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The Dilemma of Breech Birth: Prevention, Management of Care and Options

Brian O'Neil

by Marie-Paul Baxiu. She is a clinical hypnotherapist, birth doula in the LA area and the founder and owner of Childbirth Hypnosis Training: EasyBirthing.com . This article was first published in The Epoch Times

 

Part 1: A different perspective

One thing we all have in common is we come into this life through birth. However, the quality of the experience and the different choices parents make regarding the event can vary widely.

These experiences and choices can be limited for those who are in breech position in the womb and for their mothers-to-be.

In breech birth, the baby enters the birth canal with the buttocks or feet first as opposed to the normal headfirst presentation in which the baby is positioned head down, facing back.

Today, about 3 to 4 percent of babies present themselves in a breech position and the vast majority will be born by cesarian section.

Early in June, I joined leading professionals from the Los Angeles-area birthing community to discuss prevention and management of care for breeches and other malpositioned babies.

Sharing information, experiences, and insights, we addressed real alternatives to C-sections for breech births, which are so common in the United States. Ana-Paula Markel, doula (birth coach) and childbirth educator, hosted the event at BINI Birth in North Hollywood for 100 people.

Many questions were discussed, such as: Why are some babies in a breech position? Can we prevent a breech or posterior presentation? What are the options for a mother with a breech baby in our community?

Markel moderated the panel, which included Naoli Vinaver Lopez, a midwife from Mexico; Davi Kaur Khalsa, an LA-area midwife; Dr. Suzanne Gilberg-Lenz, who specializes in vaginal birth of breech twins in hospitals; Jessica Jennings, a prenatal yoga instructor who works at BINI; Dr. Elliot Berlin, an LA-area chiropractor who specializes in helping with breech babies; and Dr. Stuart Fischbein, an obstetrician-gynecologist who assists women who choose to give birth at home. Under certain conditions, Fischbein will deliver breech births at home.

Breech presentation carries the risk of serious complications to the baby during the process of birth. For example, since the largest part of the body, the baby’s head, is the last part to emerge, it may have difficulty getting through the birth canal.

Additionally, there is the risk of cord prolapse, a condition in which the umbilical cord is compressed as the baby moves toward the birth canal, slowing the baby’s supply of oxygen and blood.

For these reasons, a vaginal mode of delivery for breech presentation, as opposed to the more accepted C-section, has been very controversial in the fields of obstetrics and midwifery.

Yet a cesarean birth is not without its own risks, mainly to the mother, such as infection, hemorrhage, and stroke.

According to Vinaver, traditional midwives have many techniques that are used with a breech baby, such as specific exercises for the mother or use of ice, heat, or even a bell placed at the mother’s hip, to stimulate the baby to turn. She estimated that these techniques were successful in 98 percent of cases.

Dr. Fischbein spoke of his practice of assisting women whose babies are breech to give birth at home. However, he said, “There is zero training for breech deliveries.” There are only a handful of doctors in the Los Angeles area willing to help a mother attempt a vaginal breech birth, and hospitals frown on the procedure.

We know now that babies are fully conscious in the womb, and that communication can take place. Babies can be guided to present themselves as they are most easily born.

I feel there were some important issues missing from the forum, including the use of hypnosis to help babies present themselves in an optimal position in utero or to be guided to turn around before the birth.

At the event, we only looked at the mechanics of turning babies, treating them as ‘objects’ instead of honoring the fact that they are fully conscious beings and can be spoken to.

This awareness would lead us to explore the phenomena of why babies choose to present themselves breech and enable us to step away from the limited causes that medicine presently recognizes.

Part 2: Communication with the unborn baby

An unborn baby will usually turn to present himself in whatever position it is going to be born around week 34 to 36 of a pregnancy. Before that, it is mainly in an “across” position.

Some recognized medical reasons contributing to breech presentation at the time of labor include the following:

•       Preterm labor and birth if labor starts when the baby is still too small to move easily in the uterus.

• A placenta in the fundus: The placenta takes up some of the space in the top of the uterus.

• An unusual shape of the mother’s uterus or fibroids in the lower part of the uterus.

• More than one fetus (such as twins).

• A very relaxed uterus from many previous children.

• Too much or too little amniotic fluid.

Yet more subtle or emotional factors can be at play.

Marie-Paul Baxiu explains breech positioning from a non-medical perspective: “They sometimes hide, as parents are very fixed on the sex of their unborn child, and they are afraid of not meeting their parents’ expectations and will chose to hide their gender in utero, or there could be a parental dispute. The baby is saying, ‘I am not ready to come out the way things are,’ and there are so many other possible reasons.”

Describing how she establishes communication with an unborn baby, while encouraging the parents to communicate as well, Baxiu says: “Well, when a mother is relaxed (connected to her own body), her brain waves are much slower (4 to 7 hertz, theta brain waves. Most of us operate at beta brain-wave level, our regular cognitive state of mind, at 13 to 30 hertz).

 “A mother gets into the same brain wave her baby is in continuously while relaxed, and so there is a way to establish true connection and communication. Babies are completely conscious and capable of responding to their mother’s deepest thoughts.”

With the father, she adds, “It works differently. They can only connect to their voice, since they don’t share the same physical space.”

Midwives are traditionally trained by one another and have preserved and passed down skills that have helped eons of people be born throughout the ages. “They are often the experts who facilitate the training of gynecology students in all that is natural,” Baxiu says.

