Tienchin Ho

birthcircle TONIGHT

Tonight's birthcircle meeting is about when birth disappoints.

We are meeting at

Perfect Balance Yoga from 6-7:30pm
5091 N Fresno St #133 Fresno 93710

"The romantic image of a radiant mother, a beautiful baby in her arms, her golden hair lit by the sun’s rays, displayed on the jackets of many birth books is far removed from reality. New mothers are often unhappy. This major life transition is made incredibly difficult by poverty, poor housing, overcrowding, and social isolation. But one reason why many women have low self-esteem and cannot enjoy their babies is that care in childbirth often denies them honest information, the possibility of choice, and simple human respect."

from Sheila Kitzinger on Becoming a Mother

birthcircle: What is a Midwife?

Come meet some real life midwives at birthcircle!

Topic:       What is a Midwife?
Date: Monday    February 9, 2009

Time: 6:00 pm to 7:30 pm

Place: Perfect Balance Yoga 5091 N Fresno St 93710

Midwives vary both in their licensure and in their scope of practice.

Certified Nurse Midwives (CNM)
Some midwives are trained as both nurses and midwives. They are called certified nurse midwives (CNM). Their certification is regulated by the American College of Nurse-Midwives.

Direct-Entry Midwives (DEM)
Other midwives are like physician's assistants or physical therapists. They are not nurses and enter the field of midwifery directly. These midwives are called direct-entry midwives (DEM). Some of these midwives are licensed by professional organizations. Those licensed under the auspices of the North American Registry of Midwives (NARM) created by the Midwives Alliance of North America (MANA) are called certified professional midwives (CPM). Those registered under American College of Nurse-Midwives are called certified midwives (CM).

Some midwives practice without certification or licensure. Often they train as apprentices to established midwives. These are called lay midwives.

The practice of certified nurse midwives is legal in all 50 states. Government regulation of direct-entry midwifery varies from state to state. Midwives licensed by state legislation are called licensed midwives (LM).

Currently 24 states in the United States have legislation for the regulation of direct-entry midwives. Some states have legislation permitting direct-entry midwives to attend births without explicit regulation. Others prohibit direct-entry midwives from attending births.

The CDC report  based on birth certificate data shows that in 2006, about 8% of births in hospitals were attended by certified nurse midwives. It is not clear by birth certificate data how many out-of-hospital births are planned and attended by midwives. Not all midwives attend births. Many have office practices caring for women before and after childbirth.

According to ACNM, the majority of CNMs attend births in hospitals with only 2% in freestanding birth centers and 1.3% at homebirths. By contrast, DEMs have training in out-of-hospital births and most go on to practice in these settings.

Fresno Women's Medical Group

Last week I went downtown to the new Fresno Women's Medical Group (FWMG) location. The historic Van Valkenburgh home at 1125 T street is just across Fresno Street from the UCSF Center for Medical Education and Research. An historic home, original features such as the walls and windows are unaltered, preserving the cosy atmosphere of a home. The office is even able to provide non-stress testing on site. Dr. Gail Newel and Dr. Sharon Kopacz see patients at this location. Dr. Newel is respected as a supporter of natural childbirth. She also spends time in Africa repairing rectovaginal fistulas and teaching the surgeons there how to do repairs.

She and her partner Dr. Kelly Beingesser have had a huge positive impact on my own childbirth experiences for which I will always be grateful. I hope that other women looking for excellent obstetrical care will find them.

Some tips on choosing or changing birth attendants:

Look for local mother's groups with views on childbirth that are similar to your own. You may be able to get recommendations for attendants that also share those values. Some local groups whose members tend to support natural birth:

La Leche League

Fresno AP Mommies

ICAN of Fresno

birthcircle

Changing obstetricians is easiest to do before 27 weeks.

If a service such as vaginal birth after cesarean is not supported by your current provider, you may be able to find another provider who does even after 27 weeks.

