© Carri Schneider

Most of us don’t plan a medical induction. Most of us know that doing so sends us flying down the slippery slope of birth interventions and increases the likelihood of complications.

You spent months envisioning the natural childbirth you wanted. You took the classes, drafted a birth plan, and had your vision for the way birth would unfold. Your due date approaches, and then passes. You start combing the internet and asking everyone you know for tips on how to get baby to budge. Still nothing. Finally, your caregiver drops the “I-word.” The prospect of an induction you didn’t expect and don’t want is upsetting. But, it doesn’t mean you have to give up on every part of the birth you want for your baby.

I was very worried that having an induction meant getting an epidural, but it doesn’t have to. If you are faced with the same prospect or know someone who is, these tips might help.

Don’t give up on natural induction methods.

Try everything. And I mean everything. Keep up those natural methods of induction right until the moment your medical induction is scheduled to happen. Sure it might mean eating three pineapples, having sex on a birthing ball, doing laps around the block, and then spending hours in the bathtub calmly pleading with your unborn baby. But in the end, it’s still better for labor to begin without medication. If nature’s own pineapples and prostaglandins don’t do it, you may be facing Pitocin.

If you don’t already have a doula, get one. Stat.

There are lots of reasons to have a doula. These reasons are elevated in importance if you are facing an induction. You really need someone in your corner who can be your top advocate when you need it most. She needs to feel comfortable playing the role of advocate and strong in her desire to help you speak up for yourself. While you might have a long history of speaking for yourself, the last thing you want to worry about when you are actively emerged in a Pitocin-induced labor is how to confront an overly-eager nurse. If you already have a doula, make sure she feels comfortable with this role (some aren’t). If you don’t have a doula, make sure the one you choose isn’t timid or easily intimidated. (You can read our full birth stories to find out how having a doula saved my labor for both our first and second child.)

Make an informed decision about the induction.

Labor induction rates in the U.S. more than doubled between 1990 and 2005 to an all-time high of 22 percent. There are better reasons than others to have an induction and ways to determine if an induction is favorable in your particular situation. Not every induction is “medically necessary” — please do your research and make an informed choice. This is a personal choice and one that each woman will need to make for herself and for her baby. It was my experience, and the experience of many women I knew, that the OBGYN offered an induction automatically at that 39 week appointment. (I saw a different OB at my 39 week and he asked rather matter of factly, “When do you want to schedule your induction?” When I said I wasn’t interested in that, he was a little shocked. Surprisingly, he said he doesn’t suggest elective inductions either, but he is so used to women begging at 38 and 39 weeks to “just get the baby out” that he considers it good customer service to offer. Bananas!)

Like most, I never planned to have a medical induction. I also never planned to ever get pregnant again after what was our third, and most heart-wrenching, miscarriage. Our first daughter’s labor was guided by our doula and made possible with hypnobirthing techniques. We expected the same for our second child. However, after spending four months on bedrest for an incompetent cervix and pre-term labor, when we hit our doctor’s 41 ½ week “danger zone” without any real sign of labor, we decided not to take any more risks and went with the induction. Because I was a high-risk pregnancy and because I had already lost three babies, I didn’t want to take any unnecessary risks. There’s plenty of research out there to support women who don’t want to rush into inductions just because they are past their estimated due dates. Like most things birth-related, do your research and then do what you feel is best for you and your baby. Learning to trust yourself and trust your instincts before the baby is born will put you miles ahead of the parenting curve.

Make sure your doctor is on board. And if s/he is not, find one that is.

This is a critical piece of the puzzle. Assuming that you have already had a long discussion with your OB/GYN or midwife about your plans for a natural and unmedicated delivery, you want to now have a discussion to craft an actual plan for the induction that preserves your chances of sticking with the rest of your birth plan. Find out if your doctor has worked with an induction without pain medication before. Get a commitment that s/he is willing to work with you to realize your vision of a natural childbirth and that s/he will write formal orders for managing the induction according to your wishes.

Craft an induction plan with your doctor that honors your body’s processes and keeps you in the driver’s seat.

The most important part of the induction plan is choosing an induction method and determining a process for administering the medication. In my case, we opted for Pitocin so that we could manage the dosage. The recommended standard administration of Pitocin is an initial dose between 0.5–1 mU/min with increases at 30–60 minute intervals in increments of 1–2 mU/min until a woman’s body takes over labor naturally. Once this happens and labor has progressed to approximately 5–6 cm dilation, the dose can be reduced in similar increments until the woman’s body is off of the medication entirely. However, this is not typical practice. In most cases, women are started on a Pitocin drip that is steadily increased every 30 minutes regardless and continued throughout labor. Most women are surprised to learn that they can be removed from the Pitocin and be allowed to labor naturally still relatively early into childbirth.

It is important to work out this type of plan with your caregiver. My doctor and I worked out a plan that started with a very low 0.5 mU/min dosage and then 1 mU/min increases only as my body needed them. That is, if the Pitocin was producing contractions at the current dose, there was no need to crank it up just because 30 more minutes had passed. What’s more, my doctor agreed that once I was in obvious active labor, we could detach the Pitocin completely and I would be able to continue to labor on my own. There is no medical reason not to do this. Because most women have epidurals, it is common just to stick with the easy-to-manage schedule, but there is not a threat to you or your baby to follow a slower process.

Get a copy of the doctor’s orders and know your rights.

Almost important as having a caregiver who drafted a plan with you is to get a signed copy of the plan or a copy of the actual orders. These are your medical records and you have every right to them – even if nurses look at you like you have two heads when you ask. The “orders” will go into the file that they have for you at the hospital or birthing center. Nurses or doctors on call will refer to the orders to determine how to manage your care. If you get a nurse who decides on her own that sticking with the typical Pitocin schedule is easier or more convenient, point to your doctor’s orders as reason for her to stop. This is where having your assertive and confident doula and birth partner comes in. If the nurse has other plans for you or ignores the doctor’s orders, ask to speak to your doctor. You have the right to refuse treatment – whether that is Pitocin or any other birth intervention. Know the role everyone on your birthing team will play and even rehearse these roles. Your job is to move through labor. If you can focus on that while the others around you act as advocates, you will be much more relaxed and labor will be easier. You can go a long way to making sure this plan is going to be followed by scheduling your induction for the work-day of your doctor. In my practice, there were several doctors. Choosing your doctor’s delivery day means s/he will be there instead of someone who isn’t as familiar with you and your needs.

