It's Your Birth. Explore Your Options.


Leave a comment

Birth Talk: Share, Connect, Support

11075143_934857536546645_8434029921562669044_n

Thursday, September 10, 2015 7-9pm Kill Devil Hills Library

Birth Talk is a casual gathering for conversation and a place to ask questions, share experiences, support each other’s struggles and triumphs, and connect with others in the community. This circle of trust and support is open to everyone including expecting and new mothers, fathers, doulas, practitioners, childbirth educators, and anyone with a passion for supporting the power of birth. Babes in arms are always welcome. FREE

Bring a snack to share if you are so inspired.

Doors open at 6:45. Meeting starts promptly at 7pm. ***Please follow the sidewalk on the LEFT side of the building around to the ramp/rear door.***

For more info email outerbanksbirth@gmail.com . RSVP on Facebook: https://www.facebook.com/events/1488061488174487/

Please invite your friends. All events are FREE and open to the public.


Leave a comment

Evidence-Based Maternity Care: Pearls of Midwifery

pearls of midwiferyThursday, May 14th 7-9pm –         Kill Devil Hills Library meeting room

Certified Nurse-Midwife Lucille Lamberto will present the proven benefits of normal, physiologic labor and childbirth for mothers and their newborns. Lucille will share her passion for the science and art of the midwifery model of maternity care as well as present the benefits of evidence-based practices in any setting – home, birth center, or hospital. The Pearls of Midwifery represent fine examples of best childbearing care practices.

Partners, husbands, friends, family and babes in arms are always welcome.

RSVP: www.facebook.com/events/631033453707247/

Doors open at 6:45. Meeting starts promptly at 7pm. ***Please follow the sidewalk on the LEFT side of the building around to the ramp/rear door.***

For more info email outerbanksbirth@gmail.com or call 252-207-5601.

Please invite your friends. All events are FREE and open to the public.


Leave a comment

Having a Baby? Ten Questions to Ask Your Doctor or Midwife

Coalition for Improving Maternity Services

Have you decided how to have your baby? The choice is yours!

 First, you should learn as much as you can about all your choices. There are many different ways of caring for a mother and her baby during labor and birth.

Birthing care that is better and healthier for mothers and babies is called “mother- friendly. “Some birth places or settings are more mother-friendly than others.

A group of experts in birthing care came up with this list of 10 things to look for and ask about. Medical research supports all of these things. These are also the best ways to be mother-friendly.

When you are deciding where to have your baby, you’ll probably be choosing from different places such as:

  • birth center,
  • hospital, or
  • home birth service.

Here’s what you should expect, and ask for, in your birth experience. Be sure to find out how the people you talk with handle these 10 issues about caring for you and your baby. You may want to ask the questions below to help you learn more.

 1. Ask, “Who can be with me during labor and birth?”

Mother-friendly birth centers, hospitals, and home birth services will let a birthing mother decide whom she wants to have with her during the birth. This includes fathers, partners, children, other family members, or friends.

They will also let a birthing mother have with her a person who has special training in helping women cope with labor and birth. This person is called a doula or labor support person. She never leaves the birthing mother alone. She encourages her, comforts her, and helps her understand what’s happening to her.

They will have midwives as part of their staff so that a birthing mother can have a midwife with her if she wants to.

 2. Ask, “What happens during a normal labor and birth in your setting?”

If they give mother-friendly care, they will tell you how they handle every part of the birthing process. For example, how often do they give the mother a drug to speed up the birth? Or do they let labor and birth usually happen on its own timing?

They will also tell you how often they do certain procedures. For example, they will have a record of the percentage of C-sections (Cesarean births) they do every year. If the number is too high, you’ll want to consider having your baby in another place or with another doctor or midwife.

Here are some numbers we recommend you ask about.

