Beth Murch

Nothing breaks our hearts quite like the death of a baby.

What Is SIDS?

Every weekin Canada, Sudden Infant Death Syndrome (SIDS)/ Sudden Unexplained Death inInfancy (SUDI) claims the lives of three babies.[i] Also known as “crib death”, SIDS is the sudden and unexplained death of a seeminglyhealthy child under 1 year of age (most deaths occur between 2 and 4 months ofage).[ii] 90% of SIDS cases occur in babies under 6 months of age and it is unusual for SIDS to occur in babies younger than 1 month or older than 8 months. [iii] In order for an infant’s cause of death to be ruled as SIDS-related, a complete police investigation must take place, including: an autopsy, an examination ofthe location of death and a review of a family’s case history. Only if other factors do not appear to have been related to the baby’s demise (including any possible illnesses that were previously undiagnosed) will his death be considered to be the result of SIDS.[iv] Some conditions that may be undiagnosed and may mimic SIDS are:

-         Infant botulism

-         MCAD deficiency (Medium-Chain Acyl-Co-Enzyme A Dehydrogenase Deficiency)

-         LQTS (Long QT Sydrome/Romano-Ward Syndrome)

-         Helicobacter Pylori bacterium infections

-         Shaken Baby Syndrome[v]

Myths & Facts

Despite thorough research involving the normal development of babies, brain function,body temperature and how infants move from sleeping to arousal states, much of SIDS is still a mystery to us. There are many popular misconceptions about SIDS that may confuse and misinform parents and care providers:

Myth: SIDS only occurs in cribs or playpens.

Fact: SIDS can affect children anywhere –while they are in their crib, sharing a bed with a family member, sleeping in a parent’s arms or while laying on the floor. Increasingly, the medical community is trying to move away from the phrases “crib death” or “cot death” in order to combat this myth.

Myth: SIDS is a new phenomenon.

Fact: SIDS has likely been occurring forthousands of years. Previously, there were not always medical explanations for many babies that passed away suddenly and there were no easy ways to record statistics. A wander through an old cemetery will reveal many children’s headstones that say “sleeping in the arms of Jesus” or depicting resting angels. Many graves simply say “Infant” or “Baby” – it is certain that some of these little ones passed away from SIDS.

Myth: SIDS only occurs during sleep.

Fact: Because babies who die from SIDS are often found after a nap or first thing in the morning, it is often assumed that they passed away during their sleep. This may not always be the case.

Myth: SIDS is hereditary.

Fact: SIDS is not hereditary. Losing a child to SIDS does not mean that your other children will die of SIDS.

Myth: SIDS is contagious.

Fact: SIDS is not contagious. Losing a child to SIDS does not mean that your other children (or the children of friends, family members or co-workers) will also die of SIDS.

Myth: SIDS is due to abuse, choking,neglect or accidental suffocation.

Fact: SIDS is not related to child abuse or household accidents. A diagnosis of SIDS can only be given if abuse, choking,neglect and suffocation are ruled out by police and coronary investigation, therefore, SIDS is not the result of violence, cruelty or injury.

Myth: Co-sleeping (sharing a bed withyour baby) will result in SIDS.

Fact: While there have been cases ofinfants dying of SIDS in their parents’ beds, there have also been cases where infants have died of SIDS in locations as varied as playpens, in a parent’sarms and in car seats. [vi]

Health Canada’s Recommendations

Although we know very little about what causes SIDS, Health Canada has several recommendations on how we can protect our babies and keep them safe:

-         Put your baby to sleep on her back on a firm, flat surface (until they are able to roll over onto their tummies by themselves)

-         Avoid putting soft mattresses, fluffy pillows, comforters, stuffed toys and bumper pads in your baby’s crib or playpen because they can interfere with the airflow around your baby’s face

-         Any plastic mattress coverings or wrappings should be removed in order to reduce the chance of suffocation

-         Keep your baby warm, but not hot. Your baby should not be sweating. Use lightweight blankets that you can add or take away according to the room’s temperature (to check if your baby is too warm, place your hand at the back of his neck. If it is hot to the touch or damp with sweat, remove a layer of his clothing). Your infant usually only needs to be dressed in one layer more than what you are wearing

-         Create a smoke and drug-free home for your child before and after birth. No one should ever smoke near your baby. If you (or someone else) must smoke, have them do so outside and away from the baby. Consult your physician about ways that you and/or your partner can quit smoking and receive treatment for drug addiction

