Tag Archives: pregnancy

The Birth Plan Myth

Are you pregnant or trying to conceive?
Are you a doula or childbirth educator?
Hare you heard of the infamous birth plan?
Are you planning to prepare a birth plan?
Do you advise your clients to prepare birth plans?
Have you googled “Birth Plan” recently?
I did… Wanna know what I found???
147,000,000 results!!

Unfortunately… most of them by and large give women the false belief that writing a Birth Plan will have a significant impact on their birth experience.  The reality is, in hospitals where birth plans are respected, they are hardly needed and in hospitals where they don’t respect them…… weeelllll  it may have LITTLE impact on what happens!

Join me THURSDAY on my next FREE tele-class as I share The Birth Plan Myth.  Learn more and register for this free call HERE

After this call you will …

  • Understand how to avoid the most common mistakes women make when creating a birth plan and have insights that will help you create the birth experience you want with or without a Birth Plan
  • Know the phrases that immediately diminish the power of a Birth Plan and the language you need to feel more confident when discussing your birth with your provider.

I hope you can make it!!
Thursday, April 18th ~ 8PM CST / 9PM EST
Join us live and participate in our Q & A portion.
Can’t make the call?
Register so you can get access to the recording.

 Don’t take a birth plan to the hospital until you listen to this call!

Register HERE

I look forward to working with you to Birth Something Beautiful!

A few nuggets from the “First Food” Forum

Two weeks ago I had the opportunity to attend “The First Food Forum: Growing a movement so all children thrive” sponsored by the WK Kellog Foundation.  It was a wonderful conference.  One of my primary goals during the event was to make sure everyone I spoke with understood that there IS a connection between a mother’s pregnancy and birth experience, and her infant feeding choices.  Too often the breastfeeding world, the birth world, the reproductive rights/reproductive justice worlds are separated. The reality is we are all fighting the same fight. We are fighting so that women… and no one else… have control over their personal bodies.  It doesn’t matter if your voice is around procreation, birth, or infant feeding choices, we have the same bottom line.  It’s a shame we don’t connect collectively more often.

Over the past year, I have learned a lot about breastfeeding that I never knew or didn’t completely understand.  Things about the culture and politics of breastfeeding,  the racism in breastfeeding certifications, the racism in breastfeeding politics and culture, the laws and payment structures of lactation and lactation support etc.  At each turn of lactation education, I was reminded that we really need to connect more.  One of my midwife mentors Shafia Monroe often talks about the Community Model of Care.  She reminds us that the Black Midwife and the tradition of Black Midwifery in this country included care of mother before, during, and after birth. AND it included care for the infant, and the family as a unit. Today we are so separate and fragmented we often work in silos.  It’s this fact that I believe is intricately linked erinatal disparities and the USA’s poor outcomes as a whole… but I digress.

Below, in no particular order, I share a few nuggets of wisdom and ideas that  I brought home with me from this breastfeeding forum.  I hope at least one of them can help you as you care for families during their childbearing years.

Nugget:   Above I mentioned the need for the breastfeeding, birth, and reproductive justice movements to work more collectively.  There is also a space to align ourselves with the pink ribbon and red dress movements.  As an aside… I am not particularly a fan of “pink washing” however I do understand that women who breastfeed are less like to get breast cancer.  That being said, as folks are sporting their pink ribbons and red dresses, as interviews are given, PSAs sent out, and articles are written, information should be shared not only about the breast cancer or heart disease, but included should be information about the link between breastfeeding and reduced risks of both.

Nugget: Have you heard about the mPINC survey? From the CDC website:  “Maternity Practices in Infant Nutrition and Care (mPINC) is a national survey of maternity care practices and policies that is conducted by the CDC every 2 years beginning in 2007. The survey is mailed to all facilities with registered maternity beds in the United States and Territories.”  These surveys create reports based on state and facility data.  They are not the same as actual report cards for a facility on breastfeeding but they certainly might be the catalyst for some facilities to change their practice. Let’s hope so.  Read more about the mPINC here.