The Newborn Hearing Test

Partial or complete hearing loss delays or prevents language, cognitive, and social-emotional development. Groups such as the National Association of the Deaf advocate testing before three months of age and starting family-centered intervention by six months of age. Without automatic testing, the average child with hearing loss is not discovered until over two years old. Parent and physician observation do not usually detect hearing loss even if profound.

To find infants with hearing loss sooner, California requires hospitals with intermediate or intensive care nurseries to offer testing before a baby goes home. Usually the test is done with the infant asleep in the nursery separate from the parents. Testing can also be done as an outpatient at a hospital or a physician’s office. Testing requires informed consent. Insurance companies may or may not cover newborn hearing tests. There are no good studies that show that testing every infant leads to better long term outcomes.

Two types of testing are available, otoacoustic emissions (OAEs) and auditory brainstem response (ABR). OAEs use the sounds that are reflected back from the ear to check for problems with the structures of the ear such as the eardrum, the ear canal, and the hair cells. A small probe placed in the ear records sounds from the ear over time. OAE testing can be done with the infant in your lap or nursing as long as baby is not vocalizing.  The equipment for OAEs testing is much less expensive than that for ABR testing.

ABR uses electrodes similar to those used for brain EEGs and cardiac EKGs. These stickers send information back to a computer that monitors brain activity in response to sounds. To have a normal ABR result, the outer ear structures, the auditory nerve, and the auditory pathways in the brain must all function. ABR testing requires baby to be very still.

Here is one home birth mother's point of view on newborn hearing tests.

In Fresno you can get outpatient hearing tests at these locations:

Community Regional Medical Center
Newborn Audiology
Tammy Vawter
2823 Fresno St, 3rd Floor
Fresno CA 93721
(559) 459-2807

Children’s Hospital of Central California
Audiology Services
(559) 353-6801

Valley Pediatric Medical Group
7130 N Sharon #101
Fresno CA 93720
(559) 436-8606

Central California Ear, Nose, and Throat Medical Group
1351 E Spruce Ave Suite 100
Fresno CA 93720
(559) 432-3303

birthcircle

After a terrific year of meetings at the Big Barn, birthcircle will move to a new location, Perfect Balance Yoga at the corner of Fresno and Shaw. I am grateful to Joanne for sharing her wonderful studio space and appreciate her strong sense of community support for women.

Birthcircle provides a supportive environment for women to share stories of pregnancy, childbirth, and motherhood. Meeting topics are suggestions to start the conversation. Any concerns or stories women bring to the meeting are welcome.

Date: second Monday of each month

Time: 6:00 pm to 7:30 pm

Place: Perfect Balance Yoga 5091 N Fresno St 93710

2009 Topics:

Jan 12: Have the Birth You Want

Feb 9: What is a Midwife?

Mar 9: When Childbirth Disappoints

Apr 13: Birth Stories: Open Session

May 11: Pregnancy and Size

Jun 8: Motherhood: Now Who Am I?

Jul 13: Birth and the Law

Aug 10: Birth Stories: Open Session

Sep 14: Monitoring During Labor

Oct 12: What is a Water Birth?

Nov 9: Sex and Childbirth

Dec 14: Birth Stories: Open Session

Babies-in-arms are welcome.

Hope to see you in 2009 Year of the Ox 牛年！

Birth on Labor Day

It has been another three weeks since my last post. During this time I have sat on the talk back panel of BOLD, listened to birth stories at our monthly birthcircle meeting, made two silk dresses for my girls, and am now in Washington D.C. WHEW!

BOLD is the Birth on Labor Day play that presents eight women's birth stories. The stories are all typical of births happening today including unmedicated, non-interventional birth, induction, medicated vaginal birth, operative-assisted vaginal birth and cesarean. I thought the production at the Tower Theater here in Fresno was well done and I appreciate all the hard work that went into it by Childbirth Resource Network. 

Following the play, the audience asked questions of a panel composed of me, a home birth midwife, a pediatrician, and an obstetrician. One of the questions was: How can we create global change in the maternity care system? This question has such strong personal significance for me. I asked the very same question myself on the Lamaze Normal Birth Forum a year and a half ago.

