- Power point presentation on Shoulder Dystocia This is just the facts, targetted to the medical community.
- Article on the Gaskin Maneuver A study done to test the effectiveness of getting the laboring woman onto all fours to relieve shoulder dystocia. Note the paragraph that talks about the negative data of the study (or rather, lack thereof)
- Response to Shoulder Dystocia question on Henci Goer's forum There are links to a couple of other good resources in there too. Like What Every Pregnant Woman Needs to Know About Cesarean Section I mentioned Ms.Goer in my previous post. Her main site is http://hencigoer.com
- Homebirth Reference Page (UK) This site is written as a public service to provide information to women about childbirth. She's not a medical professional.
- Shoulder Dystocia Information Page This page is compiled by an ob/gyn in the US. It has detailed definitions, but I noticed that a lot of the language seemed to be geared towards families that want to sue and why the doctors are not at fault. I also noticed that he completely disregards the Gaskin Maneuver based on the assumption that it cannot be performed on a woman with an epidural. But in Ina May's study she discusses incidents where birth attendants assisted women who had an epidural to successfully birth on hands and knees. And when I found his contact page I found that he has a consulting business for shoulder dystocia litigation, so I guess I was right about the purpose of this site.
Wednesday, December 23, 2009
following last post... Shoulder dystocia resources
I though it might be useful to have some links for anyone who is interested, but I'm mainly compiling this so I can send my friend (whom I mentioned) to one place to find the information that she needs. I've included some background about who's writing the information for each site, because one should be aware of where one's information comes from.
Informed choices assumes you're actually informed...
Ok, first off, I'm not avoiding blogging about our car accident last Thursday. The basic account is on Yoram's blog, and I'm still processing and not fully sure how to express the experience, or even if I want to.
In the meantime, life - thank God - goes on.
So I have a question for you:
Scenario: you walk into a store to purchase a safety product for your home and in one aisle you are approached by a rep from one of the brands. The rep tells you why his brand is the best brand to buy. He shows you articles that conclude that its much safer than the other products for x, y, and z reasons, and that purchasing any other product will result in almost certain death (you know they do, even if they don't use those words). There is a rep from a competing brand in the next aisle and she has an equally impressive presentation.
What do you do?
Do you buy the product based on the rep's information?
Do you buy the one that's most expensive (this is safety we're talking about, expense must equal quality)?
Or do you do as much independent research as you can to ensure that you are buying the product that is going to best serve you and your family?
Would you be wary of information from someone with a vested interest in his or her product?
Why don't we treat our Prenatal and birthing choices this way? Why are we willing to be scared @$#%less by a doctor or midwife that has a vested interest in our choosing to submit to their course of action? I'm not saying it's always the wrong choice, I'm just saying that we always need to consider the beliefs of the speaker.
And we need to make choices because we KNOW, not because we're scared of the alternative.
I have been called upon by a very dear friend to re-enter the world of informed choices in childbirth. I know I'm still passionate about the issues. The pain and frustration I feel when I hear pregnant women tell birthing horror stories that could have been avoided, or handled better, if they had just been given all the facts. If they had just been treated as partners in the birthing process rather than patients who need to be saved from a catastrophic event, if birth professionals could infuse women with trust in birth and belief in their own strength and ability to birth - then we'd be hearing a lot fewer horror stories.
My friend has been told that since her previous birth was complicated by shoulder dystocia, she is at increased risk of that happening again, this is not proven. She was led to believe by her doctor that the fault of this complication lies with the mother's build. That's possible in cases of true gestational diabetes, or misshapen pelvis, but not in normal healthy women. Allowing a woman to mistakenly believe that shoulder dystocia is something that "just happens" to some women doesn't infuse women with trust and understanding of the birth process, it does the exact opposite - which, IMHO, will lead to more complications than any other risk factor. He presented her with all sorts of dire possibilities, but did not mention the possibility that the problem is often bad positioning of the mother and that repositioning the mother can and does relieve the dystocia!
Her doctor's rough estimate of her baby's size at her current 38 weeks is around 3000 grams. He told her that he wants her to be induced next week. Can we all remember, for a moment, the > 1000 gram margin of error in birth weight estimates after the first trimester???