There are some obstetricians/gynecologists who feel comfortable assisting women with breech babies in a hospital, people such as Ronald Wu, M.D., located in Glendale, Calif. Dr. Wu has the knowledge to facilitate such birth. He has helped breech single and twin babies to be born vaginally in the hospital setting. Unfortunately, he will soon retire.

Dr. Stuart Fischbein explained at the breech-birth event that he is comfortable assisting a woman giving birth to a breech baby as long as the baby is a frank presentation (where the baby is presented with its butt close by the cervix and his feet are close by his head).

Dr. Fischbein pointed out that any other breech presentation, such as feet first, can make things more difficult to handle in a natural vaginal birth in a home setting.

For parents facing breech birth, when choosing a natural home birth with a midwife, they won’t have the safety net a hospital birth could offer with backup doctors and equipment if a last minute C-section is needed.

What does this imply? It means that to encourage natural-minded parents to deliver in a hospital, doctors will have to learn to keep their hands off, allowing a woman to give birth without the constriction of time and all the interventions that are usually taking place unnecessarily, which too often lead to a C-section.

Part 3: Knowing one’s options

What would a solution to the breech-birth dilemma that benefits everyone look like, and what challenges would it present?

Dr. Fischbein explained at a breech-birth conference of professional birthers in Los Angeles in June that parents have to know there are options. They are not offered options because obstetricians/gynecologists do not have the training and the skills for a breech birthing other than a C-section in a hospital setting.

The clear conclusion was the need and necessity to bridge the immense gap of these two choices and the present gap in our system. Neither choice is ideal.

As it stands today, parents have only two choices: to deliver at home naturally with a midwife, without the backup of the doctor and a facility to make it safe for the high-risk delivery, or to deliver in a hospital, which demands intrusive surgery.

Empowering parents to request obstetrics to incorporate the knowledge of midwifery skills will truly offer parents and children the best of both worlds—a natural childbirth guided by the need and wisdom of the individual, within the context of the most well-equipped facility to back up a potentially dangerous situation.

A birth professional at the event stated that she didn’t even know that it was lawful to give birth vaginally to a breech baby in a hospital. She thought it was not allowed because it was against the law.

Marie-Paul Baxiu concludes: “This information should be made available to the parents who don’t know what is actually possible and are only offered a few different choices that are restricted by people’s skills in medical profession, which often don’t include options that are more holistic and safer for all involved.

“Bottom line: Mother and baby should be allowed to give birth and be born breech if this is how they chose to come to the world.

“Let’s not forget that babies are conscious beings and that skills can be acquired not just by midwives and passed down from one another but by the elite of birth professionals such as obstetricians and gynecologists, who indeed will create a safer heaven for these babies to enter this world.”

Marie-Paul Baxiu
888-218-4614
310-901-9440
www.easybirthing.com

Dr. Stuart Fischbein, MD OB/GYN
www.birthinginstincts.com
10309 Santa Monica Blvd., Suite 300
Los Angeles, CA 90025

310 282-8613 Ask for Krissy
77 Rolling Oaks Dr. Suite 306
Thousand Oaks. CA. 91361
805-371-8775

Achieving Successful VBAC: A Local Birthing Center’s In-house Study

Brian O'Neil

by Tonya Brooks. Tonya is a research scientist, midwife, educator and author of Giving Birth at Home, the Parent’s Guide to Perinatology. Through ACHI, she researched, wrote, and implemented training programs for Midwives, Midwifery Assistants, Doulas, and Childbirth Educators both nationally and internationally. www.gr8birth.com

The prevention of cesareans or the lowering of the cesarean rate does not make much sense medically, unless one understands the why of it.

First, mothers trade off a few hours of pain in labor for at least two weeks of post-surgical pain that vaginal birth moms don’t have. Women who desire more children after a cesarean face the dilemma of a repeat cesarean or the risk of a VBAC (Vaginal Birth After Cesarean). If repeat cesareans are done there is an increased risk of placenta acretas (placenta grown through the uterine wall) and maternal morbidity and hysterectomy. If VBAC; the risk of rupture in labor is higher with multiple cesareans. So for women’s health and future fertility VBACs are important. They can be successfully accomplished if during pregnancy one works a little harder.

In June 2010, the Los Angeles Times, and prior to that the Sacramento Bee, reported a 300 percent rise in maternal mortality rates related to childbirth in the last ten years. Doctors attributed the increase in death rates to women such as “Well women are having babies later, more infertility treatments, more obesity and a rise in diabetes (too much sugar and fast food).” The controversy wasn’t just that maternal mortality rates tripled in the last ten years but that the rise went unreported…

The researcher from the California State Health Department reviewed the rise maternal deaths in the last ten years and found that while women are delaying child bearing and there is a rise in infertility treatments and obesity, these accounted for only a small rise in death rates.

The largest jump in maternal mortality was due to the doubling of our cesarean rate from about 25 percent in the 1990’s to 50 percent in the year 2009. Cesarean sections were promoted to women as safer for the baby, safer for the mother, less pain, less pelvic floor trauma, better timing and the danger of allowing women with previous cesareans even to labor.

These assertions, except for time in labor, were based on junk science and lies. Cesareans are major surgery. The abdominals connective tissue is severed; the uterine muscle is cut, as this occurs the patient morphs into a high risk patient for future births because of the uterine scar. Baby’s interest can be served but are not always and deeper maternal anesthesia can play a role in newborn issues like respiratory, depression and oxygen deprivation.

