing even more obstetric choices. However, it’s important to point out that it took one mom who knew her options and knew her rights to stand up.

As expectant parents, it’s on your shoulders to take responsibility for making informed choices. Looking at a website and marketing is not making an informed choice. Staying blissfully unaware of the ins and outs of the maternity care system IS NOT assuming any responsibility for the outcome of your pregnancy and birth. You are the ones who need to ask questions. Put as much time researching your options as you spend researching cribs. Find out the difference between the different kinds of doctors and midwives that provide care. Look at freestanding birth centers. Tour hospitals and for heaven’s sake– ASK QUESTIONS. If they say they have waterbirth, ask to know the average times they use it a month. They know. If you must, tell them that you want to make sure what they market is really available.  And on the flip side, every single time something like the above happens, we need to make sure lots of people point it out and stay critical of it. Hold both marketing and maternity services to the highest standards. If nobody says anything, nothing will change.

In the MSP and surrounding communities, the voices of patients can and have produced profound change. And as much as I want to paint birth as a magical, shiny, unicorn-filled time, reality doesn’t always match that. Let’s talk about when it sucks, and when the places and people we trust create trauma, we need to raise our voices.

If you’ve seen a bait and switch in maternity care, I’d like to hear about it.

Warmly,

Veroniva

Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

6 ways to feel more productive while nursing your baby

 

do while nursing

One of the hardest parts once you conquer breastfeeding is that sometimes it makes you feel like you should be doing something…more productive. I mean, come ON…you ARE making sure your baby is growing and thriving, but we live in a society that eats quickly, and unfortunately, babies still haven’t been forced to adopt out weird societal norm. Throw into the mix that babies nurse not just out of hunger, but out of thirst, too, and it can be darn frustrating to be sitting on that chair, nursing your baby…again. So, I came up with some truly helpful things that you could do while feeding your baby.

1) Clean up your phone contacts- If you’re like me, you phone is full of all sorts of clutter and old info and numbers for people you really never want to talk to again. Going through and deleting bad info seems like a huge chore, but is a perfect thing to do with one hand. Think of how amazing you’ll feel when it’s all clean and organized!!!!!

2) Order hard copy prints of pictures from your phone- If you’ve ever had a phone stolen with all of your pictures on it, you know how gut-wrenching it is to no longer be able to look at the pictures you’ve been taking of your sweet kids. And the reality is, those digital pictures can’t be handed down to future generations. While it may seem quaint, actual pictures in photo albums or boxes are the answer. There are apps that let you order prints from your phone, and they all have free print offers. Future you will thank now you, I promise.

3) Learn a new language- My husband is trying to learn German through podcasts. I’ve long been interested in trying Duolingo, a free app to learn languages. Finding the time can be tricky. But if you use feeding time for baby as learning time for you–you may actually make progress!

4) Get a lower cable/internet bill- Yes, this one actually requires making a potentially frustrating phone call, but if you call, tell them you’re thinking of switching to the competitor, see if you can score a lower rate. It may work, it may not. It never hurts to ask.

5) Check you credit score- This one will make you feel like you’re really doing a great job of adulting. And to make sure you don’t go the the wrong place, here are the instructions from the State of Minnesota.

6) See if there’s money out there for you, friends, or family- Yep, this is a real thing. I’ve found money for family members. I’ve never found anything for me, but maybe you’ll get lucky and locate money you didn’t know you had. Here’s Minnesota’s program. You may want to check all the states you’ve lived in or relatives have lived in. Just makes sure you ONLY look via official state government pages.

And if you’re local and you want to meet other moms and chat with a nurse, make sure you check out Mama Cafe. It’s a free group for breastfeeding mothers held every Thursday from 10am-11:30am, held here at BabyLove.

Any other clever things you do while breastfeeding? I’d love to hear about them in the comments!

Warmly,

Veronica

Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

Is there a problem with doula care?

Last week Choices in Childbirth released a report on doula care and insurance coverage. As someone who is deeply interested in the subject (and very opinionated on the specific barriers and possible solutions), I found it very interesting and even useful. Unsurprisingly, the report also became fodder for an anti-doula option piece. On Slate, Elissa Strauss wrote the very click-baity titled piece “More Doulas Can Lower the Cost of Childbirth. There’s Just One Problem.” My mom actually ended up sending my the link, asking me if I could believe what she wrote. I read it. I yawned a little. It was nothing I hadn’t heard before, but I think it’s still a good idea to address her article point by point.

Point #1:  Doulas aren’t regulated or licensed

Yep, this is totally true, and realistically, it is creating a major issue in many ways. In fact, Strauss writes,

Anyone can call themselves a doula without any training, certification, or practice. I could declare myself a doula right now. So could you.

