Archive for the ‘Natural Birth’ Category

CiC Chat on Pleasure and Birth, from our Director of Program Development, Khushbu Srivastava

August 21, 2013

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Last Thursday, Choices in Childbirth hosted our first official “CiC Chat”, a new bi-monthly gathering where we sip wine, eat cheese and talk all things birth- including sharing inspiring stories, discussing pressing issues for change, and deliberating on not, new trends within the maternity care world. More than anything else, these events are one way that we have prioritized fostering a community of folks around our mission of promoting safe, healthy, and deeply fulfilling birth experiences.

Last Thursday’s event was co-hosted by CiC Board Member and Ecstatic Birth Advocate, Sheila Kamara Hay. Sheila and Debra Pascali-Bonaro, visionary, birth activist, and director of the film Orgasmic Birth, led an open conversation about the potential for pleasure in birth.

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As someone who has worked in the maternity care/women’s right field for many years, and as someone who gave birth last year, I have to say that, even I wasn’t quite sure what to expect. As the night began, I ensconced myself in a quiet corner of the room with a fluffy floor pillow, drink in hand, ready to learn. I found myself peacefully floating along as the night progressed, as Sheila shared her incredible birth story- a difficult birth, followed by a deep personal journey to reclaim her pleasure and strength in a second birth that was joy encapsulated. Debra showed a clip of the film- a beautiful birthing woman surrounded by flowers and greenery, birthing in a tub, with the most delicate expression of ecstasy- in a world that was completely her own. Debra’a laughter and easy jokes made me feel like I was sitting in a kitchen with my great-aunts and sisters, sharing naughty secrets and prized recipes.

Many women shared their own birth stories- the need for silence, the unexpected sexiness in the hospital room, the courage to stand up against those who may have tried to control our process, and the fear that perhaps this type of joy was for other women, not us. We held the many precious moments of victory and

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sadness, and laughed together.

If there is one thing that I learned that evening, it is that there is no one way to birth, just as there is no one way to be a woman. It feels really special to be part of a community that celebrates women’s innate ability to bring life into this world joyfully.

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Gotta move, gotta rock, gotta sing! Comfort Measures and Coping Techniques for Labor

March 28, 2013

By Milon Nagi

At a recent Healthy Birth Choices Workshop, we gathered to hear three new moms share the comfort measures and techniques they used to cope with labor. We were also joined by Zoe Kogan, licensed acupuncturist, who took us through some acupressure points and massage techniques which can encourage labor. It was striking to hear, coming through the unique and individual nature of each story, the common themes that emerged as each woman found her way through to the birth of her baby.

Milon Nagi and Laure Sinnhuber-Giles, members of CiC's Program Committee, practice a sacrum massage used to help women cope during labor

Milon Nagi and Laure Sinnhuber-Giles, members of CiC’s Program Committee, practice a double hip squeeze used to help women cope during labor

When Vicki began to feel the sensations that led to her baby’s birth, she didn’t at first recognize them as labor – she thought it was heartburn. Having known for over a week that her cervix was already 3cm dilated, she had learned through experience that “that effacement, that dilation doesn’t mean anything until labor really happens.” She went about her day, downloading songs from iTunes for her birth playlist and, as her contractions grew closer, checking in with her midwife, who told her it didn’t sound like labor yet. “She told me, ‘Call me when you can’t stand it anymore’,” Vicki recalls.

To ease the discomfort, Vicki got into her tub. And, when the sensations became more intense, she asked her doula to come over. She remembers feeling “huge relief” when her doula arrived, thinking “I can finally relax, I’m just going to do whatever she tells me to.” Her doula, realizing that Vicki was experiencing a back labor, recommended that she stand in the shower with the hot water raining down on her back. It felt good and there was a possibility it could encourage her baby to change positions. She stayed there for 45 minutes and, in the meantime, her doula encouraged her husband to take a nap. Emerging from the shower, Vicki followed her urge to lean forward onto the bed through contractions. She moved to laboring on the birth ball to help her baby come down. Eventually, her doula suggested now may be a good time to go to the hospital. “I don’t know how she knew,” Vicki says, “she recognized from my face or something that I was ready – I didn’t even know that.”