Fueled on by the misinformed article by Atul Gawande in the New Yorker about obstetrical care and Henci Goer's response, I was looking for ways to contribute to the birth advocacy movement. Like the person in the audience at BOLD, I was trying to share how wonderfully life changing childbirth was for me and how it could be the same for them. How can we reach those women when they aren't even remotely interested in attending a play like BOLD? Aren't we just preaching to the choir again and again?

Robbie Davis-Floyd says it best in her book Birth as an American Rite of Passage. Women have different values and beliefs. How each person perceives childbirth depends on these values. Some see childbirth as just another bodily function or a potential medical disaster prevented only by technological vigilance. Others see childbirth as an opportunity for personal growth or a powerfully feminine experience.

BOLD doesn't need to reach every woman. It just needs to be out there for the women who see childbirth as more than a physical or medical event. Women who found their response to childbirth different from those around them need to see BOLD. Midwives, doulas, pediatricians, and obstetricians who find themselves discouraged by clients who seem to miss the point need to see BOLD. BOLD connects the community of people who share common values. We need to preach to the choir because some members of the choir haven't found us yet. They need to know they are not alone.

Exercise During Pregnancy

Read any information on pregnancy and childbirth and you will find a section on the benefits of exercise. ACOG has a practice guideline for exercising during pregnancy that suggests 30 minutes a day.

Most of the advice is pretty obvious.

• Avoid activities where you might fall or get injured, such as contact sports or ski jumping.
• Choose familiar activities.
• Don't involve movements that are jarring or sudden.
• Use common sense.

Low impact activities like swimming or walking are obvious choices. There are also certain conditions which are contraindications to exercise, such as an incompetent cervix or placenta previa (covering the cervical opening).

Some things researchers worry about exercising during pregnancy:

Overheating
Any cause of higher temperatures such as a fever or sauna use is associated with increased risk for having fetal central nervous system problems. So, it is a good idea to keep cool and hydrated during exercise.

Decreased oxygen flow to baby
During exercise, working muscles are using more oxygen than at rest. Faster breathing and heart rate work to meet this increased demand. At the same time, blood flow may be shunted away from the uterus and placenta to the working muscles. Heavy exercise, resulting in heart rate over 80% of maximal heart rate, may be associated with decreased fetal movement.

Women who are later found to have intrauterine growth restriction (IUGR, abnormally small baby) due to placental problems have decreased blood flow during heavy exercise. It is unknown whether these changes in uterine blood flow make any difference to the fetus in the long run.

Fortunately, most women are able to judge whether they are exercising lightly or heavily. So, paying attention to how you feel during exercise is important. Don't overdo it.

Some potentially beneficial things about exercising during pregnancy:

Improved muscle tone, flexibility, posture, and mood
Exercise during pregnancy keeps body and mind healthy. Staying flexible and fit helps the work of labor and childbirth. The postpartum period is draining physically and emotionally; so, optimize both while you can.

Provides insight into the mind-body connection
Physical and emotional health are intertwined. Learning your personal coping methods to stress can help prepare you for the demands of labor. Physical activity reinforces body awareness and mindfulness. The practice of yoga has a special emphasis on the mind-body connection.

Controversial benefits of exercising during pregnancy:

Lowers maternal blood pressure - may prevent and treat pre-eclampsia
Some researchers are concerned that exercise in predisposed women can worsen pre-eclampsia or intrauterine growth restriction. In fact some may recommend bedrest as treatment.

SeonAe Yeo PhD, RN from the University of Michigan has been involved in women's health research since 1995. Her recent work compares stretching exercises to walking for 30 to 40 minutes about three to four times a week. She found that stretching exercises may decrease the risk of developing pre-eclampsia in women with a sedentary lifestyle who have had pre-eclampsia before.

Improves maternal sugar regulation - may prevent and treat gestational diabetes
A small study comparing bicycle exercise to insulin treatment for gestational diabetes showed that both treatments result in similar blood sugar levels and the number of newborns with low blood sugar levels.