-         Breastfeed your baby! Not only is breast milk nutritionally optimal for infants, it has also been proven to have other benefits that may protect against SIDS

-         If your baby shares the bed of another family member, make sure that they are not smokers and that they have not taken drugs, alcohol or any medications which may make them less able to respond to the baby. They should also be made aware that blankets, pillows and stuffed animals must be kept away from the baby [vii]

Theoretical Causes of SIDS

There are many theoretical causes that have been proposed as triggers for SIDS, but none of them are proven and many have not been thoroughly studied and/or peer-reviewed. As of June 2009, there were 113 such articles found under Medical Hypotheses as cited in PubMed, including (please note that this is not a comprehensive list and that these articles have neither been proven or disproven as actual factors in SIDS):

-         Anemia [viii]

-         Mattressbugs (leading to anaphylactic shock) [ix]

-         Brain abnormalities (specifically, there is evidence that cells in the brainstem fail to develop receptors for serotonin in utero) [x]

-         Low levels of vitamin C [xi]

-         Toxic gases [xii]

-         Central respiratory pattern deficiency [xii]

-         Cervical spinal cord injury (as part of birth trauma) [xiv]

-         Gender (males are 50% more likely to die of SIDS) [xv]

-         Nitrogen dioxide [xvi]

-         Vaccination [xvii]

-         Inner ear damage (records of hearing tests administered to certain infants show that those who later died of SIDS had a unique pattern of partial hearing loss) [xviii]

Pre-and-Post-Natal Risk Factors For SIDS

It has also been shown that there are many pre-and-post-natal risks factors that are associated with increased likelihood of SIDS.

Prenatal:

-         Maternal nicotine use (includes cigarettes and nicotine patches)

-         Inadequate prenatal care

-         Inadequate prenatal nutrition

-         Heroin use

-         Subsequent births less than a year apart

-         Alcohol use

-         Infant being overweight

-         Mother being overweight

-         Teen pregnancy

Postpartum Risks:

-         Mold

-         Low birth weight

-         Exposure to tobacco smoke

-         Prone sleep positioning (sleeping on tummy)

-         Formula feeding

-         Elevated room temperatures

-         Excess bedding, stuffed animals, etc.

-         Infant’s age

-         Prematurity

-         anemia [xix]

If Your Baby Isn’t Breathing

No one wants to think about the possibility of their baby being affected by SIDS, but it is always wise to educate yourself with the tools you – or someone else – may need some day.

If your baby isn’t breathing, immediately call 9-1-1 or your local emergency number.

Hamilton Emergency Services has a step-by-step instructional pamphlet on how to perform infant CPR here: http://www.myhamilton.ca/NR/rdonlyres/7BDDA448-9066-4670-8800-5E2C50BF216A/0/HowtodoCPRInfant.pdf

The baby’sbody might be bluish and there may be pink froth around her nose and mouth. These changes aren’t specific to the cause of death, but they are common to the process of dying.[xx] Be sure to note the position that you found your baby in, what colour his skin was and any unusual features.

Support For Grieving Families

Here are some supports for families whose lives have been touched by SIDS. May you know healing, revealed blessings and love.

Canadian Foundation for the Study of Infant Deaths

60 James Street, Suite 403

St. Catharines, Ontario L2R 7E7

Tel: 905-688-8884

Fax: 905-688-3300

Toll-Free: 1-800-363-7437

E-mail: sidsinfo@sidscanada.org  Website: http://www.sidscanada.org/index.html

Bereaved Families of Ontario

Midwestern Region (Kitchener-Waterloo, Cambridge and Guelph)

Grand River Hospital, Freeport Health Centre,

Pioneer Terrace, Second Floor

3570 King St. E, Kitchener

Tel: 519-894-8344

Fax:519-894-8394

E-mail: Rose Greensides, Executive Director – rose@bfomidwest.org and Melissa Lambert,Executive Director – Melissa@bjomidwest.org

The Compassionate Friends of Canada, Inc.

Tel: 1-866-823-0141

E-mail: nationaloffice@tcfcanada.net

K-W Distress Line

Tel: 519-745-1166

K-W MobileCrisis Team (available 24/7)

Tel: 519-744-1813

Crisis Clinic (Grand River Hospital)

Tel: 519-742-3611

On A Personal Note

Sudden Infant Death Syndrome has touched me several times throughout my life. When Iwas a child, a teacher of mine lost her daughter to SIDS. I remember attending the funeral and baking my teacher molasses cookies and the way her tears drenched my blouse. For many years after that, whenever I would write short stories, I would name the main character after my teacher’s daughter so that ina way, she would always live on. I just couldn’t bear the thought of that small, white coffin.