Nugget:  Let’s talk about WIC.  Did you know WIC is the is the number one distributor of formula in our country?!?!  SERIOUSLY?? And the government pays for this formula that is doled out like candy to children on Halloween. And that’s a perfect way to describe it cause this is indeed scary.  There is so much to be said about the BILLION dollar formula industry that I will save it for anohter post but his revelation was like a slap in the face. And since were on the topic of WIC… what’s in a name?? We all know WIC stands for Women Infants and Children right?  Have you ever really thought about that name? Its mission talks about the health and well-being of women, infants, and children and yet it neglects to mention a KEY component to healthy babies and families is partner involvement.  In most families that partner is a Man. Men are excluded from the picture literally and figuratively.  The WIC office basically has a sign that says “women only.” In order to heal the family we have to include EVERY member of the family. Clearly there is some work to be done in this arena.

Nugget:  Speaking of men… One of the best break out sessions I attended was the session about including fathers in the conversations and advocacy work around breastfeeding. There is a model program in the Dallas area where men are encouraged to be breastfeeding champions… breastfeeding ambassadors.  Getting fathers on board with breastfeeding is an important factor in creating healthy breastfeeding communities.  The program in Dallas in run by Muswamba Mwamba who is a father of four, an MPH, CLC, and IBCLC just list a few of his credentials.  Are you interested in creating a successful male support program for breastfeeding in your community? Give him a call, he is knowledgeable, passionate, and personable. And most importantly, from what I learned during this session… he is a HE.

Nugget:  I posted this one on my facebook page the other day.  We have all heard the conversation about providing women with private, clean places to nurse their infants while they are out and about. The idea is that these places will help support mothers who want to breast feed “in public.” The question raised during a conversation at the form…… Does this help or hurt?? If we provide private spaces for moms does that put breastfeeding “in the closet”? If it’s in the closet, breastfeeding is still not “normalized” in our society. We certainly want to provide these spaces for moms who feel most comfortable there. But how do we walk the fine line. We don’t want these spaces to become the REQUIRED place where ALL moms HAVE to go to breastfeed. What do you think?

Nugget:  My favorite presentation of the event was without a doubt the closing session key note with Kimberly Seals-Allers founder and creator of The Mocha Manual as well as Black Breastfeeding 360. If you don’t’ know about her… you should. Her presentation was passionate, personal and right on! Two of my favorites points from her  ONE:  Never let the circumstances or the conditions in a Black woman’s life determine what you believe about her character.  TWO:  As we discuss African American women and breastfeeding, let’s not romanticize wet nursing. It was NOT a romantic event and we cannot comment on wet nursing without also recognizing the historical trauma that continues to affect Black families as a result of this practice.  I’m not giving you direct quotes.  I was too engaged while she spoke to take actual notes. What I can certainly say is this.  If anyone left the room uninspired after hearing Kimberly speak… they clearly were not awake.

Welp that’s it for now. I wish these Nuggets were real gold for you. But alas they are not. They are simply ideas, concepts and conversation starters about mother’s milk ~ That life giving substance that some call Liquid Gold.  Will any of these Nuggets help you in your work? Did any of them make you say “hmmmmm?”  If so… tell me about it!

Medication in Pregnancy: Doing Without Knowing

I just finished reading a short article about the use of Odansetron (Zofran), a medication often given to pregnant women to help them when they have nausea and vomiting. While this medication has been WIDELY prescribed for nausea and vomiting in pregnancy it is NOT approved for this purpose. 

Zofran (Odansetron) IS approved by the FDA for the prevention of nausea and vomiting associated with cancer chemotherapy and for the prevention/treatment of nausea and vomiting after surgery.  What this means is using Zofran for pregnant women is an “off label” use.  Off label usage of medication is nothing new and it happens all the time. While I do understand this, I believe that we need to be MUCH more cautious and careful when working with pregnant women.  We need to do better about understanding the risks profile of a medication before putting it widely into practice.  Doing without knowing is NOT okay.

From the article “Although most often used as an antiemetic following chemotherapy, ondansetron frequently is used off-label to treat nausea and vomiting during pregnancy. However, few studies have assessed the safety of ondansetron when used for this indication. A report in the New England Journal of Medicine [1] used Danish national data to determine the impact of ondansetron on risk for spontaneous abortion, stillbirth, major birth defects, and other perinatal outcomes.”

After reading this article, I couldn’t help but think about the horrors of thalidomide.  Sold in the late 50’s/early 60’s, thalidomide was given to pregnant women in off label use for morning sickness. It was untested and after a few YEARS of use and massive birth defects were noted, it was pulled from the market. This was all in the name of stopping nausea and vomiting, which BTW is a NORMAL part of early pregnancy and can even be normal throughout pregnancy if weight gain and fetal growth are appropriate.  But I digress and that’s a topic for another post. My point today… Doing without knowing is NOT okay.