I just have to share my findings, because the more visible this information becomes the more likely we are to demand a change in protocols.
So first of all, a brief explanation of shoulder dystocia: It's defined as a case in which a baby's head is born and the shoulders take more than 60 seconds to follow. Let me clarify further: Shoulder dystocia is not something your baby "has" it is something that happens to a baby during birth. Baby's who experience dystocia in birth are often over 4kg (~8.5 lbs) but not always, and not all babies over 4kg get stuck. The risk to the baby of this complication is that (s)he can suffer an injury to the brachial plexus nerve that threads under the clavicle. Damage to the brachial plexus can, lead to permanent nerve damage to the child's arm. Namely Erb's Palsy or Klumpke's Palsy.
All the maneuvers that have been practiced to facilitate birth and attempt to prevent injury assume that the laboring woman is lying flat on her back with her feet up in the air.
Here is a brief account of a study of the Gaskin Maneuver which was brought to the US by Ina May Gaskin. This article is easy to read and very clear.
In the study of 82 cases out of 4452 birth, shoulder dystocia occured and was relieved by the completely non-invasive method of having the laboring women turn onto all fours to deliver the baby. Some of the cases involved women who were under epidural anesthesia and were none-the-less assisted into the all-fours position by birth attendants.
Another well researched article is this one from a UK Homebirth advocate. One thing that she noted, which I feel is important to highlight is that injuries that have been linked to shoulder dystocia are not caused by birth, but by the act of extracting the baby from the mother. (those are commonly known as "iatrogenic injuries" but that term is not being applied to shoulder dystocia. It's called a "birth complication". Maybe that's because a lot of "birth complications" are actually iatrogenic. But don't get me started.)
At the moment, these seem to be my friend's choices:
a) induction at 39 weeks for same reason as above (consider risks of induction)
b) elective abdominal surgery (i.e. c/section) for suspicion of high birth weight (consider risks of surgery)
c) go into labor when baby is ready if you fall into the 2% chance that a problem presents itself, get onto your hands and knees. No injuries, no additional recovery time, in most of the studied cases the babies were delivered over an intact perineum!!
I just want her to trust her body and her baby and her strong beautiful body that God gave her.
Many doctors and birth professionals (yes, even midwives - such as the midwife who was present for Yitzchak's birth) try to attribute terms and rules to pregnancy and birth. Like trying to make a corolation between previous pregnancies and the current one for no other reason than "it happened before." Even though it is the doctors and midwives who should know best that one woman's birth cannot be compared to another's, and that even one woman's previous births cannot predict any future births. Complications happen when those doctors and midwives attempt to manage a birth based on facts of previous births. Like suggesting an induction or a cesarean based on a previous case of shoulder dystocia. Induction carries it's own risks to baby and mother. And in fact, in the cases of injuries following shoulder dystocia, one of the factors was pitocim use in labor! (causing stronger, more feequent contractions than mom or baby were created to handle, also by limiting the mother's movements due to the pitocin drip, etc...) It's the classic interventions chain that is so clearly illustrated in Henci Goer's book "The Thinking Woman's Guide to a Better Birth."
This has been a long post, and I've let a lot of my reactions to the information seep in. So allow me a little ipso facto disclaimer: I am not against medical interventions in childbirth or in any other area of medical care. I believe that the technological advancements in medicine and in childbirth have saved many complicated births that would have ended in tragedy a century ago. I am critical of the medical field of pregnacy and childbirth which dictates protocols based on fear not on evidence. I am wary of following the advice of anyone who directly benefits from that advice - which doesn't mean I won't take it. It means I will research it first. And I am critical of a generation of women who are willing to allow things to be done to their bodies and their babies that have not been completely explained to them, and without getting all the information first.
In every are of life, whether it's birth, parenting, business, relationships, or religion - if you make a decision out of fear, you are making the wrong decision - every single time. I've seen it in my own life, learned it from my mentors in every area of study and seen it in practice in the lives of those I love.
Make your choices from a place of knowledge and of trust, and if you don't have access to the knowledge that you need then find someone who does. Pursue it at all costs, and live you life in joy, in complete faith, and not in fear.
"כל העולם כלו גשר צר מעוד והעיקר לא לפחד כלל" "The world is but a narrow bridge, and the main thing is not to fear at all"
In the meantime, life - thank God - goes on.
