Natural Childbirth - Not Just for Superheroes Anymore!
Written by Delilah RayWhen people ask me what I do for a living, and I tell them I teach natural childbirth classes and am a doula, I frequently get a strong reaction that goes something like this: “Oh, I could NEVER do that!!”
This perception could not be further from the truth, in my experience. Most of the time, women who would like to have a natural childbirth will be able to do so. No one has to “go natural” if they do not want to, certainly giving birth with pain medications is the overwhelmingly more common choice in the Dallas area. If women want to use pain medication, I support them in doing so, and in having that option.
However, many women do not try to have a natural birth because they think it is not possible. - Maybe you think only the diehard few “superwomen,” can do it. I understand this misconception, as I was once one of those women myself! I had an epidural with my first birth only because I was under the impression that “going natural” was something that hippies, athletes, or earth mamas did… but not something Jane Average mainstream women like me could do. I did not believe I would be able to survive without an epidural since I do not have any special pain tolerance, nor am I athletic. I did not know almost anyone who had gone natural; most of my friends raved about the epidural. My care provider and hospital staff did not behave as though natural childbirth were a viable option that I could choose if I wanted. So, I didn’t even realize that I could have a natural childbirth- I didn’t even try.
Even If Having a Natural Birth is Possible- Why Might Someone Want To?!
While using an epidural in labor can be an appropriate choice in some births, there are many advantages to choosing to give birth without using an epidural.
Epidural anesthesia carries potential risks to the mother and to the baby, and to the mother’s chances for a vaginal delivery:
Risks to the mother include low blood pressure, severe headache, short-term or chronic pain, or numbness in the back, and the rare possibility of more serious complications. Also, having an epidural can lead to the mother running a fever, which leads to baby being worked up for possible infection since it is impossible to tell if the fever is just from the epidural, or from infection.
Risks to the baby include fetal distress from the medications crossing the placenta to the baby, drowsiness and poor sucking reflex at birth.
Increased risks to the opportunity of having a vaginal birth include a cesarean being required due to the epidural causing fetal distress, prolonging of labor, less effective pushing effort, and/or the increased chance of a malpositioned baby who then will not fit due to positioning.
Sometimes the benefits of an epidural may be determined to outweigh these risks. However, many women would prefer to avoid taking these risks to their babies and to themselves unnecessarily. If, therefore, pain in childbirth could be manageable without needing to use an epidural, many women would be happy to forego taking on the additional risks of using the epidural. For more information about the benefits and risks of epidural anesthesia: http://childbirthconnection.com/article.asp?ck=10183#epidural
Proactive Steps Women Can Take So An Unmedicated Birth Can Be An Accessible Option:
- Choose your care provider and place of birth carefully. In the DFW area, fewer than 10% of women have an unmedicated birth. Many care providers strongly prefer that their patients have a medically managed birth and do not see any value in natural birth. Many hospitals are rigid in their routines and protocols which are geared towards their “usual consumers” (i.e. women choosing an epidural) and are not willing to be flexible with a laboring mom to help her meet her own individual goals for the birth. For a list of questions to ask potential care providers: http://www.motherfriendly.org/pdf/Having_a_Baby-English.pdf
- Hire a doula. Having a doula substantially increases the chances of a successful natural birth. Usually nurses are taking care of several patients at a time and are not physically with a laboring woman more than a few minutes per hour during active labor. In addition, different nurses usually take care of the mom throughout her labor because of shift changes. Usually the doctor is only present for a few brief visits during the labor, and then the last few minutes of actually pushing the baby out. A doula is with the laboring couple throughout their entire labor and birth, providing continuity of care, comfort measures, ideas to try, questions to ask, and moral support. For more information about what doulas are, and what they do: http://www.americanpregnancy.org/labornbirth/havingadoula.html
- Take an independent childbirth class that is geared towards preparing couples for natural birth. Most hospitals offer a low cost childbirth class, but it is geared towards preparing women for the type of birth that they offer and that most of their patients choose which is a medically managed birth. If you want to have a good chance at a natural birth, taking an independent class may be the best investment you make in your care. I always tell people that just because you are educated in how to avoid getting an epidural, you do not HAVE to go natural - you can still choose to get it. However, if you are not educated in how to avoid an epidural, and then circumstances prevent you from getting the epidural, you may not be equipped to deal with labor. Therefore, it is better to have the coping skills needed for natural birth, whether or not you choose to use them! For more information about different types of independent childbirth education classes: http://www.americanpregnancy.org/labornbirth/childbirtheducation.html
- Avoid common practices, which cause labor to hurt more than it needs to. Many hospital practices were put in place giving consideration only to the patient who has an epidural. Even some labor nurses are uncomfortable with women who wish to go natural. Making slight alterations to the status quo can reduce drastically a woman’s perception of pain. Your doula and childbirth classes will teach in detail about these modifications in detail.