All of this was reviewed by the American College of Obstetricians and Gynecologists (ACOG) “steering committee”. ACOG then revised its stand on VBACs again. The Technical Bulletin which is the technical practice guidelines (standards) for obstetricians. In the 60’s and 70’s the rule was once a cesarean always a C-section. By the 80’s women were encouraged to try a vaginal birth(VBAC) even after more than one cesarean and doctors offered a trial of labor (TOL) to most women even with more than one C-section. The ACOG guidelines for VBAC stated that the obstetrician was to be readily available. ACOG reversed this guideline to state immediate availability by the 1990s. This required physicians to be in hospital during labor which most doctors are not willing or able to do. This gave rise to the doubling of our C-sections rates. It seems in this case long-term outcomes were not considered.

By 2011, when the scandal broke about maternal death rates (still low but a tripling of the numbers) ACOG reversed its stand again. Now ACOG suggests a trial of labor for women even with two prior low transverse cesareans. But real little information was given on how to accomplish these VBACS.

So I present to you our own in house VBAC Study occurring at the Gentle Birth Center in Glendale, now the Natural Birth and Women’s Center. This is the “how we did it” to produce safe labors, and great long-term outcomes and in fact better births.

The VBAC Study at the Birth Center
A total of 138 attempted vaginal deliveries after one prior C-section.
VBACs outcomes: 120 women delivered vaginally at the birth center without complications.

13 were transferred during labor to the hospital. Of the 13 transferred, 6 delivered vaginally. All six women were given epidurals and Pitocin. All had stalled labors but were at least 6 centimeters dilated when they were transferred.

Of those six vaginal deliveries, 3 babies were delivered by vacuum extractions. All six mothers and infants did well. There were no maternal hemorrhages and no neonatal admissions to the NICU.

7 of the transferred group were delivered by repeat cesarean. In that group, all but one had cervical dilatation greater than 6 centimeters at the time of transfer from the birth center. All cesarean mothers subsequently did well and there were no admissions of neonates to the NICU. Many of the 13 transfers had failure of the fetus to descend adequately into the pelvis. But in many of these women this was not linked to the previous reason for the previous C-section.

Our experience has a very high success rate of vaginal births after a previous C-section. 120 of these women achieved spontaneous vaginal deliveries without incident. The following information is how we achieved that remarkable success:

1)      All women wishing to VBAC were evaluated for an adequate gynecoid pelvis. These were the majority of women.

2)      All were put on strict diets tailored to each individual woman with her weight and food philosophy factored in. These diets were designed to build healthy babies, and muscle while controlling weight. These diets included a strong individualized nutrition component. The goal was to eliminate gestational diabetes, big babies, hypertension issues and maternal infection. All are diet related.

3)      A strict walking program was initiated to make sure babies were head down and deep in the pelvis. The goal was to ensure babies were born between 37 and 40 weeks. (This controlled fetal size to some extent and decreased the risk of babies being overdue and having meconium in labor.)

4) The cervix needed to be soft and pliable prior to labor (So that labors were not prolonged). If the cervix did not soften and efface (thin out) well prior to the onset of labor the mothers were supplemented with certain homeopathics. These homeopathic remedies should be given ONLY by the midwife delivering the baby as there are 53 different ones and they do not help or cause harm if the wrong ones are given. (DOULAS ARE NOT QUALIFIED TO DO THIS!)

5) The fetus was evaluated for general health with a “biophysical profile sonogram (BPP)” which measures fetal muscle tone, breathing, amniotic fluid levels, condition of the placenta, fetal heart rate and breathing motions. And although it is not part of the BPP, we also looked for descent of the baby (how deep in the pelvis) and the length and placement of the umbilical cord.

Adequate amniotic fluid suggests the placenta is functioning and the baby is healthy. Amnionic fluid is made by the baby and placenta. If the baby’s placenta is healthy and has reserves, the baby is head down, the cervix is soft, the labor is not extremely long or difficult, and the mother is otherwise healthy—this leaves only the mechanics of labor i.e., the strength of uterine contractions and descent and rotation of baby to worry about.

6) All VBAC women were monitored with an external fetal heart monitor intermittently during labor because fetal distress is the first sign of a rupturing uterus. Mothers were labored in and out of the shower (vertically) but monitors were used. This gave us a heads up if a scar was threatened. As a midwife with over 30 years of clinical experience I have seen ruptured ruptures and prevention must be addressed prior to labor.

Because VBACs do contain a small risk of uterine rupture we wanted short, fast labors without extra risk factors. We wanted no extra augmentation for labor, no drugs, hormones, or herbs. Just straight forward, natural labors, well monitored fetuses and mothers. If we did our job, with just a little cooperation of the baby, we had 120 successful vaginal deliveries at the birth center.

I believe VBACs are safe when the proceeding plan is carefully followed. Today at the Natural Birth and Women’s Center our tradition of safety and success with VBACs continues. 

Natural Birth & Women’s Center
20201 Sherman Way Suite 109, Canoga Park, CA
Tel: 818-885-1012Fax: 818-885-1017

E-mail: nbwc@ix.netcom.com
www.gr8birth.com

How to Find a Doula

Brian O'Neil

by Rita L. Shertick RN, BSN, LCCE, CLE
Rita is a staff nurse at Downey Regional Medical Center’s Family Birth Center. She is a Lamaze certified childbirth educator and a certified lactation educator.

First thought: Yeah, we’re pregnant
Second thought: OMG, what are we going to do?

You know your partner wants to be your coach for this wonderful experience, but some experienced support would also be appreciated.