Have a pain management plan.

And now for the bad news. Pitocin isn’t called “the chemical crowbar” for nothing! It is strong stuff and yields really powerful and painful contractions. Labor is intense. Labor on Pitocin can be ugly. That said, when you aren’t a slave to the schedule, you can ease your body into labor with the medication and work your way into managing the intensity of the contractions. But, you need a plan for pain management. For us, that plan was hypnobirthing, but you can choose whatever natural child-birthing method resonates with you. Because it is the medication that is causing labor and not the baby’s signals, an induction can leave you with a feeling of loss of control. Make sure you have talked with your doula about ways to not only manage the intensity of medication-induced contractions but also any emotions and feelings you have such as anxiety or fear. Remaining relaxed is critical. Each contraction brings you one step closer to your body taking over and your baby being in your arms.

Keep your eyes on the prize.

We’ve all heard it, right? There is no medal for having a natural childbirth. But those of us who refuse the epidural aren’t doing it for the glory. We do it because we trust our bodies. We want to experience the full process of labor and we know it is what is best for us and for our babies. A natural childbirth is equal parts a gift to us and a gift to our children. Even in the hardest parts of the labor, stay focused on your reasons for wanting a natural childbirth in the first place. Discuss these reasons with your doula and/or partner and have them remind you when you need to hear it most.

There might not be a medal for a natural childbirth, but doing what your body was made to do is reward enough.

The post Pineapples, Prostaglandins and Pitocin: Planning an Unmedicated Birth in The Face of a Medical Induction appeared first on TFB Resource Guide.

© www.implementingdesignism.org

When I was diagnosed with PCOS nearly a decade ago, there were far fewer resources available. The Polycystic Ovarian Syndrome Association (PCOSA) was founded by Christine DeZarn in 1997. The first significant book for patients, “PCOS: The Hidden Epidemic” (Samuel S. Thatcher, M.D., Ph.D.), wasn’t published until 2000. Just a decade ago there was less awareness, even among medical professionals working in women’s health. I feel incredibly lucky that I was diagnosed during a time when information and support groups were just coming into existence. Even so, it’s been a years-long journey of gathering accurate information and the tools I needed to find the path back to health and fertility.

If you’re concerned about possible symptoms of PCOS, I recommend reading some reliable resources. Angela Grassi is the founder of The PCOS Nutrition Center and is a registered dietitian who has PCOS. She co-authored “The PCOS Workbook,” which is a fabulous resource for the newly diagnosed seeking accurate information. It contains a lab tracking form, which is an invaluable tool for becoming familiar with what blood work needs to be done to help diagnose or monitor PCOS. “A Patient’s Guide to PCOS” (Walter Futterweit, MD) includes a PCOS quiz and provides an in-depth review of symptoms and available treatments. For information specific to teens, read Grassi’s article “Recognize Polycystic Ovary Syndrome in Teens — The Importance of Early Detection and Treatment.”

After becoming familiar with PCOS symptoms and testing, keep a menstrual cycle record (making note of both past and present patterns), and jot down any other symptoms. It’s important to remember that oral contraceptives, while often used to treat PCOS, also mask the symptoms. For instance, they may regulate previously irregular menses, and clear up acne and hirsutism. Experience has taught me that it pays to be informed, not only to be accurately evaluated for PCOS, but because even once diagnosed, women with PCOS often have to advocate for themselves by proactively asking for the appropriate referrals and insisting on the best care. If you don’t feel like your primary care provider or OB/GYN is paying attention, trust your instincts. Ask for a referral to see an endocrinologist (I currently see one who has a clinical interest in PCOS) or reproductive endocrinologist. Prior to conceiving both of my daughters, I saw reproductive endocrinologists, who usually specialize in treating infertility, and stayed under their care until about the 10th week of pregnancy before being transferred to an OB for my remaining prenatal care.

The primary treatment for PCOS is diet and exercise. Over the years I’ve worked with dietitians, the first who told me I needed to eat a strict low-carb diet, like The Atkins’ Diet, which was common advice regarding PCOS nutrition at the time. I was even advised not to eat foods like whole-grain brown rice and beans, because they’re “too high in carbs.” Fortunately, this is now considered too extreme, and the fad of categorizing all carbs as bad has faded. Women with PCOS generally need to follow a moderately low-glycemic diet, similar to what it is recommended for type-2 diabetes. Exercise is also key to improving insulin sensitivity, as well as the high cholesterol and high blood pressure that often accompany PCOS.

My philosophy has evolved to focus on eating to create health and treating food as medicine. The mainstay of my diet is whole foods like complex carbs, fresh fruit and whole grains, paired with lean protein, and plenty of veggies. I haven’t made anything completely off limits, but restrict sugar and refined carbs as well as saturated fat and sodium intake. PCOS Diva is a fabulous resource for PCOS-friendly eating. Amy Medling provides recipes and menu plans, as well as supplement tips, and her Facebook community provides a wealth of practical and emotional support.

As previously mentioned, oral contraceptives are often prescribed for PCOS in order to address hormonal imbalances, hirsutism, acne, and irregular cycles. However, they do not treat the underlying insulin resistance and can delay an accurate diagnosis. Metformin has also become central to treating PCOS. Typically used to treat type-2 diabetes, it improves insulin sensitivity, thereby improving the hormonal imbalances associated with PCOS. (For an explanation of the link between insulin resistance and PCOS see here.) Metformin aids in regulating menstrual cycles, improves chances of ovulation, and reduces the risk of miscarriage after conception. It can also help reduce the risk of developing type-2 diabetes, as well as lower cholesterol levels and reduce the long-term risk of heart disease.