In high school, a friend of mine lost her just weeks - old daughter to SIDS. The experience definitely jarred my sense of youthful immortality. I was just so shocked that what appeared to be a perfectly healthy baby just slipped away one night. I kept thinking, “We’re teenagers – we aren’t supposed to have babies who die!”

Most recently, a very dear friend of mine (who I am content to call my sister although we are in no way related) lost her 154-day-old daughter to SIDS. I was rocked to my core. Yael, in my eyes, was just about the most awesome mother on the planet and the coolest person I knew – she wore pink Chuck Taylors, had perfect curly hair and had a son named Menachem Mendel (aka “Moo”) who called lobsters “monsters”. Her daughter, Adelle Shayna z”l (aka “Shiny”) had a smile that spread joy wherever she went. This little girl grew from a tiny pink bundle to a wiggling, grinning almost-five-month-old...and then, she was gone.  It seemed unreal that something so tragic could happen to someone that I loved so much – and I know that everyone who knew Yael and her husband felt that way.

Yael, being the amazing person that she is, reached out to others through her grief.  She wrote an amazing article called Learning To Mother Again After Losing My Baby To SIDS that you can read online and be inspired by just like myself and so many other people around the world.[xxi] She created The Shiny Project: a project that encourages people to show kindness to one another. The inspiration is remembering Shiny – every time we do something nice for a stranger or for those we love, we remember Shiny’sbeautiful smile and honour her memory.[xxii] Yael tells us that we create a “butterfly effect”: just as the flapping of a butterfly’s wings in Brazil may change the atmosphere enough to create atornado in Texas, the generosity that we show a stranger may change the world for the better.

As a doula, I have the unique opportunity to educate and empower families. I am blessed with the chance to teach families what I know about pregnancy, birth, breastfeeding and the postpartum period. As someone who believes in the awesome power of women to birth their babies and nurture them and as someone who believes in The Shiny Project, I feel that by posting my knowledge about SIDS and where individuals touched by SIDS can go for help, I am participating in the butterfly effect. I hope that someone out there reads this blog post and ittouches them...then shares it with someone else...who is touched...who shares with someone else...

I dedicate this entry to my sister Yael and to the memory of Shiny.

LOVE!!!!!

[i] “Backto Sleep” by Public Health Agency of Canada (PHAC) and The Canadian Foundationfor the Study of Infant Deaths (CFSID). Brochure available at http://www.phac-aspc.gc.ca/dca-dea/prenatal/sids-eng.php.Accessed September 8, 2009.

[ii] “SuddenInfant Death Syndrome” by Floyd R. Livingston, Jr. http://kidshealth.org/parent/general/sleep/sids.html#Accessed September 8, 2009.

[iii] “Afterthe Birth: Sudden Infant Death Syndrome by Alberta Children’s Services. http://www.parentlinkalberta.ca/publish/480.htm Accessed September 8, 2009.

[iv] Ibid.

[v] “SuddenInfant Death Syndrome”http://en.wikipedia.org/wiki/Sudden_infant_death_syndrome#Undiagnosed_conditionsAccessedSeptember 8, 2009.

[vi] “Afterthe Birth: Sudden Infant Death Syndrome by AlbertaChildren’s Services.http://www.parentlinkalberta.ca/publish/480.htm Accessed September 8,2009.

[vii] Ibid.

[viii] GizelaBA (2001). Postmortem hemoglobin concentration changing in Sprague-Dawley white mouse. Berkala Ilmu Kedokteran 33:207-210 (Indonesian, English Abstract)

[ix] SherburnRE, Jenkins RO. Cot mattresses as reservoirs ofpotentially harmful bacteriaand the sudden infant death syndrome. FEMSImmunol Med Microbiol. 2004 Sep1;42(1):76-84. PubMed PMID: 15325400.

[x] PatersonDS, Trachtenberg FL, Thompson EG, Belliveau RA, Beggs AH,Darnall R, ChadwickAE, Krous HF, Kinney HC. Multiple serotonergic brainstem abnormalities in sudden infant death syndrome. JAMA. 2006 Nov1;296(17):2124-32.

[xi] Hattersley JG. "The answer to crib death: 'Sudden Infant DeathSyndrome' (SIDS)". Journal of Orthomolecular Medicine 8 (4).http://www.orthomolecular.org/library/jom/1993/pdf/1993-v08n04-p229.pdf.

