Although childbirth is one of the most natural processes in all of human nature,  women have died in childbirth since the beginning of time. While much has been done to improve maternal morbidity and mortality surrounding childbirth, the very methods used to save women may be the very ones killing them.

Consider this. Despite having incurred the wrath of God and being banished from the Garden of Eden Eve, with only Adam at her side and no medical intervention whatsoever managed to give birth to twin boys Cain and Abel.  (Genesis 4:1-15)

Fast forward hundreds of years to a young couple in Nazareth. A young virgin named Mary is impregnated by God. (Luke 1:26-38) After she and her betrothed Joseph go t Bethlehem to register for the census, Mary gives birth to the Christ child in a stable-on her own with only Joseph and the animals to help her. (Luke 2: 1-7)

Now many people are skeptical about the accuracy of these biblical accounts. Yet one cannot deny that in earlier times, women did have very natural births, were attended by midwives or family members and were cared for by the women of their tribes, villages and family members.

Despite the natural occurrence of childbirth, there are inherent dangers in childbearing such as hemorrhage, blood clots and embolisms and heart abnormalities and respiratory emergencies. I grew up in Massachusetts and my elementary education consisted of various trips to historical sites in and around Boston. One place that always intrigued me was the burial ground behind the Old North Church.  Wandering through the various plots I was always struck by headstones that read something like, “Elizabeth Smith: 1832-1862. ” Then there was a headstones that said, “Baby Smith” and just one date like,” June 2, 1862″, indicating that both mother and child had both perished during childbirth. Some women had multiple little headstones beside theirs, indicative of the numerous children lost during the birth process.

Most recently California has come under intense scrutiny as their maternal mortality rate has steadily climbed since 1996 and is at an all time high of 16.9 in 2006, the last year for which data has been compiled. Physicians and researchers who are analyzing the data note that there are several contributing factors to the increase:

• obese mothers
• older mothers
• fertility treatments
• better reporting of outcomes and better record keeping
• Preterm labor inductions
• Rising Cesarean Section Rate

None of the people who have read the reports can deny the impact that cesarean sections may be having on maternal mortality not only in California, but also nationwide. In California, the cesareans section rate doubled between 1996 and 2006, the years for which maternal mortality showed it’s dramatic increase. Additionally, the rate of pre-term labor inductions also increased in the same time period and preterm labor induction is known to increase the rate of cesarean section. Many ask the question, “Can these results be extrapolated to other states?”

Obstetricians, midwives, birth professionals and concerned citizens are all trying to determine the proper role of cesarean section in childbirth. While no one wants to go back to the middle ages when women routinely died during childbirth, we can’t ignore that today’s infant and maternal mortality rates are rising at an alarming rate despite all of the medical advances.

The University of Illinois Medical Center’s Discovery Hospital notes early contributions to obstetrics from the Egyptians and Hebrews. The first successful cesarean section on a live woman is said to have been performed in the 1500’s in the Roman Empire by Jacob Nufer, a pig farmer who performed the procedure on his wife.  Interestingly, the procedure initially was not widely performed because of its high mortality rate-some 85%. But with the advent of anesthesia and aseptic technique, cesarean sections became safer and more widely performed and accepted. Today in the United States nearly 1/3 of children are born via cesarean section. Conversely, it is reported that many of those surgical births are not medically necessary.

In response to this growing number of cesarean sections, in 2002 Dr. David Lagrew, the medical director of the Women’s Hospital at Saddleback Memorial Medical Center in Orange County set a rule: no elective inductions before 41 weeks of pregnancy, with only a few exceptions. The results, the operating room schedules opened up, the hospital saw fewer babies admitted to the neonatal intensive care unit, and fewer hemorrhages and fewer hysterectomies occurred.

While no hospital can be accused of performing cesarean sections as a way to increase revenues, few hospitals have been quick to adopt a “no preterm induction” policy. Likewise, hospitals that have adopted a no preterm induction and/or a low cesarean rate policy have been primarily non-profit facilities (See post on Indian Health Service). These hospitals have cesarean section rates more in line with the World Health Organiztion’s 10-15% and lower maternal and infant mortality rates.

So what is the answer? Clearly no one wants to sit by and watch US maternal mortality rates rise yet the medical community is very reluctant to completely change from its current structure. This country has already lived through treacherous times for childbirth during its infancy. The advent of technology, which initially lead to a decrease in infant and maternal mortality, now poses a threat to mothers and babies nationwide. Despite the inevitable outcry from those who benefit from the use of technology (Dr. Lagrew noted in his own hospital, revenues go down when procedures go down.), it is patently evident that its use has to be reined in.