Many conversations later, with family and friends, you decide to find a birth doula. Who are they? Why are they available? What questions should you ask them? Where do you find one? You search www.dascdoulas.org, the birth and parenting resources of the Wet Set Gazette, have more conversations with family and friends, and finally you do some interviewing. To get you started, I asked questions of five birth doulas in our area. Below are their responses and recommendations for other questions you should ask when interviewing for a birth doula.

Tracy Hartley: 15 years experience, assisted 433 births
Giuditta Tornetta: 10 years, over 300 births
Margie Levy: 9 years, 264 births
Lysa Quealy: 2 years, 38 births
Emilee Benner: 1 year, 15 births

1). Any special skills?

Emilee: Kundalini yoga teacher, infant massage instructor, massage therapist, placenta encapsulation

Margie: Aromatherapy, hypnosis, pregnancy massage, Reiki, fetal positioning, working with abuse survivors, acupressure, and breastfeeding

Lysa: Certified massage therapist, aromatherapy

Giuditta: birth hypnosis, workshops on baby care, massage therapist, cook, baby usher, breastfeeding, also postpartum doula. Author “Painless Childbirth: An Empowering Journey Through Pregnancy and Birth”

Tracy: Birth Hypnosis for 12 years, diapering workshops, strong education in the birth process and navigating the hospital system, pregnancy massage, Reiki, optimal fetal positioning, working with abuse survivors, breastfeeding support.

2). How and why did you become a birth doula and what is your background?

Tracy: Lots of previous “people” jobs, among them: counseling Vietnam Vets, training dogs for people with disabilities other than blindness. Signed up for doula training 24 hours after hearing about it on a Today Show segment in 1996, knew it was the perfect job for me.

Giuditta: After being laid off from a TV producer/director job, I asked the Universe for guidance, and was lead to be a lactation educator and next a doula. I attended my first birth and it was love at first sight.

Margie: Raising my children, I knew I wanted to support women in birth but not in a medical capacity. When I learned about doulas, I knew I had finally found the right career.

Lysa: My first birth I took childbirth classes and felt informed but ended up with a caesarean. I felt I could have benefited from more support. My second birth was a successful VBAC (Vaginal Delivery After Caesarean), I made the decision based on information not fear, and now I want to give women the guidance and support not offered to me.

Emilee: Family and friends continually asked me to attend their births, I did it because I really enjoyed it and they seemed to benefit from my attendance. When I found out there was training to be a birth doula, I awoke to my calling. My goal is to help new parents feel comfortable, prepared and educated for this sacred passage.

3). Now you discuss the pros and cons of each doula. 

One of you likes the experienced grandmother type support, the other likes the calm motherly type, but the young bubbly one was very enthusiastic and had such positive energy. No scratch that, all of them had positive energy—the type of energy you want directed for your well being at this pivotal time in your life.

4). Time to consider the cost, what are the choices?

Some doulas have a pay scale for different levels of services offered. How many massages and classes do you think you’ll need? How many post partum visits? A friend had a doula for barter, a few months of free meals in their restaurant, or how about servicing her car. What can you offer in exchange for a doula’s services? And yes, she will have a contract for signing, it is a business transaction. Fortunately many insurance companies will now reimburse. If yours doesn’t, submit anyway, listing all the benefits you experienced. If you are looking for a birth doula in training, she’s $200.00 or less, budget not a problem, maybe up to $1,800.00. Generally a doula expects payment in full at least a week before your due date.

Contact Information:

Tracy: 818-448-081
877-436-8528, 877 I-Doula-U
www.bestdoulas.com

Guiditta:
www.joyinbirthing.com free virtual doula service

Margie: 818-994-6800
supportiveDoula.com
Margie@supportiveDoula.com

Lysa: 310-831-5700
www.beachcitydoula.com

Emilee: 818-383-4213
Kneadlove@Gmail.com
www.kneadlovedoula.com

Rita L. Shertick, RN, BSN
Downey Regional Medical Center’s Family Birth Center
562.904.5580
www.drmci.org

Staying Connected After Birth: A Peaceful Beginning

Brian O'Neil

by Marcy Axness, Ph.D
Dr. Marcy Axness is an early development specialist, popular international speaker, and author of Parenting for Peace: Raising the Next Generation of Peacemakers. She is a top blogger at Mothering.com and is featured in several documentary films as an expert in adoption, prenatal development and Waldorf education. Dr. Axness has a private practice coaching parents-in-progress, and considers as one of her most important credentials that she raised two peacemakers to share with the world — Ian and Eve, both in their twenties.
marcyaxness.com

My life explorations as an adopted person and my studies of the foundations of human wellbeing have consistently turned up a key element of health: the experience of and capacity for connection. Birth presents us a momentous opportunity to foster connection. It is also important to understand the costs of not staying connected after birth — whether it is due to adoption, NICU confinement, health issues in the mother, or other circumstances preventing mother-newborn connectedness. This is not about guilt or blame, but the empowerment that comes with understanding what happens with neonatal separation.       

During and immediately after birth, a complex hormonal cocktail orchestrates biochemical exchanges between a mother and her newborn, offering never-to-be-repeated opportunities to set the stage for optimally healthy psychosocial development. Levels of oxytocin — our hormone of love, connection, peace and healing — peak during this time. This paves the way for important brain circuitry to wire up in the baby’s social and emotional centers. It also nurtures the mother’s urge toward maternal behavior.