So I have a question for you:
Scenario: you walk into a store to purchase a safety product for your home and in one aisle you are approached by a rep from one of the brands. The rep tells you why his brand is the best brand to buy. He shows you articles that conclude that its much safer than the other products for x, y, and z reasons, and that purchasing any other product will result in almost certain death (you know they do, even if they don't use those words). There is a rep from a competing brand in the next aisle and she has an equally impressive presentation.
What do you do?
Do you buy the product based on the rep's information?
Do you buy the one that's most expensive (this is safety we're talking about, expense must equal quality)?
Or do you do as much independent research as you can to ensure that you are buying the product that is going to best serve you and your family?
Would you be wary of information from someone with a vested interest in his or her product?
Why don't we treat our Prenatal and birthing choices this way? Why are we willing to be scared @$#%less by a doctor or midwife that has a vested interest in our choosing to submit to their course of action? I'm not saying it's always the wrong choice, I'm just saying that we always need to consider the beliefs of the speaker.
And we need to make choices because we KNOW, not because we're scared of the alternative.
I have been called upon by a very dear friend to re-enter the world of informed choices in childbirth. I know I'm still passionate about the issues. The pain and frustration I feel when I hear pregnant women tell birthing horror stories that could have been avoided, or handled better, if they had just been given all the facts. If they had just been treated as partners in the birthing process rather than patients who need to be saved from a catastrophic event, if birth professionals could infuse women with trust in birth and belief in their own strength and ability to birth - then we'd be hearing a lot fewer horror stories.
My friend has been told that since her previous birth was complicated by shoulder dystocia, she is at increased risk of that happening again, this is not proven. She was led to believe by her doctor that the fault of this complication lies with the mother's build. That's possible in cases of true gestational diabetes, or misshapen pelvis, but not in normal healthy women. Allowing a woman to mistakenly believe that shoulder dystocia is something that "just happens" to some women doesn't infuse women with trust and understanding of the birth process, it does the exact opposite - which, IMHO, will lead to more complications than any other risk factor. He presented her with all sorts of dire possibilities, but did not mention the possibility that the problem is often bad positioning of the mother and that repositioning the mother can and does relieve the dystocia!
Her doctor's rough estimate of her baby's size at her current 38 weeks is around 3000 grams. He told her that he wants her to be induced next week. Can we all remember, for a moment, the > 1000 gram margin of error in birth weight estimates after the first trimester???
I just have to share my findings, because the more visible this information becomes the more likely we are to demand a change in protocols.
So first of all, a brief explanation of shoulder dystocia: It's defined as a case in which a baby's head is born and the shoulders take more than 60 seconds to follow. Let me clarify further: Shoulder dystocia is not something your baby "has" it is something that happens to a baby during birth. Baby's who experience dystocia in birth are often over 4kg (~8.5 lbs) but not always, and not all babies over 4kg get stuck. The risk to the baby of this complication is that (s)he can suffer an injury to the brachial plexus nerve that threads under the clavicle. Damage to the brachial plexus can, lead to permanent nerve damage to the child's arm. Namely Erb's Palsy or Klumpke's Palsy.
All the maneuvers that have been practiced to facilitate birth and attempt to prevent injury assume that the laboring woman is lying flat on her back with her feet up in the air.
Here is a brief account of a study of the Gaskin Maneuver which was brought to the US by Ina May Gaskin. This article is easy to read and very clear.
In the study of 82 cases out of 4452 birth, shoulder dystocia occured and was relieved by the completely non-invasive method of having the laboring women turn onto all fours to deliver the baby. Some of the cases involved women who were under epidural anesthesia and were none-the-less assisted into the all-fours position by birth attendants.
Another well researched article is this one from a UK Homebirth advocate. One thing that she noted, which I feel is important to highlight is that injuries that have been linked to shoulder dystocia are not caused by birth, but by the act of extracting the baby from the mother. (those are commonly known as "iatrogenic injuries" but that term is not being applied to shoulder dystocia. It's called a "birth complication". Maybe that's because a lot of "birth complications" are actually iatrogenic. But don't get me started.)