There are several more groups working to raise awareness and provide support and education on managing PCOS. Power Up for PCOS is developing a directory of medical professionals who treat PCOS, and forming support groups all over the U.S. The founder and executive director of PCOS Challenge, Sasha Ottey, created a radio show, which features interviews with various experts, as well as a TV series.

I’m so grateful for the newly thriving PCOS communities available on the web and via social networking. It can be incredibly confusing when newly diagnosed, and even after 10 years, I benefit daily from the emotional support, shared information and up-to-date research they provide, as well as access to experts and other women who are living with PCOS, just like me. PCOS is a lifelong condition, but we can help one another through every stage of life, every step of the way.

The post Putting a Face on Polycystic Ovarian Syndrome (PCOS) – Part 2 appeared first on TFB Resource Guide.

© FreeDigitalPhotos.net

Placenta encapsulation has been making the rounds recently – it was all over the news since January Jones admitted to doing it. There’s quite a lot of practical information on how to do it and why you might want to. However, there really isn’t a lot of medical evidence on the subject, which leaves women needing to make up their mind, based mostly on others’ experience.

Saying there’s no evidence for something working sounds pretty bad – it’s almost like saying that it doesn’t work. You probably wouldn’t feel too confident if a doctor gave you a drug saying “I hope this helps but there’s no evidence it actually works.” However, in the case of placenta encapsulation it’s worth taking about why there isn’t that much evidence.

Currently, in clinical practice evidence based medicine (EBM) is becoming the new normal – which is pretty great! The central premise is applying the best available evidence gained from the scientific method to clinical decision making. Basically, it means doing things which have been shown to be effective and safe in appropriately designed studies.

Relying on evidence means doctors and patients are better informed and less likely to make mistakes. Ultimately, evidence allows everyone involved to make better treatment choices. However, what if there is no evidence and worse even, what if it is unlikely that there will ever be any substantial evidence? The thing with evidence-based medicine is that the data have to be collected during trials on humans (sounds menacing, right?) For the evidence to be high quality and relevant to clinical practice (i.e. ultimately the patients), the trials need to be safe and fulfill a number of criteria:

• Everyone taking part in a trial has to be informed about it and consent (this rule was introduced after WWII.)
• It needs to be well-powered (i.e. include many people)
• It has to have an appropriate design (randomized, placebo-controlled, double-blinded). Patients need to be randomly placed into different treatment groups and neither they nor the medical staff attending them should know whether they are receiving the placebo or the treatment.
• It should be long enough to supply meaningful conclusions (e.g., a two-month study on breastfeeding will not really give much useful perspective on the issue. Something of longer duration is necessary).

These are all important factors which contribute to the significance of these studies (statistical and clinical – so both in terms of being good science and being relevant to patients). However, they also contribute to their costs. And, by golly, randomized clinical trial (RCT) costs can be enormous.

According to a National Institutes of Health study the mean cost of a randomized clinical trial is $12 million USD. This is not exactly an affordable sum for most — not charities, not universities, and certainly not for the majority of those most concerned with the results: the patients. However, $12 million USD (or more) is not a sum a large pharmaceutical company will balk at. The biggest pharmaceutical companies make from $5 to $13 billion USD profit annually. That leaves a lot of cash lying around for conducting trials, which pharmaceutical companies do all the time.

Pharmaceutical companies need to do trials to get their drugs approved and then convince doctors that their drugs are better than the competition’s. Significantly, however, they have no business in conducting trials which will not result in increased sales of their products (the ethics of trial design is a whole other issue). It doesn’t take much thinking to realize that confirming the effectiveness of placenta pills is not going to provide profit for any industry. No one who already has a lot of money will have more if placenta pills are shown to be effective. What’s more, money might actually be lost for companies (and saved by their clients). It’s feasible that women will buy fewer supplements if they’re ingesting their own placenta for nutrients.

Yes, universities or the NIH could potentially spend their limited resources on a trial, but it’d likely be a small one (and so not high quality evidence); and let’s not kid ourselves – more money goes to looking for cures than preventing disease (especially mental disease). Truth of the matter is: there is no one who has a vested interest in showing placenta encapsulation works and it’s too much below the radar for healthcare professionals to be considered worthy of an independent investigation.

My background is in science and evidence used to be my religion (it largely still is). I’m one of those arrogant, cocky patients whom (some) doctors hate – I walk into to the appointment having read the past years’ worth of the most important developments concerning whatever I’m being seen for. But I’ve also worked in healthcare and spent a lot of my time looking at clinical trials and how they work. After having my nose buried in medical research for a considerable period of time, I realized that there are some things that will never be properly investigated. It may sound cynical, but it’s true: most of the time, medicine is too important and too lucrative for trials and investigations to be motivated simply by looking for the best solution for patients.

The post Placenta Encapsulation: The Story of the Missing Evidence appeared first on TFB Resource Guide.

© Sundikova – Fotolia.com

I come from a long line of working class folk. High school graduation wasn’t expected until my parents came along, and college was certainly never in the equation for anyone. My grandmothers had worked during the War, but mostly stayed at home. My dad worked a firmly blue-collar union job until his retirement, and my mother worked in telephone customer service until she passed away unexpectedly at 47 years of age. However, my parents and grandparents were influenced by the second wave feminism in the 60′s and 70′s and the messages I received as a young girl all reflected that. I was never told there was anything I couldn’t do. I could go to college, become a lawyer or a doctor or a scientist or the President and get married and have a family and be a shining beacon of success. I would be a modern woman and balance it all.

Then, there I was at 28. MBA, married, career-tracked at a Fortune 100 company, one promotion under my belt, and I was pregnant. I had it all, just like they said I could!

The women I knew who had careers like me and had kids had all resumed their careers. Colleagues kept telling me how bored I would be at home, that they couldn’t wait until their maternity leaves were over because they’d felt so restless. It never even occurred to me that I wouldn’t want to do anything but keep right on working. ‘Staying at home’ seemed so … pedestrian. But I knew I wanted to breastfeed, and with my husband in a career that often requires very long hours, we agreed that it made sense to live closer to my job, so I could be the ‘primary parent’ on workdays. I would do most of the dropping-off and picking-up, but at least I’d only have a five minute commute, whereas his was 45 minutes.

