Baby Steps Blog

September 2, 2010

Thoughtful Thursday: Choosing the right doctor or midwife for you

Filed under: Classes,Education,Pregnancy and Birth — Tags: doctor, informed consent, midwife, ob — mcasserly @ 4:35 pm

Are all care providers create equal? No.

At the beginning of a pregnancy we tend to choose a care provider based on distance from our homes or work place or on the recommendation of a family member or friend. Many assume that all care providers are pretty much the same because for many women pregnancy is the first time we’ve sought out a specialist.

This was definitely the case for me when I was pregnant with my daughter. I already knew I wanted a midwife and so I opened up my insurance booklet and chose a group pretty much at random.

As my pregnancy went on I learned that not all care providers used the same protocols or even had the same philosophies. That was a real eye opener! It turns out that doctors and midwives are as human as the rest of us. Products of their training, experience, and even their upbringings. Some are more laid back and let the birth process unfold on its own – others choose to manage the process with multiple procedures from start to finish. And on top of that, I had my own thoughts and feelings about the birth process. I finally realized that I needed to find someone who could balance being the guardian of the process while sharing my birth philosophy and respecting my autonomy. It is totally possible! Make a list of the things that are most important to you and prioritize them. Discuss these things with your care provider. If you find that you are having to give up or compromise more than you want, then find another care provider! Every birth is important and special – you don’t have to settle. I changed care providers twice before I found the one that was right for me. And I had a wonderful birth experience!

Here are some questions to help get you started. These are excerpted from our Intuitive Birth Guidebook. The Intuitive Birth class is filled with comprehensive information about birth to help you navigate the current system. We go into great detail about choosing the right care provider for you. Carefully choosing a care provider is not limited to people seeking an unmedicated birth. Providers and women are completely individual so it’s important for every woman to find a doctor or midwife she is comfortable with.

How often do you attend unmedicated births?

Ask for a percentage of total births. 80-90% of women opt for an epidural in labor, so many doctors have very little experience with natural birth. Unmedicated births are very different from medicated births and require different skills.

Natural birth, in this case, means no Pitocin, no pain medication, and no unnecessary interventions.

Minimum requirements for an average birth?

Do they insist on an IV or hep lock?

If they require the electronic fetal monitor, how often and for how long?

Do they allow eating and drinking during labor?

Vaginal exams:

There is rarely a medical reason to have these at all during pregnancy and labor.

At what point does your birth team start doing exams during pregnancy, and how often during labor? How do they feel about your declining them?

Induction/augmentation rates & reasons:

How often (%) do they induce or augment labor?

For what reasons do they usually induce?

How long will they “allow” a pregnancy to continue?

At what point do they usually augment during a long labor?

How do you manage long labors with ruptured membranes (broken bag of water)?

At what point do they recommend Pitocin? Antibiotics?

How long can a woman labor with ruptured membranes before a cesarean is recommended?

What is your cesarean section rate?

The World Health Organization recommends a maximum of 10% for low-risk populations, and 15% when high-risk populations are included.

Nationally, the cesarean rate was 32.3% in 2008.

Your practice’s cesarean rate is your risk of having a cesarean, whether you truly need one or not.

What is your episiotomy rate?

The recommendation for episiotomy (a cut to the perineum to enlarge the birth canal) is that they should be done only in emergencies.

They cause many problems for women and shorten second stage only slightly.

The rate of episiotomies should be very low. They are more common in first time moms, so if this is your first baby ask the rate for first time moms.

Find out more about Intuitive Birth here:

Intuitive Birth

Baby Steps offers natural and prepared childbirth classes, breastfeeding classes and support, and doula services in the metro Atlanta area. Current locations include East Point, Douglasville, Marietta, Kennesaw, Buckhead, Sandy Springs, Lawrenceville, and Decatur. If these locations are not convenient for you we also offer private, in-home classes on your schedule. Contact us for more information. babysteps@babystepsonline.net

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August 27, 2010

Women are treated equally now, right?

Filed under: Education,Parenting — Tags: equality, gender bias, women — laurafields @ 6:13 am

Yesterday was the 90th anniversary of the ratification of the 19th amendment to the Constitution, giving women the right to vote. The day has been dubbed Women’s Equality Day. Surely, we’re equals now, right?