[xii] Fleming PJ, Blair PS,Mitchell EA (November 2002)."Mattresses,microenvironments, and multivariate analyses". BMJ 325(7371): 981–2. doi:10.1136/bmj.325.7371.981. PMID 12411332. PMC:112453

[xii] "Regulation of respiratory neuron development by neurotrophic and transcriptional signaling mechanisms". Respiratory physiology & neurobiology 149(1-3): 99–109. doi:10.1016/j.resp.2005.02.007.PMID 16203214.

[xiv] ICPA - SIDS Research

[xv] Mage DT, Donner EM (September2004). "The fifty percent male

excess of infant respiratory mortality". Acta Paediatr. 93 (9): 1210–5.doi:10.1080/08035250410031305. PMID 15384886.http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0803-5253&date=2004&volume=93&issue=9&spage=1210.

[xvi] Klonoff-Cohen H, Lam PK,Lewis A (July 2005). "Outdoor carbon monoxide, nitrogen dioxide, and sudden infant death syndrome". Arch DisChild. 90 (7): 750–3. doi:10.1136/adc.2004.057091. PMID 15970620.

[xvii] Sudden Infant Death Syndrome (SIDS) and Vaccines http://www.cdc.gov/vaccinesafety/concerns/sids_faq.htm

[xviii] Thomas H. Maugh II (2007) ([dead link] – Scholarsearch).Hearing loss may foretell SIDS risk.http://www.latimes.com/news/science/la-sci-sids28jul28,1,2214491.story?track=rss.

[xix] “Sudden Infant Death Syndrome”http://en.wikipedia.org/wiki/Sudden_infant_death_syndrome#Undiagnosed_conditions Accessed September 8, 2009.

[xx] “After the Birth: Sudden Infant Death Syndrome by AlbertaChildren’s Services.http://www.parentlinkalberta.ca/publish/480.htm Accessed September 8,2009.

[xxi] “Learning To Mother Again After Losing My Baby To SIDS” byYael Hanover.http://www.chabad.org/theJewishWoman/article_cdo/aid/958227/jewish/Learning-to-Mother-Again-After-Losing-My-Baby-to-SIDS.htmAccessedSeptember 8, 2009.

[xxii] “ The Shiny Project” by Yael Hanover. http://www.theshinyproject.com/index.htmlAccessed September 8, 2009.

©copyright 2008-2009 Beth Murch. All rights reserved. Duplication of this article is strictly prohibited without express written consent of the author.

This week, I came across a fascinating video made by L. Janel Martin of Baby Keeper Productions that discusses the advantages of delaying the clamping and cutting of a baby's umbilical cord until the placenta has been released by the mother and (at least) until the umbilical cord has stopped pulsing. Featured in the video are birth experts Sarah Buckley, Stuart Fishbein, George Morley, Gladys McGarey, Emmett Miller and Elizabeth Alleman. Sadly, the site won't let me embed the video - but it's just a quick cyber-jump away!

http://www.metacafe.com/watch/2870183/we_can_be_much_kinder_birth_matters_video_contest/

When I meet with clients to discuss their birth plans, we always chat about whether they would prefer to wait to cut the umbilical cord or if they would like to have it severed immediately - and why.

Have you thought about what you would like to do about your baby's umbilical cord?

On March 11, 2009, Reuters released an interesting article about how Mama experiences childbirth affects her memories of pain:

http://www.babycenter.com/204_memory-of-childbirth-pain-varies-by-experience_10310446.bc

I was struck by this quote:

"The more positive the experience, the more women forget how painful labour was. For a small group of women with a negative birth experience, long-term memory of labour pain was as vivid as 5 years earlier."

A woman's association with pain is related to her satisfaction with her over-all childbirth experience: if she feels empowered, in control, safe and comfortable, her pain scores appear to be lower than those of a woman who has a negative birth experience - perhaps a birth where she felt afraid, uninformed, powerless and uncomfortable.

As a doula, this adds to other scientific evidence that I have seen that proves that having a trained birth professional supporting a woman and her partner through pregnancy, birth and postpartum positively influences the childbearing process. By providing parents with physical, emotional and informational support, it is possible for a doula to affect mothers' experiences of their labours: a doula can disperse fear through encouragement and education, soothe with gentle words and touch, reassure with her knowledge and presence and nurture with her attentiveness and love. Partners and family of the labouring mother gain a useful ally with a doula: they no longer feel solely responsible for the birth's outcome, they have the freedom to rest and go to the bathroom when they need to, and they have someone who will guide them to support their loved one.

