Israel Doula

How to turn a breech head-down.

2007-11-19T11:50:00.001+02:00

R. called me with the message that her baby is breech. She was 37 weeks pregnant and about to give birth to her first baby. During our first prenatal meeting, R. had told me that she has a bi-cornuate uterus and that makes her chance on a breech much higher, so I was not very surprised.

R. sees a doctor that I like very much, but is too biased towards the Bikur Cholim hospital in my opinion. No wonder, he's affiliated with them himself. So I was not surprised to hear that he had sent R. to another Bikur Cholim doctor to do an ECV (external cephalic version) to turn the breech head-down.

I told R. to hold her horses and check out her options first. She was 37 weeks which means that there wasn't much time. The fetus is already big at 37 weeks, and the bigger they get, the harder it will be to turn them.
Normally when a lady finds out that her baby is breech, it's a little earlier (around 33-34 weeks) and there is time to try some less invasive techniques first.

A known technique is this one:

Lie on the floor and pace your feet against the wall, pelvis up in the air. Support yourself well with pillows. Do this for about 10-15 minutes, twice a day. Alternatively, you can place an ironing board against the couch or your bed and lie on it head-down. Put some pillows under your head.

Another pose is this one:

Also known as the knee-chest position. Kneel down on the floor (rest your knees and head on a pillow or sit on a yoga mat). Make sure that your pelvis is higher than your chest by placing your chest on the floor as well. Sit like this for 15-20 minutes, a couple of times per day.

Well-known alternative treatments for turning a breech include moxibustion (acupressure/shiatsu) and the Webster technique (chiropractics).

Only when these techniques don't work and the baby is still breech by 37 weeks, I advice my ladies to do an ECV, or external version.
I sent R. to the most experienced ECV doctor in Israel, Dr. Kanetti. He has a very high success rate.
Unfortunately, it didn't work for R. Her baby was still breech.

She went to several doctors and professors in the field to ask their professional opinion on how she could best give birth. On the one hand, outcomes for first babies who are breech who are born by c-section are slightly better than for first babies who are breech who are born vaginally. But a c-section has a lot of implications for subsequent pregnancies and births. Mothers who deliver their first babies by c-section, have a higher chance of ending up with subsequent c-sections than mothers who have already given birth vaginally.
But all the doctors R. turned to said unanimously that in her specific case, because she has a bi-cornuate uterus, a c-section was the only option. A c-section was scheduled.

Technorati Tags: birth, breech, ECV, external version, c-section

Pregnancy massage using body pillows

2007-11-01T15:30:00.001+02:00

My client M. is getting a weekly massage from me. She is 36 weeks pregnant with her first child, and really treats our weekly hour as her pamper moment. Usually when I do pregnancy massage, I put the lady on her side, do my whole massage routine, flip her over to her other side and repeat the whole thing.

Women with a pregnant belly can't lie on their stomachs, and later on in the pregnancy lying on the back also becomes problematic. Many women can't breathe while lying on their backs, because the heavy uterus is pressing on the vena cava and causes dizziness and breathing difficulties.
So I always prop pregnant ladies up on their side, supported by lots of pillows. But this time, M. really wanted to try to lie on her belly. I always use this pillow for massages:

So I propped M. up so that her belly was right in the hole of the pillow, and her chest was leaning on the top. And I put lots of pillows under her head. She was comfortable that way, and I could massage the whole back part of her body like that.
Then I flipped her over for another few minutes of chest- and belly massage.

Another great pillow is this one:

I ordered the bigger one with a special cover which is easy to wipe clean. When I put a lady on her side for a massage, which I usually do, she can hug this pillow and put one knee on it so she'll feel supported and it also keeps her hips level. This pillow is perfect for that.

Birth ABC explanation part 5

2007-10-28T19:11:00.001+02:00

Vaginal birth

Also known as normal birth, when the baby emerges through the birth canal. This is opposed to cesarean sections, which are gaining in popularity.

Water birth

A birth which occurs inside the water; the baby is born into the water. Research has proven that this is not dangerous for the baby, because he only starts breathing as soon as his skin touches air. He is still attached to the umbilical cord and keeps receiving oxygen from his mother. Read more about the water birth research here.

Xxx's for mother and baby

After the mega achievement that birth is, mother and baby deserve lots of kisses!

You can do it!

With this one I actually refer to natural birth, meaning birth without the use of pain relief. I took the quote from Pam England in her book Birthing From Within, where she says: "There are three givens about labor; it is hard work, it hurts and you can do it!".
And I truly believe that this is true.

Zzz's you won't be getting a lot of in the coming weeks

This one is actually not so true. The old cliche holds true for women after birth; sleep when the baby sleeps! Babies sleep in smaller patches than we adults are used to, and they wake up every few hours to feed. Mother will need to adapt her sleeping pattern to that of her baby, which means that she has to sleep when he does (if possible of course), and sleep in close proximity to her baby. Nature will make sure that mother will have the same sleeping cycles as baby, waking up automatically between cycles when he does. Isn't that great?
It just takes some getting used to, and might be draining in the beginning. Especially if you have a baby who is 'jet lagged'; the baby sleeps most of the day and is awake most of the night. But after a while, things will start running like clockwork in most cases.

The end!

For the whole birth ABC, click here.
Birth ABC explanation: part 1. Click here.
Birth ABC explanation: part 2. Click here.
Birth ABC explanation: part 3. Click here.
Birth ABC explanation: part 4. Click here.

Technorati Tags: birth, vaginal birth, water birth, baby, labor

Birth ABC explanation part 4

2007-10-21T20:49:00.001+02:00

Quite an experience

No matter what kind of birth you have, quick or long, natural or with an epidural, vaginal or cesarean, it is always quite an experience. This is not just another day in the life of a woman, but rather an event that will stay with her in memory for the rest of her life. Nobody argues about the fact that the most important thing is a healthy mother and a healthy baby, but having a positive birth experience is just as important for this life changing event. From research we know that it doesn't matter so much how the birth went, if the woman felt respected and supported all throughout, she's much more likely to look back on it in a positive way.