Melissa found this story, about a woman who ran an internet-based tech business. She decided to pretend to be a man, and everything changed. Not only did her business increase, but her pay increased, and her potential clients stopped trying to haggle. I’m a veteran of Corporate America myself, specifically the finance arena. When I graduated with a degree in business administration, I found that I could get a job as an administrative assistant and that was about it. I noticed that the vast majority of executives were men, and the vast majority of support staff (like administrative assistants) were women. Despite the fact that legally, women should be earning equal pay to men, we actually earn 77 cents on the dollar. The fact is, our work is not as valued as the work of men, even when that work is equal (or even superior, as I often noted in my own corporate career).

So what does this have to do with Baby Steps? Two things. One relates to how we are treated when we choose to give birth in the hospital. Do you think that if men were the ones giving birth, they would be told what to do? Intimidated, threatened, and coerced? Would they have unnecessary surgery over and over because of the biases and fears of doctors? Would they put up with the countless indignities women are subjected to in an average hospital birth? That women are not seen as having equal to standing to men, even today, affects how we are treated by doctors and nurses (who are, of course, mostly female). Not only that, it affects how we respond to such treatment. Because by and large, we accept it. We may feel like strong, confident women going into pregnancy, but over the course of things we allow ourselves to be beaten down and convinced that our bodies are dysfunctional and we are not capable of doing what we need to do to bring our babies safely into the world. This is a lie, and one women themselves help to perpetuate. If you’ve ever told a woman who planned to have a natural birth that she should just get an epidural, or “We’ll see, once you start having contractions,” you are guilty. If you’ve ever said, “Don’t be a hero; you don’t get a medal,” then you’re part of the problem.

The other thing is about how we raise our children. I have two girls, with the same parents. I absolutely believe that we are born with certain personality traits. But there is a certain way girls are treated, and a certain way boys are treated, that reinforces these biases. This is not only bad for girls, it’s bad for boys. Maddie turned 6 this year, and one of her friends’ parents asked me what she wanted for her birthday. I said she’d mentioned wanting some toy cars. What this mother got her was a Tinkerbell music box and a princess crown. My 3 year old was thrilled, as she loves all things princess. But really? I said toy cars and you thought princess gear? This is a really blatant example of how we view boys and girls as different, and raise them to be different no matter what they want. Though my 3 year old loves dresses and getting her hair fixed, she also loves lizards and snakes. My friend’s son has often enjoyed wearing dress-up clothes. Imagine if we just let kids play with what they wanted to play with, without worrying about whether they’re “too girlie” or “not girlie enough.”

Interestingly, this bias comes across even more with boys. You hear girls lovingly referred to as “tomboys.” But do you hear about boys who act “feminine?” Well, there was the news story recently about the man who beat his toddler-aged stepson to death for not being manly enough. This fear of our sons not being “manly” enough, in my opinion, is a part of the bigger picture of women (and traditionally “female” traits) not being valued as much as traditional “male” traits. Though the more obvious negative effects come out against women – less pay, lower ranking jobs, discrimination – men and boys suffer too, unable to be themselves for fear of being seen as unmanly.

I’m really not sure how to conclude this blog. I didn’t intend for it to be this long, and I have no real solution to this problem. We would love to hear your comments on the subject.

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August 12, 2010

Being emotionally receptive may help your baby sleep

Filed under: Education,Health,Parenting — Tags: baby, infant, sleep — laurafields @ 9:57 am

A new study published in the Journal of Family Psychology has found that being emotionally responsive to our children may be more important for good sleep than a routine. The study contradicts past studies that have found physical contact with a parent prevents babies from sleeping on their own. Infant and toddler sleep issues run rampant in the parenting world – it’s probably the biggest single complaint you hear about from parents. Do you think there’s something to this new, observational study? How did you get your kids to sleep?

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July 29, 2010

Cesarean vs. VBAC

Filed under: Birth Videos,Education,Health,Pregnancy and Birth — Tags: birth video, c-section, cesarean, homebirth, VBAC — laurafields @ 6:00 am

I came across this video on Facebook recently. It really shows the stark difference for moms, dads, and babies when comparing cesareans to vaginal births. The mother in this video has two cesareans, then a homebirth. The video is very emotional to watch. It’s amazing to see the differences in her experiences, and also her husband’s reactions during her natural birth.