Then my daughter was born, and our reality got a shake-down.

I loved being home with her. We breastfed and co-slept and hung out and played and I was having the time of my life. I wasn’t restless or bored. My daughter got bigger, and as the time of my leave drew to an end, I really hated the idea of going back to work. I started to question why. Why did I want to go back, again? Why was I shopping for someone else to care for my daughter for me? Why was it bothering me so much? What would Gloria Steinem say!? But… this is what modern women do, right? So, I went back, but begrudgingly. I dealt with pumping at work and day care and balanced it all pretty well. Though, I felt like I always left a piece of me at home when I went to work and a piece of me at work when I went home. I continued my success at work and ended up being close to another promotion when I got pregnant with my son a couple years later. I again thoroughly enjoyed my leave, and then went back to work part-time, because maybe that would be better. But my heart wasn’t in it, I was actually tandem nursing at that point, and pumping for my son at work, and co-sleeping, and the incredible hassle of getting two kids to and from day care all wore on me. My husband happened to get a pretty good promotion while I was on leave, and with a little extra help from family to make it happen, I left my job to become a stay at home mom.

The truth of the matter is that the many successful career women – the ones that hold political office or become CEOs – aren’t generally women with career husbands and a bunch of kids at home. They stay single, like Janet Napolitano. Or they get married, but don’t have kids, like Angela Merkel. Or they have a kid or two, but their husbands stay home, like Indra Nooyi, CEO of PepsiCo. Or they make enough money to hire a really great nanny and a housekeeper and they either don’t have the hangups and emotional conflict about such a situation that I did (and I certainly don’t judge a woman who can easily compartmentalize such things; in fact I can safely say I am quite jealous of it.) Or they resign themselves to live with those emotions. Tina Fey, in her autobiography Bossypants, describes in detail how she struggles with these very emotions regarding her own family and her thoughts of having a second child. She mentions how she keeps working because she has her dream job and that about 200 people would lose their jobs if she quit working, but that she would love to be at home with her daughter.

My struggle now comes with how I will adapt the messaging I received for my children. Looking back, I know my family meant well, and I love them for embracing the idea that I could be successful and encouraging me to live up to my real potential. I think what their message lacked was any realistic advice about how to make it happen, including the idea of sacrifice and finding balance. Will this shape the college and career advice I give to my daughters? Almost certainly. If they express a real interest in having children, I will encourage them to consider careers that lend themselves better to the flexibility that makes finding that life balance a little easier. If they have incredibly lofty career aspirations, I will make sure they know what personal sacrifices those choices might entail. Additionally, I will tell them that a major consideration in selecting a life partner is one who will truly be a partner in finding that balance. There are women, after all, such as Sheryl Sandberg, COO at Facebook. Her husband is a CEO, and she has also obviously been very successful, and they have kids. But she has said in no uncertain terms that the biggest factor in ‘having it all’ is who she chose to marry. It will also impact how I talk to my son about what his expectations should be and how he should handle his own roles of husband and father.

Above all, I want them to understand the reality of how difficult these decisions can be, and that they might never figure out that right, perfect balance. Opting out of a career is very scary, but a brave choice for a career woman; we take comfort, create identity, and feel safety in our position, in our success, in our financial security. And while staying home may not be within the feminist messages of our youth, it is an empowering choice for a woman when it is truly a choice and not a prescribed role by her husband or society. And, it turns out, Gloria Steinem agrees.

The post How One Feminist MBA Embraced Stay-At-Home Motherhood appeared first on TFB Resource Guide.

© Erica Hagerman

This is where the real action happens and when most dads experience their transformation of becoming a father. I remember being a little kid and my dad telling me about when I was born. His face was full of amazement as he recalled my birth. Most of the dads I talk to share a similar feeling while describing the birth of their children. Even for the toughest pregnancies and births, dads recount sublimely wonderful moments of holding their children for the first time.

Quite a bit has changed since our dads had kids — and the the most dramatic shift has been the attitudes about dads at birth. We are no longer expected to stay in the waiting room, wring our hands and wait for the doctor to proclaim the gender of the new baby. Today, dads are getting involved in every aspect of the birth of their children and we are showing up at the births with high value. Women making empowered birth choices are asking for their partners to take a starring role in their support while giving birth. Many of the families I work with now tell me that they couldn’t imagine not being together every step of the way.

What does it mean to be a dad showing up with high value at the birth?

It means a willingness to allow the powerful force of procreation to move freely. A woman’s body knows how to give birth. You provide the environment that allows a woman to feel safe, where she can move with the contractions. Advocate for this kind of freedom. Amazing things will happen.

How do I create an environment in which a woman feels comfortable and free to birth?

Since you will have already talked about your birth plan in detail with your partner, you’ll already know which kind of environment helps her feel safe. In the birth time, put your focus and attention on the birthing mama. I remember my wife, Andrea, asking that nobody move during the contractions when she was in transition. She told me later she could feel the air pushing against her when people were moving through the room and hearing people talk was bringing her out of her concentration. She needed absolute stillness, total silence. So I stood there and breathed with her. And our birth team was able to do the same because we chose birth attendants that were in line with our birth philosophy.

What if we’re in a situation where the birth attendants don’t share our philosophy?

If you find yourself in a situation where interventions are being suggested that don’t seem necessary, then take action. The birthing mama needs you to step in, ask questions, and get involved. Unnecessary medical interventions in a hospital setting can start a cascade that can turn a normal birth into a c-section very quickly. The C-Section rate in the United States is a whopping 32%. Are we to assume that ⅓ of all births require major abdominal surgery? I think not. The tremendous work of the modern, gentle birth movement is likely to make that number decline considerably over the next generation, and you are part of that movement when you advocate for safe birth choices. If you are choosing a hospital birth, then you have the greatest opportunity to present knowledgeably about birth and to hold fast in your birth vision. Stand tall and congruent in your decisions to get whatever it is that the birthing mama requires to respond to the procreative force within her.