Rupture of membranes

Also known as breaking of waters. This happens when the amniotic sac that surrounds the fetus inside the uterus ruptures. The bag is filled with a liquid called amniotic fluid, which serves as protection for the fetus from the outside world.
The membranes can rupture at any point during labor. Sometimes they rupture before the onset of labor, and usually contractions will start within 24 hours.
When labor stalls, rupturing the membranes artificially (also known as AROM or amniotomy) can help move the labor along. This procedure is used much more often than really necessary, and that also has negative effects. The risk of infection rises, the contractions usually become much stronger and pain medication is needed, and sometimes the baby's head will come down in a weird angle and they have to perform a cesarean. In most cases, it is best to just be patient and let nature and labor run their course.
Also, in a recent study it was discovered that artificially rupturing the membranes does not speed up the labor. Read more about it here.

Shiatsu pressure points

Shiatsu pressure points are points on the body that lie along the meridians that are known in chinese medicine. Every point corresponds with organs inside the body. There are points that are in contact with the uterus and stimulate contractions. Those points are out-of-bounds during the pregnancy because they might trigger premature labor, but during birth itself they can be very useful for making stronger contractions. Read more here.

Tea of nettles and raspberry leaf

The teas of dried nettles and raspberry leaves are known to help tone the uterus and get it into shape for labor and birth. Pregnant women are recommended to drink nettles tea all throughout the pregnancy, and add tea of raspberry leaf during the last few weeks in preparation for the birth.

Uterus

Also known as womb. This is the little house of the fetus during the pregnancy. This is what the uterus looks like when the woman is not pregnant:

It is about as big as an uninflated balloon.

At 40 weeks gestation, this is what it looks like:

The uterus is the pink balloon that surrounds the baby. By now, it has the size of a big watermelon!

To be continued...

For the whole birth ABC, click here.
Birth ABC explanation: part 1. Click here.
Birth ABC explanation: part 2. Click here.
Birth ABC explanation: part 3. Click here.

To subscribe this blog, click here.

Technorati Tags: birth, life changing event, rupture of membranes, AROM, amniotomy, shiatsu, pressure points, labor, nettles tea, raspberry leaf tea, pregnancy, uterus

Natural birth with epidural

2007-10-16T19:02:00.001+02:00

Sarah K., a doula colleague from Be'er Sheva, called me yesterday to ask if I am available to meet a client of hers at Shaarei Tzedek hospital. Sarah usually works at the hospital in Be'er Sheva but this client decided to give birth in Jerusalem, a 1.5 hour drive away.
Her client, a sweet lady, was already on her way to the hospital with ruptured membranes but no contractions. It was her 4th birth; her 1st ended in a cesarean and births #2 and #3 were both vacuum extractions. This time she wanted a normal, natural birth with a doula, preferably without epidural.

Sarah asked me to meet her client at the hospital, and to give her some reflexology to stimulate contractions. They already told her at the hospital that they would give her until the morning, and then they would induce her with pitocin if labor still hadn't started. Pitocin is extra risky for women with a previous cesarean, because it increases the risk of uterine scar rupture. There are many hospitals that won't even consider giving pit to a woman like that, but prefer to give her a repeat cesarean right away.

I went to the hospital, and gave her a nice foot rub. I also stimulated some well known shiatsu pressure points. It didn't seem to influence her right away, even though she told me that her contractions were starting to get stronger a bit. She got worried that if her labor would suddenly pick up, Sarah would still need 1.5 hours to get to her. I assured her that if need be, she could always call me and I would be there within 20 minutes.

Sarah called me again at 5 am. She was already on her way to Jerusalem, but it would take her at least another hour. Her lady had called her and her contractions were really coming on strong now. On top of that, there was suddenly meconium in the amniotic fluid. The midwives at the hospital told her that she couldn't walk around anymore because of that, and because of the fact that the head was still very high and there was a risk of cord prolapse. So the lady started to panic, because she couldn't manage labor while lying down.

When I arrived, she had just gotten her epidural. She explained to me that the contractions were manageable while she was able to walk around, but she just couldn't do it while being stuck in bed. So she had asked for pain relief.
It took a while for the epidural to settle in, and even then it did not take away all the pain. I gave her reflexology on her hands and when Sarah arrived, she started doing reflexology on her feet simultaneously.

Since the contractions started to slow down, a common side effect with epidurals, Sarah and I suggested that she turn around on all fours. She still had full control over her legs, which was a huge advantage. One of the big disadvantages of an epidural is usually that it numbs you completely from the waist down so you aren't able to move around anymore and help your labor progress. In this case, she had the best of both worlds.
And in no-time she was fully dilated and ready to push.
It took her about an hour, and then a beautiful baby girl was born without the help of a vacuum pump. This was truly a natural birth with epidural!

Technorati Tags: birth, hospital, childbirth, doula, reflexology, shiatsu, pitocin

Birth ABC explanation part 3

2007-10-14T20:02:00.001+02:00

Vitamin K oral drops

Vitamin K deficiency is a rare but extremely dangerous disease in newborns, that can easily be prevented by giving extra vitamin K at birth. Usually, this is given as an injection but it is also available as oral drops. To read more, click here.

Labor

The hard work that is needed in order to birth a baby. Usually, the term labor refers to the first and second stages of the birth: the time when the uterus dilates from 0 to 10 cm, and then the pushing stage until the baby is born. It is called labor because this is just plain hard physical work! But we can do it.

Midwife

A birth attendant who is trained in low risk, normal births. She usually comes from the point of view that birth is something normal that needs to be looked after. This is in contrast with doctors (obstetricians) that come from the point of view that all births are potentially dangerous. Obstetricians are surgeons.

There are 3 types of midwives; Direct Entry Midwives (DEM's), who went to midwifery school and got certified. Certified Nurse-Midwives (CNM's) first have a degree in general nursing and then took a midwifery course. And there are Lay Midwives who never attended official midwifery education (or never finished it) but rather learned the skills from other experienced midwives.

In Israel, only CNM's are recognized. They are the ones who attend births at the hospital, as long as it is low-risk. There are also midwives who attend home births, you can find a complete list here.

