domingo, 31 de mayo de 2009

Notes on Prematurity

Midwives have very little experience with preterm labor, not so much because we are supposed to refer it, but because it rarely happens with women in midwifery care. This has to do with 1 hour prenatals that focus on emotional support, nutritional advice and holistic care. So my first note regarding prematurity would be that every woman get a midwife. Even if she ends up with a medicalized birth and a baby in intensive care she would probably benefit on someone to guard the normal- go to her house every day and listen to her, hold her, help her figure out why her baby is feeling like she needs to get out of her mothers safe womb. A midwife can help be an advocate if they end up in a pre term birth, helping the woman keep up some sort of milk production, advocating for kangaroo care and skin to skin contact which have been proven to improve outcomes for premmies. And long term support as well. Moms often talk about how estranged they feel from their baby who spent her first few weeks in the Neonatal Intensive Care Unit with a team of experts and all of a sudden mom is home with this fragile stranger. Its hard!!!

Last year I heard a midwife who works with a group of women who have really high rates of premature birth. She talked a lot about the "toxic womb", a place so stressful and malnourished that babies have to leave them before their time. She talked about 2 important aspects- stress... what are we passing to our babies- what messages, what hormones, what thoughts.... what is the burden of continuing the pregnancy for another 2 months on the mother- exhaustion, financial drama, career stuff, on and on. Each woman needs to define deeply why it is best for her to have her child out sooner than what should be. These questions are hard and challenging, but when women identify their responsibility in that and talk to their baby and understand that finally baby in or out, those stressors are still there.

Then nutrition- its very hard to improve nutrition in adults and in women at the end of their pregnancy, however right now baby needs a lot of nourishment. Omegas, protein, liquid, etc... she must eat and eat and eat. But she needs to eat from the Earth. 

I just finished reading a book about nourishment and moms and babies (Laura Gutman, La Revolucion de las Madres, 2008). The thesis of the book is that nourishment is our relationship to being loved and giving love. The womb is the epitome of nourishment, 24 hours a day of food and love and warmth. Why would anyone want to leave that?? This author talked out premmies as starting their life immersed in high technology- their existence depending on that. She works with women to help them grasp that their bodies are sublime technology and irreplaceable. All the tubes in the world will never replace the placenta!

At Luna Maya when we have had moms in this position we recommend bed rest, nutrition and hydration and the midwives and family therapist visit her at home to clarify what is going on. Recently a woman in her 33rd week of pregnancy called to say she thought she was going into labor. I gave her Aconite (homeopathic) for her fear. Her issue was that during her pregnancy she had come to realize that her boyfriend not available to her and her pregnancy and she couldn’t count on him for fathering her child and supporting her. So she had decided to say goodbye to him.

We talked about the difference between expelling her man from her life and expelling her child from her womb. Everyone has their place in the family and that needs to be honored. Within 24 hours of intensive midwifery care and some support from the therapist she was a whole different woman with a quiet uterus. She finished the week thanking us for how safe and comfortable she feels with us. I finished the week thanking her for opening her heart so gently and taking such good care of herself and her baby.

There is a reason why we shouldn’t be born before 36 weeks and every mother facing a premature birth needs to connect deeply with that. The mother, more than her doctor or midwife needs to know that she will carry this baby to term and take her baby back to the family bed hours after birth where she belongs for delicious honey momma nourishment. And we, as those who hold moms need to provide mom with delicious honey momma nourishment. Moms who nourish their little ones need to be nourished by the rest of us. Prematurity is our responsibility.


viernes, 22 de mayo de 2009

Induction of Labor

Cristina's Handy Guide To Surviving the Induction of Labor

Im due for March 13th.... it's now March 15.... Do you think the baby is ok?... You are now 41 weeks... I will send you for a non-stress test.... Your placenta seems to be aging... your fluid levels are decreasing.... The head is still high.... Any contractions?.... You are now at 41.3 weeks.... If you pass 40 weeks we will have schedule an induction... We must induce.... We will induce... You will be induced on Friday.... We will induce on Monday.... You should have the baby within 12 hours.... Induction.... 


Seems like we have gone from "pregnancy can last anywhere between 38 and 42 weeks to"... "you are an oven and if your bun is in there for more than 40 weeks it will be horribly burnt and thus useless"... 