What if we are choosing to birth at home? What can I do to be present and supportive?

Choosing a home birth means you will be involved in the midwifery model of care, in which a birthing mama is given plenty of freedom to birth in her own way. This is why many families are choosing it. Over the months of the pregnancy, you will have formed a close relationship with the midwife and the doula, and this is the time when you all come together to be a powerful support team for the birthing mama. Your support could look like breathing through contractions with her, organizing the birth pool and managing the water, offering physical assistance through the labor in different positions, or organizing food for the birth team and birthing mama. Being present is simply about keeping your attention and focus on her needs as she goes through this amazing process.

*This is part two of a four part series: Pregnancy, Birth, Postpartum, and Breastfeeding.

The post Dads At the Core of the Experience: Part 2 – Birth appeared first on TFB Resource Guide.

www.implementingdesignism.org

Polycystic Ovarian Syndrome (PCOS)* is an endocrine disorder estimated to affect more than 1 in 10 women and is the leading cause of female infertility. The root cause of PCOS is thought to be insulin resistance. It is a close cousin of diabetes, sharing many of its increased health risks.

PCOS also raises the risk of cardiovascular disease, and is associated with higher rates of depression and anxiety, as well as endometrial cancer. Symptoms often first appear during adolescence, but too frequently, women go undiagnosed for years.

In recent years there has been an incredible surge in PCOS communities online. PCOS needs to be brought into the public health spotlight. Women’s health suffers because the vast majority of people aren’t aware that this prevalent disorder exists, and even when women seek out medical advice, their doctors may treat the symptoms without diagnosing their cause.

Some women have only one or two symptoms. Others, myself included, may experience almost every single one on the list to varying degrees:

• Irregular or absent menstrual cycles
• Obesity/unexplained weight gain/difficulty losing weight
• Infertility or recurrent miscarriages
• High cholesterol levels
• High blood pressure
• Excess or abnormal hair growth and distribution (hirsutism)
• Pain in the lower abdomen and pelvis
• Multiple ovarian cysts (often only seen on ultrasound)
• Skin tags
• Acne
• Acanthosis Nigricans (dark, velvety patches of skin)

I was diagnosed with PCOS ten years ago at 26, when I was ready to get pregnant. I’d suspected something wasn’t quite right for several years. My periods were never remotely close to regular. As a teen, I averaged 6 to 8 cycles per year. Doctors told me I would “grow out of it,” and at 19 I was told that The Pill would help regulate my cycles. It didn’t.

I now know my sporadic cycles are a common symptom of PCOS. My last semester of college, I experienced my first spurt of sudden weight gain. I was underweight as a teen, but at 21 gained 20 pounds in the course of a semester. Over the next two years 20 pounds turned into 60. I felt like I’d completely lost control over my body. It became alien, and I began to view it as my enemy.

By the time I was 24, I decided to stop taking The Pill, thinking it might be the weight gain culprit. Then I didn’t have a period for 7 months. I made an appointment with an OB/GYN who prescribed Provera on my first visit to jumpstart my menstrual cycle. The only thing she said about my sporadic cycles and the weight gain was that we should check my thyroid, which came back normal.

When I asked if I would have trouble getting pregnant, she said,

“We’ll have to wait and see. It would help if you lost some weight.”

Words women with PCOS hear too often, without receiving a thorough evaluation or referral to the appropriate specialist. I still feel angry when I recall how casually my concerns were dismissed.

Fast forward a couple of years. Due to a job and insurance change, I switched to a new OB/GYN. By this time, my husband was within sight of earning his Ph.D., and we’d begun talking about trying to conceive. After learning that the university Student Health Services provided pre-conception counseling, we made an appointment. I will be forever grateful to the nurse we saw that day for tipping me off that the symptoms that had gotten progressively worse through my 20s had a name. While reviewing facts about increasing chances of conception, she came to a card in her education kit that named the four most common causes of infertility. PCOS was one of them. I asked her to explain what it was, and as she talked the light clicked on. We discussed my own history, and she immediately said I should be evaluated for PCOS. After having a miscarriage at 6 weeks, I was referred to a reproductive endocrinologist. I was finally in the right hands.

In “A Patient’s Guide to PCOS,” Dr. Walter Futterweit states that women with PCOS experience early miscarriage at three times the normal rate. Under the care of a reproductive endocrinologist, I conceived and gave birth to my first daughter, following a second miscarriage that occurred at 8 weeks. My younger daughter was a very welcome surprise, as I managed to get pregnant without any fertility drugs or other medication after regaining control of my health and losing weight.

The journey that led to the birth of my two gorgeous girls was far from straight. They are my Hope and Grace, middle names that honor their great-grandmothers, as well as the gifts they are to us.

My goal is to raise awareness and prevent other women from suffering from undiagnosed health issues and infertility, potentially going without answers for many years. We must educate our daughters and other young women in our lives about their bodies and normal cycle lengths, for our menstrual cycles are an extension of our health, and an abnormal cycle may be the first sign of PCOS.

In my next article, I plan to cover information about testing, what doctors to seek out for accurate evaluation, treatment options, as well as the importance of nutrition and exercise.

*Please note that PCOS is referred to as both polycystic ovarian syndrome and polycystic ovary syndrome in medical literature.

To Learn More about PCOS or Take a PCOS Quiz:

• The University of Chicago Center for PCOS
• The Polycystic Ovarian Syndrome Association
• PCOS & Teens
• PCOS Quiz for Teens
• A Patient’s Guide to PCOS by Walter Futterweit, MD (This book also includes a PCOS quiz.)

The post Putting a Face on Polycystic Ovarian Syndrome (PCOS) – Part 1 appeared first on TFB Resource Guide.

© Vicki Elson

A baby born in a tree!

A baby beamed out of her mother’s body!

A baby born to Arnold Schwarzenegger!

I’ve looked at hundreds of TV and movie birth scenes to discover exactly how the mass media distorts birth.  I found that Hollywood routinely exaggerates fear, danger, and speed, like in this common motif:  the minute a pregnant woman’s water breaks, there’s a mad rush to the hospital. Cars screech around corners and run over pedestrians, or, worse, they get stuck in traffic.