Natural

Birth is natural. It is an integral part of life, just like sleeping or digesting food or having sex. Giving birth is healthy, even though it hurts. Usually, pain is a sign that something is wrong in our bodies. In this case, the pain is a sign that something is going right, the baby is on its way to being born. We should not view birth as something clinical or pathological (although it can be in some cases), but rather as something that naturally belongs to us.

Oxytocin

Oxytocin is a hormone that is secreted by the pituitary gland. It is also known as the love hormone. It is released when we make love (both in men and in women), and also during birth. Oxytocin is the hormone that causes the uterus to contract. Without it, there would be no contractions. When oxytocin reaches the brain again, endorphins are released. Endorphins are the body's natural drugs and pain killers. It makes us feel high and it also makes us feel less pain. In turn, the release of endorphins stimulate the release again of oxytocin.

Pitocin

Artificial oxytocin, used to enhance contractions. Sometimes we need a little help giving birth. In some cases it is necessary to make labor start artificially (induction of labor) or to speed up labor after it has already started (augmentation). In both cases, Pitocin is often used.
Just like oxytocin, pitocin causes the uterus to contract. The big catch however is that pitocin can't pass the blood-brain barrier which means it can't reach the brain, and endorphins are not released. This usually means that women on pitocin feel the contractions much stronger and sharper than natural contractions. Also, the contractions might be harder on the fetus and cause decelerations in the heart beat and fetal distress. This is why women on 'pit' have a higher chance to end up with a cesarean section.

To be continued...

For the whole birth ABC, click here.
Birth ABC explanation: part 1. Click here.
Birth ABC explanation: part 2. Click here.

To subscribe this blog, click here.

Technorati Tags: vitamin K, newborns, birth, hospital, labor, contractions, midwife, CNM, DEM, midwifery, Israel, home birth, oxytocin, endorphins, pitocin, induction, cesarean

Blog update

2007-10-14T15:01:00.001+02:00

Upon request, I've added hebrew translations to the Birth ABC.

Birth ABC explanation: part 2

2007-10-13T23:47:00.001+02:00

Fetal monitor

A device to monitor the heartbeat of the fetus. It works by strapping a sensor to the lower abdomen of the body that is connected to the monitoring device on the bedside table. Another sensor is strapped to mom's upper abdomen, and measures contractions. This system is known as the External Fetal Monitor, or EFM.

During birth, it is important to know that the fetus reacts well to the contractions, and that there are no decelerations in his heartbeat during a contraction or right afterwards. If there are decelerations, it can be a sign that the baby is in distress.
In a normal low-risk birth, it is not necessary to be attached to the monitor continuously.

In some cases, the external monitor doesn't register the heartbeat properly, and then it might be necessary to use an internal fetal monitor, which is attached to the scalp of the fetus. For this, the membranes must be broken (in case of need, they will break the waters manually in order to be able to attach the monitor), and monitoring will be continuous.

Go with your body

The best advice I can give ladies on how to best give birth, is that they should go with the flow. Birthing is not something that we do with our intellect, but rather with our instinct. The lady should try to switch off her mind and let her inner monkey take over, as Ina May Gaskin puts it in her book Spiritual Midwifery.

Home birth

A good option for women with a low risk is to give birth at home in stead of at a hospital. Research says that if the pregnancy and birth are low risk, a home birth is at least as safe as a hospital birth as long as it's attended by a skilled midwife. Click here to read more.

Ice chips

Munching on ice chips is a great way to stay refreshed during labor.

Jacuzzi

Spending your labor in a jacuzzi or a big bath tub is a great way to relief much of the pains. Recent research says that laboring and giving birth in the water are good for mother and baby. Click to read more.

Click here to continue.

To subscribe this blog, click here.

For the whole birth ABC, click here.
Birth ABC explanation: part 1. Click here.

Technorati Tags: fetal monitor, monitor, EFM, birth, contractions, baby, fetus, Ina May Gaskin, home birth, hospital, jacuzzi

Birth ABC explanation: part 1

2007-10-11T17:02:00.000+02:00

I received several requests to explain the words from the Birth ABC. So here goes:

Apgar Score

A score to assess the immediate condition of a newborn at 1 minute and then again at 5 minutes after birth. Sometimes it's repeated after 10 minutes as well. The name Apgar comes from Virginia Apgar, an anesthesiologist from 1952 who started this method. APGAR is also an acronym for the five criteria of the Apgar score: Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone) and Respiration.

A newborn receives a score between 0 and 2 for each of the 5 criteria. A total score of 8-10 is considered good. Most babies will receive 8 or 9 at their 1 minute Apgar assessment.

It is important to note that a low Apgar score says nothing about the long-term development of an infant!!

Birth ball

Also known as exercise ball. The ball is great to sit on during pregnancy, because you can rock on it which is a great exercise in preparation for birth.
During labor, the ball is great to sit on (in the shower or basically anywhere), or lean on. It is one of the most used tools for effectively dealing with contractions.

Contractions

During labor and birth, the uterus contracts in order to get the cervix to dilate and to move the baby down and out. False contractions are also known as Braxton-Hicks contractions, and don't put you into labor.
Real contractions can feel like waves of pain, similar to menstruation pain. Sometimes they are only felt as tugging or pressure in the abdomen, lower back, buttocks and/or thighs.

If you experience more than 4 (Braxton-Hicks) contractions per hour before 37 weeks, drink 2 glasses of water and lie down for an hour. If they don't go away, contact your care giver because it may be preterm labor.

Dilation

The cervix is the lowest part of the uterus, and ends in the birth canal (also known as vagina). During the pregnancy, the cervix is hermetically closed, and sealed off with a mucus plug. During labor, the contractions make the cervix dilate (open up) in order for the baby to be able to pass through.
Dilation is measured in centimeters (cm) or in fingers. 1 finger is the equivalent of 2 cm. The cervix needs to dilate to 10 cm, which is enough to let the baby pass through. 10 cm dilation is also known as full or complete dilation. Upon reaching full dilation, you are allowed to start pushing.

