• I need help with breastfeeding, who should I call?
• I need a doctor for my pregnancy, who should I call?
• Why should I hire a midwife?
• I'd like to hire a midwife, who should I hire?
• What is a doula?
• I need a childbirth class, where should I go?
• My baby is breech, do I have to have a cesarean?
• I had a previous cesarean, can I have a vaginal birth this time?
• What about the pain of labor?
• I'd like to file a complaint against my doctor, what can I do?
• Is it safe to take medication while I'm pregnant?
• I'd like to avoid a cesarean, is there anything I can do?
• What is a birth plan and why do I need one?
• I'd like a homebirth, but what if something goes wrong

I need help with breastfeeding, who should I call? TOP
There are several types of lactation specialists and it's important to get the right one for you. Be sure to ask the person helping you what their credentials are. The most common are Board certified lactation consultants (IBLCE), Cetified Lactation Educator Coulselors (CLC), Lactation Educators, and La Leche League Leaders.  Board certified lactation consultants have undergone 45 hours of education and passed the international board certified lactation consultant exam. Lactation Consultants are qualified to help with any breastfeeding problem and also the more uncommon medical problems of mom and baby. Certified Lactation Educator Counselors have 40 hours of education and are qualified to help with normal breastfeeding problems. La Leche League Leaders have similar education and qualifications. Lactation educators typically have 16hours of education and are usually limited to teaching breastfeeding basics classes.

I need a doctor for my pregnancy, who should I call? TOP

Family Practice Doctor:

Family Practice doctors are ideal for the normal pregnant woman. They typically approach childbirth as a normal natural event in a womans life and their training is based in normalacy. Benefits of hiring a family practice doctor include one doctor for the whole family. Not all family practice doctors offer this service but for the ones who do this is a wonderful option.

Obstetrician:

A general practitioner trained in the specialty of obstetrics. Obstetricians are typically trained in abnormality. Their specialty is with abnormal complications in pregnancy. An obstetrician also has the ability to perform cesarean sections. An OB is typically not necessary for the normal pregnant woman and may lead to a higher rate of intervention.

Perinatologist:

This is for the high risk obstetric woman. A perinatologist has 2 years education over an obstetrician in specialized complications of pregnancy. Usually used as a consultant in conjunction with your regular provider or in pregnancies with multiples.