None of this would matter if it didn’t accumulate in our subconscious minds, affecting the way we feel about labor when it’s our turn to have babies.  But a lifetime of exposure does indeed seep into us.  That can affect our minds and even our bodies during pregnancy and birth.

Hollywood makes women look silly, nutty, desperate.  Moms look helpless and in need of immediate rescue.  The scariest birth scene ever was an episode of “E.R.” directed by Mimi Leder.  A loveable woman who wanted natural childbirth soon discovered, like many TV moms, that her body was unreliable.  But her doctors were even worse.  With an insanely unrealistic set of medical mistakes, they managed to, um, kill her.  That one was a double whammy for the pregnant women who made the mistake of watching it.  It won an Emmy.

Hollywood takes footage of a normal birth and adds a gratuitously terrifying narrator:  “The most DANGEROUS journey in life…the four-inch trip… DOWN the birth canal!” and “Here on a classroom floor…a lot can go wrong!”

I even heard about a mom who gave birth squatting, but the reality-show camera crew didn’t make it in time.  So they made her re-enact the birth — lying flat on her back, working against gravity and sound physiological positioning, just because that’s what the director thought audiences should see.

But the laboring mother isn’t always the star of the show.  Her partner often upstages her with the rough time he’s having. He (it’s always a he, except for once that I know of on “Friends”) gets his fingers bitten or crushed by the laboring mom.  Or she threatens to do an instant vasectomy, or she jams his video camera into his eye.  Sometimes, his struggle to get to the hospital on time is the focus of the episode — say, crawling through ventilation ducts with Bruce Willis.

When ordinary natural normal childbirth does make it onto the screen, it’s in the olden days – say, a Native or a pioneer woman.  Or it’s a wacky woman giving birth in a remote lagoon, or swimming with dolphins.  Or it’s an alien lady enjoying painless, sweat-free reproduction with her android pals looking on.

How can pregnant people de-program themselves and cultivate healthy, realistic expectations?

Be careful what you expose yourself to.  Online births can be inspiring, or terrifying, or just plain stupid (a college student “birthing” a basketball might light up your search engine).

Fill yourself up with confidence-building imagery and information.  Take a childbirth class.  Watch “Birth Day,” a short film that captures midwife Naoli Vinaver Lopez’s robust grace and joy as she herself gives birth.  Read informative, honest books like Pregnancy, Childbirth and the Newborn by Penny Simkin, or the excellent new Pregnancy & Birth Edition of Our Bodies, Ourselves, and the treasured fear-buster, Ina May’s Guide to Childbirth by the pioneering midwife Ina May Gaskin.

“Laboring Under An Illusion: Mass Media Childbirth vs. The Real Thing” is a film I made for just this purpose, juxtaposing 100 TV and movie births with real births, so you can judge for yourself what’s realistic and what you might want for your own birth.  It’s pretty funny, and it’s got lots of clips from filmmakers whose mission is to inspire and encourage you.  You might find that you want to see those films in their entirety.  See the trailer at www.birth-media.com.

I’m alarmed to discover that my film is being well-received all over the world.  It won a couple of awards here in the USA, which delighted me, but why do I get fan mail from places like Singapore and South Africa?  Apparently, we are exporting our culture so far and wide that my critique of mass media is relevant all over the place.

I suppose Hollywood might wake up and stop scaring the daylights out of pregnant women.  In case they care, I launched “Reel Childbirth,” a script consultancy to help them out.  But I’m not holding my breath.  It’s up to pregnant women and those who love them to balance distorted media with responsible information.

Go find people who are not afraid of labor.  Find people who have had labors they feel good about, and find out what they know.  Soak up their wisdom, and turn off the TV!

Now! Enter to win your own copy of the DVD “Laboring Under An Illusion: Mass Media Childbirth vs. The Real Thing”, regularly $19.95.

a Rafflecopter giveaway

The post Kill Your Television; Birth Your Baby appeared first on TFB Resource Guide.

© imagerymajestic

If you’ve ever been pregnant, you know how you rely on your favorite fetus-nourishing foods.  You know how you cherish your collection of pillows and your comfortable bedding.  You choose your shoes and clothing carefully for comfort and self-expression.  You know how nice it is to get the kind of exercise that feels good – the pool at the Y, the yoga class, the long walks.

Incarcerated pregnant women miss all these things, and they miss their sweethearts and their older children too.  When they go into labor, they are transported under guard to the nearest hospital.  Most are shackled before, after, and sometimes during active labor.  An armed corrections officer (CO) is present for every minute of labor, birth, and postpartum at the hospital. And then the new mothers go back to jail, alone.  For all mothers, giving birth has the potential for being traumatic.  But for incarcerated mothers, giving birth is inherently traumatic. 

Each year in the U.S., 40,000 pregnant women are incarcerated.

The Prison Birth Project was created by two community-spirited young moms, Marianne Bullock and Lisa Andrews, to serve a small number of these mothers. We are a reproductive justice organization working to provide support, education, and advocacy with women and girls at the intersection of the criminal justice system and motherhood in our regional women’s jail.

The average incarcerated mom is likely to be inside for a nonviolent offense.  She is much more likely than the average American to be poor, illiterate, mentally ill, sexually abused, addicted to drugs – and African American or Latina.

The unintended consequence of the failed “War on Drugs” is that now more than 1% of the adult population of the United States is incarcerated.   It’s a huge industry.  The number of women in jail has increased 832% in the past 10 years alone.  (No, that’s not a typo.)

PBP offers advocacy, friendship, peer mentoring, and leadership development.  We organize with incarcerated people around policy change.  Our three main programs are childbirth education, doula services, and mothers’ groups.

Childbirth Education Classes, which we offer weekly, are a little tricky in jail because there are issues (like custody, or survival) that overshadow everything we ever thought was important to teach pregnant people.  Sometimes the best “classes” are just being together.