Epidural

A form of anesthesia where the lower part of the body is completely numb. It is the most popular and also the most effective form of pain management during labor. There are many risks attached to epidurals. The best known are severe headaches afterwards, possible drop in maternal blood pressure (which leads to fetal distress), maternal paralysis and even maternal death (extremely rare).
Only an anesthesiologist can administer an epidural.
For more information, click here.

Episiotomy

A cut in the perineum (the skin and muscles between the vaginal opening and the anus) in order to let the head of the baby out. In most cases, the perineum is flexible enough to let the head through without the need of an episiotomy. In fact, most agree that it's better to let the perineum tear a bit, as much as necessary, in stead of performing an episiotomy.

To be continued....click here.
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Technorati Tags: apgar score, birth, baby, newborn, birth ball, contractions, braxton-hicks contractions, preterm labor, epidural, episiotomy, dilation

6 misconceptions about hospital births

2007-10-09T21:55:00.001+02:00

Many women have the wrong idea of giving birth at the hospital. I've listed a few of the things that I hear most from women.

1. You should always go along with the doctor/midwife, they know best.

While it's true that they have learned for it for many years,
you shouldn't assume that when they offer things, you have to
go along with it. Very often they will offer something because
it's standard protocol at the hospital but you still have the
the right to refuse it, or to make a counter offer without putting
yourself and/or your baby in danger.
For example, in many hospitals it's standard to start pitocin 6 hours
after your waters break, if labor hasn't started yet. There is no
research that supports that labor must start after 6 hours. In most
cases, labor will start spontaneously within 24 hours and waiting
patiently doesn't cause any harm.

2. I don't want to room-in with my baby because I want to rest.

One thing is for sure; you won't get much rest at the hospital. And
it's not because of the baby! Hospitals have a very strict time
schedule, and most of the time they're not in sync with yours.
Meals are at a specific time, and if you don't show up (because you
are sleeping or otherwise occupied), you won't get any food.
Breakfast is served early in the morning, right at the time that
you are probably finally sleeping after having to get up a few times
at night to feed your baby.

That's the thing, if your baby isn't next to you at night, you
actually have to *get up* and *walk all the way down the hall*
in order to get to your baby in the nursery. Speaking about
tiring!

What about the nursing staff that obviously don't sleep at night
but walk around, sometimes enter your room, don't bother to
tip-toe or whisper. Sometimes they even bring in a new roommate
in the middle of the night. Or they come to check your blood pressure.

The cleaners can be expected at 6 am, then the round of nurses
at 7 am when there is a shift change. And then there is breakfast.
And in the afternoon, it's visiting hour when you want to nap, and your
roommate is hosting all her aunts and uncles. What can you say?

3. Going to the hospital early means I'll have a better birth.

Many ladies, especially those giving birth for the first time, will get
restless when labor starts. It's a natural process to start looking
for a safe, sheltered place to give birth. Just like mommy cat or dog!
Unfortunately, the hospital is not that safe and sheltered place.
Hospitals are big and impersonal, and often have their own agenda.
From my experience I can say that the earlier a woman goes to the
hospital and the more time she spends there, the higher the chance
that she'll end up with interventions and an epidural. In stead, it's
always better to wait until the pace of labor has really picked up
before going to the hospital.

4. A hospital birth is safer than a home birth or a birth center birth.

Research says that this is not true for women who are low-risk.
If you want to know more about home births in Israel, click here.

5. I will have to spend my labor lying down in bed.

Most traditional labor and delivery rooms have the bed placed
prominently in the middle of the room. When you enter, it screams:
"Lie down on me! That's what I'm for! That's what you need to do!".
If there are no specific complications, lying in bed during the whole
labor is about the worst thing you can do. In order for the birth
to progress steadily, upright and/or moving positions are the best
way to go. Not every L&D nurse or midwife will bother to tell you this.

6. The nurse/doctor/midwife will stay with me the whole time.

Unless you hired a private midwife, hospital staff will not be able
to stay beside you the whole time. Most of the time, they have
more than one patient to care for at the same time, and they
just aren't able to stay with you.
And doctors usually only come in when it's time to 'catch the baby',
even if you hired a private doctor.
If you want someone who will give you continuous support and
who won't go home when her shift is over even if you haven't
given birth yet, you should hire a doula.

Technorati Tags: birth, hospital birth, midwife, doctor, doula, baby, labor, home birth, birth center

Birth ABC

2007-10-09T00:22:00.001+02:00

A: Apgar score (אפגר)
B: Birth ball (כדור פיזיו)
C: Contractions (צירים)
D: Dilation (פתיחה)
E: Epidural and Episiotomy (or rather not)(אפידורל ואפיזיטומיה/חתך)
F: Fetal monitor (מוניטור)
G: Go with your body (ללכת עם הגוף שלך)
H: Home birth (לידת בית)
I: Ice chips (קרח)
J: Jacuzzi (ג'קוזי)
K: Vitamine K oral drops (טיפות ויטמין K)
L: Labor (לידה)
M: Midwife (מיילדת)
N: Natural (טבעי)
O: Oxytocin (אוקסיטוצין)
P: Pitocin (פיטוצין)
Q: Quite an experience (חוויה של ממש)
R: Rupture of membranes (ירידת מים)
S: Shiatsu pressure points (נקודות שיאצו)
T: Tea of nettles and raspberry leaf (תה של סרפד ועלי פטל)
U: Uterus (רחם)
V: Vaginal birth (לידה וגינאלית)
W: Water birth (לידת מים)
X: XxX's for mother and baby (המון נשיקות לאמא ותינוק)
Y: You can do it! (את יכולה לעשות את זה!)
Z: Zzz's you won't be getting a lot of in the coming weeks. (שינה שלא תקבלי בשבועות הקרובים)

For Birth ABC word explanations part 1, click here.
For Birth ABC word explanations part 2, click here.
For Birth ABC word explanations part 3, click here.
For Birth ABC word explanations part 4, click here.
For Birth ABC word explanations part 5, click here.

The story of M.'s birth.

