Posted on

Birth Plan Basics: FAQ about Elective Inductions of Labor

Q.  Should I have an elective induction of labor?

A. 

no3

 

 

 

 

Q.  I want to make sure that my OB is there for my delivery, should I schedule an elective induction?

A.

no1

 

Q.  My mother is flying in this Saturday, can I schedule an elective induction for Friday?

A.

no6

 

 

 

 

Q. It is my first baby and I am already dilated to 1cm.  I want to schedule an elective induction.

A.

      no2

 

 

 

Q.  I am 38 weeks and I am contracting 4 times an hour, I would like to schedule an elective induction.

A.

no5

 

 

 

 

Q. My ultrasound said that my baby was already 6 pounds at 37 weeks.  Should I have an elective induction at 39 weeks?

A.

no4

 

 

 

 

 

Q. I really want my baby to be born on 1/15/15.  Should I be induced electively?

A.

     no8

 

 

 

 

 

Q.  What about an elective primary cesarean section?

A.

no7

 

 

 

 

 

 

 

Q. If I have no medical reason to have an induction, should I let my baby choose his birthday?

A.

yes

 

 

 

 

 

 

I do not recommend an non-medically indicated elective induction of labor or cesarean section.

Inform yourself about the risks of inducing labor early.

Go the Full 40!

Association of Women’s Health, Obstetrics and Neonatal Nurses (AWHONN) 

Follow Carrie on Facebook

Posted on

When Pain Ruins a Good Time

Dyspareunia, painful sexual intercourse, is a symptom that people can be reluctant to speak with their health care team about.  It is a difficult to bring up at an appointment, but it can negatively impact quality of life.  Both men and women experience painful sex.   Although men can experience this symptom it is almost exclusively reported by women.  Up to 22% of women will experience it at some point in their life.  Dyspareunia can be associated with vulvar, perineal, or vaginal trauma and repair, but these are not the main contributors.   Postpartum dyspareunia can also occur in women who give birth by cesarean section.   According to the Mayo Clinic up to one in five women experience this symptom before, during or after sexual intercourse.  Half of women resuming sexual activity around the average 6 weeks postpartum point will experience dyspareunia.  Dyspareunia affects persons from all demographics, life stages and gender.  Although in most cases the underlying cause can be treated and this symptom eliminated, it is underreported to care givers.

Pain during sex is common, especially in postpartum women.  Are we talking with mothers and fathers about what it is, why it happens and what to do about it?  Postpartum advice about resuming sexual activity usually consists of wait six weeks and use water based lubrication if you experience dryness.  That doesn’t nearly cover the topic.  The table below is a quick break down of this condition.

 

* Watch the YouTube Video coming out this week for an in depth look into this important topic.

 

Dyspareunia

Risk Factors/ Health Status Disease Injury
Insufficient lubricationSurgeries or medical treatments.Scarring from pelvic surgeries i.e. hysterectomy, episiotomy

Radiation/Chemotherapy

Psychological problems: Anxiety, Depression, Self image, Fear of intimacy, Relationship problems, Stress

Abuse

Reactions to birth control products: creams, foams, jellies, diaphragm, latex

Inflammation, infection or skin disorderUrinary tract infectionEczema

Endometriosis

Pelvic Inflammatory Disease

Uterine Prolapse,

Retroverted Uterus,

Uterine Fibroids Cystitis

Irritable Bowel Syndrome

Hemorrhoids

Ovarian Cysts

Sexually Transmitted Infections:

Gonorrhea, Chlamydia, Herpes

Vaginusmus, Vestibulitis

Injury, traumaAccidentpelvic surgery

female circumcision

episiotomy

congenital abnormality

 

Digiprove sealCopyright secured by Digiprove © 2015 Carrie Halsey
Posted on

Why the Golden Rule Doesn’t Apply in Healthcare

The Golden Rule has been preached to those in healthcare for decades.  As nurses we were taught that we should treat our patients as if they were our mother or grandfather.  I have heard doctors concluding consults with, “if it were my sister I would tell her to do X procedure.”  I know well meaning nurses whom call all their patients sweetie, because that is how they address family and they want to treat their patients like family. Empathy for our patients, care, and recommendations based on how we would like to be treated seems to be the ethical and correct behavior.  It is not the right thing to do.  To assume that we know what a person should choose or how they would like to be addressed is presumptuous at best and patriarchal at worst.

We should leave the Golden Rule concept in the past.

The Golden Rule, although a benevolent seeming concept, is fundamentally flawed.  Not everyone wants to be treated the way that someone else thinks is right.  This is concept is clearly evident in labor and delivery.  Women that choose to pursue normal means of birth, such as waiting for spontaneous rupture of membranes, are commonly labeled as difficult.  Women that decline an epidural or pain medications are often met with impatience and pressure to not suffer through the pain.  Mothers that wish to give birth vaginally, after one cesarean birth, are discouraged, badgered and bullied into submitting to a repeat surgery.  All this is done by health care providers that believe that they are treating the patient according to the Golden Rule.  Pain is bad, so healthcare providers want to take pain away from mothers.  Vaginal birth after cesarean comes with risks and they would not choose to try it.  By attempting to apply the Golden Rule in these ways, we are actually doing more harm.