Oxytocin is a primary peacemaker hormone in the body: it elicits a relaxation and growth response, which in turn reduces activity in the stress (fight, flight or freeze) system. We’re all familiar with the idea that love conquers fear, and thanks primarily to oxytocin, it’s not just a worthy ideal, it’s a basic feature of our physiological design! Along with its ability to moderate a person’s tendency to switch into stress-response mode, oxytocin is involved in such basic peacemaker capacities as empathy, adaptation, tolerance, cognition, and interdependence. Impairment of the oxytocin system has been implicated in autism, as well as schizophrenia, drug addiction and even cardiovascular disease.[i]

Understanding the Trauma of Separation

Throughout generations of routine obstetrical, hospital, and adoption practice in this country, the attitude has been, “Why would the separation from its mother affect a newborn baby?” But with the advent in the last thirty years of prenatal and perinatal research, we have astounding findings about what a fetus experiences in the womb. We now know what a strong connection a baby has with its mother long before birth, and how intelligent, aware and remembering a newborn is.  Researchers currently feel the more appropriate question to be, “Why wouldn’t separation from the mother to whom he or she was connected for nine months affect an infant in fundamental ways?”

As Nancy Verrier wrote in her landmark 1993 book, The Primal WoundUnderstanding the Adopted Child,

“Many doctors and psychologists now understand that bonding doesn’t begin at birth, but is a continuum of physiological, psychological, and spiritual events which begin in utero and continue throughout the postnatal bonding period.  When this natural evolution is interrupted by a postnatal separation from the biological mother, the resultant experience of abandonment and loss is indelibly imprinted upon the unconscious minds of these children, causing that which I call the ‘primal wound.’”

Verrier’s book is well-known in the adoption world, but her insights are critically important for any circumstance in which there is prolonged or chronic neonatal separation. So as I go on to describe the implications of not staying connected after birth in terms of adoption, they can apply to other separation circumstances as well, including NICU stays. Over my years of counseling and coaching, I have seen so-called “classic adoption issues” (e.g., trust, intimacy, persecution complex) show up in those who were separated by NICU confinement. This can be a difficult line of exploration, because none of this is ever done maliciously or with anything but the best intentions. How painful it can be to discover that even our best intentions don’t trump biology! The good news is, there is always healing possible — but only once we recognize the truth of what our child experienced.

Rather than deeply question whether the experience of separation in adoption is traumatic, we as a society tend to believe that enough love and care can make everything right.  But psychologists have taught us that the first stage of psychological growth includes the development of trust, as a foundation for secure relationships with others, and ourselves.  Babies who are separated from the only connection they’ve ever known — their primordial biological and psychological matrix — have had their nascent sense of trust deeply violated.

Adoptees may unconsciously feel that it’s too dangerous to love and be loved authentically and deeply; all of the love and care parents give them sometimes has a hard time “getting in” past the child’s defenses against the hurt and abandonment that they are internally “hardwired” to expect.  As Verrier says of her own relationship to her adopted daughter, “I discovered that it was easier for us to give her love than it was for her to accept it.”

Again, varying degrees of deep distress can occur for newborns under circumstances other than adoption, such as NICU stays for premature or ill babies — in which case the trauma of separation may be compounded by painful medical procedures, isolation, and harsh, invasive surroundings.

My Own Problems Staying Connected After Birth

Separation wounds can also happen in the most “normal” of birth and postpartum circumstances. Like so many modern American moms giving birth to healthy, full-term babies in hospitals... and despite my best intentions (and the admonition of my very progressive pediatrician, to “not let them take your baby away from you!”)... I found myself overpowered by the momentum of standard hospital protocols, which involve separating mother and baby for a variety of reasons, for various lengths of time.  Not only did this have its effect on our son’s developing trust, it also interrupted the unfolding of my own maternal instincts and identity, which was a dangerous thing given my risk profile for postpartum depression.

The Trauma & The Healing

The trauma of newborn separation is registered largely on the physical level, leaving the nervous system predisposed to getting stuck in survival mode: fight or flight, or freeze. In babies, these powerful feelings are thus expressed physically, through:

inconsolable crying (or the other extreme, virtually no at all)
extreme startle responses
arching or stiffening at being held
“spacing out” or sleeping all the time
severe colic
other illness (e.g., I contracted pneumonia at 6 months of age)

The primal sense of loss, abandonment and rage that results from the trauma of separation is overwhelming to a newborn, who hasn’t yet developed an ego, much less ego defense mechanisms. Left unacknowledged and unaddressed, these unresolved nervous system patterns permeate the psychological and personality realms. They can manifest in such ways as hyper-controlling behavior (“the little tyrant”) and intense emotional volatility (adoptees often pick up the diagnosis of borderline personality disorder or bipolar, which are indeed marked by such volatility).  Or these patterns can show themselves in the opposite way — a superficially cheerful adaptiveness (“the pleaser”).

Children often split themselves off from the injured parts of their psyche, and develop a functional, acceptable, “false self.” This concept of the false self is often the explanation behind what seems like “wonderful adjustment” on the part of an adoptee, or traumatized child who has responded to the deep fear of further abandonment or trauma by becoming compliant and adaptive to the needs and expectations of the parents or caregivers. But their grief and anger is simply buried in the unconsious, curdling their social and emotional lives.