The statistical benefits of how a doula can help parents achieve a healthy and happy birth:

- A 50% reduction in cesarean rates

- A 24% reduction in the length of labour

- A 40% reduction in Oxytocin use

- A 30% reduction rate in narcotic use

- A 30% reduction rate in forceps deliveries

- A 60% reduction rate in epidural use*

Now studies are showing that very same healthy and happy birth will minimize memories of pain and reduce psychological trauma...what wonderful reasons to seriously consider including a doula as part of your birth team!

* from Mothering the Mother: How A Doula Can Help You Have a Shorter, Easier, Healthier Birth by Marshall H. Klaus, Phyllis H. Klaus, and John Kennell. NEW YORK: HarperCollins, 1998.

© copyright 2008-2009 Beth Murch. All rights reserved. Duplication of this article is strictly prohibited without express written consent of the author.

Conscious parenting begins long before that special day where you finally hold your precious baby in your arms. You instinctively know that there are certain actions that you must undertake in order to reassure your growing infant. In fact, you have been communicating your love for your child every time you caressed your belly in response to her flutters and kicks, each time you had your partner read the Dr. Seuss classic Oh, The Places You?ll Go into your navel and even by eating healthy foods that ensure your little one receives nutritive - rich blood through his umbilical cord.

There is another way that you can express your feelings for the new life growing within you, prepare your body for labour and ready yourself for motherhood - through the restorative, energizing and relaxing practice of prenatal yoga. Through gentle movement and meditative exercises, you will gain a greater awareness of how the temple of your womb houses the jewel of our planet?s future and enrich your understanding of your own body.

Prenatal yoga offers a wealth of benefits to you and your baby. First, and perhaps most importantly, attendance at a weekly yoga class or even following along with a yoga DVD from the local library creates a liminal space in which to retreat from the hustle and bustle of Life and concentrate on the energy thrumming within you. A yogic practice places stress from bills, tension from work, the blasting of car alarms and the complications of family life on the threshold of reality for a brief, blessed moment and provides you with a mini-vacation where you can indulge yourself and acknowledge the joys and fears of your pregnancy. In North America, we as a society are busier than we have ever been - even when we are no longer at the office or on the assembly line, we are constantly interrupted by cell phones, e-mails marked ?urgent? and text messages as we frantically attempt to have dinner with our families, drive our children to their after school activities and complete our household chores. Imagine creating a space where you can set aside any non-essential emotions and activities, and allow your mind to be present only in the moment. Sheer bliss!

Secondly, prenatal yoga addresses many of the physical concerns of pregnancy: morning sickness, backaches, muscle tension, leg cramping, inflexibility, aching Achilles tendons, gas, weight gain, etc. Each asana (posture) performed ?wakes up? the major muscle groups and encourages the body?s circulatory system to pump fresh blood through the veins and causes the eliminatory system to excrete toxins and waste. Often, the unpleasant sensations of pregnancy can be reduced simply through focused motility, increasing muscular strength and realigning chakras (the focal points for the transmission and reception of bio-energies). Prenatal yoga is an ideal way to heal the body because it is a non-competitive and low-impact activity: virtually anyone, regardless of body type or fitness level, can participate in a non-judgemental atmosphere?and there is no ?failure? to achieve goals. Each asana can be modified or omitted with the guidance of an instructor in order to make the experience pleasurable and safe.

As well as providing an opportunity to exercise, prenatal yoga presents a space for meditation and concentration. By focusing on the way you draw and release breath, you become aware of your life force and your unique presence in the universe. Your mind becomes clear and you will find it easier to focus on your priorities. Your baby feels the good, clean air that you are taking in for the both of you and senses the peaceful state of your mind and body and intuits that she is safe, protected and a welcome presence on this planet. He realizes that he lives under your heart for a reason - so that he is closest to the strongest source of love and light radiating from your anatomy.

