Doula Network of Fort Wayne

Delayed Cord Clamping

This excellent visual demonstration helps to better understand the mechanics of what happens with placental and infant blood supply in the moments following birth.  Penny Simkin does a wonderful job of explaining the potential risks and benefits of waiting to clamp the cord.  

 

What you should know about 40 week placentas

by Jordan S. Saalfrank, MSW, CD(DONA)

This question comes up a lot in Fort Wayne's birth community:  "Can the placenta adequately support my baby after 40 weeks gestation?"  There are many reason's why this seemingly simple question is actually quite complex and difficult to answer.  But the short answer is:  yes.  40 week placentas are more than capable to sustain a healthy baby in the womb.  Let's take a quick look at why our medical society has us so overly concerned about 40 week placentas before we talk about the long answer.

 

The industrialized, ultra-conservative birth culture in the US has led the community to believe that any pregnancy beyond 40 weeks is considered "late" and requires intervention.  Most care providers in Fort Wayne tell their patients up front that they will not be allowed to stay pregnant after 41 weeks.   When in actuality "postdate" or "postterm"  is defined as "a pregnancy that goes beyond 42 weeks gestation" (Lowdermilk, Perry, 2000).  What has happened in our culture to produce such doubt from our doctors in our bodily design?  As Valerie El Halta so wisely pointed out in "Normal Birth: Do We Believe? Can We Remember?":  "The obstetrician may say to the pregnant woman, through attitude, words or continual reliance on technology, "You have to prove to me that you can give birth to a baby"' (Midwifery Today, 1998).  This kind of doubt only gets into the cracks of a new mom's natural uncertainties and propels her into more self-doubt.  

 

How have we gotten to this point of inducing labor before a baby is even truly defined as "overdue"?  The short answer:  lawsuits.  A doctor sued for malpractice is labeled "less liable" for a maternal or fetal death if they show "proactive" approaches to managing a pregnancy and labor.  This means managing pregnancy and labors and inducing.  So inevitably due dates have become a ticking clock for doctors rather than what they truly are:  GUESS DATES.  

 

Would you agree with me that every woman is different?  From lifestyle to family to physiologic make-up; women are different.  A little wheel that predicts a due date isn't going to be right very often.  And since every woman's cycle varies it is nearly impossible to predict when the gestation began and how that woman's body will grow that baby (unless the woman tracked her basal temperature and knows the date of conception).  The truth is, over 90% of the time a woman's body will grow the baby it can birth!  Belief in the birth process that has been happening over thousands of years needs to be reclaimed and nourishing expectant families.  Valerie El Halta goes on in her article to say:  "The midwife, on the other hand, with her attitude that birth is, in most instances, a reliable event, says to this same woman, "You have to prove to me that you cannot have a baby!""  We need every woman to be supported in this way and to stop the spreading of doubt in our design to normally birth babies without intervention.  

 

So back to the long answer:  Can a 40 week old placenta properly sustain a baby in the womb?"  Women's bodies have been designed to sustain a baby well for 42 weeks.  While the risk of newborn death or stillbirth is very low, after 42 weeks gestation the risk does increase (BJOG. 2009;116(5):626-636).  But this is where a patient care provider, one who BELIEVES in the process and a woman's body to birth, and technology can help calm some of those fears.  A patient care provider tracking fetal movements and doppler technology to listen to cord and placental blood flow, babies can be monitored for any signs of a need to intervene.  Also biophysical profiles or non-stress tests can be used to evaluate baby and whether there may or may not be any danger in continuing to stay pregnant after 42 weeks.  This is a non-invasive office procedure that listens to baby's heart rate, measures the movements of baby and sometimes looks at amniotic fluid volume.  

 

A short pause for caution here:  amniotic fluid levels are constantly changing as baby sucks, swallows and pees.  Sometimes low fluid levels can just be a time where baby hadn't peed yet or mama hasn't kept her water intake levels up.  It could also be a sign that labor is coming.  It is very common to show low fluid and lose a bit of weight before onset of labor.  In any case, low fluid levels alone are not an immediate need to intervene (Cochrane Database Syst Rev. 2008).  It can be ok to ask to come back to the office the following morning for another analysis and then work in that time to drink appropriate amounts of water and rest.  If the second profile shows signs of low fluid again than that can be a good time to discuss intervention and what that would look like for you.  

 

40 week placentas are still very viable and able to nourish baby.  Very little is understood about how and when the body and baby decide to move into birth.  What is known "is that the most important trigger is a surge of hormones released by the fetus. This hormone surge, which prepares the lungs and digestive system for life outside the womb, signals the fetus's readiness for birth. In response to these signals, hormone receptors in the woman's uterus turn on and the muscles in her uterus change to allow her cervix, at the lower end of her uterus, to open. In short, when a woman goes into labor on her own, this is a powerful signal that her baby is ready to be born and that her body is ready for labor" (Childbirth Connection.org).  I would love to see care providers here in Fort Wayne change their mode of operation to believing women need to PROVE THEY CAN'T HAVE A BABY instead of fear-based care and perhaps this question wouldn't be so commonly asked.  

