Birthing Wisdom

HypnoBirthing® Classes New York/ New Jersey

noreply@blogger.com (Pauline) — Tue, 04 May 2010 19:25:00 +0000

Summer Series: HypnoBirthing® -The Mongan Method

Please register early as the spaces fill quickly.

This is a comprehensive 5 week series of childbirth, parenting and self hypnosis education classes.

Hypnobirthing® is as much as philosophy as it is a technique.
It is a rewarding, relaxing, stress-free method of birthing that is based on the belief that when a mother is properly prepared for birthing physically, mentally, and spiritually, she can experience the joy of birthing her baby in an easier, more comfortable manner.
The method is based on the belief that severe discomfort does not need to be a natural accompaniment of labor.
The aim of the program is to build confidence in the mother and for her to have confidence in her own ability to birth her baby. The philosophy of the Hypnobirthing® program is to educate the mother about the wonders of her body, to eliminate fear, as well as teach her the skills to work with the birthing process rather than fight against it. In many cases it is fear that undermines the mothers confidence in herself. The mother is introduced to techniques of self hypnosis utilizing controlled deep breathing, visualization and imagery to produce deep relaxation.

The coach and birth partner is taught how to physically, mentally, emotionally and spiritually support her throughout this wondrous journey. Extensive lectures in the birth process, birthing options and numerous self- hypnotic & relaxation techniques are taught. Other topics include: exercise, nutrition, anatomy, birth planning, c-section prevention, breastfeeding and baby care.

Location: Blauvelt, NY
Date & Time: 7/26, 8/2, 8/16, 8/23, 9/13 7:00-9:30pm
For further information contact:
Pauline Nardella RN, MPA, CCE
845-680-0385
info@BirthingWisdom.com
www.BirthingWisdom.com

www.HypnoBirthing.com
Birthing Wisdom now on Twitter and Facebook

Cameron's Birth Story

noreply@blogger.com (Pauline) — Thu, 08 Apr 2010 18:53:00 +0000

Here is a birth story that shows how HypnoBirthing works under all situations!

Cameron's Birth Story

I decided to try HypnoBirthing because I am afraid of doctors and pain, perhaps unreasonably so. I very much wanted to have my baby without feeling fear and anxiety. At the beginning of my pregnancy, I joked that if I could set up the appointment for the epidural in advance, I would. As I learned more about HypnoBirthing, I downgraded my insistence on an epidural to an "if-needed" basis. When I would tell people about HypnoBirthing, they would look at me as though I were crazy. I would say, "For some reason, it just makes sense to me." No one thought that it would actually work. I must admit that I remained somewhat skeptical as well.

It's worth noting at this point that I had three major fears around labor:
1. Pitocin induction - I had heard so many horror stories about Pitocin, I was determined to avoid it at all costs.
2. No possibility of epidural – One of my sisters had a very fast delivery with her second baby and had no time to have an epidural.
3. Back labor - A friend's account of birthing her posterior baby sounded horrific.

At 6:00 am on June 30, after a night of no sleep, I decided to call my doctor. I had been having quite a bit of pain in my upper abdomen. I knew they weren't contractions. I wasn't due for another month and the pain was constant and different than any description of labor I'd ever heard. It felt as though a steel band were being tightened around my rib cage. My doctor told me to go to the hospital to have blood work done to try and determine what the problem was. My pregnancy had been incredibly easy so far. I joked to my husband, John, that I was going to be given a dose of Gas-X and sent home.

We went to labor and delivery and were situated in a room and had blood drawn. I remember thinking it was odd that we weren't just sent to the lab. Within an hour of the blood draw, the phone in the room rang and I answered. My doctor said, "Carol, you're going to have your baby today." It turned out that I had suddenly developed severe preeclampsia. We called my sister, Robin, our birthing companion, to tell her the news.

It goes without saying that my Birthing Plan did not include preeclampsia. I was supposed to begin labor and stay at home for as long as possible before heading to the hospital, where I would be five to six centimeters dilated upon check-in. I would recite birthing affirmations all the while. I would have an epidural, if I felt I needed one. My baby would arrive peacefully and I would feel no fear or anxiety. In reality, I didn't even have my bags packed for the hospital. The baby's clothes had not been washed and we didn't have sheets for the bassinet. John and I hadn't practiced HypnoBirthing in a little over a month. We had practiced only one time with Robin present. In fact, we had scheduled a "refresher course" with Kathie for the very next night.

The form of preeclampsia I had was called HELLP Syndrome. H=Hemolysis, bursting red blood cells; EL=Elevated Liver enzymes; LP=Low blood Platelets. The cure was to have the baby. I was not allowed out of bed, so I was catheterized. My sister arrived and my husband went home to pack a bag. I was zero percent effaced and less than one centimeter dilated. There was talk of Pitocin. I spoke to the doctor and asked if my water could be broken to get labor going, if their efforts to spur effacement (similar to Prostaglandin) helped me to dilate. She said she'd have to wait and see. I put on my headphones and listened to my Rainbow Relaxation and the Birthing Affirmations over and over again.

Once I was fully effaced, about five hours after the initial treatment, I was still less than two centimeters dilated. Labor had clearly not started. The minor tightening I felt in my lower abdomen did not even register on the monitor. My blood work continued to return results that my condition was worsening. My doctor told me that they would have to begin Pitocin. With my greatest labor fear a reality, I asked for an epidural. I was told that because of my low blood platelet count, I was at risk for uncontrolled bleeding. I could not have an epidural.

It was about 5:30 pm, and I was told that the Pitocin would be started by 6:30. I put my headphones back on and said to John and Robin, "I'm checking out now." I knew that I would need to be completely relaxed once the Pitocin started, so that I could stay "on top" of things. At this point, Robin and John called Kathie to ask for some pointers. She was very reassuring, and told them that even without practice, we had everything we'd need.

At 6:40, the Pitocin was added to my IV. No one told me that it had started but I remember feeling my surges suddenly and greatly intensify. The sensation was all in my lower back. I couldn't believe it. Back labor. I told John and Robin what was happening and they looked through all of my HypnoBirthing materials to see what they could do. There was a method for getting the baby to turn that involved stacking pillows under my knees and having me turn from one side to the other with each surge. We tried that for three surges and I found it exhausting. At that point, I asked that we stop and asked Robin to apply counter-pressure to my back and for John to recite HypnoBirthing cues and provide light-touch massage on my arms and head. I had planned on listening to the Steven Halpern CD I had purchased from Kathie. However, in the rush to get my things to the hospital, John had picked up some new-age CD that we had bought at Target and had never listened to. I didn't matter. I was completely calm and felt no fear.

I can't say that there was no pain. But my mind was so far away from my body, it didn't seem to register in the usual way. The counter-pressure massage from my sister served to move the sensation from my back into my abdomen. Once it was there, I remember rubbing my abdomen lightly and saying, "Thank you my body for bringing my baby to me." This had a definite anesthetic effect. I think that acknowledging and being thankful for the fact that my body was completely in charge prevented my mind from registering the pain. I used many visualizations: breathing in to fill up a balloon that then floated away from my body, the opening rose, and being on a beach were the most effective for me.

I spent the duration of my labor laying on my left side, asking for counter-pressure with each surge and listening to my CDs. On several occasions, I was asked to turn onto my back so that my progress could be checked. I had to have a second IV set in case there was a need for a blood transfusion. The doctor attached an internal monitor to the baby's head. None of these things interrupted my hypnosis.

When I felt that it was time to begin breathing the baby down, I let John and Robin know. They told the doctor. As the room was being prepared, I remember talking and laughing with John and Robin. Because my condition was worsening, I was asked to abandon "breathing the baby down" in favor of downright pushing in order to get the baby here faster. Even that did not break the hypnosis. After 20 minutes of pushing, Cameron arrived at 9:08 pm, two hours and 28 minutes after the Pitocin began.

Despite all evidence to the contrary, it was exactly the birth I had hoped for. I was calm and unafraid and the mood of the room was the same. There was nothing but joy when our little boy came.

By the way, my doctor called me the day after Cameron was born. She said that she had never seen anything like Cameron's birth. Not only was she impressed with the fact that I actually stayed relaxed, she also commented on how terrific the support was that I received from John and Robin. They were reading directly from the materials you passed out. She said that she had been very unsure of HypnoBirthing, but had been converted!
For further information on local HypnoBirthing Classes in Rockland, Westchester & Orange Counties in New York and Bergen County New Jersey contact www.BirthingWisdom.com

Low Breastfeeding Rates Incur Billions in Medical Costs

noreply@blogger.com (Pauline) — Wed, 07 Apr 2010 18:56:00 +0000

Visit us online at www.MedPageToday.com

Low Breastfeeding Rates Incur Billions in Medical Costs

By Crystal Phend, Senior Staff Writer, MedPage Today
April 05, 2010

MedPage Today Action Points
Note that the economic analysis may have been an underestimate of the financial cost of low adherence to breastfeeding guidelines, since few of the cost projections were based on six months of exclusive breastfeeding.

Review
Poor compliance with breastfeeding recommendations costs the nation at least $13 billion each year, with nearly all of the cost related to infant morbidity and mortality, according to a comprehensive economic analysis.

If 90% of new mothers followed guidelines for six months of exclusive breastfeeding for their children, an estimated 911 deaths would be prevented annually, said authors Melissa Bartick, MD, MSc, of Harvard Medical School, and Arnold Reinhold, MBA, of the Alliance for the Prudent Use of Antibiotics, both in Boston.

Even 80% adherence would save $10.5 billion and prevent 741 deaths each year, they reported online in Pediatrics.

Taking action to help more families to follow the guidelines, such as by creating a national infrastructure to support breastfeeding, would likely be cost-effective, Bartick and Reinhold said.

Prior analyses that included fewer pediatric conditions affected by breastfeeding suggested a more modest potential savings of $3.6 billion if breastfeeding rates rose to meet the Healthy People 2010 objectives for initiation (75%) and six-month duration (50% any breastfeeding, 17% exclusive breastfeeding).

However, that data was based on actual breastfeeding rates collected by the infant formula industry and incorrectly assumed that this reflected exclusive breastfeeding, Bartick and Reinhold wrote.

So with national data now available from the CDC on breastfeeding, they aimed to get a more accurate estimate of the economics of breastfeeding.

The CDC's National Immunization Survey found actual breastfeeding rates in 2005 were 74.1% for initiation and the early postpartum period, 42.9% for any breastfeeding at six months, 12.3% for exclusive breastfeeding at six months, and 21.5% for any breastfeeding at 12 months.

"Exclusive breastfeeding" meant only breast milk -- no water, infant food, juice, formula, cow's milk, or sugar water.

Bartick and Reinhold determined direct and indirect costs of illness and premature death as assessed in a 2007 Agency for Healthcare Research and Quality analysis of the impact of breastfeeding on a host of maternal and childhood diseases.

The excess annual cost in 2007 dollars associated with the current poor levels of adherence compared with 90% compliance was:

$4.7 billion and 447 excess deaths due to sudden infant death syndrome
$2.6 billion due to 249 excess deaths from necrotizing enterocolitis
$1.8 billion due to 172 excess deaths from lower respiratory tract infections
$908 million due to otitis media
$601 million due to atopic dermatitis
$592 million due to childhood obesity
The largest proportion of these costs -- 74% -- was associated with premature deaths, although the price for more common conditions, such as otitis media and childhood obesity, was still substantial, the researchers noted.

There wasn't enough data available for type 2 diabetes to estimate the effect of breastfeeding duration, "although these costs are partially represented in the obesity analysis," the researchers said.

Furthermore, few of these estimates were based on exclusive breastfeeding for six months and most erred on the conservative side, so the projections may actually be an underestimate, they explained.

"Substantial gains could be made with exclusive breastfeeding for four months and any breastfeeding at six months," they concluded.

The researchers reported that they had no financial relationships or conflicts of interest to disclose.

Primary source: Pediatrics
Source reference:
Bartick M, Reinhold A "The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis" Pediatrics 2010; 125: e1048–e1056.
Disclaimer
The information presented in this activity is that of the authors and does not necessarily represent the views of the University of Pennsylvania School of Medicine, MedPage Today, and the commercial supporter. Specific medicines discussed in this activity may not yet be approved by the FDA for the use as indicated by the writer or reviewer. Before prescribing any medication, we advise you to review the complete prescribing information, including indications, contraindications, warnings, precautions, and adverse effects. Specific patient care decisions are the responsibility of the healthcare professional caring for the patient. Please review our Terms of Use.

© 2004-2010 MedPage Today, LLC. All Rights Reserved.

www.BirthingWisdom.com
Breastfeeding Classes
Board Certified Lactation Consultant

Infant/Child CPR, Choking & Safety

noreply@blogger.com (Pauline) — Thu, 01 Apr 2010 22:42:00 +0000

Infant/Child CPR, Choking & Safety

In the US nearly 400 children under the age of four die every month due to
unintentional accidents!
This class presents age appropriate home proofing and safety concerns inside
and outside the home from infancy to toddlerhood. Learn how to deal
with an emergency situation.

Infant/Child CPR and choking will be presented and reviewed by participants with
hands-on return demonstration on
sanitary "CPR Manikins."

Safety & CPR handouts are given to each participant for display at home.
Location: Blauvelt, NY
Date: May 1st (Sat)
Time: 10am-12:30pm
Fee: $30.00/person
Class size is limited so sign up early.

You can reserved your space in this class by sending the class fee to:
Pauline Nardella, RN, MPA
2 Private Lovett Ct
Blauvelt, NY 10913

Private classes also offered for 16 participants

To receive further information or to sign up for the next class
go to info@BirthingWisdom.com
or call 845-680-0385
www.BirthingWisdom.com

Infantino Announces Sling Recall

noreply@blogger.com (Pauline) — Fri, 26 Mar 2010 00:17:00 +0000

http://www.attachmentparenting.org/news/news.php#infantslingsafety
Infant Sling Safety

Today we received news of the Infantino sling recall, and the Today Show interviewed one of the mothers whose baby died in the sling. It goes without saying that we are deeply saddened by this mother's story of her baby's death,” said Barbara Nicholson, API Cofounder. “And hopefully this recall will heighten every parent's awareness of the importance of proper positioning of their baby in a sling. Unfortunately there is a tremendous lack of research on babywearing safety...there is not one study that proves that baby slings are actually the cause (or not the cause) of these deaths. We may never know if these babies were medically fragile, or perhaps had a SIDS death in the sling. Of course, safely using a sling is a key issue, and parents need to be cautious as they would with a car seat, walker, or any device, but there are no data/studies about slings to date. It has been pointed out that the drawings the CPSC released were not based on research either...just a good guess of guidelines/recommendations for proper use of slings. As we say in the API statement on babywearing safety concerns,” Nicholson concluded, “Our hearts go out to parents who have lost babies, and we hope that the good that comes from this is education and awareness, not only of safety, but why slings have been used for centuries all over the world for optimum baby health and well-being.

For more information, read API's Statement on Babywearing Safety Concern (PDF).

Infantino Announces Sling Recall

Infantino Commits to Work with Consumer Product Safety Commission on Ongoing Investigation of Sling-Style Baby Carriers

SAN DIEGO, March 24, 2010 — Infantino President Jack Vresics issued the following statement today:

"At Infantino, our top priority is the safety of infants whose parents and caregivers use our products, and we highly value the trust that mothers and families place in the company’s products every day. Infantino has a well-earned reputation for designing safe and enjoyable products that are manufactured to the highest quality standards.

Infantino is announcing a voluntary replacement program for the Infantino SlingRider and Wendy Bellissimo infant baby carriers to address concerns raised by the Consumer Product Safety Commission (CPSC). One million of these infant slings are being recalled in the United States and 15,000 are being recalled in Canada.