Why should I hire a midwife? TOP

By Trina Hampton Midwife. When the word midwife is said, one usually imagines an elderly tribal woman using herbs and chants. Or perhaps one thinks of a sandal clad, hippie lady from a few decades back. These may be good for laugh, but this demeaning stereotype has no reflection on the midwives who are medical professionals today. Unfortunately, the perpetuation of these images may be keeping American women from receiving the best possible pre-natal and birth care available. There are many reasons why women should consider hiring a midwife for their care. At the heart of midwifery is the philosophy that childbirth is natural and normal. Respecting that birth is an emotional and psycho-social event, not just a physical process. The word midwife means with woman and indicates in name that a midwife provides a very personal level of care. Midwives refer to their moms as clients rather than patients. The word patient infers illness and inferiority. Client indicates that they are hired by mothers to provide a service. Removing the implication of ownership over the mother-to-be, this opens up the relationship to include the mother as a partner in her care. As demonstrated by midwives' use of the phrase 'catching the baby' to describe their role, rather than 'delivering the baby'. Let's not forget who is doing the real work here, mother is given credit where credit is due. Most people know that historically midwives cared for women during childbirth, but they also believe that childbirth was deadly and that doctors, obstetricians, took over maternity care because it was safer. It may be surprising to many, but this assumption is completely false. The trend of moving childbirth into hospitals during the first part of the 20th century, managed by male doctors, was driven purely by sexual discrimination and 'class warfare'. It was a time when women were thought to be inferior to men and therefore midwives were dismissed as incapable of their task. Having little understanding of the physiology of birth, doctor and parents alike felt it was peril that women needed to be rescued from. Statistics of the time did indicate that birth in hospitals had better outcomes. We now see that these statistics were flawed in that they didn't take into account that midwives still cared for poor, immigrant, who were unhealthy and the most at risk. Hospital births composed mostly of middle and upper class white women who received some measure of pre-natal care. The introduction of interventions, drugs and hospital policies actually made the maternal and infant death rate go up. Today, midwives still care for a large majority of 'at risk' women, and yet study after study has shown that women cared for by midwives have better birth outcomes, and are just plain more satisfied with their experience. How could this be true? First, a focus is placed on pre-natal nutrition, education, and locating community assistance when necessary. Clearly this is the first step in avoiding complications in the first place. Secondly, midwives spend more time with their clients. On average, midwives spend 30-45 minutes with a client during a prenatal visit, allowing for more communication and observation. This is much longer than the average 5-10 minutes doctors spend with their patients, when they don't hand off prenatal visits to their staff. Midwives also spend more time with their clients during their labor and birth. It's common practice for doctors to only see their patients momentarily during labor , if at all, and join them only once they have started pushing, leaving the majority of maternity care up to the nurses and hospital residents. Many doctors are likely to have never even seen a normal labor from onset to birth. Midwives however, spend the majority of labor with their clients. In doing such, they are better able to honor the mother's preferences, be on time for the birth and diagnose any complications as soon as they arise. Industrialized nations around the globe with the best maternal and infant outcomes employ midwives as their principal maternity care providers. The US currently ranks 34th in the world, despite increasing use of interventions and physician dominance. This means mothers and babies in 33 other countries fare better during and after childbirth than here in the U.S. American women intending to choose the best practitioner usually pick an obstetrician, a surgeon, assuming they are safer. A study published in 1998, looked at more than four million births in the United States. Removing the high risk cases and examining only the low risk births attended by obstetricians and those by midwives, found the newborn death rate to be 33% less in the midwife group. There has never been any verifiable data to prove that obstetricians are safer for healthy low risk pregnancies than midwives. Utilizing midwives has also show reduce the cost of prenatal and maternity healthcare. A study of two California medical centers showed a 13% and 7% decrease in payroll expense when midwives were added to the maternity staff. In short, midwives cost less. Salaries are competitive, midwives provide more hands on care, so nurses can be used more effectively, and unnecessary (and expensive) procedures are more likely to be avoided. Another survey suggests that if 50% of births took place in birth centers attended by midwives there could be a saving of $4 billion annually. The cost effectiveness and improved birth outcomes resulting from midwifery is too significant to ignore.

I'd like to hire a midwife, who should I hire? TOP

There are many different types of midwives. The most common are Certified Nurse Midwives (CNM's), Licensed Midwives (LM), Direct entry midwives (DEM), and Certified Professional Midwives. (CPM) No midwife regardless of their credentials is better than the other although many will argue differently. Experience and training count for a lot. Having a skilled birth attendant is important, but orientation towards birth is equally important. Know who you hire. Remember you are the person responsible for your birth and a relationship with a midwife is not a dependent one. It should be one of mutual trust, respect, and unity.

Certified Nurse Midwife:

A registered nurse additionally trained in midwifery. Has completed a course of study and a state board exam.

Certified Professional Midwife:

A professional who has met the standards of certification set by the North American Registry of Midwives. (NARM)

Direct Entry Midwife:

An independent practitioner educated in the discipline of midwifery. They may have trained through self study, apprenticeship, midwifery school, or college program. Usually serves women in homebirth only.

Licensed Midwife:

A licensed midwife is licensed to practice in the state after satisfying state requirements and passing an exam.

For more information check http://mana.org

What is a doula? TOP

Their are two differnt types of doulas. A birth doula and a postpartum doula. A birth doula is a trained professional that assists the mother and her partner in preparing for and carrying out their plans for birth. They provide emotional support, physical comfort measures, an objective viewpoint, and assistance to the woman in getting the information she needs to make informed decisions. A doula also facillitates communication between the laboring woman, her partner, and clinical care providers. There are two main organizations for doulas. They may be DONA certified or ALACE certified. DONA doulas typically support women only in the hospital and are trained only in the support of the pregnant woman. ALACE trained doulas are trained to support the pregnant woman and have additional training in  basic evaluations of the pregnant woman including basic pelvic examination. ALACE trained doulas are more often found in homebirth, although either doula may work both in the hospital or the home setting.