Mamas on bed rest are at increased  risk of maternal mortality. Voice your concerns in the comments section so that researchers and policy makers will put the health well being of mothers and their babies before technology, protocol and revenues.

Here is a summary of the consensus statement.

• The panel affirmed that a trial of labor (TOL) is a reasonable option for many women with a prior cesarean delivery.

• Rigorous research shows that a trial of labor is successful in nearly 75 percent of cases, and maternal mortality is actually lower for women who have a trial of labor, regardless of whether they end up delivering vaginally or by cesarean, though those women who have an unsuccessful trial of labor and undergo a repeat cesarean delivery experience higher morbidity than those who have a successful VBAC.

• Concerns have arisen because although VBAC does reduce morbidity in mothers, there is a slightly increased risk of morbidity and mortality to the fetus. The Panel is asking for more research to see if these disparities can be resolved and definitive risks determined for both mother and baby.

• The panel is advocating for additional research to develop clear, evidence-based risk assessment tools to assist mothers and providers in the decision-making process from early pregnancy through delivery, accounting for individual risk factors, values, and preferences to see who is an appropriate candidate for TOL and VBAC and who is not.

• The Panel strongly recommended that policymakers and providers collaborate in the development and implementation of appropriate strategies to address malpractice concerns that may keep providers from recommending VBAC, such as increases in malpractice premiums and threat of litigation in the event of untoward events.  These factors and others seem to be (along with other factors) exacerbating barriers to TOL  for women with a previous cesarean delivery.

• The Pannel recommends that the American College of Obstetricians and Gynecologists and the American Society of Anesthesiologists reassess the requirements to have an obstetrician and anesthesiologist “immediately available” while any woman who is having a TOL is laboring.  This recommendation has created a significant barrier to TOL and VBAC for many hospitals who cite the cost of having an obstetrician and anesthesiologist constantly on call is prohibitive. They ask the societies to compare VBAC risk relative to other obstetrical complications of comparable risk, risk stratification, to see if it is truly necessary in light of limited physician and nursing resources.

• The Panel recommends that Healthcare organizations, physicians, and other clinicians should consider making public their TOL policy and VBAC rates, as well as their plans for responding to obstetric emergencies. This will help the providers and patients better assess if a TOL really is a viable option for their situation.

• They  recommend that hospitals, maternity care providers, healthcare and professional liability insurers, consumers, and policymakers collaborate to develop integrated services that would reduce or even eliminate barriers to a trial of labor and subsequent VBAC.

The full NIH Consensus Statement is available Here.

Policy makers need to hear from us if we want to have choices in how we give birth to our children. I am in contact with many advocacy groups and will share your concerns. Please add your comments to the panel discussion in the comments section.  ~DTL

For the past 2 days, the National Institutes of Health has hosted a conference to develop a consensus statement on Vaginal Birth after Cesarean Section (VBAC). In the United States, nearly one in every three births is via cesarean section, a number that is more than double the 15% cesarean section rate recommended by the World Health Organization. The high number of cesarean sections in the United States comes in large part from repeat cesareans. The current NIH discussion is to determine whether or not a woman who has had a prior cesarean section should automatically have cesarean sections with subsequent pregnancies, whether or not VBAC’s are safe and in what situations should they be performed.

Proponents of VBAC argue that VBAC’s are safe in women who are at relatively low risk and when the procedure is performed by competent labor attendants (midwives) in a mother friendly environment. (For more on mother friendly childbirth, see MFCI.) Opponents say that VBAC’s pose unacceptable risks to both the mother and baby due to the risk of uterine rupture, hemorrhage, and potential death of both mother and baby. So who is right? Ironically, both sides because the success of VBAC rests in large part with where it is done and who attends that birth.

One with nature-The Indian Health Service

The March 6, 2010 New York Times published an article by columnist Denise Grady reporting on the successful birth rates at the Tuba City Regional Healthcare System in Tuba City, Arizona. This hospital is part of the Indian Health Service, A federally funded healthcare program that serves Native American Indians and Alaska Natives, and is run by the Navajo Nation. This small hospital which delivers about 500 infants annually has a 32% VBAC rate and an overall cesarean section rate of 13.5%, despite the fact that many Native American women develop gestational diabetes and hypertension during pregnancy which, if they were being cared for by the conventional US health care system, would make them more likely to have cesarean section deliveries.  How is such success possible?