Cesarean vs. VBAC: A Dramatic Difference from Alexandra Orchard on Vimeo.

The American College of Obstetricians and Gynecologists recently released a new statement about VBAC, which you can read here. If you’ve had a previous cesarean section, that doesn’t mean you’re automatically forced to have cesareans for future births as well. If you’d like to learn more about VBAC, contact us, and join our local ICAN message board.

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July 5, 2010

A new option for childbirth classes

Filed under: Classes,Education,Pregnancy and Birth — Tags: atlanta childbirth class, intuitive birth — laurafields @ 8:16 am

Baby Steps is excited to announce a new option for our Intuitive Birth class. Previously, the class has been offered as a 9-week group class that meets for 2 hours per week, or a private class that meets for 4 weeks. Our newest option is a 6-week class that meets for 3 hours per week. This will give couples who’ve waited too long to sign up for the longer class a chance to fit in a full, comprehensive natural birth class. The content is the same; the only change is the distribution of hours over the course of the series.

The first class like this will be offered this Sunday, the 11th, in Decatur. We have another in Douglasville beginning on July 25, as well as several of our standard 9-weeknight classes coming up. As always, there is also the option of a private class if none of these will fit your schedule.

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July 2, 2010

Does Baby Steps push (homebirth, unassisted birth, not vaccinating…fill in the blank)

Filed under: Classes,Education,Pregnancy and Birth — Tags: childbirth, childbirth class, homebirth — laurafields @ 11:41 am

Anytime a company or person becomes semi-well known, there will be rumors about them. It’s just the way of the world, and something we must all accept as an unpleasant side effect of being successful. Mostly, when I hear things about Baby Steps, I hear that our classes are thorough, that we present information and support individual choice. Occasionally, I hear (usually from people who have never observed or taken one of our classes), “You know, they really push ___________________.” The blank might be homebirth, unassisted birth, not vaccinating, or whatever.

I understand how these rumors start. I’m one of the founders of Baby Steps, and my 2nd child was born at home unassisted. Yep, we planned it that way. I loved that birth experience and wouldn’t do it any other way at this point. I’m not afraid to share my birth story with people who are interested in reading it (it’s in our birth stories section if you’re one of those people). In our Intuitive Birth class, we discuss homebirth as a valid, safe option. That is, homebirth attended by a trained midwife. In our class, we do not include planned unassisted birth in the curriculum at any point. Were we to have a student planning one, we would be supportive, just as we’re supportive of the 80% or so of our students planning hospital births. The only time unassisted birth comes up in our class is when we talk about what to do in the very unlikely instance that your labor goes so fast that you don’t make it to your birth place (or, if you’re planning a homebirth, your midwife doesn’t make it to your house). If ever there is a study done on unassisted birth that proves it to be safe, maybe we’ll consider an addition to our curriculum. However, our goal is to provide evidence-based information. The evidence supports the safety of homebirth with a skilled birth attendant, so that is the information we provide.

In the United States, 99% of births take place in the hospital. Studies on homebirth have shown that for low risk women, it’s just as safe as the hospital but with fewer interventions. Almost all women who take our Intuitive Birth class are planning a natural birth and want few interventions. We want them to think about birth place and birth attendant very carefully. That is, we don’t want them to choose hospital birth by default. Therefore, we provide information about homebirth so that they can make a conscious choice. We also discuss birth attendant in great detail, since too often we pick an OB off an insurance list based on proximity to our houses, without giving much thought to whether that OB (or midwife) will support us in the kind of birth we hope to have. Sometimes, we have students decide to plan a homebirth after our class. Sometimes, they decide to stay with the hospital. We don’t care which they choose – we’re just happy to know that when they chose, they had all the information they needed to decide what was best for them. We only want the best for our students, and we know that the ONLY person who can define “best” is the individual woman who will be giving birth, with input from her partner.