A postpartum doula role is not to assume the primary care of the newborn but to assist the mother and her parner in their new role as parent so that they can more easily bond with and take care of their baby. They provide education and information about baby care and breastfeeding with parents. They also teach partners and siblings how to support the mother through the postpartum period.

I need a childbirth class, where should I go? TOP

There are many different classes available and it's important to find one that fits your needs. It is highly recommended you find a class outside of the hospital or doctors office. Independent classes typically are more parent or consumer oriented. We mention here several choices available, but check our weblinks for a more complete list of methods available.

ALACE 

My baby is breech, do I have to have a cesarean? TOP

Although most of the medical community will say yes, Ina May Gaskin the "mother" of midwives will say differently. This complication only appears 3% of the time. While it may seem like the percentage is far higher this is a true percentage AT THE TIME OF DELIVERY. The problem is most practitioners prefer to schedule a cesarean prior to labor for convenience. If your baby is breech and you would like to avoid a cesarean here are some techniques to try from the Wise woman Herbal for the childbearing year by Susan S. Weed. These techniques are more effective early so should be started at 28-30 weeks. You may also wish to try a chiropractor and/or check the spinning babies weblink for techniques to encourage optimal fetal positioning. In the event all efforts to turn a baby fails you may opt for a vaginal breech delivery. Vaginal breech deliveries is a lost art due to the fact that there is a slight increase in serious complications although there is a much higher rate of complications in cesarean delivery. In this event it is important to find an experienced practitioner. In the central valley the only known source for this practice is with the residency program where the art of the vaginal breech delivery is still being taught. For further information on vaginal breech delivery Ina May Gaskin of the farm is considered the authority. You may check her book Spiritual Midwifery or contact The Farm in Tennessee. Also check the weblink www.breechbabies.com

1. The most successful do it yourself technique is a headstand while totally immersed in water. The earlier and more often it is done the more likely it is to succeed.
2. Postural inversion is done by lying down with your hips twelve to eighteen inches higher than your shoulders for no more than 20minutes two or three times a day. Start at 28 weeks and continue only until baby turns head down and stays head down.
3. Visualization is an excellent tool for turning a breech. 5 minutes of quiet a day during which you envision the fetus lying in your uterus head down. It is important to envision the desired result already existing not becoming or changing. Visualization will enhance all other techniques.
4. The homeopathic remedy is Pulsitilla 30x.
5. Swimming frequently can cause your baby to turn.
6. Accupuncture: Indirect moxa (burning mugwort) on Bladder 67 (an accupuncure point) can turn a breech. Bladder 67 is on the outside of the little toe on both feet right next to the nail. Finger pressure may work if moxa is not available. It is best to enlist someone trained in this technique. (accupuncurist, shiatsu therapist, etc.)
7. At around 37 weeks you may try an external version (turning from the outside) Seek experienced aid of a midwife of doctor for this technique. The heart rate should be monitored throughout the turning.

I had a previous cesarean, can I have a vaginal birth this time? TOP
YES! Although most women are being told differently, the American College of Obstetrics and Gynecology (ACOG) still recommend a vaginal birth after cesarean. (VBAC) ACOG says that most women should be offered and counseled on VBAC and offered a "trial" of labor. The problem is that ACOG recently changed their VBAC guidelines requiring doctors to remain immediately available during labor causing most of the medical community to refuse to offer a VBAC. You may have to do a little "shopping" to find a doctor to support your decision but remember it is your right to have a vbac, and has been shown to be no more significantly prone to complication than any other normal birth. Contact the International Cesarean Awareness Network (ICAN) for more information.