- Eat well and stay active to keep your body healthy. It is not necessary to be in “athletic” shape to have a natural birth. It is, however, helpful to eat nutritiously to keep your energy up, and to have the stamina to periodically walk and change positions.
- Seek out other women who have successfully had natural births. Be encouraged by them. Ask them what helped them the most to achieve their natural birth, and what they wish they had known that would have helped them. Ask about their care providers, doulas and hospitals or birth centers, and what they loved and what they would change if they did it again. Surround yourself with positive stories of natural births rather than watching or listening to horror stories of how unbearable labor pain is and why you should not try. Your mind is powerful! Fill it up with what you want and hope for- not what you want to avoid.
- Be flexible. Being flexible does not mean, “A natural birth probably won’t happen; you probably can’t do it. Do not get your heart set on it or try to go for the impossible dream. Be okay with it not working out.” Being flexible means, set yourself up for success in all the ways over which you have control. Then, having positioned yourself for your best chance at the outcome you hope for, you can relax, let the process unfold, and just let it be what it is, with confidence in your ability to adjust to whatever comes as you welcome your baby.
For those who have ever considered or might consider trying natural childbirth, I will share a quote that I love:
“We have a secret in our culture, and it's not that birth is painful. It's that women are strong.” – Laura Stavoe Harm
Delilah Ray is a childbirth education and birth doula in the Dallas area, DBA Cherish Birth. Dr. Jonathan Weinstein works in unison with Delilah to provide a pleasant natural childbirth environment in a state of the art hospital, Baylor Medical Center at Frisco.
Contact Us:
Delilah Ray -http://www.cherishbirth.com
Jonathan Weinstein, MD – www.friscowomenshealth.com 972-668-8300
Preventing Preterm Birth Using Progesterone Supplementation
Written by Jonathan Weinstein
Preterm Birth in the United States (U.S.) is classified as delivering before 37 weeks, unfortunately all our research efforts have done little to decrease the percentage of preterm birth as well as the other complications of pregnancy that lead to neonatal (during 1st month of birth) death. Medications such as Magnesium Sulfate have not been shown to prolong pregnancy although OB physicians continue to administer it routinely, the same goes for bed rest.
Certain interventions have shown to help babies born early such as corticosteroids (given over a 24-hour period, i.e. Betamethasone and Dexamethasone) to mom between 28-34 weeks. Antibiotics (i.e. Penicillin or Clindamycin) during the labor of anyone less than 37 weeks or who have documented Group B Strep bacteria (by vaginal or urine culture) have decreased the complications associated with preterm delivery.
In the news recently, there have been talks about the use of a certain progesterone hormone, 17-Hydroxyprogesterone, a weekly injection starting between 16-20 weeks and ending at 36 weeks. It is indicated for anyone who has had a previous preterm delivery. This has been known for years but not always implemented by physicians. http://www.acog.org/from_home/publications/press_releases/nr10-31-03-2.cfm
The recent news is because a particular drug company is trying to take this medication and change it from generic pricing at $100 per month to over $1500 per month for a branded version, renamed Makena. Luckily, there has been a huge backlash and this is not likely to occur despite initial FDA approval.
More promising is Prochieve, a progesterone vaginal gel already available in the U.S. for infertility which would prevent women from getting painful injections for 20 weeks of their pregnancy. http://www.washingtonpost.com/national/progesterone-gel-lowers-the-risk-of-preterm-delivery-in-pregnant-women-with-a-short-cervix/2011/04/06/AFl7YmuC_story.html
Be sure to ask your Ob Gyn doctor at your first appointment if Progesterone supplementation can help you if you have had a preterm birth between 20 and 36 weeks.
Renessa offers an in-office, non-surgical treatment for Stress Urinary Incontinence (SUI)
Written by Jonathan Weinstein
Stress Urinary Incontinence (SUI), prevalent in over 15 million women, has a new non-surgical solution. The most common symptoms of SUI are leaking urine with coughing, sneezing, exercise, intercourse and just bending over.