Our company is comprised of moms, dads, sisters, aunts, uncles and grandparents and we care deeply about the quality and safety of our products. Safety is our number one concern and today's announcement of a free replacement program reflects this commitment. As an industry leader, Infantino has also been working closely with CPSC and other agencies, as well as the international agency ASTM to develop safety standards for baby slings to ensure that these products are safe and that they are used appropriately. We will continue to play a leadership role in the industry and to cooperate closely with CPSC as it continues its investigation of all baby slings."

Consumers should stop using the recalled slings immediately and contact Infantino to receive a free replacement product, including a choice of the Wrap & Tie infant carrier, the 2 in 1 Shopping Cart Cover, or the 3 in 1 Grow & Play Activity Gym, plus a Jittery Pal Rattle.

Contact Infantino at 866.860.1361 between 8 a.m. and 4 p.m. PT Monday through Friday.

On March 12, 2010, CPSC warned consumers against the use of all sling-style baby carriers in certain circumstances and announced that it was actively investigating all baby sling carriers to determine what additional action may be appropriate.

www.BirthingWisdom.com

A Gift From Life

noreply@blogger.com (Pauline) — Mon, 15 Mar 2010 17:47:00 +0000

Gisele Bundchen blogs about her amazing birth!
March 8 was International Women's Day and the Brazilian beauty chose to launch her new website on this special day and share her pride in being a powerful woman. The 29-year-old model mom will continue to share information and raise awareness for environmental issues, childbirth, motherhood, health, spirituality and so much more. Here's Gisele's first blog entry, entitled A Gift From Life:http://blog.giselebundchen.com.br/?p=772&lang=en

Carolena's Birth

noreply@blogger.com (Pauline) — Thu, 11 Mar 2010 22:44:00 +0000

Hello Dear Family and Friends!

Below is my account of Carolena's Birth. It will be up at a great home birth website soon, but I wanted to share with you all in this way too. Feel free to share this with anyone interested in a happy and loving home birth story.

Wishing you all our best,
S and C

Carolena's Birth

December 7th, 2009
The baby (cherub) is sleeping beside me on the bed, one little arm draped across her cheek. According to everyone’s advice, I should be sleeping too, but I have wanted to record as much as I could recall before it is all one beautiful glossy memory. This is the story of our daughter’s homebirth on December 3, 2009. The choice to birth at home was an easy one without many reservations. Among them were the fear of disturbing the neighbors (which is quite possible as I sang through each contraction…more on that later) and the fear of destroying my favorite rug with various gross fluids (I actually birthed on my favorite rug with many layers of towels between us, and am so happy such a beautiful piece of art holds that memory).
Notably absent is the reservation shared by many…that “something” would go wrong. From the beginning of the pregnancy, I couldn’t wrap my mind around the belief that pregnancy and birth are a medical instance in need of treatment. My husband and I both favored the idea that birth is a normal physiological event and inherently safe process. It seemed the most tangible manifestation of nature and spirit that I could imagine. Very early on I began researching models of prenatal care that could reserve intervention and treatment for medically necessary complications, and allow a normally developing pregnancy to progress into a normally developing labor and birth. The primary goal was an emotionally, spiritually, and physically healthy mother and baby. I realize labor doesn’t always progress as planned, and would have been happy and grateful to transfer our care to our local hospital in the event of an abnormality, complication, or (as most common with home birth transfers) a stall in labor progress. Luckily, there is education and information available today so that all expecting families can make choices that feel best for them. For us, this was midwife-managed care, although in the beginning we weren’t planning to birth at home. Deep in my pregnant belly I longed for the comfort of home birth, but I struggled with the myth so deeply indoctrinated in us all…you have to GO somewhere to labor and birth.
We started our journey at a free standing birth center near our apartment in Brooklyn. The center is staffed by four midwives and throughout the course of pregnancy, we saw each one (as is common with obstetrical practices, we wouldn’t know who would be on call the day labor started). Instead of packing a bag and preparing to leave for the hospital at the first sign of labor, we would pack a bag and labor at home until active labor began and then travel to the birthing center for delivery. At the center, I was so pleased with the quality of care that I found. I was surrounded by birthing professionals who reserved Pitocin use for emergency situations, wouldn’t equate a multiple pregnancy with a c-section, and didn’t even offer epidurals. I didn’t realize just how medicinal it still was. I had ultrasounds for instance, and in addition to multiple blood tests to check for a very long list of abnormalities, I drank the strange orange soda substance to check for gestational diabetes.
The midwives measured me and we listened for the baby’s heartbeat at each short visit. Because I spent most of my pregnancy deeply and quietly trusting of my body, when the portion of the check up arrived for me to ask all my burning questions, I wasn’t really interested in discussing all the strange and random pregnancy quirks, favoring talk of my meditation practice, the journal I was starting (of my experience of pregnancy that I plan to give to my daughter when she is pregnant someday J) and which affirmations were working best so far to keep me balanced. While the midwives would patiently nod while I described my vision of a peaceful, uncomplicated birth, there was a vacancy in their eyes that I can only attribute to a waiting room full of other moms needing their urine and weight checked too. It was better than what I imagined care to be at an obstetrical practice, but I wanted more.
Around my 28th week of pregnancy, we moved to a larger apartment in the Bronx, relieving some tension that had cropped up in my marriage due to sheer lack of space. While the birthing center assured me that many birthing moms traveled from over 2 hours away to labor there, my 45 minute labor commute scared me. My dreams of freedom of movement, candles, music, dancing, and laughter were replaced with nightmares of being fully dilated during rush hour traffic on the Brooklyn Queens Expressway, and an unassisted back of our SUV birth.
Enter our superwoman home birth midwife. I found her during an internet search of all places, and found her face so kind I scheduled an interview. Although I wasn’t positive yet I had the strength to make my secret longing for home birth a reality, I wanted to meet with her in hopes I would find clarity surrounding my choices. In addition to sharing experience, offering references, and generally just putting me at ease, she made us laugh. I didn’t realize how much I needed a practioner to be both knowledgeable at the craft, and also human enough to laugh at the process. We loved her. I wanted to home birth, and think I just needed someone to say YES YOU CAN. Coincidentally, we also found out a birth she attended was featured in a documentary that was next on our Netflix queue, a great movie called Orgasmic Birth. Although I had trouble picturing myself reaching orgasm during labor like some of the birthing women, we were excited to see her in action (and actually, our birth was more like her patient’s, beautiful and NOISY).

We began each prenatal visit at our homebirth midwife’s office with couch time. We discussed my diet, my feelings, my dream birth, and my questions before the routine check-up. She lent us books, documentaries, and showed us many photos of childbirth at home so we would be as prepared as possible. One of my favorite things from these visits is before our midwife measured or checked the baby’s heartbeat, she would lovingly place her hands on my belly and joyfully say “Hi, Baby!” I loved that our little mermaid girl swimming about in there was greeted. Without her, after all, we would not have been there in the first place. On average, our appointments at the birthing center lasted about 15 minutes. With our home birth midwife, they were closer to an hour.

At a prenatal appointment conducted in our home with our midwife and our doula, they both asked what sort of vision I had for the birth. They wanted to be able to respect my wishes, and also hold the type of energy in the space in case I wasn’t able to maintain it. I wanted our beautiful home to be warm and dimly lit, have softly playing music, the sound of our softly trickling fountain, a million lit candles, and ROMANCE JOY and LOVE energy filling our apartment, both to nurture me, and to make the place our little girl journeyed to beautiful and comfortable. During labor, I wanted to laugh, dance, sing, and kiss my buddy. I wanted to relax into the joy that my baby was coming, Most of all, I wanted to trust my body to know what to do. I had a commitment from the birth team of my hubby, midwife, doula and my mom to maintain a loving, safe and gentle process for me and the baby. I joined a wonderful birth circle with other expecting moms where we released residual fears, blessed our bodies, and imagined our perfect births. I created drawings and notecards to hang that reflected the vision I had of a beautiful, gentle birth in hopes that the constant reminders would somehow influence the big day.

On my due date of November 23, my mom arrived. She planned to stay for three weeks. We were all hoping the baby wanted to come sooner than later so we’d have the necessary postpartum support that is so important for women to receive. I spent over a week with my mom watching movies, tooling around Manhattan, and answering the question “do you feel any contractions yet?” about 137 times. Every so often, I felt slight tingling sensations, but without any pattern whatsoever. Each new one even felt so different from the last, that if I were to experience it again I am not sure I would recognize them as Braxton Hicks.

The morning of December 2nd, I noticed I passed my mucus plug. I excitedly went into the living room and told my mom that YES I think we’re having a baby soon. I had already decided that during my early labor, I wanted to make a birthday cake for my little girl. We decided her name would be a tribute to my late grandmother, and so I wanted to make her specialty, Italian Crème Cake. (I get a lot of mileage out of that detail…not only did I have a home birth but I made a cake during labor. People are in disbelief. J)

Not yet contracting really, but just FEELING like the day was here, I started my cake project. During the baking I became ravenous. I ate about 5 leftover pancakes, a banana, and some other assorted snacks. Later I recognized this as a typical early labor sign…my body was trying to tank up for the day’s work. While my cakes were cooling, I decided to watch a little guilty pleasure comfort TV viewing (Gilmore Girls on DVD) and rest for a while. I dozed and watched and started to notice the dull tightening sensation I had been feeling all week were occurring about every 12 minutes. I was SO excited to realize that finally after all the waiting there was a pattern to the contractions. Not wanting to get my hopes up in case it turned out to be a long day, I napped and continued my GG marathon (for any fans out there….it was the season where Rory is secretly into Jess but still dating Dean. Juicy).

With beautiful butterflies in my tummy, I decided to take a bath. As I soaked, I called out to my mom in the other room every time I felt another tightening. Just as I’d done so many times before, I rubbed my belly and imagined what that little angel looked like. Realizing I would soon find out made me grin from ear to ear. The contractions still weren’t painful, and were just a dull achy feeling. My mom said they were starting to come every 8 minutes now. This was it! By the time I got out of the tub, I started to feel like I was leaving the room. It was so intense already. I lay on my bed, closed my eyes and started to go through one of the relaxations I learned in our Hypnobirthing class. (Hypnobirthing is a childbirth preparation method in which relaxation and visualization are utilized to eliminate the fear that constricts birthing muscles and allow your mind to aid your birthing). As I became more and more attuned and present in my body, everything else just started melting. I remember calling out to my mom and husband that I think they better put together the birthing tub we rented because this baby was coming faster than I expected.
Around 3:30, I met my much appreciated and loved birthing partner, the rented Aqua Doula birth tub. Instinctively, I sat in the same position polar bears do when they labor and rocked back and forth as my hubby rolled tennis balls on my lower back. The contractions were coming about every four minutes, and were strong already. During this time, I pictured this drawing our childbirth educator shared with us of an opening flower with a baby’s head in the center. With every rise, I imagined my body opening. At the advice of the doula that led the birth circle I joined, I also mentally said YES and THANK YOU to each tightening, yet opening feeling. Over the course of the next hour, the contractions began coming every 2 minutes. I was so deep in my body that I was having trouble coming out in between contractions to carry on conversation. My husband (or my mom?) called our doula. By the time she arrived, the contractions that were bringing my beautiful baby closer to us were only 90 seconds apart. It was around this time that I started chanting. A deep, moan-y, unstructured chant come from deep within my soul each time another came on. I am told most times, I was harmonizing with the brilliant global, rhythmic birth music mix my husband made. It makes me smile that even in labor, I was creating harmonies.

Dreamlike, my midwife somehow arrived. About 5 hours into labor, I moved into our bedroom and asked her to check my progress. Luckily, I was 7 centimeters dilated and about 90% effaced. I say luckily because it is extraordinary, hard work. If I had gotten news that I wasn’t progressing as quickly as it felt like I should be, I imagine it would have been very discouraging. I feel for women who labor in hospitals and are forced into frequent and disruptive vaginal exams. Back to the tub I went where hubby resumed rubbing my back with tennis balls, which at this point was adding to the intensity. Apparently, I couldn’t control my volume when I struggled to focus long enough to ask (demand?) he STOP THE BALLS. I started picturing this spiral charm our childbirth educator gifted us. I traced in my mind its grooves while internally chanting with each contraction, “I am connected to every woman before me and every woman after”, the power and poignancy of which fueled me.
About an hour later, I was fading. I had gotten sick earlier in the day and the thought of eating again made my stomach churn. The only energy I was adding was in the form of frozen cubes of cranberry juice. My arms were tired from holding my position, and I struggled with the most challenging part of my birth…not knowing when it would be over. It is a bit like running a marathon without ever knowing just how long a marathon race is. I felt like if I just knew when I would see a finish line I could pace myself. Contractions were still coming every 90 seconds and lasting about 60 seconds. With only half a minute to rest between each, I desperately needed to know. I went back to our bedroom so our midwife could examine me. At 9 centimeters dilated and completely effaced, it seems I was somewhere around mile 20. Relief flooded me; the baby’s almost here. After the exam, the bag of waters in which my little girl so gracefully swam about for 9 months released. About 10 minutes later, I started pushing.
Because active labor was so manageable for me, I was completely overwhelmed by the intensity of pushing. Guttural screams escaped my tired throat each and every push. I was still lying on my side on our bed; eyes shut, I felt paralyzed. It was so intense that I was letting contractions pass without a push. My midwife and doula were encouraging me to try a new position, but I couldn’t move. I struggled to cry, but couldn’t find tears. Comfort comes when you most need it I suppose, because at that moment I heard a small clap of thunder and a downpour of rain. When I opened my eyes, I noticed my mom had moved a tray of candles into the bedroom and they were softly illuminating the Buddha statue on my dresser. The sound of rain and a candlelit Buddha saved me. I finally moved from the bed, sat on the birthing stool my midwife set up on my favorite rug and leaned against my sweet love husband. Finally, I reached down to find the baby was crowning. I remember hearing my mom say, “Oh, her head is out now!” Another push at 12:25am, and Carolena Frances Benelli joined the world. I looked down at her, overcome with sheer wonder and joy.
We wanted to leave her umbilical cord attached as long as possible so that she would benefit from the rich nutrients still pulsing through from the placenta. Maybe because of this, or maybe because I was just so exhausted, it was another hour and a half before I birthed the placenta. Carolena nursed and then snuggled with her grandma so I could clean up. Perhaps the most romantic moment of my life was my husband coming into the shower and cleaning my body after I gave birth to our daughter. I felt so loved and cared for in that moment. I came out of the shower to fresh sheets and a cleaned room. Our little love weighed in at 9 pounds, 3 ounces, and measured 21 1/2 inches. Around 3:30 in the morning, our midwife and doula went home, and the new grandma went to sleep in the other room. Hubby and I snuggled in with our new little angel and enjoyed our first night of sleep together.
There is not a single thing I would change about the beautiful way our daughter joined the world. Seriously, how many times did I describe something as beautiful in this account? There just aren’t many other words for it. I am so grateful for the information available that allowed us to truly make conscious choices for Carolena’s birth, and that I found the perfect birth team for me (thanks Pauline, Marin, Nancy, Anne, Mom, Chris, and all the wonderful women I’ve met before the birth and since who encouraged me). I would birth naturally, and at home as many times as my husband will agree to pregnancies J. When I tell the story, women are shocked that I “made it through natural childbirth”. To the women that think I am somehow MORE powerful than they, I would just like to say YOU’RE WRONG! My body is no different, and the power that enabled me to birth in the way it was intended is in every woman. The only difference between us is mental; I know what is possible for every woman and every baby. I learned that it is as true in birth as in life…you have the experience you intend to have. And mine was just beautiful.