  • They should not use oxytocin (a drug) to start labor for more than 1 in 10 women (10%).
  • They should not do an episiotomy (ee-pee-zee-AH-tummy) on more than 1 in 5 women (20%). They should be trying to bring that number down. (An episiotomy is a cut in the opening to the vagina to make it larger for birth. It is not necessary most of the time.)
  • They should not do C-sections on more than 1 in 10 women (10%) if it’s a community hospital. The rate should be 15% or less in hospitals which care for many high-risk mothers and babies.
  • A C-section is a major operation in which a doctor cuts through the mother’s stomach into her womb and removes the baby through the opening. Mothers who have had a C-section can often have future babies normally. Look for a birth place in which 6 out of 10 women (60%) or more of the mothers who have had C-sections go on to have their other babies through the birth canal.

3. Ask, “How do you allow for differences in culture and beliefs?”

Mother-friendly birth centers, hospitals, and home birth services are sensitive to the mother’s culture. They know that mothers and families have differing beliefs, values, and customs.

For example, you may have a custom that only women may be with you during labor and birth. Or perhaps your beliefs include a religious ritual to be done after birth. There are many other examples that may be very important to you. If the place and the people are mother-friendly, they will support you in doing what you want to do. Before labor starts tell your doctor or midwife special things you want.

 4. Ask, “Can I walk and move around during labor? What position do you suggest for birth?”

In mother-friendly settings, you can walk around and move about as you choose during labor. You can choose the positions that are most comfortable and work best for you during labor and birth. (There may be a medical reason for you to be in a certain position.) Mother-friendly settings almost never put a woman flat on her back with her legs up in stirrups for the birth.

 5. Ask, “How do you make sure everything goes smoothly when my nurse, doctor, midwife, or agency need to work with each other?”

Ask, “Can my doctor or midwife come with me if I have to be moved to another place during labor? Can you help me find people or agencies in my community who can help me before and after the baby is born?”

Mother-friendly places and people will have a specific plan for keeping in touch with the other people who are caring for you. They will talk to others who give you birth care. They will help you find people or agencies in your community to help you. For example, they may put you in touch with someone who can help you with breastfeeding.

 6. Ask, “What yhings do you normally do to a woman in labor?”

Experts say some methods of care during labor and birth are better and healthier for mothers and babies. Medical research shows us which methods of care are better and healthier. Mother-friendly settings only use methods that have been proven to be best by scientific evidence.

Sometimes birth centers, hospitals, and home birth services use methods that are not proven to be best for the mother or the baby. For example, research has shown it’s usually not helpful to break the bag of waters.

Here is a list of things we recommend you ask about. They do not help and may hurt healthy mothers and babies. They are not proven to be best for the mother or baby and are not mother-friendly.

  • They should not keep track of the baby’s heart rate all the time with a machine (called an electronic fetal monitor). Instead it is best to have your nurse or midwife listen to the baby’s heart from time to time.
  • They should not break your bag of waters early in labor.
  • They should not use an IV (a needle put into your vein to give you fluids).
  • They should not tell you that you can’t eat or drink during labor.
  • They should not shave you.
  • They should not give you an enema.

A birth center, hospital, or home birth service that does these things for most of the mothers is not mother-friendly. Remember, these should not be used without a special medical reason.

 7. Ask, “How do you help mothers stay as comfortable as they can be? Besides drugs, how do you help mothers relieve the pain of labor?”

The people who care for you should know how to help you cope with labor. They should know about ways of dealing with your pain that don’t use drugs. They should suggest such things as changing your position, relaxing in a warm bath, having a massage and using music. These are called comfort measures.

Comfort measures help you handle your labor more easily and help you feel more in control. The people who care for you will not try to persuade you to use a drug for pain unless you need it to take care of a special medical problem. All drugs affect the baby.

 8. Ask, “What if my baby is born early or has special problems?”

Mother-friendly places and people will encourage mothers and families to touch, hold, breastfeed, and care for their babies as much as they can. They will encourage this even if your baby is born early or has a medical problem at birth. (However, there may be a special medical reason you shouldn’t hold and care for your baby.)

 9. Ask, “Do you circumcise baby boys?”

Medical research does not show a need to circumcise baby boys. It is painful and risky. Mother-friendly birth places discourage circumcision unless it is for religious reasons.

 10. Ask, “How do you help mothers who want to breastfeed?”

The World Health Organization made this list of ways birth services support breastfeeding.