 

Safe Infant Sleep Symposium

 

Bedsharing parents and advocates are under assault in Fort Wayne, Indiana, as local officials attempt to censor safe bedsharing guidelines from the public.

The conflict began in July 2009, when the Indiana Department of Child Services launched an anti-cosleeping “safe sleep campaign” with a disturbing and emotionally confrontational PSA depicting a mother and baby sleeping on a sofa, only to discover upon waking that the infant was not breathing.  Following the disturbing images was the printed message “Never sleep with an infant”.  In addition to the PSA, DCS has also devoted a page of their website to the campaign, which contains a variety of links to anti-cosleeping articles as well as a banner in the middle of their home page stating that “1 to 2 children in Indiana die each week due to bedsharing”.  (To view the PSA, click here:

http://www.in.gov/dcs/files/Clip2(1).wmv)

In response to the heavily biased campaign launched by the state, Birth Matters, a Fort Wayne childbirth and family education center, has been working to present balanced information about safe sleep to the public.  In October, Birth Matters will host a Safe Infant Sleep Symposium, which will present guidelines for safe infant sleep in cribs, bassinets, co-sleepers, and parents’ beds. 

The goal of the symposium is to provide families and care providers with balanced, research-based, up-to-date information about safe infant sleep, and to support families’ rights to make informed, safe choices regarding how and where their children sleep.

The Symposium has drawn criticism from Fort Wayne authorities who say that the only message families should be given is “Never sleep with an infant”.

In an effort to work together with community leaders, Hallie Greider and Jordan Saalfrank, co-founders of Birth Matters, met with officials to discuss the symposium, and to personally extend invitations.  Despite a large, growing body of research-based evidence for safe bedsharing, supported by the World Health Organization, UNICEF, and La Leche League International, among others, officials declined to attend the symposium, stating that there was no legitimate evidence to support bedsharing as a safe infant sleep option.

Officials also presented Birth Matters with a discussion about 13 infant death cases in Allen County which were caused by unsafe sleep conditions, and suggested that providing the public with safe bedsharing guidelines could cause additional deaths.  However, when requested, Greider and Saalfrank were denied access to investigation records regarding the deaths.

“The public should have the right to know under what circumstances those babies died.  It seems incredibly unlikely to me that many, if any, of those babies were bedsharing within the safe bedsharing guidelines.  In fact, during the course of the conversation we had that day, I learned that one of the infants in question died in bed with 9 other children, another was sleeping improperly strapped into a car seat, and several were sleeping on sofas.  To say that educating the public about safe bedsharing guidelines will exacerbate the problem just seems ridiculous; none of those situations are representative of safe bedsharing,” says Greider.

Saalfrank has additional concerns: “It’s not bedsharing itself that is dangerous, it’s bedsharing outside of the safe bedsharing guidelines that is dangerous.  If families can’t implement those guidelines because they don’t have access to them, every baby sleeping with a parent is at risk.  The reality we’re faced with is that elected officials are putting infants in our community at risk by choosing to remain ignorant of what research-based evidence is telling us.”

While officials in Fort Wayne continue to push an anti-cosleeping agenda, Birth Matters recognizes that no single sleep solution will work for every family.  The upcoming symposium will provide safe sleep guidelines for a variety of different sleep situations in order to empower families, no matter where their infants sleep.  “We’re not advocating for families to bedshare; we’re advocating for families to have the right to full information about safe sleep, which includes safe bedsharing guidelines,” says Greider.

The Safe Infant Sleep Symposium will take place October 2, 2010 at the Fort Wayne War Memorial Coliseum.  Speakers include Dr. Christopher Tallo, Fort Wayne Pediatrician; Dr. Robert White, Indiana Neonatologist; and Dr. James McKenna, Director of the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame, Chair of Notre Dame’s Department of Anthropology, member of the SIDS Global Task Force, and consultant to the American Academy of Pediatrics’ Committee on Safe Infant Sleep.  Admission is free.  For more information, or to contribute to the cause, visit www.safesleepindiana.org

Birth Matters was founded in 2008 by Hallie Greider (certified childbirth educator, certified doula) and Jordan Saalfrank (MSW, certified doula) to provide comprehensive education and support for families through pregnancy, childbirth, and the transition to parenting.  For more information, visit www.birthmatters.com  

(written by Heather Puff September 2010)

"Better than I could have imagined..." -- Birth to Baby 2010

  
 

So many of the evaluations collected at the close of the Birth to Baby 2010 weekend expressed how pleased birth professionals and the public were with the educational efforts of Barbara Harper and the entertainment from BOLD Fort Wayne and the cast of "Birth!" 