Preventing Cesarean Sections

noreply@blogger.com (Pauline) — Thu, 11 Mar 2010 15:08:00 +0000

Preventing Cesarean Sections

http://www.youtube.com/watch?v=EZy0JPtubiQ

www.BirthingWisdom.com

Treating Your Baby's Cold

noreply@blogger.com (Pauline) — Thu, 04 Feb 2010 18:11:00 +0000

Treating Your Baby's Cold

Safe alternatives to medication

By Alice Lesch Kelly

Many doctors applauded federal health experts last fall when they advised against the use of over-the-counter cough and cold medications for babies and children younger than 6, leading to recalls of several infant cold medicines. "Too many parents have been misusing these medications for too long," says Gwenn Schurgin O'Keeffe, M.D., a Boston pediatrician and CEO of Pediatrics Now. So, what's the parent of a sick baby to do? Here are some safe alternatives:

Loosen mucus with steam, saline nose spray or breast milk and remove it by suctioning with a bulb syringe, advises Tara Levy, N.D., a naturopathic physician in Oakland, Calif.

Mix two drops of eucalyptus oil into one teaspoon of safflower or olive oil and massage it on your baby's chest or back to relieve congestion, Levy suggests. (Make sure it's completely rubbed in so your baby can't get it on his fingers and then accidentally ingest it by putting his fingers in his mouth.)

Use a humidifier with a clean filter to keep the air in your baby's room moist.

Keep your child hydrated by breastfeeding or bottle-feeding more often. If your baby is 6 months or older, offer him a little water or diluted juice.

Try to be patient. "Colds are caused by viruses and the only cure is time," O'Keeffe says. "A typical virus lasts about seven days.
Brought to you by
Fit Pregnancy
February/March 2008

www.BirthingWisdom.com
Empowering trust in the innate wisdom of mothers, fathers and families.

A Wake Up Story

noreply@blogger.com (Pauline) — Wed, 03 Feb 2010 22:51:00 +0000

A Wake up Story by Healthy Child Healthy World
A Wake-Up Story is a must-see video for every parent and anyone that cares about the health and development of children. Watch it. Share it. Join the movement. Awakeupstory.org

A Wake-Up Story from Healthy Child Healthy World on Vimeo.

Drinking and Eating in Labor

noreply@blogger.com (Pauline) — Wed, 27 Jan 2010 19:29:00 +0000

January 26, 2010
In Labor, a Snack or a Sip?

By RONI CARYN RABIN

Maternity wards have long forbidden women in labor to eat or drink. Even when labor goes on and on, the bill of fare is usually limited to ice chips.

Now a systematic review of existing studies has found no evidence that the restrictions have any benefit for most healthy women and their babies.

The prohibitions are meant to reduce the risk of Mendelson’s syndrome (named for Dr. Curtis L. Mendelson, the New York obstetrician who first described it in the 1940s), which can occur if the contents of the stomach are drawn into the lungs while the patient is under general anesthesia.

While rare, the syndrome can be fatal. But nowadays the use of general anesthesia during labor and delivery is also rare. Caesarean sections are generally done using regional anesthesia.

“My own view of this has always been that you could say one shouldn’t eat or drink anything before getting into a car on the same basis, because you could be in an automobile accident and you might require general anesthesia,” said Dr. Marcie Richardson, an obstetrician and gynecologist at Harvard Vanguard Medical Associates in Boston, who was not connected to the new study.

Beth Israel Deaconess Medical Center, where Dr. Richardson delivers, estimates that just 1 to 2 percent of women in labor are given general anesthesia.

The restrictions date back almost seven decades, said Joan Tranmer, an associate professor of nursing at Queen’s University in Kingston, Ontario, an author of the new review, published last week by the Cochrane Collaboration.

“We thought it was time to question this, now that we’re in the 2000s,” said Dr. Tranmer, who said she had seen all too many women in labor complaining of thirst and dry mouth resort to sucking wet washcloths.

“With improved anesthetic techniques, we don’t do general anesthesia a lot anymore,” she said. “And even when they have to administer general anesthesia, they’ve improved the techniques, and the risk is very, very low.

“So we turned the question around and asked: Is there any benefit to restricting oral food and fluid during labor? And we found no benefit and no harm.”

The authors acknowledged that they found relatively little evidence to analyze: 11 studies, including just 5 randomized controlled trials encompassing 3,130 women.

All of the studies looked at women who were in active labor and at low risk of requiring general anesthesia. One compared complete restriction of food and drink with complete freedom to eat and drink at will, two compared water with other liquids and foods and two compared water with carbohydrate drinks.

There were no statistically significant differences in such primary outcomes as the rate of Caesarean sections and fetal Apgar scores, or in secondary outcomes, like the need for pain relief or duration of labor. One small study, however, did find an increase in C-sections among women taking carbohydrate drinks compared with those limited to drinking water.

Some hospitals have lifted restrictions on drinking during labor in recent months, since the American Congress of Obstetricians and Gynecologists issued new guidelines last August allowing patients to drink clear liquids. But the guidelines kept the restriction on solid foods.

“The problem is going to be for emergency C-sections, which are rare but not unheard of,” said Dr. William Henry Barth Jr., chairman of the society’s committee on obstetrics practice. “There’s just not time in that setting to stop and do regional anesthesia. And it can be unpredictable.”

Anesthesiologists were critical of the review, saying none of the studies were large enough to evaluate the impact of eating on risks during general anesthesia.

“From an anesthesiologist’s perspective, they missed the boat on this one,” said Dr. Craig M. Palmer, chairman of the committee on obstetrical anesthesia for the American Society of Anesthesiologists.

“They looked at the impact on the progression of labor, but to be honest, that’s not an issue for anesthesiologists. Our primary concern is patient safety.”

www.BirthingWisdom.com

URGENT CALL FOR HUMAN MILK DONATIONS FOR HAITI INFANTS

noreply@blogger.com (Pauline) — Tue, 26 Jan 2010 19:13:00 +0000

URGENT CALL FOR HUMAN MILK DONATIONS FOR HAITI INFANTS

The Human Milk
Banking Association of North America (HMBANA), United States Breastfeeding
Committee (USBC), International Lactation Consultant Association/United
States Lactation Consultant Association (ILCA/USLCA), and La Leche League
International (LLLI) are jointly issuing an urgent call for human milk
donations for premature infants in Haiti, as well as sick and premature
infants in the United States.

This week the first shipment of human
milk from mothers in the United States will be shipped to the U.S. Navy
Ship "Comfort" stationed outside Haiti. "Comfort" is currently set up with
a neonatal intensive care unit and medical personnel to provide urgent
care to victims of the earthquake. An International Board Certified
Lactation Consultant stationed at the U.S. Navy base in Bethesda, MD is
assisting with providing breast pump equipment and supplies to the
"Comfort." Dr. Erika Beard-Irvine, pediatric neonatologist, is on board
the "Comfort" to coordinate distribution of the milk to infants in need.
HMBANA, USBC, ILCA/USLCA, and LLL are responding to requests to provide
milk for both premature infants and at-risk mothers who have recently
delivered babies on board the U.S.N.S. Comfort, but an urgent need exists
for additional donations.

At the current time, the infrastructure to
deliver human milk on land to Haiti infants has not yet been established.
As soon as that infrastructure is in place, additional donations will be
provided to older infants.

Mothers who are willing to donate human milk
should contact their regional Mothers' Milk Bank of HMBANA. A list of
regional milk banks is available at the HMBANA website at www.hmbana.org.
Currently milk banks are already low on donor milk. New milk donations
will be used for both Haiti victims as well as to replenish donor supplies
to continue to serve sick and premature infants in the U.S. Donor milk
provides unique protection for fragile preterm infants. Financial
donations are also strongly encouraged to allow HMBANA, a nonprofit
organization, to continue serving infants in need.

UNICEF, the World
Health Organization, the Emergency Nutrition Network, and medical
professionals all recommend that breastfeeding and human milk be used for
infants in disasters or emergencies. Human milk is life-saving due to its
disease prevention properties. It is safe, clean, and does not depend on
water which is often unavailable or contaminated in an emergency. Relief
workers, health care providers, and other volunteers are urged to provide
support for breastfeeding mothers to enable them to continue
breastfeeding, and to assist pregnant and postpartum women in initiating
and sustaining breastfeeding.

For more information, contact HMBANA at
408-998-4550 or www.hmbana.org . Additional information can be provided
from the United States Breastfeeding Committee at 202-367-1132
(www.usbreastfeeding.org), ILCA/USLCA at 1-800-452-2478 (www.ilca.org ; or
www.uslca.org ), or La Leche League at 847-519-7730 (www.llli.org) .
Sincerely,

Angela Smith, President
ILCA Board of Directors

www.BirthingWisdom.com

10 Tips to Avoid a Cesarean Section

noreply@blogger.com (Pauline) — Fri, 15 Jan 2010 22:45:00 +0000

10 Tips to Avoid a Cesarean Section

Did you know that the United States has a 31.1% Cesarean rate?

Did you know that the hospitals in our area have an even greater rate...40-50%?!

We need to realize that cesareans are major abdominal surgery and that includes all of the risks that go along with major surgery. To name a few: longer hospital stay; longer and more painful recovery; higher risk of infection, organ damage, adhesions, hemorrhage, embolism, and hysterectomy; higher chance of a complication with the next pregnancy; less initial contact with the baby; less success breastfeeding; higher risk of respiratory problems for the baby; and the most catastrophic complication of all: maternal death.

In Susan J. Buckley, M.D.'s book Gentle Birth, Gentle Mothering, she states, "Studies show that the risk of the mother dying after cesarean surgery, although low overall, is around four times higher than after vaginal birth, even considering maternal health conditions."(1-3)

Wow! So what can we as women do about this? The following list is a compilation of tips to help any expectant mother avoid the possibility of major abdominal surgery...a Cesarean section.

10 Tips to Avoid a C-Section

1.Choose a doctor who is supportive of normal vaginal deliveries and one who believes cesareans ought to be avoided.

2. Choose a spontaneous labor.

3. Hire a doula, or labor assistant.

4. Choose to move in labor. Upright positions generally give the best results.

5. Choose intermittent fetal monitoring instead of continuous.

6. Choose an unmedicated birth. If you choose an epidural, wait until you are dilated at least 5 cm to get it. Taking a Childbirth Education Class or HypnoBirthing Class can offer many options for non-medicated births.

7. Learn about different pushing positions and talk to your doctor about this.

8. Take good care of you and your baby during pregnancy. Eat 80 to 100 grams of protein daily.

9. Learn about optimal fetal positioning. http://www.spinningbabies.com/

10. Stay at home until you're sure it's labor.

Educate yourself. Know your options. Ask questions. Know the benefits and risks of various procedures.

THE BIG THREE:
*ALLOW LABOR TO START SPONTANEOUSLY
*STAY AT HOME UNTIL YOU'RE SURE IT'S LABOR
*WAIT UNTIL 5CM IF YOU GET AN EPIDURAL

Afterthoughts: We must realize that in some cases a cesarean is needed in order to have a healthy mother, healthy baby. We are thankful for the technology we have today for those few cases that truly need that kind of intervention. If you do find yourself in this category, there is still hope. Vaginal Birth after Cesarean (VBAC) is a safe and empowering option. You can find out more information and support at the following website: http://www.ican-online.org/

References:
1. Harper MA, Byington RP, Espeland MA, Naughton M, Meyer R, Lane K. Pregnancy-related death and health care services. Obstet Gynecol. Aug 2003;102(2):273-278.
2. Enkin M, Keirse M, Neilson J, et al. Effective Care in Pregnancy and Childbirth. 3rd ed. Oxford: Oxford University Press; 2000.
3. Deneux-Tharaux C, Carmona E, Bouvier-Colle MH, Breart G. Postpartum maternal mortality and cesarean delivery. Obstet Gynecol. Sep 2006;108(3 Pt 1);541-548.

Childbirth Classes New York & New Jersey

noreply@blogger.com (Pauline) — Fri, 15 Jan 2010 22:07:00 +0000

Birthing Wisdom –Childbirth Classes

Please register early as the spaces fill quickly.
It's recommended that you sign up for a childbirth course three months prior to your due date.

This is a comprehensive 8 week series of childbirth and parenting education classes.
Extensive lectures in the birth process, birthing options and numerous relaxation techniques are taught. Other topics include: exercise, nutrition, anatomy, birth planning, cesarean section prevention, breastfeeding and baby care.

The philosophy of the class is based on the belief that birth is a normal and natural function of the human body. Expectant women/couples need to understand the process that lies ahead but also and more importantly, to prepare for this journey physically, mentally and emotionally. With the knowledge gained from the classes, many fears regarding birth and parenting are diminished and or relieved allowing an expectant mother to understand and trust the physical sensations she experiences.
The coach or birth partner is taught how to physically, mentally, emotionally and spiritually support her throughout this wondrous journey.

Pauline Nardella shares with her expectant families 20 plus years experience as a Maternal Child health Nurse and 17 plus years as a childbirth and parenting educator.

Location: Blauvelt, NY
Date & Time: April 27th – June 15th on Tuesday evenings from 7:30-9:30pm
For further information contact:
Pauline Nardella RN, MPA
Clinical Nursing Professor
Certified Childbirth Educator
Board Certified Lactation Consultant
845-323-1830
info@BirthingWisdom.com
www.BirthingWisdom.com

HypnoBirthing® Classes in New York/ New Jersey

noreply@blogger.com (Pauline) — Fri, 15 Jan 2010 21:59:00 +0000

HypnoBirthing® -The Mongan Method

Birthing Wisdom

Please register early as the spaces fill quickly.

This is a comprehensive 5 week series of childbirth, parenting and self hypnosis education classes.
Hypnobirthing® is as much as philosophy as it is a technique. It is a rewarding, relaxing, stress-free method of birthing that is based on the belief that when a mother is properly prepared for birthing physically, mentally, and spiritually, she can experience the joy of birthing her baby in an easier, more comfortable manner.
The method is based on the belief that severe discomfort does not need to be a natural accompaniment of labor.
The aim of the program is to build confidence in the mother and for her to have confidence in her own ability to birth her baby. The philosophy of the Hypnobirthing® program is to educate the mother about the wonders of her body, to eliminate fear, as well as teach her the skills to work with the birthing process rather than fight against it. In many cases it is fear that undermines the mothers confidence in herself. The mother is introduced to techniques of self hypnosis utilizing controlled deep breathing, visualization and imagery to produce deep relaxation.

The coach and birth partner is taught how to physically, mentally, emotionally and spiritually support her throughout this wondrous journey. Extensive lectures in the birth process, birthing options and numerous self- hypnotic & relaxation techniques are taught. Other topics include: exercise, nutrition, anatomy, birth planning, c-section prevention, breastfeeding and baby care.

Location: Blauvelt, NY
Date & Time: March 9th - April 13th Tuesday evenings from 7:00-9:30pm
For further information contact:
Pauline Nardella RN, MPA, CCE
845-680-0385
info@BirthingWisdom.com
www.BirthingWisdom.com
National website for HypnoBirthing: www.HypnoBirthing.com

Prevention of Obesity in Breastfeeding Mothers and their Babies

noreply@blogger.com (Pauline) — Fri, 15 Jan 2010 21:49:00 +0000

Prevention of Obesity in Breastfeeding Mothers and
their Babies

Morrisville, NC-The United States Lactation Consultant Association
(USLCA) recognizes that obesity is a common problem in the United States
for both women and children. January is Healthy Weight Management Month. One of
the easiest and most healthy ways to prevent obesity is to breastfeed and to be
breastfed. In the United States 32.7% of U.S. adults 20 years and older are
overweight, 34.3% are obese and 5.9% are extremely obese. The American Obesity Association
states that 15.5% of
adolescents (ages 12 to 19) and 15.3% of children (ages 6 to 11) are obese.These
alarming statistics also drive up health care costs by $100 billion a year.

Since 1960, the rate of obese Americans has been on the rise. Children who are obese
at a young age are at risk for diabetes, heart disease, metabolic disorders,
depression and other diseases which will impact the rest of their lives. It is
estimated that the increase of obesity in this country has also attributed to
the death rate in our country. Each year in the U.S obesity causes at least
300,000 unnecessary deaths. The states with the lowest rates of breastfeeding
generally demonstrate the highest rates of overweight and obesity.