Improves maternal posture - may optimize baby's position
Some positions are more difficult for baby to come out than others. The ideal position for birthing is vertex position (head down) and occiput anterior (baby facing back). Some midwives actively help to move baby into this position. Even if your baby is already in good position, maintaining good posture may help to reduce some of the aches and pains.

Resources:

Gail Tully CPM
Online resource developed by a midwife in Minneapolis for defining your baby’s position and recommendations for optimizing it.

Perfect Balance Yoga
5091 N Fresno St Ste 133
Fresno 93710
(559) 222-6212
Conveniently located at Shaw and Fresno streets. Provides a supportive atmosphere where women can share childbirth experiences and an awareness for a variety of childbirth options in addition to the practice of yoga.

San Joaquin Valley Rehabilitation
Hospital & Outpatient Center
7173 N. Sharon
Fresno 93720
(559) 436-3600

• Aqua Moms is an aquatic exercise class for expecting and post pregnancy mothers. The pool is an indoor, warm-water, therapeutic pool (92 - 95 degrees). Mondays and Wednesdays from 5:30 to 6:30. $42 per month. Physician's medical clearance required.

• Mommy Fitness is a land based exercise program for mothers and babies (until they begin walking). It focuses on core stabilization and strengthening with the natural progressive resistance of your baby's body weight. Tuesdays and Thursdays from 5:30 - 6:30. $42 per month. Physician's medical clearance required. You will need to bring a yoga mat, stroller or sling.

Mommy Matters
1010 E Perrin Ave
Fresno 93720
(559) 433-0172

Fig Garden Yoga Studio
6045 N Palm Ave Ste A
Fresno 93704
(559) 222-5100

Coil Yoga
764 P St
Fresno 93721
(559)270-4709

Local Fresno Hospitals

Clovis Community Medical Center
2755 Herndon Ave
Clovis 93611
(559)324-4000

• Popular with birthing moms, this rapidly growing hospital has less institutional-appearing birthing rooms.
• More than 3,000 babies born there each year.
• Obstetricians on staff have varying approaches for VBAC and noninterventional births. Some reassure mothers that they will be available for all their clients’ births by inducing mothers during a time when they are available. Some discourage VBAC. Others promote noninterventional births and VBACs. Some obstetricians on staff are active members of the birth advocacy community.
• Cesarean section rate was 33% in 2007.
• VBAC rate was 6.6% in 2007.
• Exclusive breastfeeding rate was 75% in 2006.

Community Regional Medical Center
2823 Fresno St
Fresno 93721
(559)459-6000

• Only local hospital with a perinatology program with neonatal intensive care unit and perinatologists.
• More than 7,000 babies born there each year.
• Home to a training program for residents in obstetrics. Maternal care services are in-house 24 hours a day. Obstetricians, resident physicians, and hospital staff have been supportive of noninterventional births and VBACs.
• Located downtown, it serves a population spanning socioeconomic lines.
• Cesarean section rate was 29.5% in 2007.
• VBAC rate was 7.2% in 2007.
• Exclusive breastfeeding rate was 10% in 2006.

Kaiser Permanente Medical Center Fresno
7300 N Fresno St
Fresno 93720
(559)448-4500

• With a philosophy of health care focused on wellness, Kaiser has a local reputation of being supportive of noninterventional birth and VBAC.
• Some specialist care is referred out of the Kaiser system to other local medical facilities.
• Cesarean section rate was 24.5% in 2007.
• VBAC rate was 20.5% in 2007.
• Exclusive breastfeeding rate was 62% in 2006.

Saint Agnes Medical Center
1303 E. Herndon Ave
Fresno 93720
(559)450-3000

• Appealing north side location on Herndon Ave which is lined with physicians offices and other medical offices.
• Recognized by HealthGrades since 2006 as one of the top 10% of all hospitals studied based on outcomes of low risk births.
• Some obstetricians on staff do not attend VBACs. Others do. Anesthesiologists remain in-house during VBAC labors.
• More than 4000 babies born there each year.
• Cesarean section rate was 34.5% in 2007.
• VBAC rate was 4.3% in 2007.
• Exclusive breastfeeding rate was 83% in 2006.

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