Mamas on Bedrest: One Size Does NOT Fit All!

September 16th, 2013

Happy Monday, Mamas!

I was just on a tweetchat of doulas and we were discussing how we organize care for our clients. (No I’m not a doula, but my services most closely align with those of a doula, so I hang out with lots of doulas!) One of the questions was,

“Do you have different protocols for your clients who are birthing at home, in a birthing center or in the hospital?”

My response was that I obtain the same intake information, but care is always customized.

When it comes to Mamas on Bedrest, one size definitely doesn’t fit all! If one takes a look at our Facebook Page, it may look like all mamas have cervical insufficiency and a cerclage, but that doesn’t mean they all have the same type of cervical insufficiency or are all treated the same. Some women may be on strict bed rest while others may be on modified bed rest and can get up to lay on the sofa. Some mamas may be on progesterone, others not. Some mamas may have cervices that are “funneling” (opening from the top down) where as other mamas may have “shortened Cervix” (shrinking and thinning from the bottom up). While there are the so called “normal” indications of cervical insufficiency, one has to always consider that each situation is different and make adjustments to care as necessary.

In designing a service protocol for a mama and her family, we have to consider, Does she have older children who need care? Are there pets that need care? Who is available in terms of family/community support? Is mama depressed? Is mama single or married? How involved is the father of the baby?  All these factors and so many more will dictate the type of services I provide and how often I might visit a mama.

One thing that encourages me is the trend back towards more individual care in obstetrics. When I think back to my great grandmother, a granny midwife in the 1930’s and 40’s, she always customized care.  Sure, she did the same exam and often came up with the same findings. But she was always acutely aware of her client’s work habits (in the fields as opposed to working in homes or shops), how many other children she had, the relationship between the client and the baby’s father and what support this mama had. If she did not have a lot of support, my great grandmother made more prenatal visits and took extra care with this mama. This has always been the midwifery model. But it was nearly lost when midwives’ practices were severely restricted in the mid 1950’s. Instead of individualized care, mamas were placed on maternity wards with other mamas. And while one could argue that the mamas could congregate, the set up of these wards was really not conducive to such interaction. The set up was strictly for ease of patient care for the providers. And unfortunately, this is what Obstetrics has become, a discipline that provides ease for the providers. It is only very recently that the pendulum is swinging back towards individual care and the needs of the patients.

Today women have options and my goal is to make sure that Mamas on Bedrest exercise their options when considering how they want to give birth to their children and the support they need to be able to give birth to healthy full term babies. While many mamas may still need to give birth in the hospital setting, it doesn’t always mean that precludes a vaginal birth or requires and epidural or episiotomy. It also doesn’t mean  that she is “just a case” and her family/social/community needs just go by the wayside. Just because a mama has been on bed rest, she doesn’t necessarily need to be induced or endure additional procedures during her delivery. But she will likely need more help at home before and after birth and we health care providers have to consider that and help her out. Each case, each mama, each situation is different and has to be evaluated on an individual basis-no matter if the provider is a doula or obstetrician-to ensure that mamas of all prenatal statuses (uncomplicated or high risk) have all that they need to deliver healthy, happy term babies and so that they are well enough to do so.

 

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