Breastfeeding an infant through the first year can decrease childhood obesity. The Centers
for Disease Control and Prevention have reported that "for each month of
exclusive breastfeeding, up to age 9 months, the risk of obesity is decreased
by 4%." By breastfeeding a child for 9 months or more there is a 30% less
chance of a child being an overweight adult. Lactation has also been associated
with postpartum
weight loss in the exclusively breastfeeding mother.

Not only do breastfed infants reduce their likelihood of childhood obesity, they
are taught and learn from an early age what the most nutritious foods are and how
to make healthy choices. These healthy choices can potentially impact an
adult's health and can avoid the many diseases obesity can cause.

USLCA president, Laurie Beck, RN, MSN,
IBCLC calls upon hospitals, physicians, and all other health care providers to
recommend and support breastfeeding as an early preventive health behavior in
the efforts to educate women on the prevention of obesity. "Educating parents
on the optimal nutrition breast milk provides is important for healthy families
and can decrease the rate of childhood obesity in this country." says Beck.

Knowledgeable
professional breastfeeding support can be obtained from lactation consultants
with the IBCLC credential (International Board Certified Lactation Consultant).
To locate a lactation consultant for assistance with breastfeeding go to http://www.uslca.org.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Mission: To build and sustain a national association that
advocates for lactation professionals
Vision: IBCLCs
are valued recognized members of the health care team.

The United States Lactation Consultant Association(ULSCA), is
organized exclusively for the advocacy of Lactation Professionals, including
educational and scientific purposes as contemplated by Section 501 (c) (6) of
the United States Internal Revenue Code.
www.BirthingWisdom.com

10 Ways to Dramatically Increase Your Child's Health

noreply@blogger.com (Pauline) — Thu, 14 Jan 2010 17:18:00 +0000

10 Ways to Dramatically Increase Your Child's Health

By Jane Sheppard
Copyright 2010 Healthy Child
Our children are supposed to thrive. And they normally do when we allow them to develop naturally without undue interference and provide them with essential required components for health.
I put together a list of the most important ways you can increase and maintain optimum health in your children. Keep in mind that you don't have to do everything all at once. It can be overwhelming when you try to make too many changes too quickly. You can begin slowly and take one step at a time. There are probably things you are already doing or have done (for instance, your child may be past the time for breastfeeding).
If you're a new parent with a baby on the way, this is perfect timing. This information should help you give them a great beginning.
If your child is older, rest assured that there is always something more you can do to improve your child's health. And it is never too late to begin.
This short list is an introduction to natural child health care. There is much more to know. The articles on Healthy Child's website and future articles, interviews, seminars, etc. that are published in Healthy Child newsletter will provide greater depth of information.
Breastfeed - Exclusively and Extended

You've heard the term, Breast is Best. It's absolutely true. Babies are designed to thrive exclusively on human milk. Breastfeeding promotes proper brain development and protects against infectious and chronic diseases. It provides all the nutrition your baby needs.
When you breastfeed exclusively, you give your baby only breastmilk without any additional food or drink, not even water. Supplementing with formula can inhibit the natural flow and supply of breastmilk, decrease the nutrition and immune factors a baby would receive by getting breastmilk alone, and may undermine the ongoing mother and child breastfeeding/bonding experience.
What is meant by extended breastfeeding is to breastfeed long-term (as long as possible) and let your child decide when to wean. This builds a healthy immune system, increases the mother/child bond, and is by far the healthiest thing you can do for your child. Breastmilk continues to provide nutrition and immune factors during the first and second years of life and even beyond.
The World Health Organization recommends exclusive breastfeeding for the first six months of life, followed by continued extended breastfeeding with healthy foods for up to two years or beyond.
If you are unable to breastfeed, the next best thing is to receive donor breastmilk. If not able to obtain donor milk, then make your own formula according to nutritional guidelines that come as close to human milk as possible. Commercial formula is available only as a last resort.
http://www.healthychild.com/for-healthy-immunity/breastfeeding-for-a-strong-immune-system/
http://www.westonaprice.org/Children-s-Health/
http://www.westonaprice.org/Feeding-Babies.html
Formula [http://clicks.aweber.com/y/ct/?l=9wrFh&m=KdSvVFZg1HeNkG&b=vx1yfbEkqdB9K43gE2VK2Q] Recipes
http://www.westonaprice.org/Recipes-for-Homemade-Baby-Formula.html
Donor Milk
This site provides an alternative to expensive milk banks that pasteurize the milk. Pasteurization not only kills bacteria (both good and bad), it may also kill the essential immune components of breastmilk.
http://milkshare.birthingforlife.com/ ;

Vitamin D - Ensure an Optimum Level
Vitamin D is extremely important to your child's health. It's crucial for your child's brain development and immune system. The current RDA and the usual amounts of vitamin D in multi-vitamins is not enough. And it's impossible to get enough from food alone to maintain optimal levels.
Children should be getting about 1,000 IU of vitamin D3 (cholecalciferol) per 25 pounds of body weight. Both children and adults should have 25(OH)D levels greater than 50 ng/mL, year-round.
If you're pregnant or breastfeeding, your levels need to be optimal so that your baby is not vitamin D deficient. This article explains more:
http://www.healthychild.com/pregnancy/pregnancy-and-gestational-vitamin-d-deficiency/
20-30 minutes of summer sun exposure (without sunscreen) produces approximately 10,000 IU of vitamin D in a light-skinned person. For darker skin, exposure may need to be longer. If your child is not getting a good amount of sun exposure almost every day, vitamin D needs to be supplemented.
Listen to this interview with John Cannell, MD, Director of the Vitamin D Council on preventing vitamin D deficiency in pregnancy, babies and children. He gives specifics on vitamin D and provides important details about vitamin D supplements.
Dr. Cannell's Interview:
http://www.healthychild.com/immune-system-support/vitamin-d-deficiency-in-pregnancy-babies-children/
You'll find plenty of research and information about Vitamin D at this site:
http://www.vitamindcouncil.org/

Whole foods Diet
Stop buying the processed, convenience foods that are loaded with corn syrup and other refined sugars, unhealthy fats, processed white flour, preservatives, additives, and colorings. These denatured, processed foods do not provide sufficient nutrients to allow a child's body to reach its full potential of health.
Children need natural, whole foods that are prepared and preserved in a way that promotes health, not disease. Whole foods are unrefined grains, beans, nuts, seeds, fruits and vegetables as well as moderate amounts of unprocessed, humanely raised, grass-fed animal products. Your child's body relies on the nutrients from these foods for proper growth as well as mental and physical vitality. A deficiency of even one important nutrient can cause imbalances that can lead to disease. Whole foods also provide a wealth of protective compounds that can help prevent disease.
In addition to important minerals, children's diets should contain large amounts of natural vitamins A and C derived from fruits (oranges, strawberries, peaches, nectarines, mango) and vegetables (broccoli, carrots, squash, yams, red bell peppers). Vitamin A is also found in fish and eggs. They also need calcium, magnesium and other minerals to maintain health and process other nutrients. The best non-dairy sources of calcium are dark green vegetables and sesame seeds (or tahini). Vitamin D is needed for calcium absorption and magnesium, zinc, boron, and vitamin K are co-factors necessary for vitamin D to work properly. Please understand the body needs a varied whole foods diet to obtain all the nutrients that work synergistically to optimize health.
http://www.healthychild.com/child-nutrition/whole-foods-nutrition-for-healthy-kids/
http://www.healthychild.com/child-nutrition/processed-food-and-low-fat-diets/
http://www.healthychild.com/child-nutrition/the-health-benefits-of-grassfed-animal-products/
http://www.healthychild.com/child-nutrition/why-grassfed-is-best/
http://www.healthychild.com/teaching-wellness/encouraging-children-to-eat-healthy/

Healthy Fats
Healthy fats supply nutrients that are essential for growth and are necessary for energy as well as the absorption and metabolism of some nutrients. Fats are vitally important to the brain, which is 70 percent fat. They are used for building the membranes around every cell in the body and also play a role in the formation of hormones. Cold-pressed olive and flaxseed oils, fish oils, seeds, nuts, eggs, avocados, grass-fed meats, butter and whole, raw milk from grass-fed cows are good fat-containing foods.
These articles provide important information on essential fatty acids (EFAs):
http://www.healthychild.com/child-nutrition/children-need-fats-to-be-healthy/
http://www.healthychild.com/child-nutrition/fats-and-oils-for-childrens-health/

Reduce the Sugar
Most kids get way too much sugar in their diets. Sugar can suppress immunity and create mineral deficiencies, acidic digestive issues, obesity, diabetes, tooth decay, and a host of other chronic health problems. It also can cause a rapid rise of adrenaline and lead to hyperactivity, anxiety, attention problems, and irritability. You can reduce the amount your child eats, replace it with whole fruit and use healthier sweeteners in baking.
http://www.healthychild.com/sugar-and-sweeteners/sugar-n-spice-and-everything-nice/
http://www.healthychild.com/sugar-and-sweeteners/stevia-healthy-and-sweet/

Reduce the toxins
Babies' small bodies are much more vulnerable to toxic chemicals than adults since their neurological, immunological, respiratory, and other biological systems are still developing, limiting their ability to detoxify and excrete the many different toxins entering their fragile systems. Chemical exposure during the critical period of brain development can be particularly problematic. Low-level chemical exposures during susceptible periods of development can cause more harm than high doses later in life.
Read our comprehensive report on protecting your child from toxic exposures:
http://www.healthychild.cm/protect-your-baby-from-toxic-exposures/
More articles:
http://www.healthychild.com/preventing-toxic-exposures/

Question antibiotics
Antibiotics have saved many lives over the past 45 years. We are truly fortunate to have them available for serious bacterial infections. Unfortunately, antibiotics are excessively prescribed, especially to children. The Center for Disease Control estimates that of the 235 million doses of antibiotics given each year, between 20 and 50 percent are unnecessary. Tragically, this overuse of antibiotics can cause devastating health consequences to children.
http://www.healthychild.com/pharmaceutical-drugs/consequences-of-excessive-antibiotic-use/
http://www.healthychild.com/pharmaceutical-drugs/antibiotics-for-strep/

Question Vaccines
If you dig a little deeper into the vaccine issue, you'll find many gaps and limitations in the data and knowledge regarding vaccine safety. Vaccines are capable of causing serious damage. Because they contain lab-altered viruses, bacteria and toxic substances, vaccines have the ability to cause mild to severe neurological and immune damage, or even death, depending on the vaccine given, the combination of vaccines given, the health of the child at the time of vaccination, and the genetic or biological factors that predispose the child to this damage. Many parents and doctors are beginning to question the practice of injecting toxic substances into the bodies of small babies and artificially manipulating their fragile immune systems during the crucial time of brain and immune development.
http://www.healthychild.com/vaccine-choices/

Establish a Wellness Mindset
In raising healthy children, it's not enough to just focus on the physical aspect of health. To be truly healthy, a child's emotional health must be nurtured and strengthened. Developing a mental attitude of wellness is also essential. When we adopt an attitude of wellness, we take on a belief that being well is a natural, normal state. Our goal is to have outstanding, vibrant health, not just to be free of disease. With a wellness attitude, we know that we have control over our own body and how healthy it will be.
We can teach and help our children to grow up with an attitude of wellness. Children have much more control over their own health than you may think. The mind is a very powerful mechanism with miraculous control over health and healing. The more children learn to use the extraordinary powers of their minds, the healthier and happier they will be. They may also live longer than someone who takes a passive or negative approach to health.
Frequently remind your child that his or her body is amazing and they are healthy and well.
http://www.healthychild.com/teaching-wellness/a-wellness-approach-for-children/

Create and Maintain a Healthy Parent-Child Bond
To help our children reach their greatest potential, we must first create a strong bond and connection with them before, during, and after birth and consistently nurture and strengthen this connection throughout their entire childhood. Children who receive continual nurturing, plenty of loving physical contact, and have a healthy, bonded relationship with at least one parent know at a deep, core level that they are loved and valued for who they are - just because they exist. With a healthy sense of their value and worthiness, children can more easily tap into their natural state of health and happiness and develop their full potential - physically, emotionally, and mentally. We show them how to love and value themselves by being present for them and tending to their emotional needs.
http://www.healthychild.com/attachment-and-connection/parenting-our-children-to-reach-their-full-potential/
More articles on bonding and attachment:
http://www.healthychild.com/attachment-and-connection/

Healthy Child, 1275 Fourth Street, #118, Santa Rosa, CA 95404, USA

Infant/Child CPR, Choking and Safety

noreply@blogger.com (Pauline) — Tue, 12 Jan 2010 03:45:00 +0000

Infant/Child CPR, Choking & Safety

In the US nearly 400 children under the age of four die every month due to unintentional accidents!
This class presents age appropriate home proofing and safety concerns inside and outside the home from infancy to toddlerhood. Learn how to deal with an emergency situation.

Infant/Child CPR and choking will be presented and reviewed by participants with hands-on return demonstration on sanitary "CPR Manikins."

Safety & CPR handouts are given to each participant for display at home.
Location: Full Circle Family Care, White Plains, NY
Three Class offerings in 2010.
Date: January 28th, March 4th or May 6th
Time: 10am-12:30pm
Fee: $50.00/person or $75/couple
Class size is limited so sign up early.
You can reserved your space in this class by sending the class fee to:
Pauline Nardella, RN, MPA
2 Private Lovett Ct
Blauvelt, NY 10913

Private classes also offered for 10 participants

To receive further information or to sign up for the next class
go to info@BirthingWisdom.com
or call 845-680-0385

The Hidden Risk of Epidurals

noreply@blogger.com (Pauline) — Sat, 19 Dec 2009 22:02:00 +0000

The Hidden Risk of Epidurals
http://www.mothering.com/pregnancy-birth/the-hidden-risk-of-epidurals
A common intervention, epidurals are given to reduce pain during birth. But at what cost? A leading Australian physician discusses how this invasive procedure actually impedes labor and harms both mother and baby. Adapted from the book Gentle Birth, Gentle Mothering; The wisdom and science of gentle choices in pregnancy, birth, and parenting available from www.sarahjbuckley.com

By Sarah J. Buckley
Issue 133, November/December 2005

The first recorded use of an epidural was in 1885, when New York neurologist J. Leonard Corning injected cocaine into the back of a patient suffering from "spinal weakness and seminal incontinence."1 More than a century later, epidurals have become the most popular method of analgesia, or pain relief, in US birth rooms. In 2002, almost two-thirds of laboring women, including 59 percent of women who had a vaginal birth, reported that they were administered an epidural.2 In Canada in 2001-2002, around half of women who birthed vaginally used an epidural,3 and in the UK in 2003-2004, 21 percent of women had an epidural before or during delivery.4

Epidurals involve the injection of a local anesthetic drug (derived from cocaine) into the epidural space"hthe space around (epi) the tough coverings (dura) that protect the spinal cord. A conventional epidural will numb or block both the sensory and motor nerves as they exit from the spinal cord, giving very effective pain relief for labor but making the recipient unable to move the lower part of her body. In the last five to ten years, epidurals have been developed with lower concentrations of local anesthetic drugs, and with combinations of local anesthetics and opiate painkillers (drugs similar to morphine and meperidine) to reduce the motor block. They produce a so-called walking epidural. Spinal analgesia has also been increasingly used in labor to reduce the motor block. Spinals involve drugs injected right through the dura and into the spinal (intrathecal) space, and they produce only short-term analgesia. To prolong the pain-relieving effect for labor, epidurals are now being coadministered with spinals, as a combined spinal epidural (CSE).

Epidurals and spinals offer laboring women the most effective form of pain relief available, and women who have used these analgesics rate their satisfaction with pain relief as very high. However, satisfaction with pain relief does not equate with overall satisfaction with birth,5 and epidurals are associated with major disruptions to the processes of birth. These disruptions can interfere with a woman's ultimate enjoyment of and satisfaction with her labor experience, and they may also compromise the safety of birth for the mother and baby.