However, all is not lost. Parents needn’t feel hopeless in the face of these revelations. (Indeed, when faced with an inexplicably unsoothable baby... or, one who kind of “tunes out” and won’t engage... a parent without these insights could understandably feel hopeless and helpless!) When parents are provided this understanding about the impact of these early experiences upon their child, it can be very liberating (after the initial shock and grief passes). It frees them to reach beyond themselves and not take the child’s behavior personally (“He doesn’t like me!”). This can empower a parent to make herself truly available as a loving, healing presence for her baby. How?

Staying Connected After Birth with Healing Words

One of the most powerful healing forces is available to every parent, free of charge: empathy. Empathy allows a person, even a tiny baby, to feel her feelings, rather than repress them, so they can be released. Babies who have lost their original mothers, permanently or even temporarily... and babies who have suffered other painful or traumatic experiences... need to express their feelings of grief and loss.

 They need our help to do this, and this help needs to take the form of active empathy... saying the words, out loud, that let the baby know that what he or she is feeling makes sense and is allowed.

So instead of the very common dismissive mantra chanted to upset babies, “It’s okay, you’re okay, you don’t need to cry...” the thoughtful and knowledgeable adoptive parent can gently croon to her baby in distress:

“You miss your mother. You miss your connection. You’ve lost something very important, and I understand. I’m not the mom you expected, I don’t smell like her, I don’t sound like her. I’m a different mom and I am here for you... always... when you feel sad, and when you feel joyful...”

 

Infant Reflux on the Rise?

Brian O'Neil

by Richard Pass, RN
Director, Save A Little Life, Inc.

Richard Pass, RN, BS, founded “Save a Little Life” in 1999. He has been a Registered Nurse & Health Educator for over 30 years. He is on staff at Cedars-Sinai Medical Center in Los Angeles and is currently a part-time clinical instructor of nursing at California State University, Northridge. The goal for Save a Little Life is to provide a simpler, more “user friendly” CPR course. Savealittlelife.com

When doing my pediatric CPR and family emergency workshop I often hear parents concern over episodes where the infant seems to stop breathing, causing tremendous fear for that family. In some instances a 9-1-1 call is made, particularly when the baby “turns blue” (a cardinal sign of low oxygen). These episodes are frequently associated with feeding which increases the perception that a choking event is underway.

Because of these very real fears many parents visit their pediatrician’s office and want answers. According to a recently published article in the Journal Pediatrics, there has been an alarming increase in the diagnosis of “infant reflux.” Among other things, this has been the cause of a huge increase in treatment, principally with the prescribing of acid suppressing medications (Pepcid, Zantac, etc.) for these infants.

What Is Reflux?

Taber’s medical dictionary defines reflux as “a return or backward flow.” Consequently, the terms (reflux and regurgitation) are often used interchangeably. Various studies reveal that a major percentage of the infant population in the U.S. (40-70%) has some form of reflux event. In many cases these events are noted when a baby “spits up” during feeding. There are, however, numerous occasions when I have heard parents tell me that some form of regurgitation can happen during non feeding times.

The rapidly growing infant usually ingests volumes of food (breast milk/formula, etc.) that on a per kilogram basis are much greater than larger children or adults. Because of this relative high volume and a relatively shorter esophagus (stomach tube) a “spillover effect” can occur. Many pediatricians believe this to be “physiologic reflux” as opposed to “reflux disease.”

Episodes of this spillover can occur infrequently or multiple times a day. This puts many parents and care providers on constant alert, often causing significant anxiety, including fear of feeding the infant. Several medical studies suggest that the situation is self-resolving in approximately 95% of infants by 12-15 months of age.

Reflux and the Incidence of Apnea

Without question, the issue of effective breathing during these episodes is of primary concern to the parents I speak with. So, what is the relationship here? In depth studies looking at the relationship of regurgitation and apnea (cessation of breathing) consider the physiologic factors. Basically, “apnea is linked to a reflex in the larynx (near or around the air passages) cause respiratory pauses, airway closure, and swallowing immediately after regurgitation to the upper airway.” The consequences of these episodes are usually minimal to non-existent. Yet, as mentioned earlier, some infants have prolonged apnea, turn blue and on some occasions begin to lose consciousness. These are clearly the most unusual but cause the most panic in the parent or care provider.

Getting the Right Diagnosis

It is far too simple to assume that if an infant has episodes of reflux/regurgitation, that they in fact have GERD. There are specific diagnostic markers that your physician will look for before making this diagnosis. In the meantime, there has been a skyrocketing in the use of the aforementioned medications to treat the symptoms of reflux. One belief is that parents are so affected by the promotion of medications (usually seen on T.V. for the adult population) for this disorder that they demand a prescription and, in fact, often feel that the baby is under-treated if they leave the office without one. It turns out that the F.D.A. has not approved the use of these medications, specifically for the infant population.

In the meantime, what can parents do to assure that their baby is safe? The most common recommendations tend to include:

•       Propping the infant at a somewhat higher angle while feeding

•       Increase the time between feeding and going down for nap/sleep

•       Place some risers at the head of the infant’s crib (several inches at least)

•       Keep a “spitting up” or reflux log that you can refer to when speaking with your pediatrician

In those very rare instances when breathing stops and the infant turns bluish in color (either face, lips, etc.) you should be prepared to stimulate the infant by using a modified “airway obstruction” position, and use some patting to their back when they are turned in a head down position. This stimulation is most likely what will get a response, even though this is not a true airway obstruction event.

Finally, be prepared for the most unusual of events —where a baby has prolonged loss of breathing. This may require the initiation of CPR in rare cases. Haven’t taken a pediatric CPR course recently? Call Save a Little Life and sign up for one today.