  • They tell all pregnant mothers why and how to breastfeed.
  • They help you start breastfeeding within 1 hour after your baby is born.
  • They show you how to breastfeed. And they show you how to keep your milk coming in even if you have to be away from your baby for work or other reasons.
  • Newborns should have only breast milk. (However, there may be a medical reason they cannot have it right away.)
  • They encourage you and the baby to stay together all day and all night. This is called “rooming-in.”
  • They encourage you to feed your baby whenever he or she wants to nurse, rather than at certain times.
  • They should not give pacifiers (“dummies” or “soothers”) to breastfed babies.
  • They encourage you to join a group of mothers who breastfeed. They tell you how to contact a group near you.
  • They have a written policy on breastfeeding. All the employees know about and use the ideas in the policy.
  • They teach employees the skills they need to carry out these steps.

Would you like to give this information (and more) to your doctor, midwife, or nurse? This information is a part of the Mother-Friendly Childbirth Initiative written for health care providers. Download a copy at MotherFriendly.org.

© 2000 by The Coalition for Improving Maternity Services (CIMS). Permission granted to freely reproduce in whole or in part with complete attribution.


Leave a comment

The Mother-Friendly Childbirth Inititative

Outer Banks Birth Network supports, encourages, and educates women and their families by promoting the awareness and availability of evidence-based, Mother-Friendly maternity care as defined by the Mother-Friendly Childbirth Initiative (MFCI) of the Coalition for Improving Maternity Services.

The First Consensus Initiative of the Coalition for Improving Maternity Services

images (2)

© 1996 by The Coalition for Improving Maternity Services (CIMS).

 Mission

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

Preamble

Whereas:

•   In spite of spending far more money per capita on maternity and newborn care than any other country, the United States falls behind most industrialized countries in perinatal* morbidity* and mortality, and maternal mortality is four times greater for African-American women than for Euro-American women;

•   Midwives attend the vast majority of births in those industrialized countries with the best perinatal outcomes, yet in the United States, midwives are the principal attendants at only a small percentage of births;

•   Current maternity and newborn practices that contribute to high costs and inferior outcomes include the inappropriate application of technology and routine procedures that are not based on scientific evidence;

•   Increased dependence on technology has diminished confidence in women’s innate ability to give birth without intervention;

•   The integrity of the mother-child relationship, which begins in pregnancy, is compromised by the obstetrical treatment of mother and baby as if they were separate units with conflicting needs;

•   Although breastfeeding has been scientifically shown to provide optimum health, nutritional, and developmental benefits to newborns and their mothers, only a fraction of U.S. mothers are fully breastfeeding their babies by the age of six weeks;

•   The current maternity care system in the United States does not provide equal access to health care resources for women from disadvantaged population groups, women without insurance, and women whose insurance dictates caregivers or place of birth;

Therefore,

We, the undersigned members of CIMS, hereby resolve to define and promote mother-friendly maternity services in accordance with the following principles:

Principles

We believe the philosophical cornerstones of mother-friendly care to be as follows:

Normalcy of the Birthing Process

•   Birth is a normal, natural, and healthy process.

•   Women and babies have the inherent wisdom necessary for birth.

•   Babies are aware, sensitive human beings at the time of birth, and should be acknowledged and treated as such.

•   Breastfeeding provides the optimum nourishment for newborns and infants.

•   Birth can safely take place in hospitals, birth centers, and homes.

•   The midwifery model of care, which supports and protects the normal birth process, is the most appropriate for the majority of women during pregnancy and birth.

Empowerment

•   A woman’s confidence and ability to give birth and to care for her baby are enhanced or diminished by every person who gives her care, and by the environment in which she gives birth.

•   A mother and baby are distinct yet interdependent during pregnancy, birth, and infancy. Their interconnected–ness is vital and must be respected.

•   Pregnancy, birth, and the postpartum period are milestone events in the continuum of life. These experiences profoundly affect women, babies, fathers, and families, and have important and long-lasting effects on society.