We need to think about the Golden Rule in a new way.  It does not mean that we do for our patients what we would like done for ourselves or our loved ones.  We do not decide for a woman, what she should choose to do, based on what we would want our sister to choose.  A truer interpretation of the Golden Rule is respect for our patient’s wishes, requests and declinations.  Ultimately I would want my healthcare providers to respect how I want to be treated.  That is how I take care of my patients.  If they don’t want to know the details of every intervention, then I won’t tell them.  I know that education is important, but some patients do not want to hear how a urinary catheter works.  Many patients want to know every detail, and I accommodate their requests.  Personally, I prefer unmedicated labor and feel that moms miss out on something amazing when they get an epidural.  I do not treat my patients how I like to give birth.  I support them with what they prefer, whether it is an epidural, unmediated birth or somewhere in between.

I feel comfortable sharing my opinions when asked.  I give advice, but I never assume that I know what is the golden answer for each woman.

The old Golden Rule does not apply in health care.  Patient autonomy, as a priority in our nursing care, should become the new Golden Rule.  MC900439242

 

 

 

 

 

Follow Carrie on Facebook

Digiprove sealCopyright secured by Digiprove © 2015 Carrie Halsey
Posted on

Barefoot and NOT Pregnant

file0002032880342


THE BUS!!!  I jumped up and ran outside to the bus stop when I realized I was late to pick up my boys. It was a nice day and I was picturing them alone waiting for me. In my rush I didn’t slip on my shoes. I slowed down when I saw that the bus hadn’t arrived. Then something unexpected happened.  I became aware how wonderful my bare feet felt treading along the side-walk. I could feel ever pit mark and seam in the concrete. I felt the difference in temperature when I crossed from sun to shade. I arrived at the corner and let my toes wander into the grass. What ecstasy! I walked around relishing every texture. I couldn’t remember the last time I had been outside barefoot.  I felt like I had as a child.

Being a birth nerd, I quickly realized my barefoot walk was similar to my unmedicated birth experience. My journey was comfortable and enjoyable. I felt the roughness of the cement, but it added to my experience. I noticed more about that walk  than any previous ones.  If I had worn shoes, I would have missed out on connecting with my environment.  Wearing shoes simply does not feel the same as being barefoot.  I feel the same about natural childbirth. Bringing a baby into this world is a miracle under any circumstances.  Natural childbirth is the barefoot version of birthing.  There is an added dimension that going natural brings to the experience.  The difference between my medicated and natural births were marked and undeniable.  I was more in tune with my body. I was at peace during the storm of contractions.  I felt euphoric and energized after my 3 natural deliveries, which was a surprise after my first two medicated births.

The conditions were perfect for my barefoot adventure. If the temperature had been different, or if there had been broken class on the sidewalk, shoes would have been necessary.  Similarly, it is not safe or prudent for every labor to be unmedicated.  When the conditions are right we have a choice.  Our society has become accustomed to a medicalized model of birth, just as we have become accustomed to wearing shoes.  We forget that there are other choices.  We absentmindedly slip on heels or tie on a pair of sneakers.  In the majority of our healthcare experiences we trust in the safety and necessity of our medical ‘shoes’.  Birth is not inherently medical in nature.  We have been conditioned to believe that the monitors, drugs and interventions are just part of giving birth.  Medical intervention is a luxury and a safety net for a natural process.  If a mother chooses to have an epidural for comfort, great!  If a mother needs to be induced due to a medical issue, we are grateful for the medical technology.  Just as I chose to walk barefoot, natural birth is a choice.  It doesn’t mean I think my birth is better than yours.  It especially does not say anything about any one else’s choices.  It doesn’t mean that I would want to have a surgery without medication, or try to heal my hypothyroid with herbs.  Sometimes its just nice to experience life in a basic way.  I experienced birth with all my senses and I loved it.

 

 

Posted on

Birth Plan Basics: Using BRAIN

image“Well, you are the expert; we will just do what you tell us.” Admittedly it is nice to be regarded as an expert, but these are dangerous words. There is something about wearing a white coat and a stethoscope that grants healthcare professionals great power over their patients. Intelligent women and men come to the hospital and abdicate their decision making power at the door.

Your perinatal team has varied knowledge, training, experience, bias, fear, and motivation. They are experts, but they are not perfect! They have seen a lot, but they haven’t seen everything. Some have not read a new research article in years, some haven’t slept in 2 days, and some had a maternal death patient with similar risk factors as yours. Sometimes they just want to go home on time and your labor is taking too long. Some of them are biased towards low intervention, others have never met a patient they didn’t want to take to the operating room.