What about the pain of labor? TOP

Birth is not without pain. Many women doubt their ability to manage pain in labor and opt for what they believe to be a pain free birth. This is a huge myth. Childbirth is rarely without some pain, but it isn't necessarily unbearable. Even with the epidural it is not pain free. You have to reach a certain point in labor in order to get the epidural and you have to let it wear off in order to push your baby out. Where was the pain free part?  Many times women experience a lot of unnecessary pain in labor due to restrictions on movement by the intstitution or the drugs they do receive. Pain medication often decreases the efficiency of the contractions causing labor to last much longer than it would have without it. If you ask the majority of the women out there they will tell you the drugs didn't work. All they did was silence the mother. Is this what we want, to be silenced? The other thing that is rarely discussed is that it can raise your risk of a cesarean delivery by as much as 30%.  Could it be possible that pain is not all bad? Could pain have any purpose? How about bringing a baby into the world drug free? Jay Hathaway of the Bradley Method says:  Pain can be minimized, rearranged, changed or postponed, but I doubt it is ever truly gone. The saddest thing about anesthesia may be that even if it works, it also robs the woman of all the good feelings of birth.

There are many different drug free options available. Check out the different childbirth classes offered and find one that fits your needs. Remeber there is no secret or perfect method of childbirth, but it does help to understand the process, and to find coping methods you may otherwise not have known about. Take this aspect of the pregnancy very seriously. Contrary to popular belief it is now becoming more and more known that HOW a baby comes into the world IS important, and it is important to consider the newborn FIRST when contemplating pain relief options.  After all they are the innocent passenger.

I'd like to file a complaint against my doctor, what can I do? TOP

1. First, try to identify whether the conduct was unethical.
   
   The first step in filing a complaint is to determine whether the physician has acted unethically or unprofessionally. Opinions in the AMA's Code of Medical Ethics may be one way to determine this. The AMA and its Code of Medical Ethics have always maintained that physicians should provide competent medical care with compassion and with respect for patients. The AMA's Council on Ethical and Judicial Affairs (CEJA) has developed guidelines for physicians who strive to practice ethically. Fundamental Elements of the Patient-Physician Relationship, Opinion 10.01, outlines in general what the AMA believes to be the ethical basis of all interactions and relationships between physicians and patients. We hope it clearly articulates what the medical profession believes you can and should expect from physicians when you seek medical treatment.
   
   Other Opinions of the Code of Medical Ethics may be accessed online by searching through the broad topic categories found in the table of contents.

   Additionally, you may wish to contact one or more of the medical specialty societies. The AMA serves as an umbrella organization representing all state medical and national specialty societies. When a particular concern is related to psychiatry or surgery, for example, the specialty association may have policy or practice guidelines that are specific to that concern. Click here to view a PDF file of such organizations (requires Adobe Acrobat Reader).
   
   

2. Next, take action.
   
   Once you have determined that unethical or unprofessional conduct has occurred, there are a number of recommended steps you may choose to take. First, you may want to approach your physician and explain your concerns. Second, you may choose to report the behavior to another physician who works with your physician or who has treated you or a member of your family. Also, a number of hospitals and group practices have grievance mechanisms in place for patients to lodge complaints.
   
   Other avenues for addressing complaints include the state medical society or licensing board. These organizations have appropriate investigative bodies at the local level that can review physicians' conduct. If appropriate, the licensing board can take disciplinary action against a physician's license to practice medicine. Click here for contact information of the licensing boards and state medical societies in all 50 states.

3.  If your physician is a member of the California Medical Association, he or she is also member of the county medical association, you can discuss your problem with the medical society in the county where the physician practices.
   Click here for a list of county medical society phone numbers and websites.
   
   The county society may be able to arrange for other physicians, and possibly a mediation committee, to review the problem. Physicians who are CMA members are required to go through this dispute resolution process if a patient requests it.
   

   If your doctor is not a CMA member, or you want to take additional action, you can contact the California Medical Board's Central Complaint Unit at 1-800-633-2322. The Medical Board may to choose to investigate the matter and may submit your case to the California Attorney General for further action against the license of the physician. The Medical Board is the organization that licenses physicians, surgeons and other health care providers. They are the only agency that has the authority to impose discipline affecting a physician's license.