2007-10-06T23:10:00.001+02:00

M. called me at 1.30 am, sounding very urgent. Her water had broken and her labor had started, and it was very intense right from the start. Usually with first births, labor starts gradually with a long build-up. It is not uncommon that ladies are in pre-labor for a few days before active labor sets in.
It gives them time to call me with updates, so I can be ready for them when they call. I always ask that ladies call me early in the evening when they feel something starting, so I can make sure to go to bed early and prepare everything in advance, ready to jump into the car when needed.
I hadn't heard anything from M. for a few days, so I understood that this pretty much came as a surprise.

When I arrived at the hospital, Hadassah Ein Karem, I found M. in the reception area of the delivery rooms, sitting on the toilet. She was having hard contractions, and seemed to have a hard time dealing with them. I told her to relax her bottom and breathe slowly, and that helped her. The midwife who was running the reception area, asked M. to lie down for the 30 minutes of standard monitoring. It was really hard for her to lie down quietly, as it is for most women. It really doesn't matter what position you're in when you're attached to the monitor, as long as it keeps picking up the baby's heartbeat. M. found that she was much more comfortable on her knees, hugging her husband who was standing next to the bed while I was massaging her lower back.

Luckily, we didn't need to spend too much time in the reception area. and before long we were assigned a delivery room. It was one of the new ones. I saw that it even had a bath tub, but it wasn't in use yet. From what I understood, they're waiting for permission from the Ministry of Health.
In stead, M. went into the shower. It really made her feel a lot better. It was now 3.00 am.
The midwife in charge, Rivkah, wanted to check M. again and she already progressed to 8 cm!! It was really going quick.

The heart beat of the baby started to go down a bit, so Rivkah did insist that M. stayed attached to the monitor. During the check, Rivkah felt something that she couldn't quite place. She thought it might be an ear! She called in another more experienced midwife, Gila. I was really happy to see Gila. I had worked with her 2 weeks ago at R.'s birth, and that was just amazing.

Gila also wasn't sure what she was feeling, and suggested that the baby might not be in an optimal position. She called in the doctor, who also didn't know what it was, but who said that it's best to wait and see. In the end it was not an ear, and the baby was not in a bad position, and it did not cause any problems.

At 3.30 am, M. was fully dilated and ready to push. At first, she didn't really know how to to it effectively, but she learned as she went along. After an hour and a half, the midwives and doctor were not really satisfied with her progress. M. seemed to have too short contractions which didn't really give her the chance to push in an optimal fashion, and M. was starting to get tired.

It was decided to administer Pitocin to give her better contractions. As a result, M. pushed much more effectively but at the same time, the baby's heartbeat started dropping too. M. was using all kinds of positions to push in; squatting, kneeling, on all fours, but side-lying proved best in this case. When the baby started to crown, it became clear that he had to be born quickly. M. got an episiotomy, which sped the birth up by about 9 crucial minutes. If it would have taken any longer than it did, the doctor would have used a vacuum pump to get the baby out.

But that wasn't necessary. Within 1 push, a healthy baby boy was born at 5.55 am. The cord was clamped and cut right away, I guess as a precaution in case the baby needed immediate medical care. But luckily, he started crying right away. And within another 10 minutes, the placenta was born too. M. and her husband were delighted and couldn't believe their son was really there! All in all, the birth took only 6 hours from beginning to end.

Technorati Tags: birth, pitocin, doula, hospital, birth story

Using reflexology to speed up labor

2007-09-30T00:22:00.001+02:00

Yesterday I got an urgent phone call from a doula colleague of mine. She was at the hospital with a client, and the people in the delivery room next to her needed someone who knows reflexology. The lady had been in labor since the evening before, and things were not moving along. They were already talking about a cesarean, so they needed someone to 'work some tricks'.

When I arrived, I found a very cheerful lady who was in the company of both her parents and her husband. She was hooked up to an IV with fluids and pitocin, and she was currently at 5 cm dilation. I sensed that it could be going fast now. The lady was lying on her back, so I told her to move onto her left side first. Even with an epidural, or maybe especially with an epidural, it's important to stay off your back while you're in labor. Lying on your back prevents a good oxygen flow to the uterus and the baby, and it can also slow down labor.

I started massaging her feet, and I gave special attention to the points that are known to bring stronger contractions. The areas that I concentrated on most were the uterus and the uterus reflex points. Although she had an epidural, she was able to feel pressure and she said that when I was massaging her Achilles tendons, she could really feel her uterus contract. I made sure that the monitor picked up the fetal heart beat all the time, because sometimes reflexology can bring on too strong contractions that are hard on the baby.

I don't normally want continuous monitoring of the fetal heart beat when I give women in labor reflexology treatments, but in this case the woman was already hooked up to an epidural and pitocin, which are both notorious for causing decelerations in the fetal heart beat, especially when combined. Plus the fact that due to the epidural, the lady was not really able to tell if the reflexology was giving her too strong contractions.
So having her attached to the monitor was just a precaution, and luckily the baby responded really well to the treatment. And so did the lady herself.
Within 1 hour, she went from 5 to 8 cm dilation and the baby moved down a lot.
I had to leave at that point, but I am sure that the baby was born not long afterwards!

Technorati Tags: doula, reflexology, birth, childbirth, contractions, pitocin, epidural

The rights of a mother in childbirth

2007-09-23T20:42:00.001+02:00

A prominent Israeli professor in Obstetrics and Gynecology, prof. Mark Glazerman wrote a very interesting article in the Haaretz. He is asking the question if a woman in labor has the right to refuse a C-Section (or any other intervention), even if it means death for herself and/or the fetus.

In the western world, there have been several cases of mothers who refused cesareans, and were ordered by the court to have one anyway, on the basis of saving her life or that of her unborn baby.
He describes a case where the court ordered a C-Section on a woman with a large fetus. The mother escaped from the hospital, and went to another hospital where she ended up giving birth (vaginally) to a baby that was smaller in size than the other babies that she had given birth to vaginally in the past!!