Thank you to all who came out to IPFW and participated in the Waterbirth Workshop and got a chance to see the world renowned play "Birth!".  The DNFW appreciated the efforts of travel from Illinois, Ohio and Michigan as well as all the 'locals' of Indiana.  

A special thanks to our photographers:  Albright Creative Imagery who beautifully captured the weekends events.  Please visit the link below to see all of the phenomenal photos and to order your prints.    

   
 

See more pictures....
 

Waterbirth Workshop

 

“Helping Women Get Into Hot Water”

The 4th Annual Birth to Baby Family Fair, sponsored by the Doula Network of Fort Wayne. 

Birth to Baby 2010 will be a bit different than in past years.  Barbara Harper, RN, CD, CCE and the Founder of Waterbirth International, will be hosting a waterbirth credentialing and certification workshop all day Friday, April 16th.  With the safe alternative of waterbirth becoming more and more requested by birthing families we are thrilled to have the opportunity to learn from the best.

 

WORKSHOP TOPICS

Controversial and absolute contraindications to birthing in water.

Guidelines for water temperature.

Assessing maternal and fetal well-being throughout water labour and birth.

Using water as an intervention in labour.

Resolving shoulder dystocia and other complications in the water.

Characteristics of the water-born infant.

Starting hospital waterbirth programs.

 

WHO SHOULD ATTEND?

 

This workshop provides opportunity for midwives, naturopaths, nurses, doctors, childbirth educators, doulas, and all those who care for women choosing waterbirth to recieve 7 CEU’s towards their certification/licensing programs. Birthing families are also welcome and can benefit from this tremendous opportunity to learn from the best. 

WORKSHOP PRICE LIST:

$250 for OB and midwifery professionals (CEUs) 
$125 for birth professionals (CEUs)
$50 for birthing families / students

Online registration and payment is available through IPFW.  

The DNFW is thrilled to announce that Saturday, April 17th and Sunday, April 18th Fort Wayne will have the distinct honor of witnessing it's premiere performance of  Birth, a play by Karen Brody.  Tickets are available in advance at the IPFW campus bookstore, or at the door the day of the event (doors open an hour before the event, seating is limited).

Without exhibitor tables this year, the DNFW wanted to be sure to continue to offer those great resources.  The DNFW will be providing exciting canvas give-away bags to workshop attendees and to the first fifty families at the door of the Birth performance Saturday evening.  If you are interested in submitting any items for the bags please contact Amber Hagen, Sponsorship Coordinator.

Looking forward to seeing you all again this year!

 

Doulas & Cesarean Birth

  As we all know, births don't always go as planned.  Sometimes cesareans are planned way in advance due to a baby's positioning or a mother's medical history but more often than not these days, a c-section can come on as a bit of a surprise.  Women today can be planning a vaginal birth but some may find themselves ending in a cesarean.  In fact the average rate of cesarean birth here in Fort Wayne has been reported to be around 33%.  That percentage is WAY higher, (more than double), the recommended rate for optimum outcomes for mother/baby health.  Now this article is not to argue whether or not Fort Wayne's astronomical rate of cesarean births are warranted, we have posted evidence-based research articles to this question in the past.  The Doula Network would like to turn focus to 'doula-ing' the cesarean families who are left dealing with mom's recovery physically, not to mention the family's emotional recovery, from an experience they may have taken action to prevent.  Are birth and postpartum doulas necessary in cesarean birth?

Birth doulas are experienced in cesarean delivery support.  Choosing to have a doula at a unplanned or planned cesarean can prove invaluable to the process.   Postpartum doulas are very experienced in the physical care of a mom post-cesarean and can help with any breastfeeding, bonding or family needs that may arise. 

We've been lucky enough to have a local mom share her cesarean story and how her doula helped to make a difference.  The Doula Network of Fort Wayne would like to thank Allison and her husband  for sharing their story and we honor her courage in coming through an unexpected journey.    

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I will GLADLY sing the praises of a good doula during and after a c-section birth! As you know, Doug and I had big plans for the birth of our 3rd baby. These plans included a drug-free labor and delivery, a labor where I was free to walk, rock, get into the water or on the birthing ball as needed, Daddy "catching" the baby and handing him/her to me and telling me what it was, Daddy cutting the cord (as he had w/ our other 2 babies), nursing immediately, and delaying much of the testing, measuring and cleaning up for at least the first hour.

Boy, did our plans change! At my 40 wk appt I was told the baby had turned breech. Which explains the sudden extreme discomfort from the previous day on. Since my midwife had performed many versions, had had 2 done on herself, and I had a previous successful version, we decided to try that before anything else. My OB/GYN wanted to get me on an epidural before the version because it "probably wouldn't work" and then I'd be all set for a c-section. I REALLY wasn't comfortable with this as I was hoping for the version to be a success and to have them then break my water and labor naturally from there. The OB/GYN consented after a lot of convincing from my midwife.