At the moment, these seem to be my friend's choices:
a) induction at 39 weeks for same reason as above (consider risks of induction)
b) elective abdominal surgery (i.e. c/section) for suspicion of high birth weight (consider risks of surgery)
c) go into labor when baby is ready if you fall into the 2% chance that a problem presents itself, get onto your hands and knees. No injuries, no additional recovery time, in most of the studied cases the babies were delivered over an intact perineum!!
I just want her to trust her body and her baby and her strong beautiful body that God gave her.
Many doctors and birth professionals (yes, even midwives - such as the midwife who was present for Yitzchak's birth) try to attribute terms and rules to pregnancy and birth. Like trying to make a corolation between previous pregnancies and the current one for no other reason than "it happened before." Even though it is the doctors and midwives who should know best that one woman's birth cannot be compared to another's, and that even one woman's previous births cannot predict any future births. Complications happen when those doctors and midwives attempt to manage a birth based on facts of previous births. Like suggesting an induction or a cesarean based on a previous case of shoulder dystocia. Induction carries it's own risks to baby and mother. And in fact, in the cases of injuries following shoulder dystocia, one of the factors was pitocim use in labor! (causing stronger, more feequent contractions than mom or baby were created to handle, also by limiting the mother's movements due to the pitocin drip, etc...) It's the classic interventions chain that is so clearly illustrated in Henci Goer's book "The Thinking Woman's Guide to a Better Birth."
This has been a long post, and I've let a lot of my reactions to the information seep in. So allow me a little ipso facto disclaimer: I am not against medical interventions in childbirth or in any other area of medical care. I believe that the technological advancements in medicine and in childbirth have saved many complicated births that would have ended in tragedy a century ago. I am critical of the medical field of pregnacy and childbirth which dictates protocols based on fear not on evidence. I am wary of following the advice of anyone who directly benefits from that advice - which doesn't mean I won't take it. It means I will research it first. And I am critical of a generation of women who are willing to allow things to be done to their bodies and their babies that have not been completely explained to them, and without getting all the information first.
In every are of life, whether it's birth, parenting, business, relationships, or religion - if you make a decision out of fear, you are making the wrong decision - every single time. I've seen it in my own life, learned it from my mentors in every area of study and seen it in practice in the lives of those I love.
Make your choices from a place of knowledge and of trust, and if you don't have access to the knowledge that you need then find someone who does. Pursue it at all costs, and live you life in joy, in complete faith, and not in fear.
"כל העולם כלו גשר צר מעוד והעיקר לא לפחד כלל" "The world is but a narrow bridge, and the main thing is not to fear at all"
Monday, December 14, 2009
New Revelations On Winnie-the-Pooh
I love having a blog! It's this wonderful place where I can put all my random thoughts and revelations and serendipitous moments where they don't need to be at all cohesive or have anything at all to do with each other. :-)
I've always been somewhat bothered by the fact that all the characters in the Winnie-the-Pooh stories are male, except Kanga - the sweet, doting, overprotective in her words but not in her actions... (I am speaking not from the Disney interpretation of the stories, but the original A.A. Milne books.) Well, this morning I had a thought about that. Mr. Milne wrote these books for his son, Christopher Robin. He wrote them as a memorial to him, and to express the world in a way that would appeal to a little boy. Well then it makes perfect sense. As I thought about how my children engender their stuffed animals and dolls.
It's important to note that both Yoram and I are very aware of not masculinating or feminizing our children. Netanel's baby doll, which is a Cabbage Patch doll that my IL's bought him and wheres a pink and purple sleeper, is a boy baby named (affectionately) Uncle Hillel. Uncle Hillel (the doll, not my brother) has super powers to fight bad guys.
Odeliya will pick up just about anything small (seeds, sticks, dolls, bouncy balls, toy cars, etc...) and wrap it in the nearest blanket, napkin, tissue... and cradle it and call it her baby.
So in my limited experience, I would think that A.A. Milne, writing for Christopher Robin would imagine all his toys to be male. And in his make-believe world there would only be one female. The loving, doting, kangaroo momma, a depiction of his own wife, and CR's mother - embodied in Kanga.
That's my totally random thought for the day!