Her doula helped her dress and they moved to the hospital. During the car ride, especially, Vicki’s music helped her to stay present and cope with her labor. She remembers laboring without a room for a while, until a nurse noticed her squatting and “corkscrew walking” through contractions in the hallway and she was finally checked and put into a labor room. Vicki recalls noticing that it was dark when they arrived (around 6am) and seeing more light as time went on. Having arrived pushing, she expected to have her baby before breakfast. Her baby’s unusual position, however (his head was tilted to one side and he was “sunny side up”) meant that it took a while for him to make his way out. With her midwife’s and doula’s support, Vicki pushed for several hours in different positions, fending off threats of a cesarean section from the attending OB (who later returned with students to observe her, impressed with her progress!) and at one point accepting some Pitocin to keep her contractions strong. Her birth team encouraged her and reminded her how strong she was, her doula massaging and shaking her tired legs between contractions. With their “incredible” support, she gave triumphant birth to her baby son, River, just as she had hoped to.

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New Research: Doula Support Reduces Odds of Cesarean Section by 40%

February 22, 2013

A new study entitled Doula Care, Birth Outcomes, and Costs Among Medicaid Beneficiaries” was released online last week in the American Journal of Public Health and is creating quite a stir within the childbirth community nationwide.  Paired with National Birth Center Study II, released last month by the Journal of Midwifery and Women’s Health,  it seems that the movement toward more choices in maternity care is gaining strength.  The National Birth Center Study provided evidence for increased access to midwifery care and birth centers by showing that women who receive care at midwife-led birth centers incur lower medical costs and are less likely to have cesarean births compared to women who give birth at hospitals.

The new study on doula care compared childbirth outcomes of women insured by Medicaid who received doula support to those who did not.  Researchers at the University of Minnesota School of Public Health found that doula support reduced a woman’s odds of giving birth via Cesarean section by more than 40%.  They also found a decrease in preterm births of almost 20% in the doula supported group.

Past research has shown that doula support results in other positive birth outcomes, such as:

  • Increased initiation and duration of breastfeeding
  • Shorter labors
  • Less need for anesthesia or analgesia
  • Fewer vacuum and/or forceps births
  • Higher APGAR scores
  • Better mother-baby bonding
  • Less postpartum depression

The study goes on to discuss the possible cost savings to Medicaid programs if they were to provide reimbursement for doula services, since Cesarean sections are approximately 50% more expensive than vaginal births.  The researchers are hesitant to provide concrete numbers because costs and associated benefits would vary widely by state.

But since blogs aren’t held to the same high standards that research articles are, we decided to come up with a very approximate estimate, just for curiosity’s sake.

Number of births in US per year
Estimated Percent of US births covered by Medicaid
Estimated Number of US births covered by Medicaid
US Cesarean section rate (2010)
Estimated number of Medicaid-covered Cesarean sections in US
Percent of Cesarean sections prevented with doula support
Number of cesarean sections preventable through doula utilization
Difference in cost between Cesarean section and vaginal birth
Resulting savings to Medicaid programs per year
3,999,386
46%
1,839,718
32.8%
603,428
40.9%
246,802
$4,500
$1.1B

This very rough sketch of the money that Medicaid programs would save if every mother had access to doula support doesn’t take into account the considerable cost of providing that support.  If Medicaid reimbursed for doula care at $500, and offered support to every mom, the cost would be about $920M.  That would still yield a net savings, after reimbursement, of nearly $200M.  Not to mention all those better outcomes for mom and baby.

This seems (to us) to be one of those wonderfully poised, win-win initiatives that leads to both happier, healthier moms and babies and cost savings for a taxpayer-funded program.  What would happen if there was a campaign in every state to bring this issue to the forefront and get doulas for all women?  And are you willing to help?

Watch CiC’s Executive Director, Elan McAllister, discussing doula care on Huffington Post LIVE

Article Citation:

Backes Kozhimannil, K., Hardeman, R., Attanasio, L., Blauer-Peterson, C., & O’Brien, M.  (2013). Doula Care, Birth Outcomes, and Costs Among Medicaid Beneficiaries. American Journal of Public Health. e-View Ahead of Print.  doi: 10.2105/AJPH.2012.301201