Autonomy

Every woman should have the opportunity to:

•   Have a healthy and joyous birth experience for herself and her family, regardless of her age or circumstances;

•   Give birth as she wishes in an environment in which she feels nurtured and secure, and her emotional well-being, privacy, and personal preferences are respected;

•   Have access to the full range of options for pregnancy, birth, and nurturing her baby, and to accurate information on all available birthing sites, caregivers, and practices;

•   Receive accurate and up-to-date information about the benefits and risks of all procedures, drugs, and tests suggested for use during pregnancy, birth, and the postpartum period, with the rights to informed consent and informed refusal;

•   Receive support for making informed choices about what is best for her and her baby based on her individual values and beliefs.

Do No Harm

•   Interventions should not be applied routinely during pregnancy, birth, or the postpartum period. Many standard medical tests, procedures, technologies, and drugs carry risks to both mother and baby, and should be avoided in the absence of specific scientific indications for their use.

•   If complications arise during pregnancy, birth, or the postpartum period, medical treatments should be ­evidence-based.

Responsibility

•   Each caregiver is responsible for the quality of care she or he provides.

•   Maternity care practice should be based not on the needs of the caregiver or provider, but solely on the needs of the mother and child.

•   Each hospital and birth center is responsible for the periodic review and evaluation, according to current scientific evidence, of the effectiveness, risks, and rates of use of its medical procedures for mothers and babies.

•   Society, through both its government and the public health establishment, is responsible for ensuring access to maternity services for all women, and for monitoring the quality of those services.

•   Individuals are ultimately responsible for making informed choices about the health care they and their babies receive.

These principles give rise to the following steps, which support, protect, and promote mother-friendly maternity services:

* see glossary below

Ten Steps of the Mother-Friendly Childbirth Initiative

For Mother-Friendly Hospitals, Birth Centers,* and Home Birth Services

To receive CIMS designation as “mother-friendly,” a hospital, birth center, or home birth service must carry out the above philosophical principles by fulfilling the Ten Steps of Mother-Friendly Care:

A mother-friendly hospital, birth center, or home birth service:

1.   Offers all birthing mothers:

•   Unrestricted access to the birth companions of her choice, including fathers, partners, children, ­family members, and friends;

•   Unrestricted access to continuous emotional and physical support from a skilled woman—for ­example, a doula,* or labor-support professional;

•   Access to professional midwifery care.

2.   Provides accurate descriptive and statistical information to the public about its practices and procedures for birth care, including measures of interventions and outcomes.

3.   Provides culturally competent care—that is, care that is sensitive and responsive to the specific beliefs, ­values, and customs of the mother’s ethnicity and ­religion.

4.   Provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor and birth (unless restriction is specifically required to correct a complication), and discourages the use of the lithotomy (flat on back with legs elevated) position.

5.   Has clearly defined policies and procedures for:

•   collaborating and consulting throughout the perinatal period with other maternity services, including communicating with the original caregiver when transfer from one birth site to another is necessary;

•   linking the mother and baby to appropriate community resources, including prenatal and post-­discharge follow-up and breastfeeding support.

6.   Does not routinely employ practices and procedures that are unsupported by scientific evidence, ­including but not limited to the following:

•   shaving;

•   enemas;

•   IVs (intravenous drip);

•   withholding nourishment or water;

•   early rupture of membranes*;

•   electronic fetal monitoring;

other interventions are limited as follows:

•   Has an induction* rate of 10% or less;

•   Has an episiotomy* rate of 20% or less, with a goal of 5% or less;

•   Has a total cesarean rate of 10% or less in community hospitals, and 15% or less in tertiary care (high-risk) hospitals;

•   Has a VBAC (vaginal birth after cesarean) rate of 60% or more with a goal of 75% or more.

7.   Educates staff in non-drug methods of pain relief, and does not promote the use of analgesic or anesthetic drugs not specifically required to correct a complication.