Prenatal yoga is an easy and comfortable way to effectively prepare yourself for the physically and psychologically demanding hours of labour that are involved with birthing your baby. It is easy to become overwhelmed with the pain of contractions and the fear of opening wide tangibly and spiritually to bring forth new life. Through using the introspective techniques you developed through prenatal yoga, you can ground yourself by releasing tension through deep breathing and guided imagery. Much of our experience of pain is coloured by our anxiety: if you see your contractions as hugs from your uterus that are loving your baby out and into your arms, they will be far easier to manage than if you see your contractions as frightening, unendurable and inherently negative. Prenatal yoga also increases flexibility and allows you to maintain positions that work with gravity to draw your baby down the birth canal, such as: squatting, standing and kneeling. These are poses that women from all cultures have used throughout the ages to bear their children but have fallen out of use in our Western world. In our society, we no longer squat to wash our clothes in the river, rest on our heels to defecate or kneel before a fire to prepare our meals - therefore, we must train our muscles to remember the visceral work they did for our ancestors. In this way, we can prevent prolonged labours, unnecessary medical interventions, avoidable caesarean sections and reduce postpartum recovery time. A healthy labour also ensures fewer health issues for children, making it less likely for them to be whisked away by doctors for extended periods of time, compromising the opportunity to establish a breastfeeding relationship immediately after birth, universally considered to be the optimal time for doing so.

Another special benefit of prenatal yoga is the enhancement of the bond between mothers and babies. Your somatic gestures create a sweet rocking sensation for your unborn babe, soothing him to sleep. She also benefits from the tender energy that flows through your body as you form a compassionate relationship with her through internal dialogue, gentle touch and positive actions. Prenatal yoga encourages mothers to be aware of their babies long before they are born, so that when they finally hold them in their hands, they do not see strangers, but rather, people who they have already had a relationship with for nine months. This not only decreases the likelihood of women suffering from postpartum depression, it also creates happier children because each infant is born with the knowledge that they are protected and precious.

There are many reasons to pursue a prenatal yoga practice and each woman will find her own meaning on the mat. As you consciously parent your unborn baby, consider the rewards of yoga - gifts that can last you and your child a lifetime.

© copyright 2008-2009 Beth Murch. All rights reserved. Duplication of this article is strictly prohibited without express written consent of the author.

A birth plan is a great way to communicate to your care provider the desires and needs you have surrounding your upcoming birth. It is also an excellent way to encourage discussion between yourself, your birth partner, your family and anyone else who will be involved in your special day.

If you are having a homebirth, make sure that you also create a birth plan outlining what considerations you would like made in the case of a transfer of care to a hospital setting.

 
Things To Include In Your Birth Plan:

Who You Are And Who?s In Your Birth Party?

• your name and your birth partner?s name

• your address and telephone number

•        your due date
•    your care provider?s contact information
•      your doula?s contact information
•     anticipated place of birth

Your Birth Philosophy?

•   are you aiming for a natural birth with minimal interventions or are you relying upon hospital staff to suggest medications and utilize the tools at their disposal?

•   This is also a good place to note that you understand that a birth plan is not a guarantee and that things may arise that are unplanned. Part of preparing for childbirth is making plans for the unexpected. Sometimes complications arise during births that were previously unanticipated. Your care providers need to know that you have thought about that and understand that situations may arise that force them to deviate from your birth plan. You may consider using some form of the following paragraph: ?This birth plan is intended to express the preference and desires we have for the birth of our baby. It is not intended to be a script. We fully realize that situations may arise such that our plan cannot and should not be followed. However, we hope that barring any extenuating circumstances, you will be able to keep us informed and aware of our options. Thank you.?
  

First Stage of Labour?

Your Environment

 Would you like??

•  Dim lighting
• Peace and quiet
• Music
• Candles
•  Other

Mobility

Would you like??

•   To maintain full mobility (i.e. walking, rocking, squatting, going to bathroom, etc.)
•   Partial mobility (moving around in bed only)
•    Bed rest (used with epidural, use of catheter, etc.)

Hydration

Would you like??

•     No restrictions (freedom to eat or drink whatever you like, whenever you like)
• Clear fluid (water, juice, ginger ale, Jell-O, Gatorade, Labour Aid)
•    Ice chips only
•    Heparin/Saline lock (a catheter inserted into your arm to allow for the rapid administration of fluids or medications in case of an emergency. Essentially, it is step one of the i.v. process
•     I.V. (you will have this if you are receiving any medications)

Monitoring

Would you like??

•   Intermittent monitoring (from time to time) or continuous monitoring (all the time)
• Use of fetoscope (special stethoscope for pregnant moms), Doppler and external fetal monitor (for intermittent monitoring)
• Use of external fetal monitor and internal fetal monitor (for continuous monitoring)

Offers of Pain Relief

Would you like??

• Only if I ask (recommended if you wish to have a natural birth)
•  Offer if uncomfortable
•   Offer as soon as possible

Pain Relief Options:

Would you like??