Some doula trainers that I totally respect and admire have pointed out the number of certifying organizations has increased exponentially in the last couple of years. Every program is a little different, some requiring more documentation than others, some having in-person trainings while others are mostly done online. Not every organization promotes certification, either. Certification can protect families by knowing that, absent any other regulations, the doula can be sanctioned by her certifying organization. I am a birth doula who was trained to be a doula in November of 2006 and have been certified through DONA International since August 2007. Currently, no doula organization is accredited, either; however, Lamaze International IS an accredited childbirth education program.

I have more opinions about this specific subject than can fit in this post, but parents can still find doulas who are held responsible in some way, shape or form. Which brings me to her next point:

Point #2: Some doulas resent certain protocols

OK, so this is a really sweeping generalization, and I’m not sure if it makes for a good argument about why doulas are in of themselves bad. However, yes, my experience in the last 9 years is that there are doulas who can push the limits of what a non-licensed professional can and should do. However, in the absence of a standardized Scope of Practice (I follow the scope and standard of practice as set forth by each certifying organization depending on which hat I’m wearing), it’s up to the hiring party to figure out what that needs to look like.

Point #3: They are biased!

This is a tricky as heck little paragraph. Strauss states,

With standardization, women, as well as insurers, could feel confident that the doula they hired would be providing them with sound advice. This means providing information that is accurate as well as unbiased. Doulas currently have a reputation as being advocates for intervention-free childbirth; for many of them, having an epidural is a sign of personal weakness and/or capitulation to the medical industry and maybe just a big, fat failure. (Note how the report mentioned above doesn’t distinguish between C-sections and epidurals in terms of their potential value to mothers.) There are some good—if often overstated—reasons to avoid epidurals, but there are also manygoodreasons to get one. It would be unfair to women to populate our labor and delivery units with doulas who insist that childbirth will not hurt too much if the mother just remains calm and breathes.

First of all, as I’ve stated before here, too often the discussion of pros and cons is labeled as being biased. As far as I know, at no point was the CiC report meant to be a comprehensive report on the use or overuse of maternity care interventions. If Strauss needs to be enlightened on evidenced based maternity practice, I’d suggest she start by looking at the groundbreaking Obstetric Care Consensus “Safe Prevention of the Primary Cesarean Delivery” released by AGOC and SMFM. Maternity care in the US needs to be be improved in all metrics, including cost.

Second, all humans are biased. All professionals are biased. However, some are better at recognizing their biases and at removing those biases from their day to day professional interactions. As a doula, I would never, ever talk a mom out of an epidural. Now, that’s different than telling a mom who has a baby’s head halfway out that the epidural might take longer than the one push needed to finish giving birth. No care providers, be they doulas, nurses, midwives, or doctors, should ever, ever, EVER disrespect or manipulate patients. Period.

Point #4: I didn’t have one

Whenever I read or hear discussions about public health policy, it’s really silly to bring any one person’s experience into the larger discussion. Really, it’s not how anything scientific ever gets done. Since Strauss didn’t have one, it’s a great reason to ignore a really well-done report, I guess. Or it’s not. Let’s go with this being a bad reason to ignore the report, ok?

Overall, the piece points out nothing that those of us who are working on doula care access don’t already know, namely that we have a lot of work to do on standardization and definitions before we can even talk about reimbursement. And on it’s face value, it’s possible that Strauss could have written a more thoughtful piece on the other issues that exist in doula care being covered health services. Instead, it comes across as a piece to justify her own rejection of doula care under the guise of commenting on the Choices in Childbirth/ Childbirth Connection report.

Interestingly enough, the use of doulas to improve a medicalized life experience have popped up in conversation about health care on the other side of the life continuum: Death. PBS’s Next Avenue brought up the topic this week. My ideal solution to gain access to doula care as a covered service recognizes that there is a need for emotional and physical support for patients in many different health care scenarios. A proper doula serves as a conduit, a guide, a translator, and a constant companion who is wholly invested in the emotional support of the patient and his or her family. Doulas fill the gaps.

My post is by no means meant to be a comprehensive discussion on the state or future of doula care. I do have very practical, actionable ideas on insurance coverage of doula services that I’d be happy to talk about with people in person. But just because a writer on the XX Blog thinks doulas are terrible, it’s no reason you should too.