Parameters that contribute to a low cesarean section rate overall and to high VBAC rates

To Fully understand the success of Tuba City and other hospitals like it, one must look at how the the overall system is structured. There are 5 specific things that Tuba City has in place that allows for their success.

1. Midwives attend most of the vaginal deliveries.

Midwives are more likely to “wait it out” if a woman is having a long labor and the baby isn’t in distress than to recommend a cesarean section. Midwives never induce labor, a process known to increase the likelihood of a cesarean section becoming necessary. Midwives are trained to assist women during childbirth process rather than to try to control it.

There is additional incentive amongst Native Americans to avoid cesarean sections. Many Native American couples wish to have more than 2 children and are educated about the dangers of repeat cesarean sections. Additionally, Native Americans believe that incisions are a threat to the spirit of the person being cut, so surgery is something to be avoided as much as possible.

2. Any and all family members are present and welcome.

In Tuba City as well as within any Navajo community, a laboring woman is never left alone. Not only will her partner be present, most likely her mother, grandmother, aunts, cousins and any other female relatives or family members. The laboring mother is constantly massaged and offered sips of water and small bits of food. With all of this support and her own prior exposure to labor and childbirth, the laboring mother has no fear whatsoever of her own labor and delivery.

3. Easier Adherence to ACOG VBAC Guidelines

The American College of Obstetricians and Gynecologists hs issued guidelines for VBAC’s. An obstetrician and anesthesiologist should be present or very quickly accessible while a woman who has had a previous cesarean section is laboring in the event that she requires and emergent cesarean section.

While many community hospitals have been unable to meet this criteria citing cost prohibition of maintaining professional staff on call at all times, hospitals on Indian reservations have had no such problem. The Tuba City Hospital is located within the property of the Navajo Indian reservation. Many of the physicians who work at the hospital either live on the reservation or within minutes of the hospital. Many doctors who are on call may actually go home while a midwife attends a birth because if they are needed, they can be at the bedside within minutes.

4. No Threat of Malpractice litigation

The Tuba City Hospital and its doctors are federally insured against malpractice because it is a federally funded facility. Hence the obstetricians are not as concerned about being sued if complications arise or about increases to or complete cancellation of their malpractice premiums.

5. No threat of wealth

The professionals that staff the hospitals in the Indian Health Services are paid flat salaries; $190,000 to $285,000 annually for the physicians and $80,000 to $120,000 for midwives. Since the staff is not paid per procedure, there is no incentive to do more and potentially unnecessary procedures.

“Conventional” Wisdom

In conventional western medicine, childbirth is a procedure to be managed and controlled. In most US hospitals, laboring women are not allowed to move freely because they are hooked up to fetal monitors. They labor in bed and primarily on their backs-the least comfortable position in which to labor.

A woman is not allowed to have anyone she pleases at her side and many times is alone during her labor process when the doctor or nurse needs to “check her progress.”While many women hire doulas, many US hospitals still try to and successfully block their presence in the labor and delivery rooms.

Many more interventions are involved; from intravenous fluid administration, to epidural anesthesia, to labor induction with oxytocin, an episiotomy (a surgical incison in the perineum to allow passage of the baby without tearing. Not usually needed but frequently done “just in case.”), to forceps and/or vacuum extraction of the baby to cesarean section. The natural process of  labor and delivery is now seldom allowed to “play itself out.”

Why is there such a disparity between the two methods?

In this era of Health care reform and in the midst of this contentious debate, the Navajo nation is a blatant example of less being more. The United States spends more money than most industrialized nations for health care and yet we have some of the sickest, most obese citizens in the world. We also have some of the highest maternal and infant mortality rates in the industrialized world. We are in no way, shape or form getting what we are paying for.

If the United States truly wants to lower cesarean section rates to be more in line with WHO recommendations, if it wants to  improve VBAC rates and if the US truly wants to improve  maternal, fetal and infant mortality, we have to change how we do things.

• Births should be attended to by the most qualified attendants-midwives.
• In uncomplicated situations, labor and delivery should be allowed to progress naturally at their own times.
• Women should be allowed to move freely during labor and to have anyone they need present. Cultural and religious traditions should be respected.
• Treatments and interventions should be administered on a case by case basis and not as standards of care. Interventions should be kept to a minimum and not be performed as a defense against litigation.
• Monetary incentive should not be given to providers for more interventions, yet providers should be assured of adequate compensation for their skills.