The question Prof. Glazerman raises is whether it's ethical to force sane women to undergo medical treatments against their will. On the one hand, society has the duty to protect the rights of the unborn fetus (does a fetus have rights at all?). On the other hand, wouldn't it be contradicting to the basic human rights to force medical interventions upon a person (in this case the mother)? What happens if the needs of the fetus contradict those of the mother, in other words, if one had to choose between saving the mother's life or the one of the fetus. Who comes first?

In my opinion, nobody should be forced to undergo any medical treatment against their will, at any point. This includes a mother refusing a cesarean section, even if it means the death of her baby.
If a person who is not pregnant needs to undergo a life-saving surgery, can he be forced to do it? I didn't think so.
And what if a person needs to undergo surgery in order to save another person's life and he is the only one to do it, such as in the case of a kidney transplant, and he is the only possible donor, is he forced to undergo the surgery if this will save the other person's life? Unheard of!

So then, why should it be any different in the case of a pregnant woman?

Of course this doesn't mean that I think that we shouldn't try to convince mothers who refuse essential treatments. But it is very important that the mother knows the whole story of the situation, all the pros and the cons, in order to make the right choice for herself and her unborn child. If she doesn't know all the sides involved, how can she make an informed choice that is right for her?
That's why I always tell my ladies the pros and the cons of everything that comes on their path, and I also tell them that they have the right to refuse anything they don't want. They don't always realize that.

Here is the link to the article in the Haaretz.

Technorati Tags: birth, childbirth, rights, cesarean, c-section, medical treatments

Researchs says that water births are good!

2007-09-22T21:43:00.001+02:00

A new article on ORGYN.COM states that water births have excellent outcomes in low-risk women. Now it's proven officially that women who give birth while immersed in a tub of water have shorter labors, shorter births, less need for pain medication and less episiotomies. And the birth outcomes are at least as good as those of women who give birth on dry land.

Now let's hope that the Jerusalem hospitals will pick up on this, and install tubs in every room and actually allow women to give birth in them!

Technorati Tags: birth, water birth, Jerusalem

R.'s amazing birth story

2007-09-20T23:58:00.001+02:00

R. called me early in the morning, asking me to come. She had been having contractions from the day before, and now they were about 5 minutes apart and getting harder to deal with.
I arrived at her house about 20 minutes later, and I noticed that she was still acting her good old self in between the contractions. That is usually a sign that the labor is still in the early stages.

R. was 39 weeks pregnant, and more than ready to have her baby. She wanted to have an all natural birth, and therefore chose to go to Hadassah Ein Karem. Part of the reason was also that that is the only Jerusalem hospital that allows full rooming in.

We got to the hospital at 10 am, and it was really crowded. I've already noticed that there's a baby boom going on at the moment. In any case, R. was greeted by a very friendly midwife who attached her to the monitor and did an internal check. She was already 2.5 cm dilated and the baby's head was nice and low.
After the monitor, we were told to wait outside for a delivery room to become available. There wasn't a free one at that moment, and of course there was no way of telling how much longer it was going to take. R. took it really well, and we all waited patiently. In the meantime the contractions were getting stronger which was a good sign of progress.

All in all we waited about 3 hours in the waiting room, and then we finally got a room. Luckily we got one that had just been remodeled, and it was brand new and nice. The midwife in charge checked her again, and she already progressed to 4 cm. That was really great!
R. got into the shower and sat on the ball while I shampooed her hair. She didn't want to stay in there for too long, so when it was time for another monitor check-up, she got dressed and went on the bed.

While she was on the monitor, the midwife checked her again, and now she had progressed to 5 cm. Nice! It was going really well for a first birth, and at a steady pace. It wasn't going extremely fast, but R. would not have been able to handle that either. Her body was giving her exactly the right pace that she could cope with.
Then, the doctor in charge came in. He introduced himself, and then looked at the computer screen which was showing R.'s progress in a nice graph. He asked: "She's only 5 cm, did her water break yet?" and when he was told no, he went on saying that he would call in the midwife to break her water, so her labor would speed up.

What the heck??????????????????

As soon as the doctor was out of the room, I told R. and her husband that there was no reason to want to speed up labor, that she was progressing really nicely on her own, and that the artificial rupture of membranes could bring complications that otherwise would not arise.
R. only wanted to know if breaking the water would make the pain go away, but I told her that the opposite often holds true. When the bag of water breaks, the head of the baby presses directly on the cervix without the water as a cushion. That usually brings stronger contractions that are often also more effective.

R. was finding it hard to cope with the contractions she was already having, and I was afraid that rupturing her membranes would come as a 'shock' for her body, giving her extra strong contractions at a point when she wouldn't be ready for them yet. Membranes always rupture spontaneously at some point during labor (or even the birth). Sometimes labor needs to be sped up for medical reasons, and then artificial rupture of membranes (AROM) can be beneficial. But in most cases, the body knows best when it's the best time for the membranes to rupture.

There was a change of shifts, and the new midwife was not in any hurry to speed up labor, no matter what the doctor said. He came in again, and generously 'allowed' R. to progress for another hour, after which he would start 'doing something'. He made it sound like R's labor wasn't progressing at all, while the opposite was true.

The new midwife checked R., and then her water broke spontaneously. Right away, the contractions started to pick up again, and became stronger. It became really hard for her to cope now, but the midwife and I both knew that it would go fast now.
R. needed the both of us next to her with every contraction, one to rub her lower back in circles, the other so R. could squeeze her hands. R. was feeling pressure already but she was nowhere ready to push, so concentrating on squeezing my hands in stead of on the very strong contractions really helped her a lot.

Our amazing midwife stayed with us the whole time, rubbing R.'s back, holding her hands, holding the monitor in place in order to get a good reading of the heartbeat, encouraging R., and answering any questions that any of us had.
I wish there were more midwives like her!! I realize that we were lucky that she was not taking care of another lady at the same time, or she would not have been able to stay with us the whole time.

Finally it was time to push, and R. pushed for nearly an hour. For the longest time, it was not sure if her perineum would stretch far enough in order to allow the head to come out without an episiotomy, but our fantastic midwife had all the patience in the world, and eventually a healthy 3200 gr baby boy was born. R. only had a tiny scratch!
He started crying right away, and he was so incredibly cute!