8.   Encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions.

9.   Discourages non-religious circumcision of the newborn.

10. Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital Initiative” to promote successful breastfeeding:

        1.             Have a written breastfeeding policy that is routinely  communicated to all health care staff;

        2.             Train all health care staff in skills necessary to implement this policy;

        3.             Inform all pregnant women about the benefits and management of breastfeeding;

        4.             Help mothers initiate breastfeeding within a half-hour of birth;

        5.             Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants;

        6.             Give newborn infants no food or drink other than breast milk unless medically indicated;

        7.             Practice rooming in: allow mothers and infants to remain together 24 hours a day;

        8.             Encourage breastfeeding on demand;

        9.             Give no artificial teat or pacifiers (also called dummies or soothers) to breastfeeding infants;

        10.           Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospitals or clinics.

† This criterion is presently under review.

* Glossary

Augmentation: Speeding up labor.

Birth Center: Free-standing maternity center.

Doula: A woman who gives continuous physical, emotional, and informational sup­port during labor and birth—may also provide postpartum care in the home.

Episiotomy: Surgically cutting to widen the vaginal opening for birth.

Induction: Artificially starting labor.

Morbidity: Disease or injury.

Oxytocin: Synthetic form of oxytocin (a naturally occurring hormone) given intravenously to start or speed up labor.

Perinatal: Around the time of birth.

Rupture of Membranes: Breaking the “bag of waters.”

Bibliography

American College of Obstetricians and Gynecologists. Fetal heart rate patterns: monitoring, interpretation, and management.        Technical Bulletin No. 207, July 1995.

—. Guidelines for vaginal delivery after a previous cesarean birth. ACOG Committee Opinion 1988; No 64.

Canadian Paediatric Soc, Fetus, and Newborn Committee. Neonatal circumcision revisited. Can Med Assoc J 1996;154(6):769-780.

Enkin M, et al. A Guide to Effective Care in Pregnancy and Childbirth 2nd rev ed. Oxford: Oxford University Press, 1995. (Data from this book come from the Cochrane Database of Perinatal Trials.)

Goer H. Obstetric Myths Versus Research Realities: A Guide to the Medical Literature. Westport, CT: Bergin and Garvey, 1995.

Bureau of Maternal and Child Health. Unity through diversity: a report on the Healthy Mothers Healthy Babies Coalition Communities of Color Leadership Roundtable. Healthy Mothers Healthy Babies, 1993. (A copy may obtained by calling (202) 821-8993 ext. 254. Dr. Marsden Wagner also provided maternal mortality statistics from official state health data.)

International Lactation Consultant Association. Position paper on infant feeding. rev 1994. Chicago: ILCA, 1994.

Klaus M, Kennell JH, and Klaus PH. Mothering the Mother. Menlo Park, CA: Addison-Wesley, 1993.

—. Bonding: Building the Foundations of Secure Attachment and Independence. Menlo Park, CA: Addison-Wesley,1995.

Wagner M. Pursuing the Birth Machine: The Search for Appropriate Birth Technology. Australia: ACE Graphics, 1994. (Dr. Wagner’s book has the “General Recommendations” of The WHO Fortaleza, Brazil, April, 1985 and the “Summary Report” of The WHO Consensus Conference on Appropriate Technology Following Birth Trieste, October, 1986.

 

Ratified by these members of the Coalition for Improving Maternity Services (CIMS), July, 1996

 

Organizations (names of organizations’ officers may have changed since ratification):

Academy of Certified Birth Educators (Olathe, KS), Linda M. Herrick, RNC, BSN, CCE, CD; and Sally Riley, BSEd, CCE, CD, & Judie C. Wika, RNC, MSN, CNM, CCE, Co-Directors

American Academy of Husband-Coached Childbirth (The Bradley Method™), (Sherman Oaks, CA), Jay and Marjie Hathaway, Executive Directors

American College of Nurse-Midwives (Washington, DC), Joyce Roberts, CNM, PhD, FACNM, President

American College of Domiciliary Midwives (Palo Alto, CA), Faith Gibson, CPM, Executive Director

Association of Labor Assistants and Childbirth Educators (Cambridge, MA), Jessica L. Porter, President

Association for Pre- & Perinatal Psychology and Health (Geyserville, CA), David B. Chamberlain, PhD, President