Epidurals and Labor Hormones
Epidurals significantly interfere with some of the major hormones of labor and birth, which may explain their negative effect on the processes of labor.6 As the World Health Organization comments, "epidural analgesia is one of the most striking examples of the medicalization of normal birth, transforming a physiological event into a medical procedure."7

For example, oxytocin, known as the hormone of love, is also a natural uterotonic"ha substance that causes a woman's uterus to contract in labor. Epidurals lower the mother's release of oxytocin8 or stop its normal rise during labor.9 The effect of spinals on oxytocin release is even more marked.10 Epidurals also obliterate the maternal oxytocin peak that occurs at birth11"hthe highest of a mother's lifetime"hwhich catalyzes the final powerful contractions of labor and helps mother and baby fall in love at first meeting. Another important uterotonic hormone, prostaglandin F2 alpha, is also reduced in women using an epidural.12

Beta-endorphin is the stress hormone that builds up in a natural labor to help the laboring woman transcend pain. Beta-endorphin is also associated with the altered state of consciousness that is normal in labor. Being "on another planet" as some describe it, helps the mother-to-be to work instinctively with her body and her baby, often using movement and sounds. Epidurals reduce the laboring woman's release of beta-endorphin.13, 14 Perhaps the widespread use of epidurals reflects our difficulty with supporting women in this altered state, and our cultural preference for laboring women to be quiet and acquiescent.

Adrenaline and noradrenaline (epinephrine and norepinephrine, collectively known as catecholamines, or CAs) are also released under stressful conditions, and levels naturally increase during an unmedicated labor.15 At the end of an undisturbed labor, a natural surge in these hormones gives the mother the energy to push her baby out and makes her excited and fully alert at first meeting with her baby. This surge is known as the fetal ejection reflex.16

However, labor is inhibited by very high CA levels, which may result when the laboring woman feels hungry, cold, fearful, or unsafe.17 This response makes evolutionary sense: If the mother senses danger, her hormones will slow or stop labor and give her time to flee to find a safer place to birth.

Epidurals reduce the laboring woman's release of CAs, which may be helpful if high levels are inhibiting her labor. However, a reduction in the final CA surge may contribute to the difficulty that women laboring with an epidural can experience in pushing out their babies, and to the increased risk of instrumental delivery (forceps and vacuum) that accompanies the use of an epidural (see below).

Effects on the Process of Labor
Epidurals slow labor, possibly through the above effects on the laboring woman's oxytocin release, although there is also evidence from animal research that the local anesthetics used in epidurals may inhibit contractions by directly affecting the muscle of the uterus.18 On average, the first stage of labor is 26 minutes longer in women who use an epidural, and the second, pushing stage is 15 minutes longer.19 Loss of the final oxytocin peak probably also contributes to the doubled risk of an instrumental delivery"hvacuum or forceps"hfor women who use an epidural,20 although other mechanisms may be involved.

For example, an epidural also numbs the laboring woman's pelvic floor muscles, which are important in guiding her baby's head into a good position for birth. When an epidural is in place, the baby is four times more likely to be persistently posterior (POP, or face up) in the final stages of labor"h13 percent compared to 3 percent for women without an epidural, according to one study.21 A POP position decreases the chance of a spontaneous vaginal delivery (SVD); in one study, only 26 percent of first-time mothers (and 57 percent of experienced mothers) with POP babies experienced an SVD; the remaining mothers had an instrumental birth (forceps or vacuum) or a cesarean.22

Anesthetists have hoped that a low-dose or combined spinal epidural would reduce the chances of an instrumental delivery, but the improvement seems to be modest. In one study, the Comparative Obstetric Mobile Epidural Trial (COMET), 37 percent of women with a conventional epidural experienced instrumental births, compared with 29 percent of women using low-dose epidurals and 28 percent of women using combined spinal epidurals.23

For the baby, instrumental delivery can increase the short-term risks of bruising, facial injury, displacement of the skull bones, and cephalohematoma (blood clot under the scalp).24 The risk of intracranial hemorrhage (bleeding inside the brain) was increased in one study by more than four times for babies born by forceps compared to those with spontaneous births,25 although two studies showed no detectable developmental differences for forceps-born children at five years old.26, 27 Another study showed that when women with an epidural had a forceps delivery, the force used by the clinician to deliver the baby was almost twice the force used when an epidural was not in place.28

Epidurals also increase the need for Pitocin to augment labor, probably due to the negative effect on the laboring woman's own release of oxytocin. Women laboring with an epidural in place are almost three times more likely to be administered Pitocin.29 The combination of epidurals and Pitocin, both of which can cause abnormalities in the fetal heart rate (FHR) that indicate fetal distress, markedly increases the risk of operative delivery (forceps, vacuum, or cesarean delivery). In one Australian survey, about half of first-time mothers who were administered both an epidural and Pitocin had an operative delivery.30

The impact of epidurals on the risk of cesarean is contentious; differing recent reviews suggest no increased risk31 and an increase in risk of 50 percent.32 The risk is probably most significant for women having an epidural with their first baby.33

Note that the studies used to arrive at these conclusions are mostly randomized controlled trials in which the women who agree to participate are randomly assigned to either epidural or nonepidural pain relief. Nonepidural pain relief usually involves the administration of opiates such as meperidine (aka pethidine). Many of these studies are flawed from high rates of crossover"hwomen who were assigned to nonepidurals but who ultimately did have epidurals, and vice versa. Also, noting that there are no true controls"hthat is, women who are not using any form of pain relief"hthese studies cannot tell us anything about the impact of epidurals compared to birth without analgesic drugs.

Epidural Techniques and Side Effects
The drugs used in labor epidurals are powerful enough to numb, and usually paralyze, the mother's lower body, so it is not surprising that there can be significant side effects for mother and baby. These side effects range from minor to life-threatening and depend, to some extent, on the specific drugs used.

Many of the epidural side effects mentioned below are not improved with low-dose or walking epidurals, because women using these techniques may still receive a substantial total dose of local anesthetic, especially when continuous infusions and/or patient-controlled boluses (single large doses) are used.34 The addition of opiate drugs in epidurals or CSEs can create further risks for the mother, such as pruritus (itching) and respiratory depression (see below).

Maternal Side Effects
The most common side effect of epidurals is a drop in blood pressure. This effect is almost universal and is usually preempted by administering IV fluids before placing an epidural. Even with this "preloading" episodes of significant low blood pressure (hypotension) occur for up to half of all women laboring with an epidural,35, 36 especially in the minutes following the administration of a drug bolus. Hypotension can cause complications ranging from feeling faint to cardiac arrest37 and can also affect the baby's blood supply (see below). Hypotension can be treated with more IV fluids and, if severe, with injections of epinephrine (adrenaline).

Other common side effects of epidurals include inability to pass urine (necessitating a urinary catheter) for up to two-thirds of women;38 itching of the skin (pruritus) for up to two-thirds of women administered an opiate drug via epidural;39, 40 shivering for up to one in three women;41 sedation for around one in five women;42 and nausea and vomiting for one in twenty women.43

Epidurals can also cause a rise in temperature in laboring women. Fever over 100.4 F (38 C) during labor is five times more likely overall for women using an epidural;44 this rise in temperature is more common in women having their first babies, and more marked with prolonged exposure to epidurals.45 For example, in one study, 7 percent of first-time mothers laboring with an epidural were feverish after six hours, increasing to 36 percent after 18 hours.46 Maternal fever can have a significant effect on the baby (see below).

Opiate drugs, especially administered as spinals, can cause unexpected breathing difficulties for the mother, which may come on hours after birth and may progress to respiratory arrest. One author comments, "Respiratory depression remains one of the most feared and least predictable complications of intrathecal [spinal] opioids."47

Many observational studies have found an association between epidural use and bleeding after birth (postpartum hemorrhage).48-53 For example, a large UK study found that women were twice as likely to experience postpartum hemorrhaging when they used an epidural in labor.54 This statistic may be related to the increase in instrumental births and perineal trauma (causing bleeding), or may reflect some of the hormonal disruptions mentioned above.

An epidural gives inadequate pain relief for 10 to 15 percent of women,55 and the epidural catheter needs to be reinserted in about 5 percent.56 For around 1 percent of women, the epidural needle punctures the dura (dural tap); this usually causes a severe headache that can last up to six weeks, but can usually be treated by an injection into the epidural space.57, 58

More serious side effects are rare. If epidural drugs are inadvertently injected into the bloodstream, local anesthetics can cause toxic effects such as slurred speech, drowsiness, and, at high doses, convulsions. This error occurs in around one in 2,800 epidural insertions.59 Overall, life-threatening reactions occur for around one in 4,000 women.60-63 Death associated with an obstetric epidural is very rare,64 but it can be caused by cardiac or respiratory arrest, or by an epidural abscess that develops days or weeks afterward.

Later complications include weakness and numbness in 4 to 18 per 10,000 women. Most of these complications resolve spontaneously within three months.65-69 Longer-term or permanent problems can arise from damage to a nerve during epidural placement; from abscess or hematoma (blood clot), which can compress the spinal cord; and from toxic reactions in the covering of the spinal cord, which can lead to paraplegia.70

Side Effects for the Baby
Some of the most significant and well-documented side effects for the unborn baby (fetus) and newborn derive from effects on the mother. These include, as mentioned above, effects on her hormonal orchestration, blood pressure, and temperature regulation. As well, drug levels in the fetus and newborn may be even higher than in the mother,71 which may cause direct toxic effects. For example, epidurals can cause changes in the fetal heart rate (FHR) that indicate that the unborn baby is lacking blood and oxygen. This effect is well known to occur soon after the administration of an epidural (usually within the first 30 minutes), can last for 20 minutes, and is particularly likely following the use of opiate drugs administered via epidural and spinal. Most of these changes in FHR will resolve themselves spontaneously with a change in position. More rarely, they may require drug treatment.72 More severe changes, and the fetal distress they reflect, may require an urgent cesarean.

Note also that the use of opiate drugs for labor analgesia can also cause FHR abnormalities. This process makes the real effects of epidurals on FHR hard to assess because, in almost all randomized trials, epidurals are compared with meperidine or other opiate drugs. One researcher notes that the supine position (lying on the back) may contribute significantly to hypotension and FHR abnormalities when an epidural is in place.73 Another found that the supine position (plus epidural) was associated with a significant decrease in the oxygen supply to the baby's brain (fetal cerebral oxygenation).74

The baby can also be affected by an epidural-induced rise in the laboring mother's temperature. In one large study of first-time mothers, babies born to febrile (feverish) mothers, 97 percent of whom had received epidurals, were more likely than babies born to afebrile mothers to be in poor condition (low Apgar score); have poor tone; require resuscitation (11.5 percent versus 3 percent); or have seizures in the newborn period.75 One researcher noted a tenfold increase in risk of newborn encephalopathy (signs of brain damage) in babies born to febrile mothers.76

Maternal fever in labor can also directly cause problems for the newborn. Because fever can be a sign of infection involving the uterus, babies born to febrile mothers are almost always evaluated for infection (sepsis). Sepsis evaluation involves prolonged separation from the mother, admission to special care, invasive tests, and, most likely, administration of antibiotics until test results are available. In one study of first-time mothers, 34 percent of epidural babies were given a sepsis evaluation compared to 9.8 percent of nonepidural babies.77

Drugs and Toxicity
Every drug that the mother receives in labor will pass through the placenta to her baby, who is more vulnerable to toxic effects. The maximum effects are likely to be at birth and in the hours immediately after, when drug levels are highest.

There are few studies of the condition of epidural babies at birth, and almost all of these compare babies born after epidurals with babies born after exposure to opiate drugs, which are known to cause drowsiness and difficulty with breathing. These studies show little difference between epidural and nonepidural (usually opiate-exposed) babies in terms of Apgar score and umbilical-cord pH, both of which reflect a baby's condition at birth.78 However, a large-population survey from Sweden found that use of an epidural was significantly associated with a low Apgar score at birth.79

There are also reports of newborn drug toxicity from epidural drugs, especially opiates administered via epidural.80 Newborn opiate toxicity seems more likely with higher dose regimes, including those where the mother is able to self-administer extra doses, although there are wide differences in individual newborn sensitivity.81

It is important to note that a newborn baby's ability to process and excrete drugs is much less than an adult's. For example, the half-life (time to reduce drug blood levels by half) for the local anesthetic bupivacaine (Marcaine) is 8.1 hours in the newborn, compared to 2.7 hours in the mother.82 Also, drug blood levels may not accurately reflect the baby's toxic load because drugs may be taken up from the blood and stored in newborn tissues such as the brain and liver,83 from where they are more slowly released.84

A recent review also found higher rates of jaundice for epidural-exposed babies. This result may be related to the increase in instrumental deliveries or to the increased use of Pitocin.85

Neurobehavioral Effects
The effects of epidural drugs on newborn neurobehavior (behavior that reflects brain state) are controversial. Older studies comparing babies exposed to epidurals with babies whose mothers received no drugs have found significant neurobehavioral effects, whereas more recent findings from randomized controlled trials (which, as noted, compare epidural- and opiate-exposed newborns) have found no differences. However, these older studies also used the more comprehensive (and difficult to administer) Brazelton Neonatal Behavioral Assessment Score (NBAS, devised by pediatricians), whereas more recent tests have used less complex procedures, especially the Neurologic and Adaptive Capacity Score (NACS, devised by anesthesiologists), which aggregates all data into a single figure and which has been criticized as insensitive and unreliable.86-88

For example, all three studies comparing epidural-exposed with unmedicated babies, and using the NBAS, found significant differences between groups:89

Ann Murray et al. compared 15 unmedicated with 40 epidural-exposed babies and found that the epidural babies still had a depressed NBAS score at five days, with particular difficulty controlling their state. Twenty babies whose mothers had received oxytocin as well as an epidural had even more depression of NBAS scores, which may be explained by their higher rates of jaundice. At one month, epidural mothers found their babies "less adaptable, more intense and more bothersome in their behavior." These differences could not be explained by the more difficult deliveries and subsequent maternal-infant separations associated with epidurals.90

Carol Sepkoski et al. compared 20 epidural babies with 20 unmedicated babies, and found less alertness and ability to orient for the first month of life. The epidural mothers spent less time with their babies in the hospital, in direct proportion to the total dose of bupivacaine administered.91 Deborah Rosenblatt et al. tested epidural babies with NBAS over six weeks and found maximal depression on the first day. Although there was some recovery, at three days epidural babies still cried more easily and more often; aspects of this problem ("control of state") persisted for the full six weeks.92

Although these older studies used conventional epidurals, the total dose of bupivacaine administered to the mothers (in these studies, mean doses of 61.6 mg,93 112.7 mg,94 and 119.8 mg,95 respectively) was largely comparable to more recent low-dose studies (for example, 67.5 mg,96 91.1 mg,97 and 101.1 mg98).