• Natural or Medicinal?
•  An epidural or a narcotic (i.e. morphine or Nubaine)? * Please note that Grand River Hospital does not provide ?walking epidurals? (low-dose epidurals that permit mothers to remain mobile)
• Relaxation, freedom to change positions, hydrotherapy (use of water), alternating use of heat packs and ice packs, massage, acupressure, reflexology, etc.

Augmentation

Would you like??

•   Natural or chemical
•   Walking, nipple stimulation, etc.
•   Use of herbs (i.e. black and blue cohosh)
•   Amniotomy (also known as AROM ? artificial rupture of membranes; breaking the bag of waters)
• Other?

Second Stage of Labour?

Pushing

Would you like??

• To choose your position or to be directed
• Prolonged length (before use of forceps or other external measures)
• Spontaneous bearing down
• Directed pushing
  
•  Stirrups for leg support
• Foot pedals
•    Squat bar

Perineal Care

Would you like??

• To avoid an episiotomy unless you are going to tear
• To avoid an episiotomy even if you are going to tear
• To have an episiotomy
• Use massage, heat, compresses and changes in positioning instead of surgical alternatives

Watching The Birth

Would you like??

• A mirror so that you can watch your baby emerge as you push
• To touch your baby?s head as it is crowning
• To avoid watching your  baby emerge
• To not touch your baby?s head as it is crowning

After The Baby Is Born?

Cutting The Cord

Would you like??

• The cord to be cut immediately
• The cutting to be delayed until the cord has stopped pulsing
•  To have your partner cut the cord
• To cut the cord yourself

The Placenta

Would you like??

•  To view the placenta
• To keep the placenta
• Avoid seeing the placenta
• The placenta to be discarded

Medical Procedures

Would you like??

• Medical procedures to be performed immediately
• To delay medical procedures (if possible)

Feeding Baby

Would you like??

•  To breastfeed only
• To bottle feed only
• To both bottle and breast feed
• To limit exposure to pacifiers and glucose water (* please note that Grand River Hospital does not administer bottles or glucose water and has a strict breastfeeding policy. You will be expected to provide your own pacifiers, bottles, nipples and formula if you choose not to breastfeed)

Circumcision

Would you like??

•  No circumcision (state this even if you plan on having your baby circumcised out of the hospital)
•  No foreskin retraction
• To be present at the circumcision 
• Anesthesia used (depends on the health care practitioner)

Complications and Cesareans?

Cesarean Section

Would you like??

•   To have your doula present
•  To have your partner present
•   Pictures taken
•  The screen lowered to view birth
• Description of the surgery
• To touch the baby
• To cut the cord
• To have your partner cut the cord
• To breastfeed in the recovery room
• Other?

Sick Baby

Would you like??

• To breastfeed as soon as possible
•  Unlimited visitation for parents
• To hold and handle baby whenever possible      
• To be moved with baby to another facility if necessary
• Other?

The Associated Press

updated 2:00 p.m. ET, Sun., Feb. 24, 2008

Ina May Gaskin, 69, a midwife who never formally studied nursing, has helped to bring back home birth and lay midwifery from the brink of extinction in America. Here, Gaskin measures the growth of Cayla Whitehead's abdomen while teaching a class in midwifery at The Farm in Summertown, Tenn. Mark Humphrey/ ASSOCIATED PRESS  View related photos var hasRelatedPhotos = 'false';if (hasRelatedPhotos=='true'){var vRPL = document.getElementById("viewRelatedPhotosLink");if (vRPL!=undefined) vRPL.style.display = "";var vLRPG = document.getElementById("linkRelatedPhotos");var vLIRPG = document.getElementById("linkImgRelatedPhotos");if (vLRPG) {if(vLIRPG) vLIRPG.href=vLRPG.href;}}

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SUMMERTOWN, Tenn. - Despite living on a commune in rural Tennessee, Ina May Gaskin has had the kind of career success most people only dream about.

A midwife who never formally studied nursing, Gaskin has helped to bring home birth and lay midwifery back from the brink of extinction in the U.S. An obstetrical maneuver she learned from the indigenous Mayans of Guatemala has made it into scientific journals and medical textbooks, and her insistence on the rights of a birthing mother empowered a generation of women to demand changes from doctors and hospitals.

With a lifetime of accomplishment, the 67-year-old Gaskin has earned the right to slow down. But that is the farthest thing from her mind.

?At the time we began, I couldn?t have dreamed that in 25 years? time women would be actively seeking Caesareans,? she said.

Gaskin largely blames the nation?s rising maternal death rate on the increase in Caesarean section births and the drugs sometimes used to induce labor.