Most physicians in our current health care system would balk at these recommendations because these would represent sweeping changes in the way they are trained, how they practice medicine and most especially in the way that they are paid. However we Americans, especially we women, have to ask ourselves how much longer are we going to put up with and pay into a system that clearly does not have our best health at its core?

It will be interesting to see what the NIH consensus comes up with. Quite frankly I am not all that encouraged that much is going to change, but the fact that there was even the discussion means that we are moving, ever so slowly, in a more positive direction.

I attended the Coalition for Improving Maternity Services (CIMS) annual forum for the first time this past weekend.  I learned a lot about new research in pregnancy, labor and delivery and delivery of care for pregnant women and their families. But the one thing that kept nagging at me throughout the conference was that many of the findings and initiatives, including the Mother Friendly Childbirth Initiative (MFCI), are not available to “mamas on bed rest” or high risk pregnant women. While I wholeheartedly agree with the initiative, I kept wondering to myself, “What about mamas on bed rest?”

In my opinion, high risk pregnant women need mother friendly childbirths more than women having uncomplicated childbirths. When that red “High Risk” is stamped on a woman’s chart, she automatically loses the bulk of her power to choose the course of her pregnancy. She is told if she has to go on bed rest-there isn’t choice not to. She is told when she will deliver and where (often in a hospital operating room with a cesarean section). She will have medications and interventions-often without being told or asked if she wants to have them and all the while she will be told that if she wants to have a baby to bring home at all, this is how it has to be. Mother Friendly? Not in the least.

I don’t dispute that when a woman is having a high risk pregnancy that more medical intervention may be needed to sustain the pregnancy or to deliver the baby. What I am railing against is the powerlessness that high risk pregnant women have to succumb to in order to have a child. While many of us may already be humbled by infertility and conception difficulties, and threatened miscarriages and preterm labor, doesn’t it stand to reason that we need the support and comforting atmosphere of a mother  friendly environment even more so? Can’t we apply even a few of the MFCI points to high risk pregnancy right now?

I know well how using even just a few of the MFCI points can make a huge difference. When I had my daughter, I went into preterm labor and all hell broke lose! I was admitted emergently by one of my OB’s partners because she was off. Since I was scheduled for a cesarean section I was admitted and prepped in a surgical anteroom. My husband was present at times, but for the epidural and other procedures, he was asked to leave and I was all alone to endure the clang of instruments being opened and laid out, bright lights directed at the OR table and draped and masked “blue people” I didn’t recognize telling me everything would be okay. It was unnerving to have my belly bared to a room full of strangers; some to care for me and some to “take” care of my baby .

Once the epidural was administered, I began vomiting profusely and little was done to stop it except adding things to the IV bag. When my husband came into the delivery room there was so much commotion he was completely overwhelmed. When my daughter was born I asked him what she looked like and he was completely undone by the “crater” they had created in me to get her out. My daughter was quickly whisked out for more “intensive” care due to breathing difficulties and was only paused briefly by my face. My husband went with the baby and once again I was on my own. I was alone in the recovery room, vomiting and in pain for 2 hours before being transferred to the post partum floor.  A neonatologist briefly stopped by to tell me that my daughter was okay, they were checking her out and that I would see her shortly. She did not arrive while I was in recovery. We did roll by the nursery on my way to the floor. I still hadn’t held my baby and by now 4 hours had passed since her birth. On the floor I continued to vomit until 2 am when the anesthesiologist finally graced us with her presence and gave me something in the IV bag to stop the vomiting and put me to sleep. It was the next morning, 12 hours later, when I held my daughter for the first time before she was transferred to the neonatal intensive care unit.

The picture was completely different when I had my son 3 1/2 years later. First and foremost, he was nearly term, born at 39 weeks. I actually had him at a different hospital because I wanted to have my tubes tied and the first catholic hospital did not allow the procedure. The second hospital tried to make the surgical suites more friendly. It may seem strange, but a nice color and curtains at the windows does a lot to warm up a place. Every room was tastefully decorated with a place for a partner to sleep and a place for the baby’s bassinet. My OB delivered my son and I felt so much more comfortable with her attending the birth. My husband was so shell shocked from my daughter’s birth that we agreed he wouldn’t be present at my son’s birth. We flew my older sister in to be with me instead. She was by my side at all times and we were laughing so hard at one point, my OB had to ask us to stop giggling so she could stitch me up!