Also, we never know for sure if we’re going to see a woman only once or if we’ll see her every week for her entire pregnancy. It doesn’t matter.  Any respect and kindness – and food – that we offer isn’t wasted.  If you’re interested, I’ve written a suggested class plan. You’ll also find some short handouts: what I think pregnant women need to know if you only meet them once, and a postpartum guide specifically for incarcerated moms.

Doula Care starts with prenatal visits.  We try to help laboring moms feel more in control.  We try to create a “bubble” that consists of the mom, her family (if they’re present), and her doula.  We help CO’s and hospital staff create a friendly atmosphere, but we try to let the mom decide who gets to be in her bubble.  It feels odd that we doulas are allowed to touch her, but her close family members are not.  We try to channel their touch, and offer suggestions for how family can participate in ways that are allowed under Department of Corrections protocols.

Of all the women who have ever received PBP’s doula services and then been released, very few have returned to jail. We believe that doula care is stopping a cycle of violence and trauma to mother and baby during delivery, and helping women to have the tools to make healthier choices. Other prison birth programs report similar decreases in recidivism.

In addition to doula care, we offer full-spectrum reproductive care.  This might include pregnancy options counseling.  We serve as adoption support and as abortion doulas – as controversial as that is, we feel that all women deserve services that will lower their chances for further traumatization.  We help women with custody issues and interactions with the Department of Children and Families.  We offer support in the courtroom.

Mothers’ Groups are available for ALL mothers at the jail.  So far, more than 75 moms have participated in “Mothers Among Us,” PBP’s peer-led support group. MAU offers a safe place to be real and honest about the full spectrum of mothering experiences.  Both participants and facilitators are reclaiming their resiliency and strengthening their core selves.

PBP is dedicated to having incarcerated and formerly incarcerated women fill at least half of our positions of leadership.  We are training women to lead MAU groups.  We are exploring offering childbirth educator and doula trainings inside.  We are hoping that others will offer similar services at jails, prisons, and re-entry programs nationwide.  An article in the upcoming issue of Midwifery Today will include some suggestions for those of you who wish to serve these families in your own communities.

The post Pregnant In Jail appeared first on TFB Resource Guide.

©Kate Donahue at Portland Doula Care

The January 11, 2012 Slate.com article “The Truth About Epidurals: Are they really so bad?” by Melinda Wenner Moyer concludes with this paragraph:

“Women shouldn’t cave to pressure from either side.” [Of the 'mommy wars' between natural birth advocates and pro-epidural advocates] “They should make informed decisions based on their goals and priorities. I aspired to have a comfortable birth even if it meant being surrounded by nurses and doctors and tubes and incessant beeps; other women may trade pain for a more intimate birthing experience. Each choice comes with its own benefits and unpleasantries. My unnatural childbirth left me with a memory that does not involve intolerable pain, and that’s exactly what I wanted.”

I’m concerned about this piece for a number of reasons, but the most significant are summed up in this paragraph, so I’d like to start here.

I agree that women should make their own best and informed decisions. I object to the continued polarization of “us” and “them.” I also disagree with the characterization of the options as choices between benefits and “unpleasantries.”  This minimizes the fact that we must weigh benefits and risks when considering birthing options. This includes risks to babies as well as ourselves. Thus, while the decisions very well may be based on “goals and priorities” I would argue that the highest priority must be the health and well-being of the mother-baby dyad. Reducing the choice to that of comfort vs. an “intimate” experience ignores that many women choose natural birth not because of the “experience” but to minimize risk.

Intervention was introduced for a valid reason and, when used appropriately, has the potential make a difficult birth better. That does not mean every intervention is appropriate for every situation. When used inappropriately, every intervention has the potential to also cause problems. This includes epidurals and other labor drugs. To suggest otherwise is disingenuous and a huge disservice to those trying to make an informed decision.

Wenner Moyer mentioned studies in her article, but failed to cite them. I did not find her references, but she was correct in her assertion that the evidence is “inconclusive.” The vast majority of studies do say that rates of surgical deliveries increase due to a multitude of reasons involving epidurals. A handful suggested otherwise.

The Cochrane Collaboration, the largest independent collection of available medical studies, encapsulated in A Guide to Effective Care in Pregnancy and Childbirth, states:

“In women with epidural analgesia, both the first and second stages of labor are longer, and oxytocin use, malrotation and cesarean sections are more frequent.” (Enkin, et al p. 291)

The Cochrane Collaboration last updated in 2011 states:

“The review identified 38 randomised controlled studies involving 9658 women. All but five studies compared epidural analgesia with opiates. Epidurals relieved labour pain better than other types of pain medication but led to more use of instruments to assist with the birth. Caesarean delivery rates did not differ overall and nor were there effects of the epidural on the baby soon after birth; fewer babies needed a drug (naloxone) to counter opiate use by the mother for pain relief. The risk of caesarean section for fetal distress was increased. Women who used epidurals were more likely to have a longer delivery (second stage of labour), needed their labour contractions stimulated with oxytocin, experienced very low blood pressure, were unable to move for a period of time after the birth (motor blockage), had problems passing urine (fluid retention) and suffered fever. Long-term backache was no different. Further research on reducing the adverse outcomes with epidurals would be helpful.” (Anim-Somuah, Smyth & Jones, 2011)

Cesarean rates did not increase overall, but the risk of cesarean section for fetal distress was increased. The experience of very low blood pressure often leads to fetal distress which leads to surgical birth. If a complication can be directly attributed to the epidural, and it leads to emergency surgery, is the surgery then considered due to a medical complication instead of the epidural, even though the complication would not have occurred in the absence of the epidural? If a study does not compare natural birth to medicalized birth, how can any conclusions be drawn about how the interventions impact a birth?

And does it matter if the research is possibly tainted by special interests anyway?

Dr. Marcia Angell, the Editor of the New England Journal of Medicine, said in 2009:

“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.” (Angell, 2009)

When looking at the evidence in trying to make a decision as important as that regarding the long term health of our children, this should lead consumers to ask: Where is the funding for a coming from and who is performing it?

