Archive for the ‘Pregnancy’ Category

Preventing First Cesareans- Consumer Statement

May 14, 2014

Many expectant parents are concerned about the high rate of cesareans. Indeed, they have reason for concern. One in three women in the United States (32.8%) now give birth by cesarean, and the dramatic rise in the cesarean rate has not improved outcomes for women or babies.  The World Health Organization recommends a cesarean rate between 5 and 15 percent, because data suggest that rates above 15 percent may do more harm than good. Cesareans can be lifesaving when they are needed, but when they are used without a medical reason, the risks can outweigh the benefits.

In order to bring down the rising cesarean rate in the U.S., the American College of Obstetricians and Gynecologists (AGOG) and the Society for Maternal-Fetal Medicine (SMFM) released guidelines for the “Safe Prevention of the Primary Cesarean” in February 2014. These groundbreaking guidelines recommend changing many standard elements of maternity care and have the potential to dramatically improve the quality and experience of maternity care for the women of New York City and across the United States. CiC has created a summary, available for free download, of some of the key recommendations made by ACOG and SMFM so that you can discuss them with your doctor or midwife.

Ask how your doctor or midwife and your hospital or birth center are responding to these new recommendations

Preventing First Cesareans- Consumer Statement

Choosing a Care Provider Education Class

November 26, 2013

Choices in Childbirth hosted our free monthly workshop this past Thursday (11/21/13) at the 14th Street Y; this month’s topic was Choosing a Care Provider.  As the CiC intern with no plan of baby in my near future, I have thought little of what my potential care provider will look like. Yet as the room filled up with expectant women and their partners, it became clear that this is a topic on a lot people’s minds.  Tanya, a member of our education and program committee, and a student midwife and child educator herself,facilitated the discussion and introduced couples that struggled to find their right fit.  As the stories accumulated, this idea of choosing the right care provider felt a lot like Goldie Locks and the Three Bears: you have to test all the beds until you come to the one that makes you feel comfortable and safe. 

Each couple shared their stories of starting with an obstetrician, midwife, doctor, hospital, birthing center, etc. and feeling as though they weren’t part of “the team”: they weren’t being included in the decision making process, despite feeling like they knew and trusted their bodies.  They also described the shame and embarrassment that their former providers caused.  For instance, all three women were told they had gained too much weight in a short span of time, and how this would negatively impact their pregnancy, labor, and baby.

Another common theme throughout their stories was their feeling disconnected from their provider. Their provider took no time to get to know them and thus learn what they wanted from their birthing experience.

All the women ended their stories with this pearl of wisdom: keep looking until you find the provider whose values align with yours. If you go into your birth experience with someone who doesn’t have the same vision, then it will likely be bad. But if you’re able to find the person who you feel understands what you want, then it will be good. That, and get a doula.

 sky diving

October 1, 2013

The Little Leaks Your Mother Never Told You About:

Pregnancy and the Pelvic Floor

Julie Sygiel is founder and CEO of Dear Kate, a line of leak-free lingerie for women with a built-in breathable liner. Take $10 off your first order at www.dearkates.com with the code “ChoicesinChildbirth” valid through September 30, 2013.

It’s the elephant in the room: pregnancy-induced stress incontinence (SI).

Did you know that 1 in 3 new moms experience light bladder leaks for at least 5 years after giving birth? Stress incontinence refers to the accidental lose of urine during physical stress such as laughing, sneezing, or exercising. Many women experience stress incontinence during pregnancy, and the severity and duration can vary greatly.

So will it happen to you?

The incidence of SI is low in the first trimester, rising rapidly in the second trimester and continuing to increase, albeit more slowly, throughout the third trimester.  Age and body mass index are important factors; women who are older or heavier are more likely to experience leaks. And for some women, pregnancy may be relatively leak-free but delivery leaves them with postpartum SI issues.

Many women experience the worst leaks for the first few days after delivery, even following a cesarean section. Things generally improve within 7-10 days of giving birth, but for other new moms, SI will continue to be an issue for several months or years after the pregnancy. All of this means that hitting the gym post-baby can be literally stressful.

Bladder issues during and after pregnancy can have several causes, the most obvious being increased pressure on the bladder. Pregnancy can also damage the nerves that control the bladder, and the bladder and urethra are prone to shift during pregnancy. Additionally, when an episiotomy is performed during delivery, many women experience post-baby bladder leakage issues.

A number of strategies can be used to mitigate the problem.  The first recommendation is Kegel exercises. While Kegels can be a powerful method for improving bladder control, it’s important to be aware of the many misconceptions surrounding them.  This article (insert link: http://acnm-midwives.blogspot.com/2010/12/do-you-really-know-kegels.html) on Midwife Connection does a fabulous job of dispelling the myths.

Kegels alone cannot always correct the problem.  Some women find vaginal weights to be an effective way of strengthening the pelvic floor muscles. They are available in a range of sizes, so you can work your way up to heavier weights as you improve muscle strength and control.

If these at-home methods don’t work, seek out a physical therapist who specializes in women’s health and the pelvic floor. They have got a range of tools, including biofeedback, which is especially useful for gauging muscle control.  Physical therapy, including pelvic muscle exercise, has been consistently shown to resolve or improve SI.

If the problem persists, your therapist will be able to recommend appropriate treatments, including medicine or surgery.  Above all, know that there are solutions! While pregnancy-induced incontinence is very common, it does not need to be taken as a normal part of childbirth to be borne in silence. If incontinence affects your quality of life, it can and should be corrected.

 

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