We introduced the electronic fetal monitor (EFM) in the 1960’s in the name of preventing birth defects. The use of the fetal monitor quickly became widely used nation wide without research. It is the number one intervention on labor and delivery units today even though it is common knowledge among birth professionals that EFM has not and does not create better birth outcomes. And in the face of research that shows continuous EFM increases c/sections and intermittent monitoring is safe and effective at detecting fetal distress we continue to use electronic fetal monitors nation wide! In this case we initially did without knowing. Now we know better but since EFM has become such a part of our maternity culture that we still do even though we shouldn’t.

Honestly, this is really is just a little rant. Reading the first part of the article irritated me.  I’m continuously like… SERIUOSLY?!?!  When will we stop experimenting with women and our unborn children.  This article goes on to say that the researchers found no increase in birth defects, miscarriage or still birth. This article highlights however that we still casually do without knowing and this is NOT okay. Doctors and midwives prescribe medications and procedures all the time either without full knowledge of the risks or without full disclosure of the risks. It’s not fair to women and its NOT okay.

The take home message:  Please remember ALL substances that you take, whether it’s a vitamin or hard drugs and everything in between… ALL of them DO in some way, and in some amount, cross the placenta and get to your baby.  Whenever you are prescribed a medication… ask a question. Find out if there is a better/different option. Ask about waiting until later in pregnancy. Ask. Ask. ASK.  Don’t assume everything they give you is necessarily safe, or that it is even necessary.  What medications did you take during pregnancy? Would you take it again?  Share your experiences…

In Birth and Love
Nicole (Dont forget to follow me on twitter @SistaMidwife)

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Wordless Wednesday: Birth Herstory Conference – Get Registered!!

Birth Herstory Conference

Travelling While Pregnant ~ Some Random Thoughts

The past couple of weeks I have not been travelling/flying as much as I normally do for my J.O.B. and this has left me with time to think about things…. among them… Flying and travelling LOL.  Every time I fly I see at least one pregant woman. Usually I see a few but certainly I see at least one. Three thoughts always cross my mind….

One… Does her midwife (or doctor) know she’s travelling while pregnant? Its  not that they have to know but personally I always wanted to know if my patients were travelling. I wanted to know when, where, how, for how long and sometimes I even wanted to know why. I wanted to know so I could provide extra education about things to consider while travelling. I wanted to know so I could counsel them and encourage them to wait if they could. I wanted to know so I would make sure to pay special attention at their next appointment or so I would be sure to follow up extra special if they missed that appointment. And well… Sometimes I just wanted to know cause I was nosy. Not in an intrusive way but in an I’m your midwife, we have a special relationship and I just wanna know what your up to sort of way *_* LOL

Two… I wonder if she has her prenatal records with her. When I knew a patient was travelling away, even it were just for a day I would give her a copy of her records. This would ensure… should something happen while she was away, she would be treated better…. treated with respect.  You may  be wondering what I mean by that.  Here’s the deal:  if you are out of town, and you show up to the local hospital travelling while pregnant with a problem and no prenatal records… Let me just say it doesn’t make the hospital staff happy. Some will wonder if you “REALLY” have had prenatal care. Some nurses believe, no matter the reason, you should NEVER travel pregnant and here you are 30 weeks pregnant at 2am with pre term contractions and no prenatal history that they know of. It pisses them off to be honest and it can affect the way you are treated.  I am in no way advocating for sub par treatment based on the absence of prenatal records. I am simply sharing some information from the inside. The reality is having your records makes life easier for all of us. You, your primary provider, and the nurses and providers who will be taking care of you during your out of town prenatal visit. You may think this all sounds a little shitty but its truth. Bottom line, when you travel, take a copy of your records. You will be happy you did.

Third… And this one is all about ME!!! I wonder… Is she gonna be on my flight? Will she go into labor? And will I be able to run to the rescue AND most importantly will I get a free round trip airline ticket as a reward for my inflight midwife skills LOLOL. I know of one midwife who helped birth a baby on a flight from ASIA!! She got a pair of first class round trip tickets. That happened more than 20 years ago. These days  I would probably get a bag of peanuts LOL

Welp… There you have it.
The random thoughts that go through my head when I see a woman  travelling while pregnant.  Did you fly or travel while you were pregnant? Did you tell your midwife? Did you have your prenatal records with you? Tell us about it..