As a group, doulas and childbirth educators tend to be pro-homebirth, anti-circumcision, pro-attachment parenting, pro-breastfeeding. And sure, there will be a handful who push their preferences on others. For the most part, though, what we hope for is a world where parents are able to make their own choices with the full support of us (their childbirth educators & labor support), their birth attendants, and their pediatricians. For us it’s not about what the parents choose, but THAT THEY GET TO CHOOSE FOR THEMSELVES.

So if you hear that Baby Steps pushes _________________, don’t believe it. If you’re a pregnant woman, come take our class and find out for yourself. If you’re a doula, you’re welcome to observe a series as long as there’s space. We try to be supportive of other childbirth educators and doulas. We believe wholeheartedly that we’re all working towards a common goal: to improve the lives of families. We see this not as a competition, but as a collaboration. Above all else, we believe in the absolute necessity of supporting women and their partners in making their own decisions for their families, based on a thorough understanding of all the relevant facts.

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June 23, 2010

Book Recommendation: Active Birth

Filed under: Books,Education,Pregnancy and Birth — Tags: active birth, atlanta, balaskas, birth, childbirth, class — laurafields @ 7:02 am

by Crystal Bowden

Active Birth: The New Approach to Giving Birth Naturally

By Janet Balaskas

This book uses an approach of preparation using Hatha yoga to ready your body for childbirth. Active birth is the process of having a normal labor and birth by following the instincts of your body. Included are very in depth descriptions of the exercises along with pictures, which make them easy to do even for someone who has no prior experience with yoga. There are also great explanations of why each exercise is beneficial and guidelines for times when they should not be attempted.

This book makes great use of its pictures, showing many different positions for labor and birth. They are really beautiful photographs, portraying women without fear that have complete faith in their bodies. There is much emphasis put on the use of the squatting position for the second stage of labor, along with many different ideas on ways squatting can easily be accomplished. There is also a nice little section on homeopathic remedies to use during labor and a great recipe for an herbal bath for after birth.

Active Birth was a great book to read with the added benefit of not being too time consuming because of the amount of pictures used throughout. I definitely think that it is a book every doula or childbirth educator should read and especially every expectant mama!

Crystal is a doula and a childbirth educator for Baby Steps. She lives in Douglasville with her husband, son, and daughter.

Baby Steps offers natural and prepared childbirth classes in the metro Atlanta area. Current locations include East Point, Douglasville, Marietta, Kennesaw, Buckhead, Sandy Springs, Lawrenceville, and Decatur. If these locations are not convenient for you we also offer private, in-home classes on your schedule. Contact us for more information. babysteps@babystepsonline.net

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June 16, 2010

A childbirth class for Father’s Day?

Filed under: Classes,Education,Parenting,Pregnancy and Birth — Tags: birth, childbirth class, father's day — laurafields @ 7:01 am

We often think of a childbirth class as something that moms-to-be need, and that dads-to-be are dragged to with varying degrees of reluctance. Often, that’s how the dads themselves see it before class starts. In my experience, however, by the time the class is over most dads are at least as happy as their partners that they took the class.

Often, when a woman is pregnant, she watches birth videos on YouTube. She reads books about labor and birth and all that comes along with that. She talks to her friends and family members about their experiences with labor. By the time she starts the class, she’s got a foundation knowledge upon which to build. Sometimes, dads do their own research, but often they go with the flow, assuming that she will do the work and all he has to do is show up and hold her hand. Anyone who’s ever attended a birth knows there’s a lot more to labor support than that! Moms and dads both leave a good childbirth class feeling prepared and confident. Taking the class together helps them solidify their values regarding birth, such as what type of pain medications might be acceptable, what newborn procedures they should allow and which should they waive, and where they might be willing to compromise should the need arise. A class gives dads the tools they need to be truly involved and helpful during the births of their babies, a bonding experience for the whole family that lasts a lifetime.

If you’re a dad and you took a childbirth class during your partner’s pregnancy, please post a comment and let us know how the class helped you!

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June 11, 2010

Are you looking for a cheap doula?

Filed under: Education,Pregnancy and Birth — Tags: doula, low cost — laurafields @ 8:03 pm

Written by Christine Strain

TheFeministBreeder posted this great blog about doulas the other day about her initial impression of what a doula was, and how that changed when she met the doula for her second birth.