I have never seen such a great birth with such a fantastic midwife. The lights were dimmed, the music was playing softly, and we were speaking in low voices. There were (almost) no disruptions.
I wish that every birth would be like this!

Breathing techniques for birth

2007-09-16T21:41:00.001+02:00

Breathing techniques are usually a very important part of traditional childbirth education. A very well known technique is of course the Lamaze technique. When you say Lamaze, most people automatically think about breathing.
Although Lamaze is much more than just breathing nowadays, the breathing exercises are part of the course curriculum.

So here's the deal about breathing techniques:
What's most important to remember is to keep breathing, and not to hold your breath. And you should make sure that you're breathing at a slow pace and that you won't start hyperventilating. And for the rest, it's important that you keep your body as relaxed as possible.

If you think that a structured breathing pattern could be beneficial for you, I will try to write down the Lamaze breathing technique.

In the beginning, the contractions aren't very strong yet. You can easily keep walking and talking through them, and it's fairly easy to 'ignore' them.

When the contractions get a bit stronger, there will come a point where it will be hard or even impossible to walk or talk through them, and you will have to concentrate a bit harder on your breathing. Here is what you do:

Inhale through your nose 2-3-4, exhale through your mouth 2-3-4.

When the contractions become stronger again, and this technique doesn't seem to cut it anymore, this is what you do:

Hee-hee, hee-hee, hee-hee, hee-hee

This is actually a bit hard to explain, but I'll give it a try anyway. The hee's are very short, and you sort of lead the air along your upper palate. With the first hee you inhale, with the second you exhale.

So what you actually do is: in-out, in-out, in-out, in-out. Keep them in groups of 4, that way they're easy to keep track of. And again, make sure that you don't do this too fast or you'll start to hyperventilate.

When this also doesn't help anymore, move on to the next step:

Hee-hee, hee-hee, hee-hee, hee-huuuuuuu

It is exactly the same as the one before, only the fourth hee-hee is replaced by a hee-huu. Make sure to make the huuuuuu nice and long, and keep your voice low.

Now for pushing this is what you do:

Take a full breath, take out a little air, hold and push down

Don't hold your breath too much, this should be more or less instinctive. You should be able to get 2-3 pushes out of 1 contraction.

If the midwife or doctor tells you not to push, blow out a candle. It is physically not possible to blow and push at the same time.

It is best to practice these breathing techniques a few times a day so that they'll become second nature. The better your body knows how to do this, the more beneficial it will be.
By the way, this technique is not only helpful during birth. It's good for any stressful or painful situation you come across in life.

Technorati Tags: lamaze, breathing techniques, technique, birth, course

Teaching and thinking

2007-09-11T20:11:00.001+03:00

I met with R. again today. She's 38 weeks now, and still had to get her class about breastfeeding. This is R.'s first child, and she is very natural oriented, so it was easy to convince her why breast is better than bottle.
I brought my teaching doll, pregnancy/nursing pillow, and The Breastfeeding Book by Martha Sears.
It was fun teaching about how to latch, and demonstrating it. I think that of all the teaching subjects, breastfeeding is probably my favorite.

I also showed R. the story of my last birth, and discussed it with her. She is going to give birth at Hadassah Ein Karem, so it's less likely that something similar will happen to her as well. In any case, it is a good idea to discuss these scenarios with women before they give birth, so that they are aware of the games that are sometimes being played in the delivery room.

C.'s birth

2007-09-10T15:20:00.001+03:00

Yesterday at 11.45 am C. called me with the message that something was starting. Since it was her 3rd birth, I trusted that this was the real thing.
She said that the contractions weren't very strong yet, but she was calling me to let me know that I could expect a birth later. I always ask my clients to let me know as soon as they think something is starting, so that I can make my arrangements and be sure to be available to her when she needs me.

A few hours went by without any change, but at 6 pm C. called me again that the contractions were coming every 5 minutes now, and that she would be needing my presence soon. And about an hour later, her husband called me to tell me to come. I jumped into my car andraced to their house, because I had a suspicion that it might go quick. I picked up C. and her husband, and drove them to the hospital. C. had chosen to give birth at Shaarei Tzedek this time. The previous 2 times, she gave birth at Bikur Cholim, and she wanted to try something else this time.

We arrived at the hospital, and C. was checked by a midwife. She was 10 cm dilated already!! We were all thrilled, because she would give birth soon. C. was given a room and was told to lie down on the bed. In Jerusalem hospitals, they don't allow women to push anywhere else but on the bed. C. did not protest.
She really had to push now, but the midwife did not allow her, because she was not standing next to her to check her. This was after it was already determined that C. was fully dilated. We both didn't understand why the midwife wouldn't let her, and I told her quietly to do whatever her body told her to.

Then the midwife came next to the bed, and checked C. (again). Apparently she didn't trust her colleague's judgment and needed to see for herself that there was full dilation. While her hand was in there, she told C. to push. But C. said that she didn't need to push, so the midwife stepped away again. A few seconds later, C. said that she had to push again, but now the midwife was across the room and not next to the bed, so she told C. to hold it up again. We were starting to get fed up!!

C. heard her midwife say something about getting the pitocin ready, and told the midwife that she was not interested. The midwife started explaining to her that she was only getting it after the birth, when the baby would already be out.
C. knew that, she wasn't stupid, but she still was of the opinion that she didn't want it. There was no arguing with the midwife though. She pretended to be dumb, and acted like she didn't understand that C. was actually refusing it.

During the last few hard contractions, C. wanted me to massage her back. I gave her counter pressure and she said it was helping a lot. Finally at long last, the midwife decided to join C. next to the bed, and allowed her to push. It took only a few minutes, and then a healthy baby girl was born! Seemingly effortless.
I went to get C.'s husband who had been waiting right outside the door. I mostly work with jewish orthodox couples, who keep very strict rules. A man is not supposed to see his wife give birth, and many ultra religious men choose to stay behind the curtain or even outside the room at the moment of the actual birth.

