Labor

Mamas on Bedrest: Where Will You Give Birth?

September 27th, 2013

I was sent this infographic from the Institute of Medicine. I found it very interesting and worthy of sharing. So Mamas, where will YOU give birth? What influenced your choice? Are you giving birth in the setting most comfortable for you? If not, can you change your venue to better suit your comfort? Share your insights on this infographic and your experiences in the comments section below.birthsettingsgraphic

Mamas on Bedrest: Midwifery Care is Safe for Mamas on Bedrest

September 20th, 2013

IMG_3750 1x13One of my greatest disappointments being a high risk mama was that I was unable to have my births attended by a midwife. In Austin at the time when I was having my children, midwives had been banished from the hospitals and the only women who could have a midwife assisted birth were women who gave birth at home or at Birthing Centers. Thankfully that trend is reversing and many (but not all) women in Austin, TX have access to and the ability to choose midwifery care.

However, a recent study out of Australia reports that midwifery care is safe and cost effective for all women regardless of the level of complication of their pregnancies. Published in The Lancet and reported in MedScape OB/GYN Women’s HealthSally K. Tracy, DMid, a professor in the Midwifery and Women’s Health Research Unit at the University of Sydney, Royal Hospital for Women in Randwick, New South Wales, Australia, and colleagues sought to see of the benefits and positive birth outcomes seen in low risk pregnant women who are receive prenatal and intra-partum care from midwives could also occur for high risk pregnant women who received care from midwives. This was an unusual undertaking, the first of its kind, as midwives are usually removed from a woman’s case once she is labeled “high risk”, and her care is assumed by obstetricians and Maternal Fetal Medicine Specialist.

“We undertook a randomised controlled trial to assess maternal and perinatal clinical outcomes and cost of care for caseload midwifery compared with standard maternity care for women of all risk,” the authors write.

The researchers randomly assigned 871 pregnant women to caseload care consisting of antenatal, intrapartum, and postpartum care from a “caseload” (study prescribed) midwife and 877 women to standard care provided separate wards or clinics.

As for outcomes, the outcomes were fairly similar. There were similar number of cesarean sections for each group, however the number of elective cesarean sections for the standard care group was significantly higher as were the number of labor inductions. Instrumentation, use of epidurals and numbers of spontaneous vaginal births was similar for both groups. Women in the study group were significantly more likely to experience spontaneous labor onset, less likely to have labor induction, and more likely to have labor augmentation (walking, massage, manual manipulations, etc…) than women in the standard care group. Those in the study group were significantly more likely to have birth-related blood loss of less than 500 mL, but the risk for severe blood loss (>1000 mL) was similar between the groups. There were no maternal deaths during the trial. Additionally, more mothers from the study group were breastfeeding their babies than the standard group at 6 weeks post partum. There was no significant different difference in the infants at birth as assessed by Apgar scores, NICU admissions or birthweight.

A very significant difference was cost. The cost of midwifery care for prenatal and peri-partum care versus the standard hospital care was on average $566.74 (in Australian dollars) less.

While this is the first study of its kind to delve into providing midwifery care to high risk pregnant women, I feel its a landmark study. Midwifery has been the standard of care for childbirth since the beginning of time. Midwives and other women in the community would come and attend a birthing mother, caring for not only the mother but also for her family. With the advance of modern day obstetrics and hospital care, much of the intimate woman to woman care and community care of the family has been lost. It is my hope that with studies like this one and others all women will be able to experience pregnancy and childbirth and a safe and loving environment. Yes, sometimes things happen and interventions are necessary. However, there is always time and space for “humanizing” of the experience and that is what midwifery brings.

Mamas on Bedrest: Support for those supporting Mamas on Bedrest

August 12th, 2013

One of the most difficult things to do is to watch someone you love in pain. So for those of us who are mamas, imagine watching your child in pain? Most of us would gladly suffer any sort of pain or difficulty to spare our child suffering. But the reality is that our children are here on this earth on their own journeys, and those journeys include periods of pain and suffering.

If you are a member of our Facebook community, you know that we have been praying for and virtually supporting a Mama on Bedrest named Amber. Amber is a first time mama pregnant with a baby boy she has already named Christian. Amber has developed a severe case of Pre-eclampsia and is in critical condition. Her doctors have been doing everything possible to lower Amber’s blood pressures and to stabilize her body (under major stress and strain) so that Amber can remain pregnant for as long as possible and give Baby Christian the best possible start.

At the current time, Amber’s body has endured about all that it can and her doctors are determining at what point it will be necessary to deliver Christian. In the meantime, Amber’s husband Brett has had to stand by and watch, helplessly, as his wife battles for her life and the life of their unborn child. Likewise, Amber’s mother Kelley is watching in agony as her(bold italics) baby fights to give birth to a baby of her own.

While it is clear that Amber needs our love, support and prayers, we cannot forget that those around her, her loved ones, need love and support too! Studies show that caring for caregivers and supporters of those who are ill is as important (or more so) as supporting the ill family member! One must always remember, ill family members have a whole team of medical professionals tending to their every bodily need; they are feed, hydrated, medicated and a much as possible, kept comfortable. This is NOT the case for family members and loved ones! They are often keeping constant vigil at the hospital, maybe eating maybe not, are typically sleep deprived and sometimes have not showered or tended to their own personal needs in days. So as we continue to pray for and send healing thoughts to Amber and Christian, what should be done for her husband, her mother and other loved ones keeping vigil?

1. Bring nurtritous meals and snacks to the family. We all know that hospital food is less than tasty. Healthy, nutritious meals and snacks that require no heating and if possible no utensils are a great help to those keeping vigil. Sandwiches, dips (such as hummus) fresh fruits and vegetables, crackers or other flat breads along with water and juices are often best. Bringing such a meal in a cooler will enable loved ones to graze as they so desire. (often loved ones have little to no appetite, so it is best to avoid heavy meals and snacks!)

2. Come, sit and listen. Sometimes the best support is simply your presence. It’s hard to imagine the fear, anxiety and physical stress that Brett and Kelley and other loved ones are facing. So don’t try to wax philosophical. Let family members share as they need to. Hug them, hold them, but mostly listen to them. Sit quitely beside them. It’s not about what you (bold italic) do and how you feel doing it, its about being present for whatever support the family needs.

3. Offer to tend to matters at home. With all the focus on Amber and her baby, if there is a pet at home, they too are pretty stressed due to all the tension and change in schedule. Offering to walk and care for the dog or cat-or perhaps getting the pet to a kennel takes added weight off the shoulders of the family. Bring in the newspaper, collect the mail. Offer to do a light cleaning and tidying to the house. (Or pay for a housekeeper to come in and tidy up!) With all eyes focused on events at the hospital, it would be a great help to have someone handling the home front.

4. Help care for the older children. Many mamas on bed rest have older children at home. Imagine how confusing it must be to a toddler if mama is suddenly gone, you can’t see her and all the adults in your world are frantic? Likewise, school aged children may feel anxious because tasks normally done by mama are being done by someone else or not at all? Older children often hold tremendous guilt and anxiety for not being able to help or to ease the situation. If you cannot help at the hospital, perhaps helping at the home is best.

UPDATE: Little Christian was born on August 9 at 2:42 pm. He weighed in at 1lb 9 oz. Please continue to pray for Amber, Christian, Amber’s husband Brett, her mother Kelley and the rest of her loved ones keeping vigil for her in your prayers.