   
   
   

   The Medical Board of California may be contacted as follows:

   Medical Board of California
   1426 Howe Avenue, Suite 54
   Sacramento, CA 95825-3236
   Toll-free number: 1-800-633-2322
   www.medbd.ca.gov

   
   

Is it safe to take medication while I'm pregnant? TOP

The American Academy of Pediatrics have stated that there is absolutely no drug proven to be safe for an unborn baby. Many drugs are considered to be safe but have never been proven to be. When considering taking medication it is important to consider whether or not the drug is truly necessary. Would it be harmful to the pregnancy or baby if it were not taken? Are there any alternatives to the medication? It is usually best to avoid all medication in pregnancy unless the benefits of the medication outweigh the possible risk to the baby. For specific information on medications during pregnancy or breastfeeding check www.motherisk.org

I'd like to avoid a cesarean, is there anything I can do? TOP

The Public Citizen Health Research Group in Washington, D.C. has estimated that half of the nearly one million cesarean sections done every year in the United States are medically unnecessary. That is, with more appropriate care during pregnancy, labor and delivery, half of the cesareans could be avoided. Clearly there are times when cesareans are very necessary. However, cesarean delivery presents increased risks to both mothers and babies, and if those risks can be avoided, both mothers and babies will benefit. The following suggestions are things you can do to help avoid an unnecessary cesarean. By preparing throughly, you can help insure that your birth experience is as healthy and positive as possible.

Before Labor

• Read and educate yourself. Attend classes, groups and workshops inside and outside of the hospital environment.
  
• Research and prepare a birth plan. Submit copies to your hospital or birth facility, doctor or midwife, and labor support persons.
  
• Interview more than one care provider. Ask key questions, see what their responses are and how your probing influences their attitudes. Are they defensive or pleased by your interest?
  
• Ask your care provider if there is a set time limit for labor and second stage pushing. See what he/she feels can interfere with the normal process of labor.
  
• Tour more than one birth facility, note their differences, and ask about their cesarean rate, VBAC (Vaginal Birth After Cesarean) protocol, etc. Become aware of your rights as a pregnant woman.
  
• Find a labor support person. Interview more than one, look for someone who has attended several births and has background experience with normal, non-interventive birth. A recent medical journal article showed that female labor support can significantly reduce the need for a cesarean.
  
• Help ensure a healthy baby and mother by eating a well-balanced diet. Eating foods rich in protein, vitamins and minerals can prevent complications in pregnancy, labor and delivery. Salt restriction is not recommended during pregnancy. Salt food to taste.
  
• If your baby is breech, ask your care provider about "tilt-position" exercises, external version (turning the baby) and vaginal breech delivery. You may want a second opinion.
  
• If you have had a prior cesarean, seriously consider and explore the option of VBAC. According to the October 1988 VBAC guidelines from the American College of Obstetricians and Gynecologists, VBAC is safer in most cases than a scheduled repeat cesarean and up to 80% of women with prior cesarean sections can go on to deliver their subsequent babies vaginally.
  

During Labor

• Stay at home as long as possible. Walk and change positions frequently. Labor in the position most comfortable for you. Remember, squatting can help. Do not labor or birth flat on your back as the weight of your baby on the vena cava (a major blood vessel in the mother's abdomen) can decrease the blood supply and oxygen to your baby.
  
• Continue to eat and drink lightly, especially during early labor. The uterus is a muscle, and like all muscles, it must be nourished to work effectively.
  
• Avoid pitocin augmentation for a slow labor. If your labor is progressing slowly, you may want to try nipple stimulation. Nipple stimulation and loving caresses may also get your labor going when you are past your due date. Remember, delivering past your due date and/or a slow labor may be normal for you.
  
• If your bag of water breaks, don't let anyone do a vaginal examination (to avoid the risk of infection), unless medically indicated for a specific reason. Discuss with your care provider about how to monitor for signs of infection.
  
• Recent studies have shown that the routine use of continual electronic fetal monitoring contributes to an increase in cesareans without related improvements in fetal outcome. Request the use of a fetoscope or perhaps just an initial monitoring strip upon admission to your birthing facility.
  