These neurobehavioral studies highlight the possible impact of epidurals on newborns and on the evolving mother-infant relationship. In their conclusions, the researchers express concern about "the importance of first encounters with a disorganized baby in shaping maternal expectations and interactive styles."99

Animal Studies
Animal studies suggest that the disruption of maternal hormones caused by epidurals, described above, may also contribute to maternal-infant difficulties. Researchers who administered epidurals to laboring sheep found that the epidural ewes had difficulty bonding to their newborn lambs, especially those in first lambing with an epidural administered early in labor.100

There are no long-term studies of the effects of epidural analgesia on exposed human offspring. However, studies on some of our closest animal relatives give cause for concern. M. S. Golub et al. administered epidural bupivacaine to pregnant rhesus monkeys at term and followed the development of the exposed offspring to age 12 months (equivalent to four years in human offspring). She found that milestone achievement was abnormal in these monkeys: at six to eight weeks they were slow in starting to manipulate, and at ten months the increase in "motor disturbance behaviors" that normally occurs was prolonged.101 The author concludes, "These effects could occur as a result of effects on vulnerable brain processes during a sensitive period, interference with programming of brain development by endogenous [external] agents or alteration in early experiences."102

Breastfeeding
As with neurobehavior, effects on breastfeeding are poorly studied, and more recent randomized controlled trials comparing exposure to epidural and opiate drugs are especially misleading because opiates have a well-recognized negative effect on early breastfeeding behavior and success.103-107

Epidurals may affect the experience and success of breastfeeding through several mechanisms. First, the epidural-exposed baby may have neurobehavioral abnormalities caused by drug exposure that are likely to be maximal in the hours following birth"ha critical time for the initiation of breastfeeding. Recent research has found (rather obviously) that the higher the newborn's neurobehavior score, the higher his or her score for breastfeeding behavior.108

In another study, the baby's breastfeeding abilities, as measured by the Infant Breastfeeding Assessment Tool (IBFAT), were highest among unmedicated babies, lower for babies exposed to epidurals or IV opiates, and lowest for babies exposed to both. Infants with lower scores were weaned earlier, although overall, similar numbers in all groups were breastfeeding at six weeks.109 In other research, babies exposed to epidurals and spinals were more likely to lose weight in the hospital, which may reflect poor feeding efficiency.110 Other research has suggested that newborn breastfeeding behavior and NACS scores may be normal when an ultra-low-dose epidural is used, although even in this study, babies with higher drug levels had lower neurobehavior (NACS) scores at "Ntwo hours.111

Second, epidurals may affect the new mother, making breastfeeding more difficult. This situation is likely if she has experienced a long labor, an instrumental delivery, or separation from her baby, all of which are more likely following an epidural. Hormonal disruptions may also contribute, as oxytocin is a major hormone of breastfeeding.

One study found that babies born after epidurals were less likely to be fully breastfed on hospital discharge; this was a special risk for epidural mothers whose babies did not feed in the first hour after birth.112 A Finnish survey records that 67 percent of women who had labored with an epidural reported partial or full formula feeding in the first 12 weeks compared to 29 percent of nonepidural mothers; epidural mothers were also more likely to report having "not enough milk."113

Two groups of Swedish researchers have looked at the subtle but complex breastfeeding and prebreastfeeding behavior of unmedicated newborns. One group has documented that when placed skin-to-skin on the mother's chest, a newborn can crawl up, find the nipple, and self-attach.114 Newborns affected by opiate drugs in labor or separated from their mothers briefly after birth lose much of this ability. The other Swedish group found that newborns exposed to labor analgesia (mostly opiates, but including some epidurals) were also disorganized in their prefeeding behavior"hnipple massage and licking, and hand sucking"hcompared to unmedicated newborns.115

Satisfaction with Birth
Obstetric care providers have assumed that control of pain is the foremost concern of laboring women and that effective pain relief will ensure a positive birth experience. In fact, there is evidence that the opposite may be true. Several studies have shown that women who use no labor medication are the most satisfied with their birth experience at the time,116 at six weeks,117 and at one year after the birth.118 In a UK survey of 1,000 women, those who had used epidurals reported the highest levels of pain relief but the lowest levels of satisfaction with the birth, probably because of the higher rates of intervention.

Finally, it is noteworthy that caregiver preferences may to a large extent dictate the use of epidurals and other medical procedures for laboring women. One study found that women under the care of family physicians with a low mean use of epidurals were less likely to receive monitoring and Pitocin, to deliver by cesarean, and to have their babies admitted to newborn special care.119

conclusion
Epidurals have possible benefits but also significant risks for the laboring mother and her baby. These risks are well documented in the medical literature but may not be disclosed to the laboring woman. Women who wish to avoid the use of epidurals are advised to choose caregivers and models of care that promote, support, and understand the principles and practice of natural and undisturbed birth.

NOTES
1. G. R. Hamilton and T. F. Baskett, "In the Arms of Morpheus: The Development of Morphine for Postoperative Pain Relief" Can J Anaesth 47, no. 4 (2000): 367-374.
2. E. Declercq et al., Listening to Mothers: Report of the First National U.S. Survey of Women's Childbearing Experiences (New York: Maternity Center Association, October 2002): 1.
3. Canadian Institute for Health Information, Giving Birth in Canada: A Regional Profile (Ontario: CIHA, 2004):7
4. National Health Service, NHS Maternity Statistics, England: 2003-04 (Crown Copyright, 2005): 6.
5. E. D. Hodnett, "Pain and Women's Satisfaction with the Experience of Childbirth: A Systematic Review" Am J Obstet Gynecol 186, Supplement 5 (2002): S160-S172.
6. S. J. Buckley, "Ecstatic Birth: The Hormonal Blueprint of Labor" Mothering no. 111 (March-April 2002): http://www.mothering.com/articles/pregnancy_birth/birth_preparation/ecstatic.html
7. World Health Organization, Care in Normal Birth: A Practical Guide. Report of a Technical Working Group (Geneva: World Health Organization, 1996): 16.
8. V. A. Rahm et al., "Plasma Oxytocin Levels in Women During Labor With or Without Epidural Analgesia: A Prospective Study" Acta Obstet Gynecol Scand 81, no. 11 (November 2002): 1033-1039.
9. R. M. Stocche et al., "Effects of Intrathecal Sufentanil on Plasma Oxytocin and Cortisol Concentrations in Women During the First Stage of Labor" Reg Anesth Pain Med 26, no. 6 (November-December 2001): 545-550.
10. Ibid.
11. C. F. Goodfellow et al., "Oxytocin Deficiency at Delivery with Epidural Analgesia" Br J Obstet Gynaecol 90, no. 3 (March 1983): 214-219.
12. O. Behrens et al., "Effects of Lumbar Epidural Analgesia on Prostaglandin F2 Alpha Release and Oxytocin Secretion During Labor" Prostaglandins 45, no. 3 (March 1993): 285-296.
13. M. Brinsmead et al, "Peripartum Concentrations of Beta Endorphin and Cortisol and Maternal Mood States" Aust NZ J Obstet Gynaecol 25, no. 3 (August 1985): 194-197.
14. G. Bacigalupo et al., "Quantitative Relationships between Pain Intensities during Labor and Beta-endorphin and Cortisol Concentrations in Plasma. Decline of the Hormone Concentrations in the Early Postpartum Period." J Perinat Med 18, no. 4 (1990): 289-296.
15. A. Costa et al., "Adrenocorticotropic Hormone and Catecholamines in Maternal, Umbilical and Neonatal Plasma in Relation to Vaginal Delivery" J Endocrinol Invest 11, no. 10 (November 1988): 703-709.
16. M. Odent, "The Fetus Ejection Reflex" in The Nature of Birth and Breastfeeding (Sydney: Ace Graphics, 1992): 29-43.
17. R. P. Lederman et al., "Anxiety and Epinephrine in Multiparous Women in Labor: Relationship to Duration of Labor and Fetal Heart Rate Pattern" Am J Obstet Gynecol 153, no. 8 (15 December 1985): 870-877.
18. G. Arici et al., "The Effects of Bupivacaine, Ropivacaine and Mepivacaine on the Contractility of Rat Myometrium" Int J Obstet Anesth 13, no. 2 (April 2004): 95-98.
19. B. L. Leighton and S. H. Halpern, "The Effects of Epidural Analgesia on Labor, Maternal, and Neonatal Outcomes: A Systematic Review" Am J Obstet Gynecol 186, Supplement 5 (May 2002): S69-S77.
20. Ibid.
21. E. Lieberman et al., "Changes in Fetal Position During Labor and their Association with Epidural Analgesia" Obstet Gynecol 105, no. 5, Part I (May 2005): 974-982.
22. S. E. Ponkey et al., "Persistent Fetal Occiput Posterior Position: Obstetric Outcomes" Obstet Gynecol 101, no. 5, pt. 1 (May 2003): 915-920.
23. COMET Study Group UK, "Effect of Low-Dose Mobile versus Traditional Epidural Techniques on Mode of Delivery: A Randomised Controlled Trial" The Lancet 358, no. 9275 (7 July 2001): 19-23.
24. J. H. Johnson et al., "Immediate Maternal and Neonatal Effects of Forceps and Vacuum-Assisted Deliveries" Obstet Gynecol 103, no. 3 (March 2004): 513-518.
25. B. S. Jhawar et al., "Risk Factors for Intracranial Hemorrhage Among Full-Term Infants: A Case-Control Study" Neurosurgery 52, no. 3 (March 2003): 581-590 (discussion, 588-590).
26. W. G. McBride et al., "Method of Delivery and Developmental Outcome at Five Years of Age" Med J Aust 1, no. 8 (21 April 1979): 301-304.
27. B. D. Wesley et al., "The Effect of Forceps Delivery on Cognitive Development" Am J Obstet Gynecol 169, no. 5 (November 1993): 1091-1095.
28. S. H. Poggi et al., "Effect of Epidural Anaesthesia on Clinician-Applied Force During Vaginal Delivery" Am J Obstet Gynecol 191, no. 3 (September 2004): 903-906.
29. See Note 19.
30. C. L. Roberts et al., "Rates for Obstetric Intervention Among Private and Public Patients in Australia: Population Based Descriptive Study" Br Med J 321, no. 7254 (15 July 2000): 137-141.
31. See Note 19.
32. E. Lieberman and C. O'Donoghue, "Unintended Effects of Epidural Analgesia During Labor: A Systematic Review" Am J Obstet Gynecol 186, Supplement 5 (May 2002): S31-S68.
33. J. A. Thorp et al., "The Effect of Continuous Epidural Analgesia on Cesarean Section for Dystocia in Nulliparous Women" vAm J Obstet Gynecol 161, no. 3 (September 1989): 670-675.
34. See Note 23.
35. L. M. Goetzl, "Obstetric Analgesia and Anesthesia" ACOG Practice Bulletin, Clinical Management Guidelines for Obstetrician-Gynecologists no. 36, Obstet Gynecol 100, no. 1 (July 2002): 177-191.
36. L. J. Mayberry et al., "Epidural Analgesia Side Effects, Co-Interventions, and Care of Women During Childbirth: A Systematic Review" Am J Obstet Gynecol 186, Supplement 5 (2002): S81-S93.
37. D. B. Scott and B. M. Hibbard, "Serious Non-Fatal Complications Associated with Extradural Block in Obstetric Practice" Br J Anaesthv 64, no. 5 (May 1990): 537-541.
38. See Note 36.
39. See Note 35.
40. See Note 36.
41. D. Buggy and J. Gardiner, "The Space Blanket and Shivering During Extradural Analgesia in Labour" vActa Anaesthesiol Scand 39, no. 4 (May 1995): 551-553.
42. See Note 36.
43. Ibid.
44. See Note 19.
45. See Note 32.
46. E. Lieberman et al., "Epidural Analgesia, Intrapartum Fever, and Neonatal Sepsis Evaluation" Pediatrics 99, no. 3 (March 1997): 415-419.
47. P. DeBalli and T. W. Breen, "Intrathecal Opioids for Combined Spinal-Epidural Analgesia During Labour" CNS Drugs 17, no. 12 (2003): 889-904 (892-893).
48. N. S. Saunders et al., "Neonatal and Maternal Morbidity in Relation to the Length of the Second Stage of Labour" Br J Obstet Gynaecol 99, no. 5 (May 1992): 381-385.
49. L. St. George and A. J. Crandon, "Immediate Postpartum Complications" Aust NZ J Obstet Gynaecol 30, no. 1 (February 1990): 52-56.
50.. E. F. Magann et al., "Postpartum Hemorrhage after Vaginal Birth: An Analysis of Risk Factors" South Med J 98, no. 4 (April 2005): 419-422.
51. T. M. Eggebo and L. K. Gjessing, ["Hemorrhage After Vaginal Delivery"], Tidsskr Nor Laegeforen 120, no. 24 (10 October 2000): 2860-2863.
52>. B. Ploeckinger et al., "Epidural Anaesthesia in Labour: Influence on Surgical Delivery Rates, Intrapartum Fever and Blood Loss" Gynecol Obstet Invest 39, no. 1 (1995): 24-27.
53. L. Gilbert et al., "Postpartum Haemorrhage: A Continuing Problem" Br J Obstet Gynaecol 94, no. 1 (January 1987): 67-71.
54. See Note 48.
55. See Note 35.
56.M. J. Paech et al., "Complications of Obstetric Epidural Analgesia and Anaesthesia: A Prospective Analysis of 10,995 Cases" Int J Obstet Anesth 7, no. 1 (January 1998): 5-11.
57. P. C. Stride and G. M. Cooper, "Dural Taps Revisited: A 20-Year Survey from Birmingham Maternity Hospital" Anaesthesia 48, no. 3 (March 1993): 247-255.
58. S. N. Costigan and J. S. Sprigge, "Dural Puncture: The Patients' Perspective. A Patient Survey of Cases at a DGH Maternity Unit 1983-1993" Acta Anaesthesiol Scand 40, no. 6 (July 1996): 710-714.
59.. See Note 56.
60. See Note 37.
61. See Note 56.
62. D. B. Scott and M. E. Tunstall, "Serious Complications Associated with Epidural/Spinal Blockade in Obstetrics: A Two-Year Prospective Study" Int J Obstet Anesth 4, no. 3 (July 1995): 133-139.
63. J. S. Crawford, "Some Maternal Complications of Epidural Analgesia for Labour" Anaesthesia 40, no. 12 (December 1985): 1219-1225.
64. F. Reynolds, "Epidural Analgesia in Obstetrics" Br Med J 299, no. 6702 (September 1989): 751-752.
65. See Note 37.
66. See Note 62.
67. See Note 63.
68. See Note 64.
69. MIDIRS and the NHS Centre for Reviews and Dissemination, "Epidural Pain Relief During Labour" in Informed Choice for Professionals (Bristol: MIDIRS, 1999): 5.
70. See Note 37.
71. R. Fernando et al., "Neonatal Welfare and Placental Transfer of Fentanyl and Bupivacaine During Ambulatory Combined Spinal Epidural Analgesia for Labour" Anaesthesia 52, no. 6 (June 1997): 517-524.
72. J. Littleford, "Effects on the Fetus and Newborn of Maternal Analgesia and Anesthesia: A Review" Can J Anaesth51, no. 6 (June-July 2004): 586-609.
73. G. Capogna, "Effect of Epidural Analgesia on the Fetal Heart Rate" Eur J Obstet Gynecol Reprod Biol 98, no. 2 (October 2001): 160-164.
74. C. J. Aldrich et al., "The Effect of Maternal Posture on Fetal Cerebral Oxygenation During Labour" Br J Obstet Gynaecol 102, no. 1 (January 1995): 14-19.
75. E. Lieberman et al., "Intrapartum Maternal Fever and Neonatal Outcome" Pediatrics 105, no. 1, pt. 1 (January 2000): 8-13.
76. L. Impey et al., "Fever in Labour and Neonatal Encephalopathy: A Prospective Cohort Study" Br J Obstet Gynaecol 108, no. 6 (June 2001): 594-597.
77. See Note 32.
78. Ibid.
79. K. Thorngren-Jerneck and A. Herbst, "Low 5-Minute Apgar Score: A Population-Based Register Study of 1 Million Term Births" Obstet Gynecol 98, no. 1 (2001): 65-70.
80. M. Kumar and B. Paes, "Epidural Opioid Analgesia and Neonatal Respiratory Depression" J Perinatol 23, no. 5 (July-August 2003): 425-427.
81. Ibid.
82. T. Hale, Medications and Mothers' Milk (Amarillo, TX: Pharmasoft, 1997): 76.
83. See Note 71.
84. T. Hale, "The Effects on Breastfeeding Women of Anaesthetic Medications Used During Labour" The Passage to Motherhood Conference, Brisbane, Australia (1998).
85. See Note 32.
86. W. Camann and T. B. Brazelton, "Use and Abuse of Neonatal Neurobehavioral Testing" Anesthesiology 92, no. 1 (January 2000): 3-5.
87. R. Gaiser, "Neonatal Effects of Labor Analgesia" Int Anesthesiol Clin 40, no. 4 (Fall 2002): 49-65.
88. S. H. Halpern et al., "The Neurologic and Adaptive Capacity Score Is Not a Reliable Method of Newborn Evaluation" Anesthesiology 94, no. 6 (June 2001): 958-962.
89. See Note 32.
90. A. D. Murray et al., "Effects of Epidural Anesthesia on Newborns and their Mothers" Child Dev 52, no. 1 (March 1981): 71-82.
91. C. M. Sepkoski et al., "The Effects of Maternal Epidural Anesthesia on Neonatal Behavior During the First Month" Dev Med Child Neurol 34, no. 12 (December 1992): 1072-1080.
92. D. B. Rosenblatt et al., "The Influence of Maternal Analgesia on Neonatal Behaviour: II. Epidural Bupivacaine" Br J Obstet Gynaecol 88, no. 4 (April 1981): 407-413.
93. See Note 90.
94. See Note 91.
95. See Note 92.
96. See Note 71.
97. J. R. Loftus et al., "Placental Transfer and Neonatal Effects of Epidural Sufentanil and Fentanyl Administered with Bupivacaine During Labor" Anesthesiology 83, no. 3 (1995): 300-308.
98. See Note 23.
99. See Note 90: 71.
100. D. Krehbiel et al., "Peridural Anesthesia Disturbs Maternal Behavior in Primiparous and Multiparous Parturient Ewes" Physiol Behav 40, no. 4 (1987): 463-472.
101. M. S. Golub and S. L. Germann, "Perinatal Bupivacaine and Infant Behavior in Rhesus Monkeys" Neurotoxicol Teratol 20, no. 1 (January-February 1998): 29-41.
102. M. S. Golub, "Labor Analgesia and Infant Brain Development" Pharmacol Biochem Behav 55, no. 4 (1996): 619-628 (619).
103. L. Righard and M. O. Alade, "Effect of Delivery Room Routines on Success of First Breast-Feed" The Lancet 336, no. 8723 (November 1990): 1105-1107.
104. M. K. Matthews, "The Relationship Between Maternal Labour Analgesia and Delay in the Initiation of Breastfeeding in Healthy Neonates in the Early Neonatal Period" Midwifery 5, no. 1 (March 1989): 3-10.
105. A. B. Ransjo-Arvidson et al., "Maternal Analgesia During Labor Disturbs Newborn Behavior: Effects on Breastfeeding, Temperature, and Crying" Birth 28, no. 1 (March 2001): 5-12.
106. E. Nissen et al., "Effects of Maternal Pethidine on Infants Developing Breast Feeding Behaviour" Acta Paediatr 84, no. 2 (February 1995): 140-145.
107. L. Rajan, "The Impact of Obstetric Procedures and Analgesia/Anaesthesia During Labour and Delivery on Breast Feeding" Midwifery 10, no. 2 (June 1994): 87-103.
108. S. Radzyminski, "Neurobehavioral Functioning and Breastfeeding Behavior in the Newborn" J Obstet Gynecol Neonatal Nurs 34, no. 3 (May-June 2005): 335-341.
109. J. Riordan et al., "The Effect of Labor Pain Relief Medication on Neonatal Suckling and Breastfeeding Duration" J Hum Lact 16, no. 1 (February 2000): 7-12.
110. K. G. Dewey et al., "Risk Factors for Suboptimal Infant Breastfeeding Behavior, Delayed Onset of Lactation, and Excess Neonatal Weight Loss" Pediatrics 112, no. 3, pt. 1 (September 2003): 607-619.
111. S. Radzyminski, "The Effect of Ultra Low Dose Epidural Analgesia on Newborn Breastfeeding Behaviors" J Obstet Gynecol Neonatal Nurs 32, no. 3 (May-June 2003): 322-331.
112. D. J. Baumgarder et al., "Effect of Labor Epidural Anesthesia on Breast-Feeding of Healthy Full-Term Newborns Delivered Vaginally" J Am Board Fam Pract 16, no. 1 (January-February 2003): 7-13.
113. P. Volmanen et al., "Breast-Feeding Problems After Epidural Analgesia for Labour: A Retrospective Cohort Study of Pain, Obstetrical Procedures and Breast-Feeding Practices" Int J Obstet Anesth 13, no. 1 (2004): 25-29.
114. See Note 103.
115. See Note 105.
116. S. Kannan et al., "Maternal Satisfaction and Pain Control in Women Electing Natural Childbirth" Reg Anesth Pain Medvv 26, no. 5 (September-October 2001): 468-472.
117. J. M. Green et al., "Expectations, Experiences, and Psychological Outcomes of Childbirth: A Prospective Study of 825 Women" Birth 17, no. 1 (March 1990): 15-24.
118. B. M. Morgan et al., "Analgesia and Satisfaction in Childbirth (The Queen Charlotte's 1000 Mother Survey)" The Lancet 2, no. 8302 (9 October 1982): 808-810.
119. M. C. Klein et al., "Epidural Analgesia Use as a Marker for Physician Approach to Birth: Implications for Maternal and Newborn Outcomes" Birth 28, no. 4 (December 2001): 243-248.

