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 Easy Questions to Ask Your Midwife or Doctor

Questions to ask your OB

I’m a big fan of talking to your care provider about things that have a huge impact on the outcome of birth for both mom and baby, but I know some of those big questions can seem awkward. After talking with some of my Confident Birth and Beyond (Lamaze) classes lately, I’ve come up with some questions that should be pretty easy to just slide into your prenatal appointments.

1) When’s the last time you did an episiotomy?- Episiotomies are only really necessary in very rare, very specific circumstances (victims of female circumcision can need episiotomies, for example). If you trace the history of episiotomies, it’s pretty clear that it’s rarely needed. A good answer to this question goes something along the lines of, “Well, I haven’t done one in 8 years” or “I’ve done maybe 4 in my whole career at the very most.”

2) Are you OK with me using upright pushing positions?

and

3) Are you going to make me lie down for the actual birth? Question #2 and question #3 kind of go hand in hand, but you’d be surprised how often a doctor or midwife tells a mom she can PUSH in any position, but will then, at the last minute, tell a mom that she HAS TO lie down for the “delivery”. Lamaze Healthy Birth Practice #5– Avoid Giving Birth on Your Back is best for moms and best for babies, period.

4) So, what do you think about the ACOG/ SMFM Consensus Statement on the Safe Prevention of the Primary Cesarean Delivery? When it came out in March of 2014, the Consensus Statement was a really big deal. How big? It redefined the onset of active labor from 4 cms cervical dilation to 6cms of dilation. That’s just one of the numerous guidelines published to help improve our rising maternal mortality rate in the US. Your care provider should be up to date and following these practice guidelines, because there is a need for improvement from the normal way of doing things.

5) Do you do a lot of VBACs? The issue of VBACs versus Elective Repeat Cesareans is so much bigger than just the oft-cited “rupture”. The rising cesarean rate in the US is largely a result of reduced access to VBACs, and our rising maternal mortality rate has been tied to repeat cesareans. Most women who gave birth by cesarean are candidates for VBACs; it’s a matter of finding a care provider who will “allow” them. And if your doctor “allows” them (see how I put that in quotation marks? heh), does he or she actually DO any?

6) How quickly after birth do you clamp the umbilical cord? The case of delayed versus immediate cord clamping is pretty much decided– it needs to be delayed. A recent study on cord milking following cesareans (since you can’t really wait for the cord to stop pulsing on it’s own during a surgery) had some pretty important results, including a reduction in cerebral palsy. Yeah, you know that thing fetal monitoring was supposed to prevent but doesn’t? At this stage, it’s pretty hard to defend immediate cord clamping, even when babies are born prematurely or need resuscitation. Clamping and cutting needs to wait.

  • What questions did I miss?
  • Did you ask your provider about any of these things?
  • What kind of answer did you get?

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 Workshops: VBACs, Sibling Prep, and Pregnancy After Loss

We’re kicking off this summer with a set of workshops presented by the various providers here at BabyLove. We’ve chosen some common topics, like sibling preparation, and some not so common ones, like Pregnancy after Loss. All of them have low registration fees, and we’d love to have you join us. Tell your friends and family, too! Workshops currently listed include:

  • Your Growing Family: Preparing parents and siblings for the birth of a new baby, Wednesday, June 24th 6pm-7pm; $10/ family
  • Make & Take “Coping Box” Activity, Thursday, June 25 10am-12pm; $3.50/ child
  • Make & Take workshop: Summery essential oils products, Wednesday, July 8at 7:00pm – 8:00pm; $7-$10
  • After a Cesarean (or two): VBAC versus a repeat cesarean, Wednesday, July 22nd 6pm-7:30pm; $10/ family
  • Another Beginning: Pregnancy after loss, Wednesday, August 12th 6pm-7:30pm; $10/family
  • Self Care for Moms, Wednesday, September 16th 6pm-7:30pm; $10

For more information and links to register, visit the workshop page.

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 a Doula the same as a Childbirth Educator?

doula same as childbirth educator

This Thursday, I’ll be heading down to the Lamaze International/ DONA International joint annual conference. I’ve been to a Lamaze conference. I’ve been to a DONA conference. As far as I know, this is the first time they two organizations have had a joint conference. It’ll be interesting to see what happens when both groups are in the same room. You see, there is some doula/ childbirth educator crossover, but not as much as you’d think. One reason? It’s far easier to get trained and certified as a birth doula than to be trained and certified as a Lamaze Certified Childbirth Educator, mostly because there are simply more doula trainings. One thing, though, that I feel very strongly about is making sure people realize that hiring a doula is not an acceptable substitute for childbirth education, and a childbirth educator isn’t a substitute for a doula. Both are necessary, and they have very, very different roles.

A childbirth educator, and thus, a childbirth class, is important to help you understand the birth process, various interventions, and help you set realistic expectations for the first few weeks after your baby is born. You need to know these things before you go into labor– once you’re in the midst of birth and postpartum, you just won’t have enough bandwidth to absorb any of that information. And as I wrote previously about the relevancy of childbirth education in 2014, the conversations that we can have in class can not be replicated through any other means.