So Your Doctor Says You Need A Hysterectomy, Do You Really?
Multiple studies have shown Hysterectomy to be one of most overly performed surgeries in the United States, probably second only to Cesarean Section.
Hysterectomy definitely has its place in the treatment of female problems but in the last 15 years, there have been new medications, outpatient and inpatient procedures that are not as dangerous as hysterectomy yet can be just as effective. Why is it that some physicians can do five times as many hysterectomies in year as I do yet my patients are extremely satisfied with the care I provide?
Think second opinion when it comes to major surgery, it should not offend your current doctor if they are truly looking out for your best interest. Ask your doctor what your alternatives are, what kind of hysterectomy are they performing, i.e. abdominal, vaginal, laparoscopic assisted or da Vinci robot assisted hysterectomy?
There is a big difference, robot assisted hysterectomy requires special training and a hospital that owns the da Vinci robot. If you look at the daVinci surgery website, you will see a list of doctors who have performed at least 20 robot-assisted surgeries. In the last year and a one-half, I have used the daVinci robot for hysterectomies on patients with severe scar tissue, uteri as big as 24 weeks in size, the removal of fibroids in patients with severe bleeding, pain, or those trying to get pregnant. In addition, the da Vinci robot is used for the correction of pelvic relaxation from uterine prolapse to bladder and rectal hernia repair.
What is the big deal with robot hysterectomies? Simple, much less bleeding, less than 23-hour hospitalization, less pain, return to work for many patients in a week and precision surgery using a high definition 3-D camera that can see and avoid the smallest nerves and arteries. If your doctor is planning to perform an abdominal hysterectomy, they are likely doing you a major disservice.
Before the robot, I did almost exclusively vaginal hysterectomies, a skill taught in residency over 13 years, while the majority of OB/GYN’s were doing 80% abdominal hysterectomies. So why did my professors train me this way? Vaginal hysterectomies allow women to go home the next day with much quicker recovery and higher patient satisfaction. The da Vinci robot has taken this major female surgery to a completely new level, with even greater patient satisfaction and shorter recoveries at a time when women need to get back to work or to their regular routine as quickly as possible.
Da Vinci robot surgery requires a significant amount of additional training that physicians do not receive in residency. If your doctor has not made the effort to keep up with the procedures that are best for you, then are you with the right physician?
If you have any questions or just want a second opinion about your particular case, please do not hesitate to make an appointment. I am here to educate women on their options whether they are medical or surgical.
Talking About The Birds & The Bees aka The Sex Talk
Written by Jonathan WeinsteinFor those unaware, I have a 19 year old step daughter, Blair, a 10 year old daughter, Zoe and my youngest is a son, Ashton age 3.
There comes a point in every parent’s life they will have to give their child a talk about safe sex, when to start having sex and how to avoid the unintended pregnancy. On numerous occasions I have provided my services in assisting in this conversation.
First off I always tell your child what they say in my office is between them and me, so do not expect me to go back and give a synopsis to the parents. This is physician-patient confidential info.
Of course, in an ideal world we would love to tell our little not so innocent daughters, ‘don’t have sex until you get married or I will kill you.’ That approach is only going to lead them in the opposite direction. As my wife and friends have pointed out although I take my job very serious I seem to have a knack for talking to the teenagers. My wife thinks it’s because my childhood was lame, as I was a nerd, who finished high school at 16 and graduated from college before I was old enough to legally drink. She does admit it does give me a special bond with my youngest children because I will play the silliest of games with them for hours. Heck last week Zoe had me playing two characters on the board game Clue just so we could meet the minimum three player requirement.
Anyway, if any of you fellow parents would like me to provide an educated discussion (I can provide pictures if needed for full effect) on safe sex, including the numerous sexually transmitted diseases that boys carry without any symptoms, just give me a call. I have even had medical training on bi and homosexual relationships, as yes staying with the same sex does not mean you cannot get diseases.
I will make your child feel comfortable and answer any questions they may have, nothing can embarrass me after 13 years in private practice. I also will give them options if they need them.
Unfortunately for us parents it does not cost any money for them to have sex, but, who’s going to get stuck helping to raise those grandchildren?
Research shows that eating dinner with your family has these important benefits. Decreases the likelihood of childhood obesity, your children are more likely to stay away from cigarettes, drugs and alcohol. In addition, school grades will be better.