Sarah J. Buckley is a family physician, an internationally published writer, and a full-time mother to Emma, Zoe, Jacob, and Maia Rose, all born at home. She is the author of Gentle Birth, Gentle Mothering: The wisdom and science of gentle choices in pregnancy, birth, and parenting, published in early 2006. To read more from Sarah J. Buckley, and to order her book, visit www.sarahjbuckley.com.

Mom fights, gets the delivery she wants

noreply@blogger.com (Pauline) — Sat, 19 Dec 2009 21:49:00 +0000

Mom fights, gets the delivery she wants
By Elizabeth Cohen, CNN Senior Medical Correspondent
December 17, 2009 9:17 a.m. EST

(CNN) -- Seven months into her pregnancy with her fourth child, Joy Szabo's obstetrician gave her some news she didn't want to hear: Because she'd had a previous Caesarean section, the hospital where she planned to deliver was insisting she have another one.

Szabo wanted a vaginal delivery, and argued with hospital executives, but they stood firm: They refused to do vaginal births after Caesareans (VBACs) because they have a slightly higher risk for complications.
After they lost that fight, Szabo and her husband, Jeff, made an unusual decision. About three weeks before her due date, Szabo moved nearly six hours away from their home in Page, Arizona, to Phoenix to give birth at a hospital that does permit women to have VBACs.
In the end, the Szabos got the birth they wanted. On December 5, their son Marcus Anthony was born in Phoenix via an uncomplicated vaginal delivery, weighing seven pounds and 13 ounces.
"It was such an easy birth," Szabo says. "I was in the pains of labor for about four or five hours, then I pushed once, and he popped out."

The Szabos' story has a happy ending, but it shows that with the rising C-section rate -- now one in three babies is born via Caesarean -- women who want vaginal births sometimes have to fight to get them.
That fight is especially difficult when the decision to perform a Caesarean is made in the delivery room when there's often not much time to talk and consider all the options.
"It's a tough situation," says Dr. Bruce Flamm, a spokesman for the American College of Obstetricians and Gynecologists. "Mom is tired. Dad is tired and nervous, and most people haven't spent their lives reading obstetrical textbooks and don't know all the details involved."

Dina Ste. Marie was told she'd need a C-section, but a simple change in position allowed Isabella to come out vaginally.
Dina Ste. Marie, from Whitby, Ontario, remembers a tense moment in the delivery room three years ago when she was in labor with her first child. She'd been eight centimeters dilated for six hours, and the baby wasn't budging.
"We were near the end, but it just wasn't ending," she remembers.
When her obstetrician suggested she might be headed for a C-section, her doula, Stefanie Antunes, remembered a maneuver she'd seen midwives use to get a reluctant baby to come through the birth canal.
"Stefanie said if I laid down flat on my back it might help the baby get in a new position," Ste. Marie says. "I distinctly remember the labor nurse looking at her like she had 10 heads, but she said, 'You can try it if you want.' "
Ste. Marie got on her back, and the baby started moving around. Twenty-five minutes later, her daughter, Isabella, was born.
"It was such a major relief," says Ste. Marie. "I really wanted to avoid a C-section if I could."

Read more Empowered Patient stories
Not every mother wants to avoid a C-section -- in fact, some request them -- but if you do, here are some tips for what to ask your doctor (or midwife) in the delivery room if the suggestion is made that it's time to give up on a vaginal birth and head to the operating room.
Video: How to get the birth you want

1. "Doctor, is this an emergency, or do we have time to talk?"
Sometimes you need a C-section to save your life, your baby's life, or both. In those cases, there's no room for discussion.
Delivery room emergencies include excessive bleeding, a breech position where the baby is headed out foot-first, or when the baby has certain heart rate problems, according to Flamm.
"In these situations, this is not a good time to talk about your desires for a natural birth," Flamm says.

2. "Doctor, what would happen if we waited an hour or two?"
The vast majority of the time, when your doctor or midwife tells you it's time for a C-section, it's not an emergency, Flamm says.
In many cases, women just need more time to labor, he adds. In fact, he says the No. 1 reason for a C-section is "failure to progress" during labor. "If that's what we're talking about, then it's not an emergency," he says.

3. "Doctor, are you sure the baby is too big for me to deliver?"
Sometimes parents are told a baby is too big to deliver vaginally. Dr. Ware Branch, medical director of women and newborns clinical program at Intermountain Healthcare in Utah, says parents should ask whether a C-section is absolutely necessary, especially if labor hasn't advanced very far.
"If it was my wife in labor and she's three or four centimeters dilated and the obstetrician says the baby's head is too big and she can't deliver him, I'd say, 'Nonsense, she hasn't really had a trial of labor, doctor.' "

4. "Doctor, is there something else I can try before having a C-section?"
Antunes, a spokeswoman for DONA International, which certifies doulas, says there may be options such as maneuvers like the one she used on Ste. Marie to get a slow labor moving.

5. "Doctor, can we talk more about the baby's heart rate?"
If you're told you need a C-section because of the baby's heart rate, try to get your doctor or midwife to be as specific as possible.
Some heart-rate problems mean a C-section is necessary immediately, but other types of heart-rate issues are not nearly as serious, and you may be able to labor longer.
"This is a very gray area," says Debbie Levy, a certified nurse midwife in Marietta, Georgia. "It takes years to learn how to read fetal heart tones, and it's not an exact science."
Levy says it can be difficult to ask these questions when the person delivering your baby says it's time for a C-section, especially since mom and dad are often exhausted.
"This is a very tough discussion to have in the delivery room," she says. "You're vulnerable, because you're talking about your baby's well-being."
But she says as long as it's not an emergency, you should have these delivery room conversations with your doctor or midwife.
"You shouldn't be afraid to speak up and say you'd like to try to labor longer," she says.

2009 H1N1 Flu (Swine Flu) and Feeding your Baby: What Parents Should Know

noreply@blogger.com (Pauline) — Tue, 15 Dec 2009 20:32:00 +0000

http://www.cdc.gov/h1n1flu/infantfeeding.htm#
2009 H1N1 Flu (Swine Flu) and Feeding your Baby: What Parents Should Know
October 23, 2009 2:00 PM ET

This document updates previously posted information for parents about infant feeding and 2009 H1N1 flu (swine flu). It now more clearly addresses parents who are formula feeding as well as breastfeeding, suggests that parents sick with 2009 H1N1 flu (swine flu) find someone who is not sick to feed the baby, and provides more detailed strategies for breastfeeding mothers to maintain breastfeeding throughout the course of infection. This document is based on current knowledge of the 2009 H1N1 flu outbreak in the United States, and may be revised as more information becomes available.

What is this new flu virus?
This novel H1N1 flu virus (sometimes called “swine flu”) was first detected in people in April 2009 in the United States. This virus is spreading from person-to-person, probably in much the same way that regular seasonal influenza viruses spread.

What can I do to protect my baby?
Take everyday precautions such as washing your hands with plain soap and water before feeding your baby. If soap and water are not available, use an alcohol-based hand rub* to clean your hands before feeding your baby. See more tips on good health habits for preventing sickness from the flu virus. In addition, try not to cough or sneeze in the baby’s face while feeding your baby, or any other time you and your baby are close. If possible, only family members who are not sick should care for infants. If you are sick and there is no one else to care for your baby, wear a facemask, if available and tolerable, and cover your mouth and nose with a tissue when coughing or sneezing. For more information, see the Interim Recommendations for Facemask and Respirator Use.

Feeding Your Baby
Is it ok to for me to feed my baby if I am sick?
Infants are thought to be at higher risk for severe illness from 2009 H1N1 infection and very little is known about prevention of 2009 H1N1 flu infection in infants. If you are breastfeeding or giving your baby infant formula, a cautious approach would be to protect your baby from exposure to the flu virus in the following ways:

Ask for help from someone who is not sick to feed and care for your baby, if possible.
If there is no one else who can take care of your baby while you are sick, try to wear a face mask at all times when you are feeding or caring for your baby. You should also be very careful about washing your hands and taking everyday precautions to prevent your baby from getting flu. Using a cloth blanket between you and your baby during feedings might also help.
If you are breastfeeding, someone who is not sick can give your baby your expressed milk. Ideally babies less than about 6 months of age should get their feedings from breast milk. It is OK to take medicines to treat the flu while you are breastfeeding.

Does breastfeeding protect babies from this new flu virus?
There are many ways that breastfeeding and breast milk protect babies’ health. Flu can be very serious in young babies. Babies who are not breastfed get sick from infections like the flu more often and more severely than babies who are breastfed.

Since this is a new virus, we don’t know yet about specific protection against it. Mothers pass on protective antibodies to their baby during breastfeeding. Antibodies are a type of protein made by the immune system in the body. Antibodies help fight off infection.

If you are sick with flu and are breastfeeding, someone who is not sick can give your baby your expressed milk.

Should I stop breastfeeding my baby if I think I have come in contact with the flu?
No. Because mothers make antibodies to fight diseases they come in contact with, their milk is custom-made to fight the diseases their babies are exposed to as well. This is really important in young babies when their immune system is still developing. It is OK to take medicines to prevent the flu while you are breastfeeding. You should make sure you wash your hands often and take everyday precautions. However, if you develop symptoms of the flu such as fever, cough, or sore throat, you should ask someone who is not sick to care for your baby. If you become sick, someone who is not sick can give your baby your expressed milk.

Is it okay to take medicine to treat or prevent 2009 H1N1 flu while breastfeeding?
Yes. Mothers who are breastfeeding and taking medicine to treat flu because they are sick should express their breast milk for bottle feedings, which can be given to your baby by someone who is not sick. Mothers who are breastfeeding and are taking medicines to prevent the flu because they have been exposed to the virus should continue to feed their baby at the breast as long as they do not have symptoms of the flu such as fever, cough, or sore throat.

If my baby is sick, is it okay to breastfeed?
Yes. One of the best things you can do for your sick baby is keep breastfeeding.