Outside of out of hospital midwifery, the induction epidemic is rampant. I will not go into the dangers of induction in this entry. You can learn all about those in books, movies and webpages and by asking midwives. Instead I have created a list of questions to ask your doctor or midwife when they schedule or suggest an induction. I'd love to hear your comments:

10 Questions to Ask your Inducing Provider:

1. How many more years might I be pregnant? 

2. If I am pregnant for another year will my child learn to walk and garble in the womb? 

3. If my pregnancy lasts 3 years will my child learn to identify colors in the womb? 

4. After you put the artificial oxitocin in my vein how do you expect to compensate for the other hormones that won't be naturally produced by my body that are necesary for labor, such as endophines, prolactin, catacolmines, prostaglandins.... and won't be produced by my body because of the artificial oxitocin. 

5. How do you feel about the fact that I will be expereincing contractions that are about 3 times stronger than natural contractions? Does that matter to you at all? Will you be there to hold my hand and help me breathe? 

6. How do you feel about my chances of me ending up in an emergency cesarean? Does that make you nervous at all? Are you pretty good at doing emergency cesareans? 

7. After my baby is in intensive care for meconium aspiration, will you have any trouble sleeping at all? Do you think you might have nightmares? 

8. After my baby comes home from the NICU and feels like a complete stranger to me, can you recommend where I can find my "maternal instincts" and "innate ability to breastfeed"? 

9. What are your thoughts on the fact that, if my baby hasn't initiated labor maybe its not ready to be born, may be too small, not ready to breathe, not ready to handle extrauterine life, and may need another week to mature? 

10.  So, can you, once again, really clearly explain to me why it is dangerous for my baby to stay within MY womb, where it has lived its ENTIRE life for another week?

lunes, 11 de mayo de 2009

How's is Everything? How are you?

Would you describe this day as SUNNY or CLOUDY? does it look like it might rain? 

Im in a situation (or several situations) in my life right now that are more than just good and bad. They are dense and thick and complicated. They are situations that people ask me about, hows it going with.....? How are things with....? How is it? 

And I have no idea how to answer. Some parts are good, some parts are bad, some parts require knowing me for 30 years and understanding how I think, some parts require listening for 5 minutes without stopping or judging, some parts require silence, a little bit of this and a little bit of that. In short, I wish people wouldn't ask me. 

So this situation made me think of when we ask women, "How was your BIRTH?". Well it was good because no one died. It was bad because my husband is an idiot and he behaved like one during the birth. It was good because I didn't have surgery. It was bad because I didn't think I would make it. I was good because my mother caught the baby. It was bad because there was meconium adn the baby was aspirated. It was good because my midwife was wonderful. It was bad because she wouldn't stop asking me how I was doing and what I needed. and on, and on, and on. 

It made me realize what a rediculous question this is and how it is so hard to answer. I imagine its a bit like, how was your marriage? (after 50 years). How was your relationship with your mother (a bit of everything??)

Anyway, in the end I think that what I am getting at is that I wish people would just listen to what I want to say and stop asking questions. I wonder if thats what women want in Maternal care. Perhaps, instead of asking questions in the Prenatal room we should start by saying "What do you want to talk about today?". And when we ask about MAJOR life experiences we should ask "If there anything you want to tell me about? How can I best listen to you?" 

When women have hard births, for example a transport in a homebirth, a cesarean when that wasn't the intention, a cold provider when we wanted some more support, how can we ask women about that and listen to what they have to say without saying: AT LEAST NO ONE DIED. 

So anyway, its a bit like this picture. Yes the sun is out, yes the clouds somewhat cover it. Theres a lot to say about the weather in this picture. There's a lot to say about us. And theres a lot that can go unsaid, just by observing. 

La Luz de tu Vientre

Ive been off line for a month because I was in Spain teaching and Fundraising. This song was created in a workshop I gave in Galicia with a group I've been working with for several years now. The lyrics are: 
Tierra, Tierra, Tierra
Tierra Viva
Tierra Madre
Tierra Amada
Esa soy yo
Esa eres tu
Somos una

Soy rio que fluye
Agua de la fuente
Fruto que alimenta 
La luz de tu vientre

Gracias a las Meigas Gallegas por compartir tu Magia!!!