Flu Vaccine Recommended During Pregnancy
Written by Jonathan WeinsteinFlu Vaccine during pregnancy recommended.
In the wake of the 2009 H1N1 flu pandemic, there has been a lot of concern regarding the safety and effectiveness of the flu vaccine, especially in relation to high risk groups like pregnant women and infants. For most healthy adults, the flu is a significant illness that will often cause a person to feel miserable and miss several days of work, but the risk of serious illness or death is rare. However, for certain populations, the risk of serious illness or death is a very real possibility. The Center for Disease Control (CDC) reports that "people 65 years and older, people of any age with certain chronic medical conditions (such as asthma, diabetes, or heart disease), pregnant women, and young children are more likely to get complications from influenza." According to the CDC, 36,000 people (on average) die from the seasonal flu every year, and most of these deaths occur in people who would be considered high risk.
Unfortunately, with increased concern and awareness about the flu, has come increased concern and speculation about complications from the flu vaccine. This concern and reluctance to receive the vaccine has been most prevalent among pregnant mothers and parents of young children. Concerns about the effects of the flu vaccine on a developing fetus or small child have resulted in many parents deciding to avoid the vaccine and roll the dice that their child won't get sick. This is an unfortunate occurrence as we have very clear evidence that the flu vaccine is very safe for pregnant mothers and their fetuses, as well as children older than 6 months. In fact, a recent study published in the Archives of Pediatrics and Adolescent Medicine suggests that babies born to mothers that received the flu shot during pregnancy may have added protection against flu themselves. Even if this initial observation does not hold up to further scientific scrutiny, we know that the vaccine is safe for pregnant mothers and that the best way to protect a newborn child from the flu is to have the parents vaccinated so that they do not get the flu. This is especially important since the flu vaccine is only approved for children over 6 months of age which means that the children who are most at risk are not able to get the vaccine. If you are considering the flu vaccine for yourself or your children and you have questions about the vaccine, please discuss them with your doctor. You can also visit www.Flu.gov for more information.
Michelle Kravitz, M.D., a board certified pediatrician and a Fellow of the American Academy of Pediatrics, shares her recommendation with Dr. Jonathan Weinstein regarding the need for pregnant women, fathers, family members and caretakers to get the flu vaccine. Doctor Kravitz is part of the experienced team of six pediatricians at Forest Lane Pediatrics with offices conveniently located in Presbyterian Hospital Plano, TX and Medical City Dallas Hospital. http://www.forestlanepediatrics.com/
NOW THAT’S SURGICAL ADVANCEMENT
Yesterday I removed an 11 cm ovarian mass from a 68 year old woman, using the da Vinci Robotic System at Baylor Medical Center at Frisco. What’s the big deal? Her largest incision was 1.5 cm, she lost less than 50 cc of blood while removing her uterus and ovaries (Robot Assisted Total Vaginal Hysterectomy, Bilateral Salpingoopherectomy) and she went home in the morning. Ninety-nine percent of OB/GYN physicians in America would have cut her open (laparotomy) from her pubic bone to her belly button and she would have stayed in the hospital for at least 3 days with easily 6 times the blood loss.
Moral of the story, keep up with the latest training and your patients will benefit immensely.
Why Do You Need The HPV Vaccine (Gardasil)?
For years, women have been subjected to multiple Pap smears, colposcopies with cervical biopsy and Conization of the cervix (removal of a large part of the cervix) because of a sexually transmitted disease, the Human Papilloma Virus (HPV).
Are you overdue for your dreaded yearly exam? I like to remind people that a gynecology visit is often the only time most women take the opportunity to see a doctor. It is your opportunity to address your physical and emotional well-being.
Our ObGyn practice has just experienced our first patient whose 3 month old baby developed Whooping Cough (Pertussis) here in Frisco, TX. For those not familiar with this condition, it is a scary bacterial infection that initially starts out like any other cold but quickly leads to coughing spells that in children can cause them to stop breathing or turn blue, these same symptoms can apply for infected adults. It also can progress to pneumonia and require hospitalization. Medically, up until 3 years ago, there was no vaccine for adults, just for children.
The childhood vaccine requires 5 injections and takes 6 months to establish immunity. The Tdap vaccine for adults should be given to significant others and caregivers who are around current or future newborns. A booster is given every ten years to adults. Our office will gladly administer the vaccine to anyone in contact with your baby, just call. Children receive their last booster at 9-10 years of age.
Look for a more detailed article on the website soon.