When you are admitted to the hospital you will not know what is behind the smiling faces and monitoring machines. In most cases what you see is what you get. Doctors and nurses that are working hard to make ensure you and your baby make it safely through labor and delivery. There are many paths to that outcome. You need to be a part of the decision making.

The first step is to get educated prior to the delivery. Taking a prenatal class is an excellent way to prepare for childbirth. I personally recommend the Hypnobabies course, but there are many other programs available. Check with your local hospitals. They often offer low/no cost courses and you will be able to learn more about how labor is approached where you will be delivering. If you do not have time to attend a traditional class, there are self study options or online courses available. AWHONN, INJOY, and Evidence Based Birth are websites that have great information.

The second step is to make a birth plan. If a written birth plan is not appealing, you can still take time to discuss with your support person and your doctor/midwife your thoughts, goals and wishes for your labor and delivery. Having a mutual understanding can help make decisions during labor easier.

Third: Use your BRAIN! Every decision you make should be collaborative between you and your healthcare team. The most important person in the equation is you. Each time a decision is required, use the simple decision making tool BRAIN.

Benefits: What are the benefits of the intervention?brain

Risks: What are the risks involved? It is important to explore this and get the full list of risks. Many times healthcare providers will mention the most common or the most devastating risks. You need to be told all the risks to be able to make an informed decision.

Alternatives: Are there alternatives? Sometimes there are no alternatives, but in many situations there are alternative interventions that can be attempted. Find out your options and if you have an alternative in mind, suggest it.

Intuition: Take a minute to think and discuss with your support person. What is your gut telling you? Doctors and nurses use intuition to care for their patients too.

Nothing/not now: What if you did nothing? What if you waited an hour or three? Time can clarify most situations. In other situations doing nothing may cause a bad outcome for you or baby. How does doing nothing affect this particular situation?

Being empowered and educated will help you have the birth experience that is best for you and your baby.

Remember to use your BRAIN!

Posted on

What Hippies Taught Me about Birth

 

I learned a lot about labor from granola nurses and crunchy parents.  Here are my favorite lessons that I learned taking care of laboring patients whom were skipping pain medications.  It has made me a better labor nurse for all my patients.  What lessons have you learned in the world of labor and delivery?

 

Feed moms or they get cranky.

 

 

 

rose bloom
A cervix blooms like a rose.

 

 

 

 

drugs
It is okay to ask the tough questions

 

 

 

 

 

volcano
Don’t assume that all parents want vaccines, baths, disposable diapers or a pacifier, unless you want to see  crunchy mom wrath.

 

 

 

 

amniotic fluid
Babies like their amniotic fluid.  Don’t AROM their swimming pool.

 

 

 

 

hugs
Everyone needs a hug sometimes.

 

 

 

 

range
Make sure you are keeping a safe distance when its pushing time.

 

 

 

 

stay
Sometimes a mom will need you every minute.

 

 

 

 

 

hug2
Sometimes a mom only needs her partner

 

 

 

 

 

 

windy
Not all moms wear deodorant, have a fan handy.

 

 

 

 

 

red fox
It is okay to name your son Red Fox. (Or any other unconventional name)

 

 

 

 

 

cut
Wait until the umbilical cord stops pulsing to cut!!

 

 

 

 

 

 

intermittant efm
Continuous fetal monitoring is not always necessary.

 

 

 

 

 

 

 

chase
Always knock on the door first! I have been surprised on more than one occasion about what was going on in the room!

 

 

 

 

 

 

pulling out baby
Moms deliver babies, not doctors.

 

 

 

 

 

 

 

dad gaze
Watching a  dad and mom look at each other after the baby is born always makes me cry.

 

Posted on

My 10 Crunchy Mom Fails

And Why I’m Okay With It

 

1. I didn’t save my placenta to plant with a tree, eat,
make placenta prints or to encapsulate

          lone surviver

2. I tried using aluminum free deodorant for exactly one day

sure

3. I can’t bring myself to pay more for Organic

 grapes

4. Does mashing parts of my own dinner count as making my own  baby food?

baby eats

5. I was disgusted by cloth diapers in my childhood and passed on it as a mom.

diaper

6. Never made cute art out of my belly

 belly art

7. Didn’t want to have  a Water Birth

 bath

8. Never even heard of lactation cookies until this year

 lactation cookies

9. Struggle growing an herb garden

plant

10. Never declined newborn medications

 syringe

I don’t fall neatly into a mom category. I bet you don’t either! I’m a little crunchy, a bit soccer, a lot grizzly and a full time working mama. Sometimes I feel like I am a goddess of natural birth and attachment parenting, sometimes I’m driving through McDonalds for the second time in a week. That’s why I’m okay with my crunchy mom fails.  I don’t need to try to fit in to someone else’s idea of what makes a good mom.  I am a good mom. I’m a Boho mama.

I have the freedom to parent the way that I choose!

Maybe some of the above crunchiness is right for you.  Click on the links to learn more.