When joined C. next to the bed again, i saw that the placenta was already delivered. After only 2 minutes or so! I asked the midwife if she had given her the pitocin shotafter all. The midwife said that the other midwife, who had come in to give her a hand, had not asked C. so many questions and had just given it to her without asking. It made me so furious!!! Of course I had to keep my face straight, because as a doula I am not allowed to express my opinions openly in front of the staff. I feel very sad on behalf of my lady. I think it's outrageous that hospital staff will just disregard the wishes of their clients like this. There was no case of emergency, they could easily have waited with the pit to see if the placenta would come out by itself. C. was not even given a chance!

Technorati Tags: birth, childbirth, hospital, midwife, pitocin

Healthy outcome for birth centres

2007-09-06T16:23:00.001+03:00

Ruth Pollard, Sydney
September 3, 2007

BABIES born in birth centres had significantly lower death rates than those born in hospitals, a new Australian study of more than 1 million births has found.
For the whole article, click here.

Pregnancy Massage

2007-09-06T16:08:00.001+03:00

Recently I've finished the Reidman course in pregnancy massage. Massage is wonderful, especially when you are in your 3rd trimester, when your belly is big and your body is heavy.
Massage is also a very safe method of treatment, as long as the therapist knows what not to do.
It is recommended to get a massage once a week, to help relieve tensed muscles, and to take a moment for yourself. It is also great for the bond between you and your unborn baby.

The massage should be given in an enclosed and intimate space. The room should be quiet without disturbances from outside. It is nice to have calming music in the background too. The room should be not too hot and not too cold.
There should be a massage table with plenty of pillows, preferably special pregnancy body pillows. There could also be a birth ball.

For the massage itself it's best to use plain almond oil. It is not recommended to add aromatherapy oils such as lavender or tea tree, unless you've been using it since before you got pregnant. There are certain oils that cannot be used in pregnancy at all. For a complete list and more info, click here.

I give prenatal massages in my clinic in Jerusalem. Please contact me for an appointment.
The massage is suitable for women in the 2nd or 3rd trimester (13 weeks and up).

About Me

2007-09-05T19:37:00.001+03:00

It is important for every blog to have an About Me section. I noticed that I didn't have one yet, so here it is:

My name is Michal Levy, and I am the writer of this blog, Israel Doula.
It is a blog about my adventures as a birth doula, and as a professional massage therapist for pregnant women. I also give prenatal reflexology and reiki treatments.
I became a doula 2 years ago, first through DONA-International, and later also through the israeli ICEC/Reidman College. Since then, I 've been going to births.
At the same time, I trained to be a reflexologist and massage therapist and specialized in pregnant women.
I am writing this blog to give an insight into my life as a birth doula, and to discuss pregnancy and birth related topics with anybody who is interested.

To contact me, please call (+972) 054-2322216 or email: zussss@gmail.com.

I can also be reached through facebook.

Technorati Tags: blog, pregnancy, women, birth, doula, israel, adventures, about me, massage, contact, reflexology, discussion

Relaxation techniques

2007-09-03T21:03:00.001+03:00

I went to R. for another birth preparation lesson this morning. I was alone with her today, her husband was at work. It was the class about comfort measures and relaxation during birth. It was a really interesting because R. seems very into it. I have the feeling that she is well prepared for her upcoming birth, mentally as well as physically. She is interested in a natural birth without drugs.

Giving birth naturally is a realistic option for most women. You need to realize that giving birth, being in labor, is very hard work. But it can be done. Being mentally prepared for the tough job is half of what you need, the other half is relaxation. Being relaxed is key to having a successful drug-free birth. If you know how to relax your body, I mean really relax your body, you will be able to ride the contractions like a wave.

When you tense up, your contractions will feel more painful. And the more painful it is, the more tense you will be and before you know it, you're going around in a downward spiral. So, you need to train yourself to relax the different body parts. It is something you need to practice during your pregnancy, so that your body will know what to do when the time is there.

We did some relaxation exercises, and I noticed that R. knows how to relax her body really well. That is going to work to her advantage during labor! It makes my job a whole lot easier, because it's extremely difficult to teach someone how to relax, especially during the birth.
I also taught her some good positions and movements for labor, as well as the Lamaze breathing technique. Doing the Lamaze breathing is not the most important thing. It doesn't matter how you breathe, as long as you do it! Relax your body and keep breathing, that is what will get that baby out. The Lamaze breathing technique can help to focus on the breathing, which can be a good way to get through the contractions.

All that is left for R. now is the breastfeeding class, and then she will be ready to meet her baby!

Doulas deliver help for birthing moms

2007-09-02T14:57:00.000+03:00

I found this article on cnn.com:

Doulas deliver help for birthing moms

Doula is a Greek word meaning "woman's servant." Part birthing coach, part mother's assistant, doulas are showing up in more delivery rooms than ever before.
For the rest of the article, click here.

Booked Doula

2007-09-01T23:24:00.000+03:00

I got a phone call from a lady who is looking for a doula. She's due around now, and got my phone number through a doula colleague of mine. Unfortunately I had to tell her to keep looking, because I already have 3 births in the coming month.

Every lady has a window of 5 weeks in which she can give birth (37-42 weeks), with a peak in the week around her estimated due date (EDD).
I can't take on more than 3 births per month, because I want to give her the certainty that I will be attending her birth, and not the back-up doula. Of course I can never give a 100% guarantee that I will be there, and that's why every doula should always work with a back-up. Even if my births are spaced out nicely on paper, the lady in week 39 can end up giving birth on the same day as the lady in week 42. And their estimated due dates were 3 weeks apart!

The more births I take on, the higher the chance that they will be at the same time, or right after each other. I don't think that that is fair to any of my clients, because they all need me at my best.

I referred the lady on the phone to another doula friend of mine, and I told her to call me back if she really doesn't succeed to find a doula. I've already noticed that this is a very busy time of the year birth-wise. All my doula friends also already have 3 or more births lined up in the next month! But after the holidays, I have space for a few more births.