Speaking of doulas, the non-profit I run, The BabyLove Alliance, Ltd, offers doula services on a sliding scale. Our very first Doula Information night is coming up on January 29th at 7pm at BabyLove at 4590 Scott Trail, Suite 102, Eagan, MN. Come meet our doulas (who aren’t pushy, btw), find out what makes our doula services more complete than anywhere else, and ask any questions you have about having a doula at the birth of your baby. Email info@thebabylovealliance.org or call Veronica at 651-200-3343 for more information. Spread the word!

Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

When your breastfed baby won’t accept a bottle

baby wont take bottle

One of the biggest questions I get during breastfeeding class is, “when can I introduce my baby to the bottle?’ And while the answer is different for everyone depending on their situations, there’s one thing that doesn’t come up enough: When breastfed babies reject a bottle. When that happens, it’s frustrating for moms because they feel like they can’t leave their babies, and it’s frustrating for dads and other caregivers because the bottle rejection can feel so personal. So, here are some things you can try if you’re in this situation.

Please note: If your baby is simply not eating anything in any form for a length of time, please seek immediate, appropriate medical care.

  • Is the milk yucky?–Sometimes I forget to ask moms if they’ve had a chance to taste the milk that they have pumped. Sometimes, the pumped milk, due to an excess of lipase (which we dont really understand why this is the case for some moms), can end up tasting or smelly soapy. Kellymom.com has a great set of instructions to help you make your milk more palatable if this is what you’re dealing with.
  • Try a different bottle–Not all bottle are created equal, and even the (unfounded) marketing claims make it hard to figure out what kind of bottle to use for your baby. What I usually tell moms is that usually simpler is better, and a wider bottle is better. No matter what, I’d discourage any mom from making the choice for kind of bottles without baby’s input. He or she will let you know what he likes. One note: It may seem like a faster flow nipple will be better, but if your baby is already leery of bottles, a fast flow can end up coming out too fast and result in scaring your baby, compounding the issue.
  • Try movement– some babies need to be distracted into taking a bottle. the person giving baby a bottle may need to walk, swing, bounce, or sway while trying to feed baby. Some babies need to be sung to while being fed. Some babies prefer to look out of a window, while others may prefer to sit in the dark. Try all of these things– you never know what will work.
  • Try different temperatures of milk– it may seem like the best choice is to heat up the breastmilk to body temperature, but some babies get very upset when the milk is the right temp– but there’s no mom attached to the milk. If this is the case, try cold milk, try milk that’s warmer than body temp (but not hot), and see if any of those changes help.
  • Try something other than a bottle– Bottles are relatively new inventions in the scheme of things. Sometimes the best way to feed a baby who won’t take a bottle is to use something else to feed baby. Cups and spoons are two common things used to feed babies. And rather than me try to explain how to do it here or to send you out to the great web to find information, here’s a great playlist someone already put together of some really great videos:  Again, patience is the key.

If you find yourself in the predicament, it can be helpful to seek good lactation help, too. Sometimes having another brain in the mix can help you figure out what’s going on.

Have you dealt with this? Do you have any ideas? Share below!

Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

Where to go to prevent tearing

vaginal tears

Awhile back, I did a quick post on a few of the rates of tears at different hospitals in the Twin Cities area. The info has been slightly updated, and I decided to pull the information for all of the area hospitals.

A few notes: The website that lists this information doesn’t specify what degree of perineal tears they are talking about. Tears are rated first degree, second degree, third degree, and fourth degree. First and second degree tears can be pretty common. Most epidemiological discussions about tears focus only on 3rd degree tears and second degree tears. I’m hoping to get some clarification on what the heck they are talking about when they say “tears”, and I’ll update this post as I can.

Perineum Tears: Rates for Vaginal Deliveries without Instruments; for some reason, St. Joseph’s is missing.

Lowest rates to highest:

  1. Shakopee- 1%
  2. Ridgeview- 1%
  3. St. John’s- 1%
  4. HCMC- 2%
  5. Lakeview-2%
  6. Unity- 2%
  7. Regions- 2%
  8. North Memorial- 2%
  9. Mercy Hospital- 2%
  10. University of Minnesota- 3%
  11. United- 3%
  12. Regina- 3%
  13. Ridges- 3%
  14. Methodist- 3%
  15. Northfield- 4%
  16. Woodwinds- 4%
  17. Southdale- 4%
  18. Maple Grove- 4%
  19. The MotherBaby Center/ Abbott Northwestern- 5%

Perineum Tears: Rates for Vaginal Deliveries with Instruments

Lowest rates to highest:

  1. Regina- 0%
  2. University of Minnesota- 5%
  3. Hennepin County Medical Center- 10%
  4. St. John’s- 10%
  5. Woodwinds- 10%
  6. Regions- 12%
  7. Unity- 12%
  8. St. Joseph’s- 13%
  9. Southdale- 13%
  10. Northfield- 13%
  11. United- 14%
  12. Shakopee-15%
  13. Ridges- 16%
  14. North Memorial Medical Center- 16%
  15. Mercy- 19%
  16. Methodist- 24%
  17. Ridgeview- 27%
  18. Maple Grove- 20%
  19. The MotherBaby Center/ Abbott Northwestern- 24%

Beyond choosing your care provider and place where you give birth with a lot of thought and care, make sure you know the different ways you can make pushing and birth as safe as possible. Check out our Confident Birth and Beyond (Lamaze) classes, too, to learn how to have a safe and healthy birth.

Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

Real Mom Confessions: Body Image Edition

Real Mom Confessions

It’s now the end of summer vacation for the kids, and I’m happy to say we all made it through in one piece. Coordinating care for the kids wasn’t too bad; I had lots of help from my husband and mother-in-law.  I’m now trying to get back into the swing of things around the office, figure out my schedule, and cook up lots of other wonderful things here at BabyLove Headquarters.

As I type this, I’m wearing a pair of jeans for the first time in…10 months? A year? It’s not just that jeans aren’t very comfortable, but I didn’t have a pair that fit me until last week. Why? Well, for the myriad of usual reasons, my weight has inched ever-upward since last fall. I had to face reality when I was at my last check with my doctor for my anxiety meds and saw the number on the scale.

I’m not sharing this just to bitch or complain, but I have had a lot of thoughts about this issue as I struggled with my own response to my weight gain. Weight and health are such a complicated issue, and I’m not a doctor or even weight loss expert (obviously!), but maybe some of what I’ve come up with will resonate with you, too.

First, yes, my weight gain jumped up a little after my first pregnancy; it didn’t help that the resident I was seeing during my pregnancy didn’t blink once as I gained 89 pounds during my first pregnancy. By the time I was pregnant with #2, I was lucky to have a great midwife who WOULD speak up if I started to gain too much weight as my pregnancy went along. I think I gained something like 34 pounds before I gave birth to my son. By the time I was going back to work, I had mostly lost all of the pregnancy weight; the milk I was pumping while I was gone was 75% fat. However, once we quit breastfeeding, my weight started the slow, irritating creep upwards, up to where I am today.

With a pre-teen daughter who is just starting to understand body changes and body image, I don’t want her to buy into the seduction of thinness and body shame. I’m trying very hard to dress and act and speak in a very body-positive way. I don’t want her to see me “dieting”. I absolutely, under no circumstances, want her to label entire groups of food as “bad”.  I think it’s OK to talk about “sometimes” and “almost never” foods, but beyond that–it’s important to me to have kids who have a positive relationship with food. To that end, I try not to telegraph my own complicated relationship with food. When I eat a salad or lots of veggies, I try to emphasize how my body feels better when it gets fresh fruits and veggies. Instead of it being something I have to do, it’s something I enjoy doing. So that means a rigorous, strict diet plan is totally out.

I’m aware that I could be trying to get more exercise, but that has it’s own challenges: namely, time and money. We did the whole gym membership thing for a year; we had no time to use it and it cost us an annoyingly significant chunk of money. I have other excuses, too: child care, my asthma, my wrist injury…all of them add up to me not formally “exercising”. I am trying to be more active throughout the day and count the steps with my phone, and I do notice some things have started to get easier. I’m going to try to keep up the extra movement as the Fall rolls on.

Beyond that, I’m trying to practice self-acceptance. My blood pressure is far better than it was a year ago. I’m making some better choices. My mental health is DEFINITELY better than it was a year ago.

My old pants may not fit. I may not look as svelte in pictures as I used to. This is my mommy body. This is the container that carries me. I’ll try to like myself a little better, take each day and each choice as it comes, and maybe, just maybe…you can find the courage to do the same. Comparing my body to yours and trying to make a value judgement about either one of us is just plain silly, right? Right.

Now, pass the veggie tray and box of chocolates. Ahem.

With love,

Veronica

Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

Will the new Evenflo car seat prevent heatstroke deaths?

car seat heatstroke

Last week, Evenflo and Wal-Mart announced that they had partnered up to create the ADVANCED SensorSafe™ Embrace™ DLX infant-only car seat. The seat has special technology in the chest clip that goes to a wireless receiver to alert the driver when a child is being left behind in a car. I’m not going to get into how the technology works or if it’s reliable. There are a few things I want to delve in on, though, when it comes to the issue of kids dying of heatstroke in cars and if this is going to be a good solution to reducing deaths.