Do not stop breastfeeding if your baby is sick. Give your baby many chances to breastfeed throughout the illness. Babies who are sick need more fluids than when they are well. The fluid babies get from breast milk is better than anything else, even better than water, juice, or Pedialyte® because it also helps protect your baby’s immune system.
If your baby is too sick to breastfeed, he or she can drink your milk from a cup, bottle, syringe, or eye-dropper.

www.BirthingWisdom.com

Postpartum Depression Strikes Fathers, Too

noreply@blogger.com (Pauline) — Tue, 08 Dec 2009 00:56:00 +0000

Postpartum Depression Strikes Fathers, Too
http://www.nytimes.com/2009/12/08/health/08mind.html

Breastfeeding Reduces a Womans Risk of Developing Metabolic Syndrome

noreply@blogger.com (Pauline) — Fri, 04 Dec 2009 19:52:00 +0000

http://www.news-medical.net/news/20091203/Breastfeeding-reduces-a-womans-risk-of-developing-Metabolic-Syndrome.aspx

Problems with New Induction Brochure

noreply@blogger.com (Pauline) — Fri, 04 Dec 2009 19:36:00 +0000

http://www.thefamilyway.com/home/archives/233

The Agency for Healthcare Research and Quality (AHRQ) has published a new consumer brochure on labor induction. Unfortunately, this brochure is poorly written and misleading. One would think from reading the brochure that elective induction is a completely innocuous procedure that is fine for any woman who is “uncomfortable” (their word!) towards the end of her pregnancy. Just recently the National Center for Health Statistics released released a report on the rise of late preterm births in the U.S. and placed part of the blame on obstetric interventions such as induction and scheduled cesarean surgery. When we all should be working together to reduce unnecessary inductions, I am shocked that AHRQ has published such a misleading brochure.
Here are my strong objections to this brochure:
1. Inside Front Cover: Fast Facts – The second fact, “A cesarean section (c-section) might be needed if there are problems with labor. This is true for labor that is induced and for labor that starts on its own” implies that there is no difference between risk of cesarean surgery for those who are induced and those who begin labor on its own. This is misleading.
2. Inside Front Cover: Fast Facts – The fourth fact, “The risk of C-section with elective induction depends on if you have ever had a baby before” is true. However, the more important fact for consumers is that the risk of C-section is doubled for first-time mothers if labor is induced. This fact is conveniently left out.
3. Page 2 – A consumer brochure published by a “scientific” agency of the government should include the fact that misoprostal (Cytotec) has not been approved by the FDA for use in labor and that, in fact, the FDA has issued a strong warning about its use in labor.
4. Page 3 – Under the reasons why someone might not want to induce labor, there should be more information about the risks of iatrogenic prematurity. This pamphlet is written at a low literacy level. Unfortunately, we know that women from lower socioeconomic groups are more likely to delay getting prenatal care. Without an early ultrasound to confirm the due date, there can easily be a 2 to 3 week error in calculating the due date.
There is also no mention of the possible benefits to the baby of allowing labor to begin on its own. Scientists at the University of Texas Southwestern Medical School believe that it is the baby who initiates labor once the lungs are fully mature. Neonatalogist Dr. Lucky Jain said at the NIH State-of-the-Science Conference: Cesarean Delivery on Maternal Request in March 2006 that:
“In summary, physiologic events in the last few days of pregnancy, coupled with the onset of spontaneous labor, play a critical role in fetal maturation and preparation of the fetus for neonatal transition.” (last paragraph on page 104 of the conference papers)
5. Page 5: Statement of bottom of page – “ Research can’t tell us if any one woman’s chance of having a C-section is different is she chooses to be induced rather than waiting labor to start on its own.” This statement infuriates me. Yes, it’s true (for any one woman), but it minimizes the increased risk of cesarean with an induced labor. Why include this statement unless the intent is to downplay the risks of induction?
6. Page 6 – The statement, “Research shows that inducing labor does not mean that babies have a higher chance for a newborn breathing problem…” is also misleading. According to Dr. Lucky Jain (see #4 above) there are important physiological benefits to the baby in allowing labor to begin on its own. And if the due date is off and the baby is born late pre-term, then there is compelling evidence that the baby is at higher risks for respiratory and other problems.
7. Page 6 – The statement “Research doesn’t have the answers about the effect inducing labor can have on the use of pain medications, length of hospital stay, breastfeeding problems, and problems for the baby during labor” is also misleading. Earlier in the brochure, the authors acknowledge that induced contractions may be stronger and more painful earlier in labor. I don’t think that there is any doubt among healthcare professionals that induced contractions are more painful and that women who are induced are more likely to request epidural analgesia. For the first-time mother whose risk for cesarean is doubled with induction, there is a greater risk for longer hospital stay, breastfeeding problems, and problems for the baby if cesarean surgery is required.
8. Page 8 – Things to Think About: Question: Am I more likely to have a C-section if I have my labor induced? The first line of the answer, “Research can’t tell us if inducing labor makes having a C-section more likely than waiting for labor to start on its own” is untrue for first-time mothers. The second line of the answer, “But your chances of a C-section are higher if you have never had a baby vaginally before” may be a little confusing for some readers and fails to include the important information that the risk for cesarean surgery is doubled for first-time mothers who are induced.
9. Page 8 – Fourth Question: The correct and appropriate answer to “How can I improve my chances of having a vaginal birth?” is to allow labor to begin on its own. This brochure addresses only elective induction!
10. Page 9: Questions to Ask Your Doctor or Midwife – Most of the questions do not provide the information needed to make a true informed decision. None deal with the potential risks of elective induction.
I certainly hope that you will not distribute this brochure in your childbirth classes and that you will consider voicing your own objections to this poor use of taxpayer dollars which has the potential of increasing requests for elective inductions; increasing the risks for unnecessary cesareans; and increasing medical complications for both mothers and babies.

Delayed Cord Clamping Should Be Standard Practice in Obstetrics

noreply@blogger.com (Pauline) — Fri, 04 Dec 2009 19:25:00 +0000

http://academicobgyn.com/2009/12/03/delayed-cord-clamping-should-be-standard-practice-in-obstetrics/
Delayed Cord Clamping Should Be Standard Practice in Obstetrics
December 3, 2009Nicholas FogelsonLeave a commentGo to comments
There are times in our medical careers where we see a shift in thought that leads to a completely different way of doing things. This happened with episiotomy in the last few decades. Most recently trained physicians cannot imagine doing routine episiotomy with every delivery, yet it was not so long ago that this was common practice.

Episiotomy was supported in Medline indexed publications as early as the 1920s(1), and many publications followed in support of this procedure. But by as early as the 1940s, publications began to appear that argued that episiotomy was not such a good thing(2). Over the years the mix of publications changed, now the vast majority of recent publications on episiotomy focus on the problems with the procedure, and lament why older physicians are still doing them (3) (4). And over all this time, practice began to change.

It took a long time for this change to occur, and a lot of data had to accumulate and be absorbed by young inquisitive minds before we got to where we are today, with the majority of recently trained OBs and midwives now reserving episiotomy only for rare indicated situations.

Though this change in episiotomy seems behind us, there are many changes that are ahead of us. One of these changes, I believe, is in the way obstetricians handle the timing of cord clamping.

For the majority of my career, I routinely clamped and cut the umbilical cord as soon as it was reasonable. Occasionally a patient would want me to wait to clamp and cut for some arbitrary amount of time, and I would wait, but in my mind this was just humoring the patient and keeping good relations. After all, I had seen all my attendings and upper level residents clamp and cut right away, so it must be the right thing, right?

Later in my career I was exposed to enough other-thinking minds to consider that maybe this practice was not right. And after some research I found that there was some pretty compelling evidence that indeed, early clamping is harmful for the baby. So much evidence in fact, that I am a bit surprised that as a community, OBs in the US have not developed a culture of delayed routine cord clamping for neonatal benefit.

I think that this is a part of our culture that should change. This evidence is compelling enough that I feel like a real effort should be made in this regard. So to do my part in this, I am blogging about it.

As this is Academic OB/GYN, of course I am going to lay out this evidence I speak of. But before I do that, I want to present some logical ideas under which this evidence ought to be considered.

Prior to the advent of medical delivery, and for all time in animals, it has been the natural way of things for a baby to stay on the umbilical cord for a significant period of time after delivery. Depending on culture and situation, the delay in cord separation could be a few minutes or even a few hours. In some cultures the placenta is left on for days, which of course I find excessive and gross (5). But whatever the culture and time on cord, the absence of immediate cord clamping allows fetal blood that was previously in the placenta to transfuse back into the baby. Studies have demonstrated that a delay of as little as thirty seconds between delivery and cord clamping can result in 20-40 ml*kg-1 of blood entering the fetus from the placenta (6).

Considering this data, I have to think about evolution and function. I am a strong believer in evolution, but even under creationist thinking I have to believe that if the system meant for babies to have been phlebotomized of 50-100 cc of blood at birth, we would have been born with higher hemoglobins. Clearly the natural way of things is for this not to happen.

So does this mean that early cord clamping is necessarily harmful? Absolutely not. But what it means is that the burden of proof is on us to prove that early cord clamping, which amounts to planned fetal phlebotomy, is a beneficial thing. Otherwise, all things being equal we ought to give the tykes a few minutes to soak up what blood they can from the placenta before we cut’em off.

So the question is whether or not there is strong data either way.

It is easy to imagine a randomized study of immediate vs. delayed cord clamping, with quantitative analysis of fetal lab values and clinical outcomes. So easy in fact, that it has been done many times – and in just about every study, there is a clear benefit to delaying cord clamping, even if it is just for 30 seconds after delivery. These benefits include important outcomes such as decreased rates of intraventricular hemorrhage and necrotizing enterocolitis in preterm neonates. Furthermore, aside from some intermittent reports of clinically insignificant polycythemia and hyperbilirubinemia in term infants, there appears to be no harm that can be linked to delayed cord clamping. It feels like being a doctor 10-15 years ago looking to see if there is any data about episiotomy, and finding that there’s a lot, and it says we’ve been doing it wrong for awhile now.

So here’s the data:

Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial(7)

Randomized 72 VLBW infants (< 1500 grams) to immediate or delayed cord clamping (5-10 vs. 30-45 seconds). Delayed cord clamp infants had significantly less IVH (5/36 in delayed group vs. 13/36 in immediate group, p = 0.03) and less late onset sepsis (1/36 vs. 8/36, p = 0.03).

The Inﬂuence of the Timing of Cord Clamping on Postnatal Cerebral Oxygenation in Preterm Neonates: A Randomized, Controlled Trial (8)

Randomized 39 preterm infants to immediate clamping vs. 60-90 second delay, and examined fetal brain blood flow and tissue oxygenation. Results showed similar blood flow between groups, but increased tissue oxygenation in the delayed group and 4 and 24 hours after birth.

Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomized controlled trial(9)

Randomized 476 infants to immediate or 2 minute delayed clamping and followed them for 6 months. Delayed clamped babies had higher MCVs (81 vs. 79.5), higher ferritins (50.7 vs. 34.4), and higher total body iron. Effects were greater in infants born to iron deficient mothers. Delayed clamping increased total iron stores by 27-47mg. A follow up study showed that lead exposed infants with delayed clamping also had lower serum lead levels than immediate clamped infants, likely due to iron mediates changes in lead absorption.

A randomized clinical trial comparing immediate versus delayed clamping of the umbilical cord in preterm infants: short-term clinical and laboratory endpoints(10)

Infants delivering at 30 to 36 weeks gestation randomized to immediate vs. 1 minute delay. Delayed group had higher RBC volumes (p = 0.04) and hematocrits (p < 0.005), though there was no difference in RBC transfusions. There was a small increase in babies requiring phototherapy in the delayed group (p = 0.03) but no difference in bilirubin levels between groups.

Immediate versus delayed umbilical cord clamping in premature neonates born < 35 weeks: a prospective, randomized, controlled study (11)

Randomized 60 infants to clamping at 5-10 seconds vs. 30-45 seconds. Delayed clamping infants had higher BPs and hematocrits. Infants < 1500 grams with delayed clamping needed less mechanical ventilation and surfactant. Trend towards more polycythemia in delayed group, but not statistically significant.

And that’s just some of it. I’ll be happy to send you an Endnote file with a pile more of you’d like it. If the burden of proof is on us to prove that immediate clamping is good, that burden is clearly not met. And furthermore, there is strong evidence that delaying clamping as little as 30 seconds has measurable benefits for the infant, especially in premature babies and babies born to iron deficient mothers.

So basically, we should be doing this. I’m going to try to effect some change in my department, but there are a lot of things that need to happen for us to change as a general culture. It can’t just be the OBs. L and D nurses and pediatricians need to buy in as well.

Some people will argue that premature babies need to be brought to the warmer right away for resucitation. I don’t know the answer to this, but it’s worth study. One might think that it is important to intubate a very premature baby right away, but I have to wonder if that intact cord will be better at delivering oxygen to the baby for 30-60 seconds than the premature lungs. Particularly in cases of fetal respiratory acidosis, there is strong logical argument that a baby might be better resuscitated by unwrapping the cord and letting it flow a bit than trying to oxygenate it through its lungs. Until that placenta is detached, you have a natural ECMO system. Why not use it? Certainly there are exceptions to this logical argument, abruption being the biggest one, and perhaps even severe pre-eclampsia and other poor feto-maternal circulation states.

I wonder at times why delayed cord clamping has not become the standard already; why by and large we have not heeded the literature. It is sad to say that I believe it is because the champions of this practice have not been doctors, but midwives, and sometimes we are influenced by prejudice. Clearly, midwives and doctors tend to have some different ideas about how labor should be managed, but in the end data is data. We championed evidence based medicine, but tend to ignore evidence when it comes from the wrong source, which is unfair. It is fair to critique the research and the methods used to write it, but it shouldn’t matter who the author is. In this case, Mercer and other midwives have done the world a favor by scientifically addressing this issue, and their data deserves serious consideration.

To quote Levy et al (12) “Although a tailored approach is required in the case of cord clamping, the balance of available data suggests that delayed cord clamping should be the method of choice.” We ought to heed this advice better. Like episiotomy, this change in practice may take awhile, but we should get it started. I’m going to work on it myself. How about you?

1. Martin DL. The Protection of the Perineum by Episiotomy in Delivery at Term. Cal State J Med 1921 Jun;19(6):229-31.

2. Barrett CW. Errors and evils of episiotomy. Am J Surg 1948 Sep;76(3):284.

3. Rodriguez A, Arenas EA, Osorio AL, Mendez O, Zuleta JJ. Selective vs routine midline episiotomy for the prevention of third- or fourth-degree lacerations in nulliparous women. Am J Obstet Gynecol 2008 Mar;198(3):285 e1-4.

4. Gossett DR, Su RD. Episiotomy practice in a community hospital setting. J Reprod Med 2008 Oct;53(10):803-8.

5. Westfall R. An ethnographic account of lotus birth. Midwifery Today Int Midwife 2003 Summer(66):34-6.

6. Weeks A. Umbilical cord clamping after birth. Bmj 2007 Aug 18;335(7615):312-3.

7. Mercer JS, Vohr BR, McGrath MM, Padbury JF, Wallach M, Oh W. Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial. Pediatrics 2006 Apr;117(4):1235-42.

8. Baenziger O, Stolkin F, Keel M, von Siebenthal K, Fauchere JC, Das Kundu S, et al. The influence of the timing of cord clamping on postnatal cerebral oxygenation in preterm neonates: a randomized, controlled trial. Pediatrics 2007 Mar;119(3):455-9.

9. Chaparro CM, Neufeld LM, Tena Alavez G, Eguia-Liz Cedillo R, Dewey KG. Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial. Lancet 2006 Jun 17;367(9527):1997-2004.

10. Strauss RG, Mock DM, Johnson KJ, Cress GA, Burmeister LF, Zimmerman MB, et al. A randomized clinical trial comparing immediate versus delayed clamping of the umbilical cord in preterm infants: short-term clinical and laboratory endpoints. Transfusion 2008 Apr;48(4):658-65.

11. Kugelman A, Borenstein-Levin L, Riskin A, Chistyakov I, Ohel G, Gonen R, et al. Immediate versus delayed umbilical cord clamping in premature neonates born < 35 weeks: a prospective, randomized, controlled study. Am J Perinatol 2007 May;24(5):307-15.

12. Levy T, Blickstein I. Timing of cord clamping revisited. J Perinat Med 2006;34(4):293-7.