Provider Care

Mamas on Bedrest: Don’t Lose Sight of What’s Truly Important!

April 30th, 2014

Happy Wednesday, Mamas!

In this video blog I want to encourage you to partner with your health care provider-not contradict or become adversarial-for best birth and health outcomes for you and your baby.

I was on one of my birthing professional sites and happened to read a disturbing account written by a woman who had hired a doula for her birth. The Doula essentially told this woman to do the opposite of whatever her OB advised, telling her that the OB was just trying to control her birth and give her a c-section. I was really moved by this account and got into a deep online discussion with some other workers on the site. Some wanted to blame the mama for listening to the doula, but I countered with “If you are unsure and has hired someone to help, it is natural to defer to their “expertise”.

That sparked this vlog. While I am a wholehearted proponent of doulas, THEY ARE NOT MEDICALLY TRAINED PROFESSIONALS! I really want to re-emphasizes the importance of having complete trust and confidence in your provider, being able to ask questions and have them answered fully to your satisfaction and being able to have the ancillary support that you need. Enjoy the post and please share your comments and experiences in the comments section below.

Mamas on Bedrest: What’s The Worst That Can Happen?

April 14th, 2014

Top of the morning Mamas!

Today I’m going to suggest you take a walk on the dark side. Lately I’ve been worrying about something and that worry has translated into sleepless nights, trouble concentrating and being more than a bit snippy with my kiddos. I finally called a girlfriend the other day and told her what was going on. She already knew about the issue that was worrying me, but did not know how much it was interfering with my daily functioning. Since my friend is a life coach, she took me through this exercise which I am going to share with you today.

This exercise is exploring What’s the worst that can happen? I suggest that you do this exercise with a partner. This can be your spouse, a friend, a family member…with whomever you feel most comfortable. I say “most comfortable” because you must be able to be really transparent with your feelings with this person-no holds barred so to speak. How the exercise works is you share with your partner your greatest fear about some issue going on in your life. Then, you and your partner create a counter argument as to why your greatest fear likely won’t happen. Finally, you two will brainstorm what you could do if your greatest fear actually were to come true.

Why do an exercise like this? Primarily, because the scenarios that our minds create about situations in our lives are far more dramatic than what would actually happen. When we are afraid, our minds create all kinds of mayhem around situations and in a sense feed our fears. In this exercise, taking a hard look at these “fictitious” outcomes and with our partners refuting how they are not likely helps ease our fears.

So that you can see how it works, I am going to do an abbreviated version for you. Let’s say that the issue is you have an incompetent cervix and you are worried that you are going to lose your baby. The issue isn’t just that you are worried you are going to lose your baby. The issues are also that you really want this pregnancy and this child and the future that you see for yourself, your partner and your family. You may have already picked out names, purchased furniture and made special preparation. So losing this baby would not only mean losing the physical being, but also all the hopes and dreams associated with this little one. (Hang on, this gets better, I promise!)

Now with your partner, list all the reasons this is not likely to happen. Here’s what your list may look like:

1. I have a cerclage and my doctor said it was easily done, done properly and in perfect position

2. I am now on bedrest and although not fun, being recumbent takes the pull of gravity off my cervix relieving any potential pressure

3. I am _____weeks along and every day that I remain on bed rest is a day more mature my baby becomes.

4. My baby is moving about happily and content within me.

5. My last doctor’s exam showed that everything is okay (i.e. my cervix may have shortened, but is holding steady at___mm; the baby is growing and developing perfectly normally; I have no spotting, bleeding, cramping, etc….)

6. I have family and friends to support me

You see where this is going? These are just the first thoughts that came into my head. I am sure you’ll have more and I recommend that you really personalize the answers. Hopefully your partner will really dig with you for the goodness that is going on right now so that you can see the silver lining in this cloud of darkness.

“But what if the worst happens? What if I lose my baby?”