When my son was born, my doctor held him up so that I could see him. She did suction him (a midwife care no no)  and then she laid him on my chest. He nursed with a vigor I didn’t know a newborn could muster! The nurses wiped him off and wrapped him up to go see my husband. That was the only time he was away from me. He and my sister rode with me to the recovery room where my husband, my parents, my sister and baby were all present. My son nursed at will and also rode with me to my room and stayed with me in my room until I was discharged.

One could argue that my second delivery was so much better because my son was a healthy term baby and my daughter was preterm and had breathing complications. I did not have lots of choices regarding my care or treatment for either birth. But even within those parameters, I believe that the “warmer” , friendlier environment, having my OB who tended me throughout my pregnancy deliver my child and having a friend/family advocate always at my side keeping my spirits high and making sure I had what I needed went a long way to making my second delivery much calmer, more memorable (in a positive way) and more “Mother Friendly” than the first. Small changes such as these and a few others would go a long way towards making “mother friendly” births for mamas on bed rest.

I’m so excited! The Coalition for Improving Maternity Services (CIMS) Annual Meeting and Forum will be held in Austin this weekend, February 26-27th and I’m going to be there!  Some of the most prominent experts in mother and baby care will be presenting and relating data from their latest research. I know that I am going to learn a lot about how to better care for and serve mamas on bed rest. Of course I will be sharing all that I learn with you.

CIMS defines itself as,

“The Coalition for Improving Maternity Services (CIMS) is a coalition of individuals and national organizations with concern for the care and well-being of mothers, babies, and families. Our mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs. This evidence-based mother-, baby-, and family-friendly model focuses on prevention and wellness as the alternatives to high-cost screening, diagnosis, and treatment programs.”

What does CIMS do for Mamas On Bedrest?

“How does this pertain to me? I have a high risk pregnancy and all of those “natural” treatments and birthing options won’t work for me. There will be lots of medical intervention in my birth-there already has been!” CIMS is dedicated to ensuring that all mamas have as natural and as safe a pregnancy, labor and delivery as possible-whether they are considered “high risk” or an “uncomplicated” pregnancy.

Why is CIMS’ work so important?

Mostly because of the poor maternal and infant mortality rates in the United States. According to the March of Dimes 2003 data , infant mortality rates in the US are at approximately 6.8 deaths per 1000 births. This is a sobering number given that in the US, we have some of the most technological treatments available. Despite our technological advances and our ever rising medical costs, the United States lags far behind most industrialized nations and many developing nations in infant mortality. For all we do, many American infants still die well before their first birthdays. The statistics are worse or African American babies. Black babies die at a rate of 13.5/1000 according to the March of Dimes.

Maternal mortality is not much better. According to the US Department of Health and Human Services Health Resources and Services Administration, in 2006 13.3 maternal deaths occurred for every 100,00o births. This may not seem like a lot, but in 1n 1987, that number was 6.6 per 100,000. We’re going backwards, not forwards. What is most alarming to me, an African American woman, is that the vast majority of deaths occur in African American women and babies. African American mothers are 3 times more likely to die from complications of pregnancy or childbirth than their white counterparts.

Part of the problem is that for all of our technology and advanced treatments, they are not readily available to everyone. Women from lower socioeconomic groups, women without insurance  and women whose insurance dictates caregivers or place of birth are at the mercy of whatever care their providers choose to give them.

And in many cases, that means cesarean section. The United States has one of the highest rates of cesarean section delivery in the world. Nearly a full 34% of babies born in the United States are born via cesarean section. While cesarean section is a necessary procedure in certain cases, often in the United States cesarean sections are elected based on convenience or to avoid the potential for a poor outcome and subsequent litigation. The World Health Organization (WHO) clearly states,

“Countries with some of the lowest perinatal mortality rates in the world have cesarean rates of less than 10%. There is no justification for any region to have a rate higher than 10-15%” (From the International Cesarean Awareness Website, www.ican-online.org)

CIMS is working with ICAN and other organizations to push tougher regulations on cesarean sections so that mamas and babies won’t be put at unnecessary risk.

CIMS is also at the forefront when it comes to education, especially regarding breast feeding. It has long been established that breastfeeding is the best way to nourish an infant and has been endorsed by the WHO and the American Academy of Pediatrics. Yet a small percentage of American women and their babies have established breastfeeding by 6 weeks. CIMS’ members work diligently to provide breastfeeding education resources to underserved areas and to assist mamas who want to breast feed to do so.

CIMS is working to change the way American clinicians provide prenatal care to pregnant women. They advocate for the midwifery model of care which sees a woman as the primary driver of her health care and as an active participant in all decisions regarding her prenatal care.