Save a Little Life, inc.
818.344.1442
Savealittlelife.com

 

Journaling: Pregnancy, Birth, and Postpartum

Brian O'Neil

by Zoë Etkin
http://umeboshibabies.wix.com/zoeetkincoach

Zoë is a certified birth and postpartum doula, childbirth educator, and writer. She owns Umeboshi Babies Doula Services, serving families on the westside of Los Angeles during their pregnancy, birth and postpartum journeys. She is also training to become a Women’s Sexual Wellness coach/sex educator, and loves helping women better understand their cycles and their bodies. Her mission is to empower women to make conscious choices around their health and sexuality, at all stages of life.

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As a Los Angeles-based birth and postpartum doula, my goal is to bridge the gaps in care for mothers, babies, and families through the perinatal period by providing physical and emotional support, education and resources. My other life’s passion is writing, and a year ago I earned my MFA in poetry. However, the main type of writing I’ve done throughout my life is journaling. My first journal dates back to my 5th or 6th year of life! Journaling has always allowed me to explore my thoughts and feelings, or jot down a strange dream, or even complain. Now that I work with mamas, I see how important it is for them navigate the complex waves of emotion that come with pregnancy, birth, and new motherhood.

Sometimes it’s difficult for new moms to express those feelings out loud. Writing and journaling through our ups and downs can relieve stress, help center and focus the mind, and force us to carve out a little “me time” in our busy lives. Keeping a pregnancy-specific journal is beneficial in several ways: it helps you focus on and connect to the baby growing inside, keeps a log of your emotions and physical sensations, and helps you work through fears and anxieties. Depending on your relationship to writing, you may journal with ease. For women who need prompts, I recommend the following as a guide.

Pregnancy Journal

Today’s Date:
Emotional Landscape: Today I am feeling….
Physical Sensations: (Examples: hunger, morning sickness, kicks or flutters of baby, tiredness, belly is growing, I see the pregnancy glow, etc.)
Today I want to tell my baby….
Today’s affirmation: My body is strong and capable of birthing my baby.
Today’s question: (Here you can talk about things you aren’t sure about. Fears, concerns,
              questions, etc.)

Today I am planning for you by doing…. (Here you can talk about prenatal check ups, classes you may be taking, buying things for the nursery, hiring a doula, making a list of people who will help out once baby is here, etc.)

Birth Stories

The topic of birth stories is actually one where people have varying schools of thought. Many doulas write birth stories for their clients. Some take a practical approach, chronicling the various times and events that took place, others take a more narrative approach and make it into more of a story. Either way it can be nice to have someone else’s perspective on how the birth went, since time is experienced much differently by the birthing woman. However, it can be important and cathartic for the woman herself to write the experience down as it was to her. If you had a traumatic birth or an ideal birth, writing through the experience can help release feelings you may be having or can affirm and celebrate positive experiences.

Another angle on the birth story is to write it for your child. Some write it as a children’s book for a young child, others write it for when their child is an adult. Either way, it can be a beautiful way to share that experience with your child.

Postpartum Journaling

There will be much less time to write once the baby has arrived, but I still encourage postpartum moms to journal when they can. Just like the pregnancy journal, it’s a nice way to chronicle your emotional landscape, as well as record all the baby milestones. Certainly a baby book makes room for that sort of thing, but it doesn’t give the mother the opportunity to write through her changes and her experiences. I find that postpartum moms can often feel ignored in the bustle of the new baby. Friends and family are constantly visiting and doting on the baby and moms can kind of feel like, “Hey, what about me?” It’s important that the mom have certain support persons who are there to concentrate on her. Postpartum doulas do this job well. Journaling, too, can help moms to take a few minutes to turn inward and focus on themselves and their feelings. It’s so important that postpartum women feel supported and also have an outlet for their feelings. I want to say, though, that if you see a postpartum mom who seems disengaged, or showing extreme emotions, she might need to talk to a professional, as she might be displaying signs of a postpartum mood disorder. Emotions certainly run high for new moms, but it’s important that she have people who are supporting her and have an eye out for behavior that might need further attention.

Allowing some time to journal during the perinatal period can give a woman the opportunity to think through and connect to her experiences in a special way. It also creates a record of her experiences that she may choose to go back to in the future. The process of journaling encourages growth in that it affords the ability to go back and read about yourself at different moments of your life, through different patterns of thought, different approaches to situations. You learn from your past, reflect on your present, and dream about your future all in one space that you can return to when you want, or not when you don’t. Mamas, I encourage you to grab a pen and paper and begin your writing journey today!

Find out more about Zoë's services at http://umeboshibabies.wix.com/zoeetkincoach
Read some of her poems and writing at
http://umeboshibabies.wix.com/zoeetkinpoet#!publications/c9jw
and here http://umeboshibabies.wix.com/doulazoe#!blog/c7jh

Birth Bag(s): What to Pack?

Brian O'Neil

 

By Nikol Anderson – ZumMallen, Nikol is a working, breastfeeding mom, with one daughter, Claire. Check out her blog at www.celebratewewill.weebly.com/blog

It's getting close and you're feeling extra large these days. Packing up your "it's time" bag now will help to alleviate some of your nervousness--you're ready for this, right? But what to pack? Nikol Anderson put together these great suggestions for bags--one for mom, one for dad or birth partner and mom, and one for baby (yup, don't forget, the baby will need a few things too).