The next day we met at the hospital with our doula Shelly and prepared for the version. Doug had been up all night with a stomach flu and was not at all a "fit" labor coach. Shelly did everything she could to help him out as well as me. She got him snacks and kept an eye on him as we went through the preparation steps for whatever would follow. At this point the OB came in to talk to us and again try to talk me into doing an epidural. With the help and support from the midwife and Shelly we again talked her into trying the version first. The OB ordered no meds to be administered during the version because if it did go to a c-section she didn't want the baby groggy.

There in a cold surgical suite on an inverted table I tried my best to relax as the midwife and OB began pushing and prodding, trying to get the baby turned. It HURT. No one was really talking to me and I wasn't sure what I was supposed to do.... Then Shelly spoke slow and calm to me as I assume she would to a laboring mother experiencing contractions. She directed me to breathe to relax as much as possible through the pain. She continued to coach me through the deep breathing with empowering words for the several minutes they attempted to move the baby. Then my OB said " Are you ready to give up and do the C-section?" The way that was worded hit me like a ton of bricks. I could feel that the baby was firmly planted and not going to be movable.... but a kinder, more sympathetic way of wording it would have been appreciated. I teared up and said " I don't want to say it..."

At this point my husband also was pretty upset that we were not going to get the experience we'd looked forward to. Shelly was very sympathetic and reassuring to us both. Mostly without words. Which we appreciated. She and Doug left the room while they prepped me for surgery. When they came back we made sure Shelly had her camera. Although we cried through the c-section a little it was very exciting too.

From the moment they got the baby's little bottom out Shelly started snapping pictures and showing them to me so I felt more a part of what was going on instead of so disconnected. It was great to have Doug and Shelly there so one person could be with me and one with the baby at all times until I joined him in the recovery room. She also unlatched my arm to touch the baby better after my pitiful attempts to stroke his little head while restrained for the surgery.

Shelly was intregal in getting me nursing the baby within 40 minutes of birth (not bad for a c-section!) She continued "nursing" Doug back to health a little bit by getting him what he needed and also helping out so he could get to the post partem room to rest for a bit. I was wheeled to my room with my sweet baby latched on and nursing like a pro!

Once we were settled in our room for a little bit Shelly asked if it would be ok timing for her to slip out for a bite to eat and to develop the pictures. When she returned she had an album of all the pictures she'd taken. I cried as I flipped through them... I would continue flipping through them MANY times over the next few weeks until I had memorized them so it actually felt like my memories instead of the actual memories I had of trying so hard to see everything and be a part of it while my baby was so far away at the little bassinet as they measured and treated him (the whole time he's just wailing for Mama)

I can't describe how much it meant having Shelly there. I am trying to in this email, and I tried to when I wrote her a thank you note after coming home from the hospital. But she was much more than a doula to me that day. She was a mother figure that I so needed. She filled that role when I needed it most. She was concerned for me and excited for me and I felt as if I'd always known her. She was truly the only advocate I really felt I had that day with me. My midwife was not able to be there during the c-section, and Doug was still kind of coming around and trying to get to feeling better himself. It was a very emotional day- but thanks to Shelly and her support the deliriously joyful emotions outweighed the negative. I had a happy, healthy (Big) boy and was well cared for with my medical needs. Shelly helped give me memories by taking pictures of what I otherwise would not have seen. I can't tell you the value of that. It's priceless. I wonder if a doula isn't maybe even more needed w/ a c-section than a normal labor/birth- for the emotional side of it anyway. Even though it's such a shorter period of time. I guess everyone's experience is different. Shelly helped make the overtones of the day very happy. I just don't know how many different ways I can say it. Hope this helps!

~Allison

 

Corban Douglas  Born 9-24-08  8 lbs 14 oz  19 1/2"

"It's Worth It!" Becomes Finalist in National Film Competition

 

 The Doula Network's own Kathleen Hickey is announced as a finalist for the short film competition hosted by Birth Matters Virginia!  Kathleen partnered with Fort Wayne's Albright Creative Imageryto not only photo journalize the relationships and journeys of birth but also to develop original song and lyric that portray birth's true emotions. 

Guest judges:  Ricki Lake and Abby Epstein, acclaimed producers of The Business of Being Born and Sarah Buckley, M.D., international birth expert and author of Gentle Birth, Gentle Mothering will be viewing the finalist entries and rendering a winner by mid-June!

View the video on You Tube.  Feel free to share the link and pass on this great piece for others by which to become inspired about the power of women in our community.  

 

"It's Worth It!" 

http://www.youtube.com/watch?v=AJ7J8BIYa7g