Who loses revenue if tools like epidurals are used sparingly? I hear a lot of disparaging remarks about natural birth advocates, but what do they have to gain by questioning the safety of labor drugs?

Wenner Moyer suggests that we compare the objective evidence with “…the reassuring words of obstetricians and anesthesiologists who tout epidurals as being completely safe.” What makes her think that her doctor or anesthesiologist is making a recommendation on scientific evidence anyway? Reading the summary of ACOG recommendations for suspected fetal macrosomia (big baby) 2/3 of obstetrical recommendation not evidence-based. (Chatfield, 2001) A Guide to Effective Care in Pregnancy and Childbirth reveals this is hardly unusual.

If we are only asking “Do epidurals effectively reduce or eliminate pain?” and “Is there 100% consensus on safety?” Wenner Moyer’s article addresses those questions. That is also providing that the only thing one is concerned about is whether the mother will end up with a surgery that has a 5 times greater mortality (death) rate than natural birth. But what about other consequences of epidurals, like the increased risk of maternal fever, slowed labor, augmentation, vacuum or forceps assisted delivery, and perineal tearing? (Childbirth Connection, 2011.)

If the debate is framed in such a way as to present the only choice as excruciating pain or “completely safe numbness”, it would seem illogical to opt for natural birth as opposed to “risk-free” drugs. Except that isn’t being honest, there is no such thing as a “risk-free” drug, and these extremes aren’t our only options.

When women are confident that they are fully capable of making the best decisions for themselves, because they made their decisions on the actual events specific to them and not an imagined potential reality, they tend to feel good about their choices. Becoming a mother comes with enough challenges without having to deal with ones that might have been avoided. One of the best ways to avoid the pitfalls is to take an independent childbirth class and educate yourself fully on your options.

References:

AIMS. (Alliance for the Improvement of Maternity Services): Drugs not FDA approved for obstetrics http://www.aimsusa.org/ObstetricDrugs-NotApproved.htm

Angell,M., 2009. Drug Companies & Doctors: A Story of Corruption. The New York Review of Books. http://www.nybooks.com/articles/archives/2009/jan/15/drug-companies-doctorsa-story-of-corruption/

Anim-Somuah M, Smyth RMD, Jones L., 2011. Cochrane Supparies: Independent high-quality evidence for health care decision making. Epidurals for pain relief in labour. http://summaries.cochrane.org/CD000331/epidurals-for-pain-relief-in-labour

Chatfield, J., ACOG Issues Guidelines on Fetal Macrosomia, Am Fam Physician. 2001 Jul 1;64(1):169-170. Retrieved from http://www.aafp.org/afp/2001/0701/p169.html

Simkin, Penny. “Best Evidence: Labor Pain | Labor Pain :: Childbirth Connection.” Childbirth Connection: helping women and families make decisions for pregnancy, childbirth, labor pain relief, the postpartum period, and other maternity care issues.. N.p., 30 June 2008. Web. 7 Feb. 2012. http://www.childbirthconnection.org/article.asp?ck=10183#epidural.

Enkin, M., Keirse, M., Neilson, J., Crowther, C., Duley, L., Hodnett, E., Hofmeyr, J., A Guide to Effective Care in Pregnancy and Childbirth, 3rd edition, 2000. Oxford University Press, USA.

Wenner Moyer, M., 2012. The Truth About Epidurals: Are they really so bad?  Posted Jan. 11, 2012, at 3:28 PM http://www.slate.com/articles/health_and_science/medical_examiner/2012/01/the_truth_about_epidurals.html

The post The Evidence-Based Truth About Epidurals appeared first on TFB Resource Guide.

© Erica Hagerman

“In this postmodern era, we have gone beyond the unconscious, anesthetized births of the 1940’s and 1950’s, the systematic elimination of lay midwifery, the demise of breastfeeding, and even ‘natural childbirth’ to an enormous range of options and historical shifts. These include the presence and active involvement of fathers during pregnancy and at birth.” (Davis-Floyd & Sargent, 1997)

Women are making empowered birth choices, and they want their partners there to support them. Men might not know how to get involved, or might feel anxious about the process because it’s not happening in their bodies. Yet the pregnancy is a vital time for bonding between the couple and preparing for this new life to enter the family.

Making empowered birth choices means taking responsibility, educating yourself, and holding a vision of what you want your birth to be — together. Write that vision down. That’s your birth plan. Think about who will be there, what kind of food you’ll be eating, if you’ll have a birth pool, if your older children will be there. Allow the birth plan to evolve as the pregnancy progresses.

If you are an expectant mom and you want your partner to be more present and involved, you can help him understand the importance of his role by asking him questions about his ideas of birth and becoming a father. Have a conversation about what matters to him, and what concerns he might have.

If you’re an expectant father, congratulations! You’re already a dad. Every bit of care and attention that you offer to the pregnant mama is also for the baby inside of her. Here are some ways to be proactive in your approach to getting involved.

What can I do?

• Understanding the pregnancy, birth, and postpartum process is key.
• Go to the childbirth education classes
• Talk to other dads
• Be present at the appointments with the birth professional
• Get one-on-one coaching
• Read blogs books, and watch videos of births that embody the birth you want

Self-Care

• Physical exercise: get your heart rate up at least 3 times a week. Every day is even better
• Meditate on becoming a father: what does it mean to you?
• Eat healthy, nutrient dense food and drink
• Drink an alkalizing beverage such as water with lemon, green drink
• Get the right amount of sleep for your body
• Think positive thoughts about the birth and becoming a dad

Make it easy on yourself.

Connect with your birth professionals. This is your opportunity to ask questions, speak up about concerns, and create a bond with them so that you can all be on the same team supporting the birthing mama.

*This is part one of a four part series: Pregnancy, Birth, Postpartum, and Breastfeeding.

Reference:

Davis-Floyd, R.E. & Sargent, C.F. (1997). Childbirth and authoritative knowledge: Cross cultural perspectives. Berkely, CA: University of California Press.

The post Dads At the Core of the Experience: Part 1 – Pregnancy appeared first on TFB Resource Guide.