I totally hear you! I lost my first pregnancy so soon after realizing that I was pregnant I really didn’t have time to get too attached-yet I was still devastated. However, I became completely unglued when I lost my second pregnancy. After my first miscarriage we learned that my fibroids were making it nearly impossible for me to carry a pregnancy to term. So I had them removed and then had my daughter. I thought I was home free! The second miscarriage was a blow from left field in my mind. I had done everything right. I had had a baby. How could this happen?

With your partner, I am going to ask you to go to that dark place, the worst case scenario. I invite you to cry and really give into your emotions and LET THEM OUT!! When we are chronically upset and especially when we’re holding things in, our bodies are releasing cortisol and adrenaline and neurotransmitters (brain chemicals) that are keeping our bodies in “red alert mode”. This more detrimental to our health than the actual impact of the negative event! When we have the negative event, we go through the process of grieving and processing the event and then onto resolution. When we are simply in “red alert mode”, we don’t process, we don’t move through and we keep out bodies in stress. In this state, we can actually bring about that which we are most afraid of happening! So again, talk about what it would be like if the worst were to happen, you actually lost the baby. Who would you tell? Who would be available for support? What would you want to know from your doctor? Would you want to try to get pregnant again? What are your chances of having another miscarriage? What would you need to do in between pregnancies to optimize your chances?

See where this is going? You are taking action. You are actually being proactive and hence taking control of your situation. So rather than feeling like a “sitting duck” waiting for the worst to happen, you are ready. As Dr. Jennifer Gunter so eloquently stated, “Prepare for the worst, but expect the best!”

To this end, I also strongly suggest that you have a candid talk with your health care provider about your fears. Sometimes what we are thinking is so far out of line with reality, it helps to have an “expert” reign us in with the facts. Also, if your fears are founded, again, take a proactive stance and get all the information, support and resources you can to help your situation.

I know that this is not an easy or pleasant topic, but it is necessary. It’s not okay for you to be on bedrest stressed out, not sleeping and essentially worrying yourself into the worst case scenario. Please, please, please, dump your doubt! Perhaps you and another mama in our community would like to pair up and support one another?? Who knows better what you are going through than another Mama on Bedrest? What better way to strengthen your ties in our community?? And remember, if you cannot find a partner to speak with, you can take advantage of the Free 30 Minute Bedrest Breakthrough Session with me!!

Questions? Comments? If you do the exercises, please be sure to share your results in our comments section below!!

Mamas On Bedrest: How Did You Decide With Whom and Where to Deliver?

March 14th, 2014

Greetings Mamas,

I was just surfing around and came across a most disturbing webpage. Under the guise of wanting to “protect babies” this webpage’s content focused soley on disparaging midwives, lay midwives and Certified Professional Midwives in particular.

Now I am going to out myself right here and now and say that I have immense respect for midwives and the work that they do. I know both Certified Nurse Midwives-midwives who studied and trained at major universities here in the United States, as well as Midwives who were trained in other countries and chose to simply sit for the midwife exam rather than repeat their entire education (and pay the hefty educational costs) here in the US. I also know a few “lay midwives”, women who had such a passion for midwifery and childbearing that they have spent countless hours appreticining beside a midwife. All of these women are extremely dedicated to their clients and provide excellent care. Like all professionals, I do believe that they have all had some “untoward events”, i.e. births that have gone poorly. And like all professions, I believe that there are some really good midwives and some that aren’t so good.

The same can be said of physicians. We all know really excellent physicians and we also know physicians we wouldn’t let care for the neighborhood Alley cat! We must all remember that in every medical school, there are those students who graduate at the top of their class and those students who are amongst the bottom tier. Yet, We cannot (well, we should not) judge an entire profession based on the performance and habits of a few.

I was really disheartened to see this webpage really bashing midwives. There were a lot of sensational articles and posts, but little to no data to back up the claims. The moderator made very disparaging comments stating that laymidwives and Certified Professional Midwives had little more than highschool diplomas. It was shocking because most of the midwives that I know have sat for and passed national certifying examinations. I am all for having an opinion for or against something, but if you are going to make claims-and especially if those claims are disparaging or potentially impactful to those who may not be aware of all the facts-you must be able to back up what you are saying with hard evidence.