As a childbirth educator, my certifying organization works very hard to make sure we are staying up to date on evidence-based care. In fact, I’d argue that since we aren’t contractually required to follow a set curriculum that is rarely updated, Lamaze Certified Childbirth Educators are the most likely to have the most up to date policies and guidelines included in the class content. The policies and standards of care are ever-evolving; usually with the goal of improving outcomes for moms and babies.

As a doula, I prefer if the parents I work with have developed their birth preferences separate of my input. That way when the doctor or midwife asks them about their preferences, I know that the family has fully thought through what they want and don’t want. Education allows them to sort through all of their options, and doula support seeks to help them achieve those goals. And really, to think that 2 or 3 prenatal visits can cover as much as is covered in a birth prep class is an insult to those of us who are childbirth educators.

BUT…as a doula, I offer in-person support at the time of birth. That’s obviously not something I do for the families who take classes at BabyLove (unless they contract with me and my doula partner for doula services).  As a doula, my role is to stay there, in the moment, to offer physical and emotional support to the birthing mother and her partner. The act of being a doula is fluid, sometimes intangible, and it’s hard to articulate exactly what I do. So much of what I do comes from instinct, from my experience with other births, and largely just following mom’s lead.

As doulas have become more mainstream, the role of childbirth education has diminished. And I am frustrated that the same women who are fighting so hard to promote paid doula care are also trying to say that what they do is a replacement for childbirth education. If they want respect, they should be respectful. We would all do a lot better if we could acknowledge that it takes interdisciplinary cooperation to best care for and support new families.

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.

Why You Need a Birth Plan

Image via Flickr by Jason Lander used under a creative Commons Lisence
Image via Flickr by Jason Lander used under a Creative Commons License

 

 

 

 

 

 

 

 

 

 

The Birth Plan, or Birth Preferences, originally seen as an important tool for families to communicate their ideas about birth, often comes under fire from the nurses, OBs, and midwives who end up having to read them.  Parents tell me all the time that they get told specifically NOT to write a birth plan. I say that’s crazy and horrible advice.  Birth plans are useful for everyone.  A well-written and well thought-out plan can serve many purposes. Granted, they can be very poorly done as well. So before I explain why birth plans are a crucial part of planning for birth, let me first explain why they can be so hated, too.

First, I don’t think parents truly expect that they can dictate things like how long their labor will last, how long they plan on pushing, the size of the baby, or any of those things that clearly can’t be changed by anyone.  Secondly, I do realize that a lot of families will go online and find some of the “Birth Plan Generators” where they can just check off a bunch of things without giving much thought to whether or not those things even apply to the place where they are planning to give birth. Finally, some birth plans can end up being really long and full of useless information.  The worst birth plan I ever saw was about 11 pages long, filled with information such as the names, ages and personalities of the mom’s 3 dogs, complete with pictures of the dogs and her entire family.  The irony with this was that the only actual mention of birth was one line:”I want an epidural.” As anyone who has taken a good childbirth class knows, an epidural doesn’t mean you don;t have to think about your birth.

So then, what are the good reasons to write a birth plan?

The process of writing a birth plan can help families frame their expectations for how they’d like others to respect their personal birth experience.  Things like the lighting, what mom would like to wear, perhaps certain religious preferences, and music all are appropriate to list. No matter what happens, if interventions are used, ALL of these preferences can and should be respected. If a caregiver balks at any of them, I’d suggest that the family consider finding a more respectful place in which to give birth.

Also, the process of actually writing a birth plan can be a great exercise for the families to start thinking more about the actual day of birth.  Thinking through all of the choices and options is a wonderful way to actually focus on birth, and not just the baby.  I’ve found that the process of writing a birth plan helps parents mentally place themselves at the birth place, imagining who will be there, and even thinking about certain logistics, like what to bring and who to notify.  Many families (especially if they haven’t taken any childbirth classes, or took really awful scary ones) find that they’d rather avoid the birth plan process so they don’t have to start thinking about the actual birth. The answer then is to find some help- hire a doula, take classes, or seek out a therapist to get good, confidence-building information, get support, or to get to the root of any fears.

If there are special religious preferences that your families has and there are specific traditions or rituals that are very important to you, a birth plans can be the way these are explained to and communicated to everyone involved in the birth.  Hospitals are required by law to respect and make allowances for cultural and religious preferences. And while I’d usually say that birth plans should be one page maximum, if there are extensive rituals and traditions that need to be explained, then the birth plan should be as long as it needs to be.

Finally, a well-written birth plan is just a great tool for setting a tone, expectations on the level of respect, and for explaining any specific details that may be pertinent to an individual’s situation.  Things like previous births, who is allowed into the birth room, and any medical conditions should go in the introduction.  These details paint picture of who you are and will help good staff do a better job of taking care of you. If you have a care provider who talks you out of even the most reasonable requests, then you really need to rethink your choice of a care provider.

At BabyLove, we have a workshop to help you write a good birth plan. Held every other month, it’s time to learn what can go into a plan, and we give families to to work on crafting and refining a helpful, positive birth plan with our help. Find out more about the class and register for workshop by visiting our website.

Have you found a birth plan to be useful? Share in the comments 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.