• Epidurals and other anesthesia can slow down labor and can cause complications for the mother and baby. If you do have an epidural and are having trouble pushing effectively, let the epidural wear off and then resume pushing.
  
• Do not arrive at the hospital too early. If you are still in the early stages of labor when you get to the birthing facility, instead of being admitted, walk around the hospital or go home and rest.
  
• Find out the risks and benefits of routine and emergency procedures before you are faced with them. When faced with any procedure, find out why it is being used in your case, what are the short and long term effects on your baby, and what are your other options.
  
• Remember, nothing is absolute. If you have doubts, trust your instincts. Do not be afraid to assert yourself. Accept responsibility for your requests and decisions.
  

Copyright© 1992, International Cesarean Awareness Network

What is a birth plan and why do I need one? TOP

Birth plans are ideas and expectations that you have about the birth of your baby. They are used to help people, who come into contact with you during your labor and birth, know a bit more about you, how you have prepared for this baby, and what you want from the birth.

A lot of people misunderstand and assume that you are writing orders for people to follow. Ah, if only labor would allow us to do this. Most people have preferences of how they would like things to be done for their labor and birth. It is important for everyone to understand that this is a dream, and it is understood that sometimes this plan may need to change. Changing the plan may be necessary for the health and well being of the baby. It should be made clear to the healthcare provider that while you understand changes may be necessary you wish to have informed consent first. All of these topics should be discussed prenatally with your care provider. I prefer that they are written down and even signed by your care provider if you are going to a birth center or hospital, so that the people that you don't know, with whom you will come into contact with, will know your preferences.

There are many types of birth plans in written format. Some are many pages long, and some are just a single paragraph that simply "set the tone" for the birth. There is always a happy medium and only you will know what works for you.

If you need more examples of birth plans feel free to talk to your doula, childbirth educator, or breastfeeding consultant. There is even an interactive birth plan online.

Good luck and good birth!

I'd like a homebirth, but what if something goes wrong TOP

Birth isn't without risk. There is a slight risk that a major catastrophe could happen which could possibly be better handled in the hospital, such as umbilical cord prolapse, uterine rupture, abrupted placenta, postpartum hemorrhage. Birth is generally a slow process and there is usually ample time to transport even in the case of a true emergency. A skilled midwife provides one-on-one care and monitors the laboring woman carefully for potential problems.

Shoulder dystocia is handled better at home because of the freedom of birthing positions. If there are signs of trouble, a midwife can easily and quickly help the birthing woman get onto her hands and knees (the Gaskin maneuver, named for Farm midwife Ina Mae Gaskin). In the hospital, the beds aren't as adequate for allowing this type of position change.

The baby's oxygen supply is preserved at home by delaying umbilical cord cutting. In the hospital, the cord is cut immediately, increasing the need for resuscitation efforts.

Postpartum hemorrhage can be remedied at home by putting the baby to the breast immediately to stimulate oxytocin production and uterine contractions. Compression of the uterus can also be done at home. Some midwives carry IVs or an injection of Pitocin for these circumstances.

For true emergencies that require transport to the hospital, women laboring at home 20 minutes from the hospital have the same access to emergency surgery as women laboring at that same hospital. Many hospitals cannot prepare for an emergency surgical delivery in less than 20 minutes. The ACOG standard is currently "30 minutes decision to incision" for all non-scheduled cesarean sections.

What supplies will the midwives bring to the birth?

The most important supply is your midwife’s training. She will bring her accumulated knowledge along with her for the birth, and that includes the wisdom of her senior midwives. Most midwives bring supplies to suture, give neonatal resuscitation (complete with oxygen (usually 2 tanks) and tools to administer it to adults and newborns), and a variety of herbs and/or medications to handle bleeding. Depending on her training she may be able to give IV treatments, catheterize and give injections of medications to stop bleeding postpartum. Certain herbs and alternative treatments can be used for treatment of labor and delivery difficulties and your midwife may pack those supplies if she is skilled in their use. Different states have different views about which medications your midwife will bring, so that will vary from midwife to midwife. An important part of interviewing your midwife is finding out what she carries and what she will bring to your birth.