The National Center for Health Statistics reported last month that the maternal death rate for 2005 has risen to about 15 women per 100,000 live births, more than double the 1998 rate of 7.

At least part of that increase is due to better reporting, but researchers say Caesareans also may be a factor.

Promoting natural birth
Gaskin passionately believes natural childbirth is the answer. The number of women giving birth with a midwife has doubled over the last decade and accounts for about 8 percent of births today ? the vast majority in hospitals. Still, she says it?s a challenge to promote natural birth to a generation that favors comfort and convenience.

Promoting home births is an even tougher sell. The American College of Obstetricians and Gynecologists has continuously warned against home births as too risky.

In 1975, Gaskin published ?Spiritual Midwifery,? which included birth stories and a primer on delivering babies. Her book has sold around 750,000 copies, has been translated into four languages and has inspired a generation of women to become midwives.

Mark Humphrey / ASSOCIATED PRESS Ina May Gaskin watches as Jen Mayer, left, listens for a baby's heartbeat during a class in midwifery at The Farm in Summertown, Tenn., on June 26, 2007.

Part of Gaskin?s success has been that she combines an analytical mind with an instinctual understanding of birth.

She promoted the idea that a woman?s state of mind will influence how easy her birth is and encouraged unorthodox ways to improve the woman?s experience, like encouraging her to make out with her husband during labor.

At the same time, she kept detailed records of each birth, providing her commune, The Farm, with statistics that would prove important in the debate over the safety of out-of-hospital births.

She has tried to widen the reach of her message by airing natural birth videos from The Farm on television. ?The women are so beautiful giving birth,? she said.

TV stations rarely have run them, calling them too graphic.

?I started to think I should put them on YouTube,? Gaskin said.

High C-section rate
But the high rate of Caesarean sections in the U.S. may help Gaskin?s message gain some traction. Former talk show host Ricki Lake produced and starred in a recent documentary that features Gaskin and is critical of hospital births and their high rate of C-sections.

The U.S. now has a Caesarean section rate of 31 percent, a figure the College of Obstetricians and Gynecologists agrees is troubling.

At the same time, this group of doctors who perform the C-sections also reiterates its ?long-standing opposition to home births.? In a recent statement, the organization said childbirth decisions ?should not be dictated by what?s fashionable, trendy, or the latest cause celebre.?

Home births are not safe, their statement warns, because ?a seemingly normal labor and delivery can quickly become life-threatening.?

Over the years, studies on the safety of home births have conflicted. The doctors? group says research comparing the safety of home and hospital births has been limited and is not scientifically rigorous.

Their organization approves of the assistance of hospital midwives certified by the American College of Nurse Midwives. These midwives have nursing degrees or comparable training. The college of obstetricians warns against lay midwives like Gaskin, who have no formal medical training and who aid in home births.

Even so, the College of Nurse Midwives says home births can be safe, and they are fans of Gaskin?s. ?She?s quite a remarkable woman and an icon of midwifery,? said Mairi Breen Rothman, a nurse midwife and consultant to the midwives college. Rothman herself was inspired by Gaskin?s book.

?The Orgasmic Birth?
Gaskin began her practice as one of about 250 hippies who pooled their money in 1971 to buy rural land south of Nashville to form a commune. Soon she and a few other women on The Farm were delivering 25 to 30 babies each month.

While training herself, Gaskin sought out doctors and other midwives and devoured medical texts. But she never sought a medical degree, instead helping to create an alternative certification so lay midwives could prove their competency.

Mark Humphrey / ASSOCIATED PRESS Ina May Gaskin teaches a class in midwifery at The Farm in Summertown, Tenn.

Not all obstetricians think home births are inherently unsafe. New York obstetrician Heidi Rinehart spent a few weeks at The Farm while a medical student. Although her husband also is an obstetrician, when they were having a baby, they asked Gaskin to be their midwife.

But even doctors who?ve never heard of Gaskin have felt her influence because of patients who have read her books, seen her birth videos or heard her speak.

?They request or demand or vote with their feet to have the kind of birth they want,? Rinehart said.

Now, Gaskin has a film in the works that is in keeping with her anti-establishment, freewheeling nature.

?We?re doing a movie called ?The Orgasmic Birth,? ? she said.

That?s not a metaphor. Gaskin says that under the right circumstances women experience a sort of birth ecstasy.

?I mean, it?s not a guarantee,? she said, shrugging her shoulders and smiling, ?but it?s a possibility.

?It?s the only way I can think to market it to (this) generation.?

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URL: http://www.msnbc.msn.com/id/23239361/