The Mother Friendly Childbirth Initiative (MFCI)

With all of these interests, CIMS has issued The Mother Friendly Childbirth Initiative (MFCI). MFCI clearly states the position of CIMS on maternal, child and family birth and health care and what they are doing to change our current maternal health care system. The entire consensus statement can be read here.

CIMS is not a bunch of loud mouths hippies calling for everyone to have home births, and unfortunately, that is how some of their opponents try to portray them. On the contrary, CIMS is an organization whose members and advocates research pregnancy and child birth while adhering to the most stringent medical research methods currently required.  Any treatment or procedure that they advocate is endorsed because there is clearly defined evidence that the treatment is effective and beneficial and works with minimal or no inhibition to the natural course of pregnancy, labor and delivery. As we all know there are a number of treatments and procedures performed today during the course of “normal” prenatal care, pregnancy, labor and delivery that while they “get the job done,” they are often detrimental to mama and baby either physically and/or emotionally. CIMS raises awareness about such procedures while at the same time advocating for alternatives that are more supportive, nurturing, and equally beneficial and effective for mama and baby.

CIMS is an advocate for safe, natural pregnancies and births. No, they are not going to reem you for being high risk and needing intervention such as bed rest. But they are going to advocate that you be offered all possible options for your situation, that you get the support that you need while you are on bed rest regardless of your economic or insurance situation, that you be allowed to at least try vaginal birth in the absence of an evidence based contraindication, that you be close to your baby as soon as possible after delivery and that you have all the education, assistance  and support that you need to skillfully breastfeed your newborn.

I’ve said it before and I’ll say it again. Being on prescribed bed rest with a high risk pregnancy does not mean that you, a mama on bed rest,  lose all rights to decide your course of care. Nor should it prevent you from receiving the best care for you and your baby; care that supports you, nurtures you and results in both of you. CIMS may advocate for vaginal births and a midwifery model of care, but at its heart, CIMS seeks to defend and advocate for the health and well being of mothers and babies.

Reasons for Domestic Abuse During Pregnancy

The most common reason for abuse during pregnancy is that it is a continuation of pre-pregnancy abuse. Women who are abused prior to pregnancy are at increased risk of being abused during the pregnancy. Domestic abuse during pregnancy is also the result of:

• Stress related to the pregnancy-especially if the pregnancy was unintended.
• Financial concerns regarding the pregnancy, delivery and subsequent addition to the family
• Change in the partner’s relationship, especially insecurity and/or jealousy of the father regarding mother’s divided time and increased attention to the baby.

How Common  is Domestic Abuse in Pregnancy?

The March of Dimes and other resources state rates of domestic abuse during pregnancy reach as high as 25% of all pregnancies. Abuse of pregnant women occurs in all ages, races and ethnic groups and in all socioeconomic levels.

What is Considered Abuse?

The abuse can range from name calling, verbal insults and controlling/isolating behavior to pushing, hitting, punching, kicking or choking. While emotional abuse is extremely stressful, physical abuse can be extremely harmful-even deadly to mother and baby. If you are unsure if you are in an abusive relationship, ask yourself the following questions:

• Does my partner always put me down and make me feel bad about myself?
• Has my partner caused harm or pain to my body?
• Does my partner threaten me, the baby, my other children or himself?
• Does my partner blame me for his actions? Does he tell me it’s my own fault he hit me?
• Is my partner becoming more violent as time goes on?
• Has my partner promised never to hurt me again, but still does?

If you answered “yes” to any of these questions, you are in an abusive relationship and need to get help-if not for yourself, then do it for your baby.

Effects on Mother and Baby

Abuse certainly has detrimental effects to both mother and baby. For mother, the increased and persistent stress can cause her to withdraw. She may begin missing prenatal appointments and thus not getting much needed care for herself and her baby. She may not eat well or sleep well and is at increased risk of depression. If the abuser is controlling, she may have lost contact with family, friends and loved ones. Isolation is an integral part of abuse as it keeps women from seeking and obtaining help. It also helps hide the physical signs of abuse-if there are any.

If mother has any sort of chronic disease, these will likely get worse and can cause complications for both mom and baby. Mother may not be taking necessary medications or getting necessary treatments so her overall physical health is compromised. Hence the energy and nutrients she has to give to her baby are also compromised.

The added stress is no better. When mom is stressed, so is baby. Additional stress has been linked to preterm labor,  miscarriage and even still birth.