So that being said, Mamas on Bedrest, how did you decide with whom to deliver and where? If you are wondering how to figure this out, I’ll share with you how I made my decision.

1. Determine what type of practice and birth you want. I knew I wanted a midwife. I love the midwife model of care and I love that woman to woman interaction. I chose a practice that was all women. This is not to say that a practice that has men can’t be good or can’t be sympathetic. In my current area, the practices that are predominantly male were not as open to the less invasive, expectantly wait “midwifery”  model. But I do want to say, before I got married I had a wonderful OB/GYN that was a man, and only switched because I moved out of state.

2. Interview the practices. Now I have had many people gawk when I say this. But let’s be real. You interview contractors before you have work done on your house. You interview daycare providers before leaving your children. Heck, I interviewed vets before I ever took my beloved cats even near the door! Don’t you deserve at least as much? And when I say interview practices, I mean OB/GYN practices as well as Midwife practices. Your personalities have to mesh! Ask about call schedules, ask about meeting the other providers, ask about classes and how questions are answered and how soon phone calls are returned and how lab results are delivered. Make sure that you are able to have the level of communication and attention that suits you! Every practice is different and you must feel comfortable, heard and free to ask questions and get a reasonable response. If you feel put off, if things are more automated than you like, If you just don’t feel comfortable, try another practice.

3. Know your As/gynecologic history. I had a history of uterine fibroids and was over 35 conceiving, so I knew that I was at increased risk of having complications. While I wanted the back up of obstetricians, I also wanted a practice that would be as minimally invasive as possible. Be reasonable. If you have a history that is complicated, you may not be a candidate for a midwife. Don’t be mad and don’t berate her skills. If she tells you that she isn’t comfortable handling your case, you should thank her. She is putting your health and well-being first! Likewise, if you have a complicated history like I did and a midwife tells you, “No problem, you can totally deliver out of hospital!” Be wary. She may be operating beyond her scope of practice and potentially putting you and your baby at risk.

4. I wanted as much midwife interaction as possible. Almost immediately, my first pregnancy went high risk and my hopes of a midwife delivery went out the window. However, my OB worked closely with a midwife and so I was able to see the midwife for many of my OB visits. Additionally, after I gave birth to my daughter, I was able to have my follow up visits with the midwives. Go for what you want as much as possible. I was not a candidate for a midwife attended birth in a birthing center birth, but I was able to have a lot of education and interaction with midwives. For me, I got the best of both worlds.

5. Speak to friends, Get references. One of the best indicators of a practice is references and testimonials. There are a lot of websites where patients rate their experiences with doctors or doctor’s offices. This is a good place to start. Likewise, Midwives are also rated and referenced. But far and away the best information comes from other mamas. Try to connect with other mamas in your community to see what their experiences were like. Remember, every pregnancy and every birth will be different, and not all personalities mesh. But if you have a practice that everyone loves, you can be pretty sure that it’s a good practice. Likewise, if there is a provider that consistently gets poor reviews-be it OB or midwife-you may want to steer clear (or at the very least, do a thorough evaluation to see if this is the provider for you!). Also, the American Medical Association (AMA), the American Congress of Obstetricians and Gynecologists (ACOG), the American College of Nurse Midwives (ACNM),  and Midwives Alliance of North America (MANA) all have ways to find out about those in their profession, evaluate their performances, etc…

It all comes down to being a savvy consumer. Don’t be swayed by positive or negative advertising. Do your homework and get enough information so that you are making a wise and informed decision about who will provide health care to you.

And this is important even if you are in a small town or have limited options. I frequently get e-mail from mamas saying, “I can only go to this one practice because its the only one covered by my insurance.” Or “I have to go to this practice because its the only one in my town that serves high risk pregnancies.” No matter. You still need to do your homework. Get to know the providers and the staff. Get to know how the office works and who you need to contact if you need information. Establish as much open communication as possible so that you can voice your concerns and make your preferences heard.

Mamas, how did you choose with whom and where you will deliver your baby? Please share your experiences and any tips for other mamas in the comments section below.