I was reading and nodding along, especially when I read this line:

“I realized not only that doulas are real professionals with real skills, but many of them weren’t at all what I had pictured in my mind.”

Later in the post she mentions cost, though. And she offers up advice that I have seen (and even given myself, in the past) on many email lists and message boards:

“So now you know WHY you should hire a doula, but maybe you think you can’t afford it. Not true! There’s a doula for every budget. Check into community-run doula programs or volunteer programs. Ask local childbirth educators if they know any doulas who are in the process of certifying – they may work for free or at a minimal cost. Many highly experienced doulas even work on a sliding scale or a payment plan. In most cases, you just have to ask.”

Indeed, one of the big doula certifying organizations even has community service doula work as a part of their Code of Ethics:

“Community Service
The doula is encouraged to assist the DONA International vision of ‘A Doula For Every Woman Who Wants One’ by making reduced cost or no cost labor support services available when possible.”

But does this mean that every woman should have a low cost or free doula? Think about a food bank – that food is there donated by those who have more, to help those who have less. Would you go to a food bank to get free food if you really didn’t NEED free food? Would you go just because maybe there are other things you would rather buy than food right now, even though you have the money? For most people, the answer is probably “no”. Yet more and more I am seeing women say that they want a doula, but they don’t want to pay full price.

If you are considering hiring a doula, think about the reasons why. Women who have doula assistance at their births have lower rates of interventions and cesareans, and higher rates of natural birth (if that is what they desire – doulas aren’t only for women who want natural births). Ask women who have given birth with a doula how they feel about it and you will hear things like “at that moment we would have paid her double her fee” or “she was worth every penny” or “she was worth her weight in gold”.

There are many items in the course of a lifetime that people will budget for, but a doula isn’t always high on the list. The average cost of a wedding cake is $543. Is a doula worth as much as a wedding cake? I would say much, much more. During pregnancy a doula is there to answer questions, point you to resources, and acknowledge and calm the fears and stresses that can accompany the end of pregnancy. In labor, your doula offers comfort techniques, both physical and mental, as well as information to help navigate the choices that you will face and help you achieve the best possible outcome and experience.

When a doula goes “on call” for your birth, she is saying that for several weeks, she is willing to drop anything at a moment’s notice to come to your birth. That includes everything from not planning vacations during that time, being willing to leave a family event, or even being interrupted during an intimate moment. Every night your doula checks her phone to make sure it’s on and charged, maybe even calls it to make sure it’s working (not that I have ever done that…). She finds a skilled peer to act as backup in case an illness or emergency mean that she has to miss your birth, and if she has kids, she puts together lists of people who can watch her children on short notice.

So when you think about hiring a doula, and you think about how much you are willing to pay, think about all of that too. Yes, there are doulas who are willing to work for a lower fee, or donate births. But remember that “doulas are real professionals with real skills” and they deserve to be paid for the work that they do!

If you really truly cannot afford a doula, there are definitely avenues of help available to you. For more information on how to find a certifying doula, contact the Georgia Birth Network.

Christine Strain is a mother of three, birth activist, and doula. She is excited to be training as a Baby Steps educator later this year. After her first birth ended in cesarean, she joined ICAN to help prepare for her future births (both VBACs) and found a passion for helping other women have empowered birth experiences. She serves in leadership roles for both the Atlanta chapter and the international Board of Directors of ICAN. You can visit her website at www.doulachristine.com.

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May 3, 2010

Being the birth partner – what do you need to know?

Filed under: Books,Classes,Education,Pregnancy and Birth — Tags: birth, childbirth, childbirth class, doula, homebirth, labor, natural, partner — laurafields @ 11:42 am

This is a great article with some rules for birth partners to follow. Yes, daddies-to-be, that means you. This is a great starting point for learning how to support your partner during her labor. Another great source is The Birth Partner, Second Edition by Penny Simkin. It’s very important that you understand the process of labor and birth, that you have some general ideas about how you might offer your partner comfort during labor, and that you know her wishes for her birth experience extremely well. A comprehensive childbirth class can make a huge difference in how both you and your partner experience labor together, and hiring a doula will give you an extra set of hands and the benefit of someone experienced to help you when the going gets rough. You can find several doulas on the Baby Steps website, as well as through the Georgia Birth Network.

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