MY BAG

1. Comfy maternity top. I am not going to pretend that I will be losing tons of baby weight right after she comes out.
2. Only the sexiest maternity underwear.
3. Leggings. I am not usually a leggings as pants wearer but this day I might make an exception. I might end up in Ryan’s basketball shorts. Who knows.
4. Dermoplast, pain relieving spray. It has been an amazing friend for the last few months and I hear I will only be leaning on it more after the birth.
5. Socks. I am gonna want to be comfy.
6. Nursing bra.
7. Hair ties and a brush.
8. Slippers. I will probably go home in sandals though, but we will see what the feet swelling is like.
9. Nipple cream. I just keep hearing that I will need it and thankfully I have been gifted some, so that is going in the bag.
10. Pads. Lets take it on back to jr. high.
11. Chapstick. Any brand will do but I do love me some Burt’s Bees
12. Make up bag. I am gonna need to freshen up for all of these photos.

OUR BAG

1. Camera and charger. We have not decided what kind of photos we will be wanting. Crowning or not. But I know I will want a lot taken. Thanks in advance mom :)
2. iPhone and ear buds. I might also need to buy an iDock if I want everyone in the room to hear my affirmations and my birth play lists [I need to make these by the way]
3. Charger. If my friends are like me they will be blowing up my phone for news, we will need to charge our phones.
4. Bathing suit for Ryan in case he decided to get in the birthing tub with me.
5. Toothbrush and toothpaste. We will be practicing hugs before drugs so I don’t want my breath to scare him away.
6. Traveling cooler. We will need this to bring my placenta home for the encapsulation.

BABY'S BAG

1. Newborn car seat. She should come home with us I think.
2. Boppie or My Breast Friend. I haven’t figured out which one would be better to bring for her. Opinions welcome.
3. Little mittens for her little hands & socks for her little feets.
4. Aden + Anais swaddle blankets. They are so cute and I have heard the best things about these blankets. We have gotten so many adorable ones. I am looking forward to practicing with them.
5. Going home outfit. This will be tough as we have been given the cutest baby clothes I have ever seen. I will take a look at the newborn sizes and see what would be just perfect.
6. Diapers and wipes, for her first little bowel movements.

Do you have any other suggestions?

Hot Moms, Cool Babies

Brian O'Neil

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by Dr. JoBea Holt, Author of Baby's Day Out in Southern California—Fun Places to Go with Babies and Toddlers—a travel guide to helping you find more adventures for your baby.

There’s always that super hot, unexpected week in fall. What do you do now? Put on your sunglasses and enjoy the water. Here are a few cool ideas.

Beaches with Extras
Forget the beach on the weekend, but weekdays are delightful. You can usually park close and take over a fairly large portion of the sand. Try a beach that has some extras – kites, aquariums on the pier, or merry-go-rounds to spice up your day. A simple sturdy kite that lives in the trunk of your car will always add to a day at the beach! Always check the water pollution report on the Heal the Bay website before choosing a beach (http://www.healthebay.org/baymap). “Mothers’ Beaches” tend to be in quiet areas where there is little water circulation and can often be polluted. 

Reservoirs
You don’t have to go to the ocean to go to the beach. Local reservoirs usually have a section roped off for swimming. A favorite is Puddingstone Reservoir that not only has a nice shallow beach, but also often has more lifeguards than kids - and lots of birds. Santa Fe Dam has a special Children’s Water Park that is like a playground structure sitting in a very shallow swimming pool with water jets shooting out in all directions. And Lower Castaic Lake has a delightful beach area. If your child likes big rigs - you can combine your lake trip with a visit to the Castaic truck stop. 

As you enjoy these special places in Southern California, it is never too early to start teaching your child to have good conservation habits. Of course you will need to bring water, but bring it in a reusable bottle. Disposable bottles not only pollute our landfills, but, more importantly, they take energy to make and deliver - far too much energy than should be needed to give you and your baby a drink of water! 

Buy a few good quality sand toys rather than cheap ones that break the first time. Or better yet, look in the kitchen for some old cups and large spoons. Too much energy and water are used to make children’s toys that last only days. 

And when you leave, find ten little pieces of trash to pick up and throw away. Small children are especially good at finding and picking up little colorful pieces of plastic. You could even start a plastic collection! These little pieces of trash look like food to birds and are often picked up and fed to nesting babies. 

So find your sunglasses and reusable water bottle, grab your sunbonnet and old measuring cups, and have a cool summer.

Happy trails!
JoBea Holt

Beaches
Manhattan Beach  www.ci.manhattan-beach.ca.us/
Manhattan Beach Roundhouse Marine Studies Lab   www.roundhouseaquarium.org/
Huntington Beaches  www.parks.ca.gov/?page_id=643
  www.huntingtonbeachca.gov/residents/beach_info/index.cfm
Kite Connection on Huntington Beach Pier  www.kiteconnection.com
Santa Monica State Beach  www.smgov.net/portals/beach/
Santa Monica Carousel  santamonicapier.org/fun/
Santa Monica Pier Aquarium  www.healthebay.org/smpa/

Reservoirs

Puddingstone Reservoir Beach  http://www.bonellipark.org/
Water Play Area-Santa Fe Dam Recreation Area
     
http://parks.lacounty.gov/wps/portal/dpr/parks/santa_fe_dam_recreational_area
Lower Castaic Lake  http://www.castaiclake.com/lowerlake.html

and
Castaic Truck Stop  You will drive right by the big rigs as you get off the freeway and head for Lower Castaic Lake.