Physical abuse is quite possibly the most dangerous form of abuse. In addition to the overall physical injuries a pregnant woman may sustain, physical blows to a pregnant woman’s belly can result in placental damage or abruption, vaginal bleeding, injury to the fetus, preterm labor or even miscarriage.

What To Do

First and foremost, if a pregnant woman (or any woman) is at risk for domestic abuse, she needs to get help.

Start by speaking with your obstetrician or midwife (if you can speak with them alone). Health care providers often have access to resources or people on their staff can help you get help.

Contact your local police department if you feel you are in immediate danger.

Find a safe place to stay where you can get help. This may be with a good friend, neighbor or family member. You may be able to get help from your church or other civic organizations. If woman’s shelters are available in your area, contact them to see if they can assist you.

Gather some of your things, especially important documents such as bank account numbers, credit card information, prescriptions, etc…Have a bag ready and easily accessible in the event you have to leave abruptly. You may even want to have them somewhere outside your home (at a friend’s home for example) in the event that you have to flee unexpectedly.

Domestic abuse during pregnancy is more common than many of us realize. However, it is not normal and need not be tolerated. Help is available from the resources below.

National Council of Child Abuse and Family Violence
http://www.nccafv.org

Alliance for Children and Families
http://www.alliance1.org

Stop Abuse for Everyone
http://www.safe4all.org/resource-list/

National Domestic Violence Hotline (800) 799-SAFE (7233)
http://www.ndvh.org

This post was compiled using data from The March of Dimes, Cyberparent.com and Women’s Healthcare topics.com

Kegels are essential exercises for all women, but especially for pregnant women on prescribed bed rest. Mamas on bed rest, with their prolonged inactivity and growing uteri are at increased risk of weakened pelvic floor muscles which will be further stretched and potentially weakened if they vaginally deliver their babies. The results can be urinary incontinence (involuntary loss of urine with coughing, laughing, sneezing), organ prolapse (bladder, uterine or rectal prolapse (bulging or protrusion of the bladder, uterus or rectum through their respective openings to the outside), or decreased sexual sensation due to the lax musculature. But I don’t want to get ahead of myself here. Let me start with the basics and work forward.

Dr. Arnold Kegel developed “Kegel” exercises to help women strengthen the pelvic floor muscles following pregnancy. Dr. Kegel noted that women frequently became incontinent following pregnancy and found that if they could strengthen the pubococcygeus “PC” muscle (the muscle that is suspended along the pelvic floor like a hammock and holding all of the pelvic organs in place), they could often improve or reverse urinary incontinence as well as bladder, uterine or rectal prolapse. He started teaching his patients how to contract the PC muscle and Kegels were born

So how is a Kegel done? First, you have to be sure that you are working the proper muscles. If you are squeezing and releasing your buttocks, you are probably not working your pelvic floor muscles-at least not effectively. You can be sure you are working the pelvic floor muscles:

• By stopping the flow of urine while urinating. While this is a good way to get to know the pelvic floor muscles and what they feel like when contracted, do not stop the flow of urine ROUTINELY as a way to strengthen the pelvic floor muscles. This practice will actually weaken the muscles and cause or worsen urinary incontinence.
• You can look at your perineum and watch as you contract the muscles. If you are performing the exercises correctly, you will see the anus “wink” the perineum move up and down and the clitoris “nod” (thanks to Desiree Andrews of Prepforbirth.com for these great visuals!). This is a great way to see and learn which muscles are working. You can place a mirror on the floor and squat over it to see the muscles or hold a mirror between your legs. However, if you’re pregnant, it may be hard to hold the mirror between your legs and see and this is really hard of you are on bed rest. But for non-pregnant women, this is a good way to start learning how to Kegel.
• You can feel for muscle contractions by placing a finger or two into your vagina and then contracting the pelvic floor muscles around your fingers. Again, once you know which muscles to contract, you can effectively perform Kegels.
• There are devices that one can use to help stimulate the PC muscles. Physical therapists often use such devices when teaching clients how to do Kegels. Additionally, one can buy such devices and learn to Kegel using the devices.

Now once you get the basic muscle contractions down, you can then move on to some “advanced” Kegeling.

Squeeze, Hold, Release : This is just as it states. Squeeze your PC muscle, hold for a few seconds and release.

Elevators: This is an increasing contraction and likened to making floor stops while on an elevator. You begin by lightly contracting your pelvic PC muscle. After about 2-4 seconds, increase the contraction further pulling up the PC muscle. Hold for another 2-4  seconds and then tighten the contraction again. Hold for 2-4 seconds and then release. A variation is to gradually release the contractions holding for 2-4 seconds as the “elevator goes down.”