I've always been somewhat bothered by the fact that all the characters in the Winnie-the-Pooh stories are male, except Kanga - the sweet, doting, overprotective in her words but not in her actions... (I am speaking not from the Disney interpretation of the stories, but the original A.A. Milne books.) Well, this morning I had a thought about that. Mr. Milne wrote these books for his son, Christopher Robin. He wrote them as a memorial to him, and to express the world in a way that would appeal to a little boy. Well then it makes perfect sense. As I thought about how my children engender their stuffed animals and dolls.
It's important to note that both Yoram and I are very aware of not masculinating or feminizing our children. Netanel's baby doll, which is a Cabbage Patch doll that my IL's bought him and wheres a pink and purple sleeper, is a boy baby named (affectionately) Uncle Hillel. Uncle Hillel (the doll, not my brother) has super powers to fight bad guys.
Odeliya will pick up just about anything small (seeds, sticks, dolls, bouncy balls, toy cars, etc...) and wrap it in the nearest blanket, napkin, tissue... and cradle it and call it her baby.
So in my limited experience, I would think that A.A. Milne, writing for Christopher Robin would imagine all his toys to be male. And in his make-believe world there would only be one female. The loving, doting, kangaroo momma, a depiction of his own wife, and CR's mother - embodied in Kanga.
That's my totally random thought for the day!
Sunday, December 13, 2009
Giving Thanks
I would like to publicly give thanks to the One for constantly providing exactly what we need, and for constantly renewing my faith in my decision to follow the path that has been set for me and my family!
This morning Yoram called to tell me that the winery announced officially that the seasonal workers are going to be hired as full time employees as of January 1st! Thank you, Hashem, for providing for us on every step of this journey!
note: Hashem literally means "the name." It is the way most Orthodox Jews refer to God. I'm in search of a more personally fulfilling way to refer to Hashem, but I have yet to find one that I connect to. Just thought I'd share in case anyone was wondering.
This morning Yoram called to tell me that the winery announced officially that the seasonal workers are going to be hired as full time employees as of January 1st! Thank you, Hashem, for providing for us on every step of this journey!
note: Hashem literally means "the name." It is the way most Orthodox Jews refer to God. I'm in search of a more personally fulfilling way to refer to Hashem, but I have yet to find one that I connect to. Just thought I'd share in case anyone was wondering.
Wednesday, December 9, 2009
Yeast Update
I had to let it go. :-(
I'm going to try again and start on a Sunday and set a timer to remind myself to feed it and all that, but I started midweek, had to abandon it on Shabbat, thought I could probably revive it at some point on Monday, but then forgot about it and when I remembered it, oh boy, I did not want to go there!
Back to buying from the store for now, oh well.
I'm going to try again and start on a Sunday and set a timer to remind myself to feed it and all that, but I started midweek, had to abandon it on Shabbat, thought I could probably revive it at some point on Monday, but then forgot about it and when I remembered it, oh boy, I did not want to go there!
Back to buying from the store for now, oh well.
Monday, December 7, 2009
A Lesson in Spiriruality from a 2 year old
Yoram starts work too early to go to prayer services at the synagogue so he's been saying שחרית, the morning service at home. As much as I support him going to מנין (group sevices) there is definitely power in numbers, but I'm not complaining b/c it means he's here at 6am when Odeliya wakes up and I can stay in bed a little longer!
There's a section of the prayers during which talking and interruption should really be avoided.So Yoram has a little huddle with Odeliya before he starts that section where he tells her, "Odeliya, right now I'm going to be talking only to Hashem. It's very important and I wont be able to answer you, so if you need something you need to go up to Mommy, ok?" She nods and continues playing/eating breakfast/etc,... So the other day,Yoram finished praying and thanked Odel;iya for behaving so nicely and being so patient.
Odeliya's response: "ok, and what Hashem say?"
There's a section of the prayers during which talking and interruption should really be avoided.So Yoram has a little huddle with Odeliya before he starts that section where he tells her, "Odeliya, right now I'm going to be talking only to Hashem. It's very important and I wont be able to answer you, so if you need something you need to go up to Mommy, ok?" She nods and continues playing/eating breakfast/etc,... So the other day,Yoram finished praying and thanked Odel;iya for behaving so nicely and being so patient.
Odeliya's response: "ok, and what Hashem say?"
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