So far for 2015 (as of this writing), we have seen 11 children die of heatstroke after being left in a car in the US. There were 44 and 31 deaths in 2013 and 2014, respectively. In the Upper Midwest, we do have fewer heatstroke deaths than in the South or the West, but it does still happen. Since 2003, 3 children have died of heatstroke in a car in Minnesota; 8 kids have died in Wisconsin during the same time frame.

According to information collected in Heatstroke Deaths of Children in Vehicles by Jan Null, CCM of the Department of Meteorology & Climate Science at San Jose State University, most of these deaths (for the years 1998 through 2014) occur under 3 main circumstances:

  • 53% – child “forgotten” by caregiver (336 Children)

  • 29% – child playing in unattended vehicle (186)

  • 17% – child intentionally left in vehicle by adult  (111)

This new car seat technology is really only designed to address the first and third scenarios. It’s critically important to teach your kids to never, ever, EVER play in cars and make sure that a car is locked when it’s parked. Kind of like you need to teach your kids to not play with lighters or matches. Remember the gut-wrenching case in Wisconsin 2 years ago with the toddler who was hiding in a car truck and died? Cars are not toys.

Back to the car seat in question, I have a few issues with someone buying this seat.

First of all, this is an infant only seat, with a maximum weight of 20 35 pounds and a maximum height of 30 inches. The average baby is 30 inches by around the age of a year, but some babies outgrow an infant-only car seat before they are this old. Currently, the technology isn’t offered on a convertible car seat. Less than one-third of heatstroke deaths were in babies less than a year old. 22% of the deaths were in kids ages 1-2 years old, and 13% were in ages 2-3 years old. This is a solution for a very limited time period, and ONLY if your car is model year 2008 or newer.

Second, this piece of technology increases the cost of the seat from $90 to $150. That’s a $60 clip! While that’s not to say that saving lives isn’t important, is this cost increase worth it when it’s only useful for a very limited length of time?

Third, will this lull parents into a false sense of security?

Ideally, technology like this will become standard in all car seats. My cynical guess is that it’ll take 10 years or more before something like this is universally adopted, if ever. In the meantime, there are some common sense tips out there, but probably the best one is this:

Get in the habit of putting your phone, either in your purse or diaper bag on the floor whenever you put your child in the car seat. Do it every time, without fail. Not only will it serve as a reminder to always check your back seat, but it also removes the cell phone as a distraction while you’re driving. Really, the cell phone is a danger in of itself that should be removed from the process of driving, baby or not. As my neighbor Anna says, “Phone down, eyes up.”

What tips do you have to keep your kids safe in cars in hot weather? Share below!

Warmly,

Veronica

 

Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

Summer Baby Safety

Summer Baby Safety

Today is our very first 90 degree day of the year, so it’s time to get everyone up to date on the things you need to know to keep your baby safe.

No water for newborns 

Your baby should ONLY be given breastmilk or formula for the first 6 months. Nothing else. Water can actually be dangerous; their kidneys aren’t able to get rid of the excess water and it can make babies very ill. And really, we take access to safe water for granted (BIG TIME). Even some things in the water supply that an adult body can handle, a newborn’s body can’t.

Nurse that baby!

When the weather gets warmer, don’t be surprised if your little one has more frequent feedings. We get thirsty more often, and your baby does too. So watch your baby for cues and listen to what he’s trying to tell you: It’s hot and he’s thirsty. It’s OK. It won’t spoil your baby.

Stay in the shade

The AAP cautions against using sunscreen on babies under the age of 6 months. Their skin isn’t mature enough to handle it. Get a hat that allows for decent ventilation with an SPF and use an umbrella or anything else to make sure you avoid prolonged sun exposure.

Cover that car seat

If you’ve been through at least one summer with kids, you’ll know this, but it’s still important to repeat: Car seats get very hot in the sun. Kids and babies alike try to avoid getting burned (smart kids!). While your car is sitting out in the sun, cover the car seat with a thick blanket to keep it from getting too hot.

Rethink the beach

Here in Minnesota, in the land of lots of lakes, going to the beach in the summer seems like a birthright. Yeah, not so fast. While nobody is claiming that lakes should be squeaky-clean, the reality is that our lakes aren’t very clean. The Minnesota Department of Health has a wonderful set of resources to help you figure out if your favorite spot is safe, but again– what we can tolerate as adults can easily make babies and toddlers sick. Stick to the pool instead.

Nobody wants to miss out on our precious summer days because of injury or illness. Any other summer safety concerns? Let me know!

Warmly,

Veronica

Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.