Quick Bursts: These are just what they say, quick contractions. You quickly contract the PC muscle, say 10 times. Rest for a brief moment and then repeat the series. This should be done several times over the course of about 5 minutes.

Some people recommend that women “Kegel” approximately 20o times a day-performing a variety of contractions. If you Kegel regularly, say 3-4 times a day performing 10 or more Kegels at a time, you will strengthen the PC muscle. But as the saying goes, the more you work a muscle, the stronger it becomes. So if you want to keep your PC muscle strong and have a strong pelvic floor, Kegel often, several times a day and in various situations so that you not only develop pelvic floor muscle strength, but also muscle control which can help prevent incontinence and enhance sexual pleasure.

Note: Second image courtesy of www.menstruation.com.au

Well, I’m glad that you asked. Sitting over breakfast I too was thinking of how to make this a special day for my own “hunny bunny”. As per usual, I am running late for the train, so I was thinking of things that I could order for quick delivery. So here are 9 ideas that I came up with over my breakfast taco and chai tea. If you use one for your “hunny” send a comment and let me know how it turned out!!

9 Valentine Ideas for Mamas on Bedrest to share with their partners

1. Send flowers. Yeah, kinda screams “I forgot” but at least you remembered in time to order something.
2. Edible Arrangement. The company that bears the name will deliver a beautiful arrangement composed of fruit. If you choose certain arrangements, you can have chocolate dipped fruit (strawberries, bananas, etc…) or hunks of chocolate on skewers added to the arrangements. www.ediblearrangements.com
3. Luv’s Brownies. I add this one because it belongs to a friend out in my beloved San Jose, CA. Aundrea Lacey is the owner and founder of Luv’s brownies (www.luvsbrownies.com) and has taken brownies to another level. You can order brownie cakes, brownies in coffee mugs, she’s written a book…If it’s brownies your love likes, they will love Luv’s Brownies.
4. Candy. Believe it or not, candy (namely chocolate) is still an all time favorite for Valentine’s Day. No longer is it just Lammes or Russell Stover’s. If you go to Candygram.com, you can order a wide range of candy items and have them shipped directly to your honey. Won’t that be a nice little “pick me up” to their day at the office??
5. Massage. Okay, this is if you want to spend a little change. Now if you’re feeling the love, you’ll arrange to have a local massage therapist come out to your home and give your honey a relaxing massage. But if you’re like me, no one is allowed to be massaged in my home without me! Solution, order a couple’s massage. It’s really great. 2 massage therapists arrive at your home, will bring their tables and you and your honey can be massaged at the same time. If that’s too pricey, you can still have the massage therapist do you both in tandem. In any event, it’s sure to please!!
6. Pajamagram. My husband ordered me one of these a couple of years ago, I think for my birthday and I got a real kick out of it. Pajamagram.com has a whole catalogue of pajamas that you can order and they will ship them in the cutest boxes, sometimes with cute little accessories and all. Wouldn’t your honey look cute in a pair of boxers??? You may not be able to “touch” but hey, a little eye candy never hurt anyone!
7. Personal Chef Services. There’s nothing like a really good home cooked meal. Now that you are on bed rest, you can’t give your honey that special “luvin’ from the oven!” But a personal chef can do that and more. After a consultation (and this can be done over the phone!) the chef will go grocery shopping, arrive at your home with their own cutlery and cookware, cook a sumptuous dinner and prepare it for service. Many personal chefs will also bring table cloths, china, flatware, candles….Check in the catering sections of your local listing to see if there are personal chefs in your area and see what types of services they offer.  Bon Appetit!
8. Portrait Photography. If this is your first baby, this will be the last time you and your partner will be a “duo” for many years to come. Why not capture the moment? There are many photographers that specialize in  pregnancy photography, of if you prefer, you can do something a bit more formal of you and your partner. If your children are anything like mine, they’ll enjoy looking at such photos of themselves in “mama’s tummy.”
9. Write love letters to one another. With all of the hoopla surrounding your pregnancy and ensuing bed rest, it’s easy to forget that it was love that brought you to this very moment in time.  Take a moment to remember those things that made you fall in love with your partner; a smile, a laugh, special times spent together. Write them all down in a keepsake letter. Choose beautiful paper and perhaps a spritz of your favorite perfume or oil. It’s guaranteed to be something they’ll cherish.