Finding the Right Prenatal Care Provider in the Lehigh Valley

Unfortunately in America we seem to have bought into the idea that the most important things about choosing a care provider are if they are on our insurance plan, how close they are to our home or work, and if we like the waiting room decor.  Okay…I might be exaggerating a bit on the last point…but really…the things we take into account really aren’t often important.

I admit…I’ve been guilty of the same kind of decision making.  In choosing my first OB, I just stuck with the GYN I’d seen for about 4 years prior to pregnancy.  I had chosen the practice based on recommendations from friends that they were a “Christian” practice.  I would later learn that just because the care providers shared the same religious faith with me, it did not mean they shared the same philosophy about birth.

There is a LOT of variation in practice philosophy amongst care providers, since, as my father used to say, doctors practice medicine. Its part science, but also part ideology, where entrenched beliefs often are contradicted by medical research.  Just looking at the Christian birth care providers I’m familiar with, there are some that:

  • will cut episiotomies without consent, even though research shows they are usually unnecessary,
  • state outright that they do not trust vaginal birth and much prefer planned cesareans,
  • will allow women a lot of latitude in how a hospital birth is carried out–asking her every step of the way if she wants option A, B, or C and avoiding cesarean whenever possible,
  • will attend homebirths with a woman who has had 2 prior cesareans.

During my first pregnancy I started realizing that the practice I was using was a philosophical mismatch with me, but I didn’t switch.  Why?  Because I felt too busy perhaps?  All I can say is please don’t follow my example!  It is only through the grace of God that my inaction did not result in my having a cesarean. Had any of the doctors from my chosen practice been on call when I went into labor, my birth would have been very different.  Care provider choice does matter.

So how do you go about choosing the right care provider for you? The first step is knowing what your options are.

In the Lehigh Valley we have 5 hospitals that provide birth services:

For the most part, a hospital birth in the Lehigh Valley will be with an obstetrician. There are large practices, and smaller practices. With small practices you can generally develop a closer relationship with your care provider(s), but you should be sure you understand how your provider handles being on call for births, so that you know what happens when your chosen provider is not available. Lehigh Valley Health Network has a large number of offices each staffed with a few obstetricians, but at the current time, all of the doctors form a pool to take call for births, resulting in a situation where most women who go into labor spontaneously will not have met the doctor who is on call for their birth.

It should also be noted that Lehigh Valley Health Network and the St. Luke’s hospitals are all “teaching hospitals,” so typically residents will be overseeing much of your care in labor. You can usually decline care from a resident, but your ability to do this often depends on the availability of your chosen doctor. You may also be asked if you are okay with student doctors and/or student nurses observing your care. You may decline to have students present without this impacting on how care is delivered to you.

There are a limited number of family physicians who attend hospital births, and one obstetrician practice at LVHN has midwives on staff that do a few births each year, however the odds of birthing with a midwife are very low. Women may choose to travel to Pocono Medical Center, Reading Hospital, or Morristown Hospital to birth with midwives.

A variety of midwives provide home birth services:

For women who desire a birth center environment with Certified Nurse Midwives, they will find that they need to travel a bit to access this option:

Choosing between these options will involve a mix of understanding your personal philosophy about birth and needs based on your risk level, and understanding which option is best for you given your insurance and financial situation. Some women shy away from home birth or birth center birth because of lack of insurance coverage, only to find that using these options can be less expensive than using care providers that are covered by insurance.

Many women will ask in various local mom groups for recommendations for care providers, and this can be a great thing to do. But the result is often just a list of women saying “I used Dr. Smith and loved her!” That’s not enough to go on. What did the woman love about Dr. Smith? Is that a feature that you are looking for? So make your questions a bit different. Instead just of asking for names of doctors, ask “who was your birth care provider, and what did you like and dislike about her?” This can give you a bit more of a window into the care providers’ styles. In more in-depth conversations you might also ask what routine prenatal appointments include, how long wait times are for appointments, what is the care provider’s policy on attending vaginal birth after cesarean (an important question even for first time moms to ask!), and what protocols does the care provider follow during the birth?

If you are considering a home birth in the Lehigh Valley, you will have to be more proactive about evaluating your chosen care provider. Consider using the PA Midwives’ Alliance guide Know Your Local Midwife to help you decide what questions are important for you to ask.

I recommend that women interview at least three care providers before choosing one. I also recommend touring 2-3 birth places (and perhaps ask the nurses what care providers they see provide the style of care you are looking for).  I have to admit, I didn’t interview my care provider in my first pregnancy. I distinctly recall how unprepared I felt to make choices about maternity care early in my first pregnancy; and given that, I probably would not have made a good choice even if I had interviewed several different care providers. For this reason, I strongly encourage women to take a healthy pregnancy class early in pregnancy that covers care provider options (as my 2 week Healthy Pregnancy class does). I also encourage women that you can switch care providers at any point in pregnancy when you realize a different care provider would be a better choice–I have even had clients who switched care providers in labor!

Even with my second pregnancy I only interviewed one care provider–the one who had been the on-call doctor when my first was born.  It wasn’t until my 5th birth that I actually interviewed 4 different care providers (and kind of half-way interviewed a 5th over the phone), and chose one.

She wasn’t covered by my insurance.  And yet she probably cost me less than either of the “in network” providers I interviewed would have cost considering that I would have had a $300 deductible and 20% co-pay for the in network providers who were both hospital based.

She was the furthest away from my house.  Of course after signing up with her I found out she would do home visits for a small fee, and so my appointments literally took only 30-60 minutes of my time, and ALL of that was face time with the midwife, unlike the 2-ish hours I often spent on appointments during my first pregnancy between driving (just 10 minutes from work!), waiting in the waiting room, having vitals taken by nurse, waiting in the exam room some more…then seeing the OB for 5-10 minutes.  Even when I did drive to her office for two visits, I still only devoted a bit less than 2 hours to each visit, and saw my midwife for 30-ish minutes.

In the end, each woman’s choice of maternity care provider will be made based on a unique set of criteria. Making the decision thoughtfully will help you to be most satisfied with your care.

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Motherhood…Glorified Babysitting?

supernanny

Do you remember Jo Frost – Super Nanny?  I remember watching her show, mesmerized at her wisdom and ability to bring order to chaotic homes across America and the UK.  Even today, at 45 years old and without children of her own, she strives to teach families how to manage and discipline their children with strict routine and order.  I do wonder if her philosophy would change if she had her own children….

Long before having my own children or even getting married, I had the privilege of caring for other people’s children. I believe I was 11 years old when I first started babysitting. I instantly became infatuated with nurturing and caring for children and did so as a nanny, babysitter and mother’s helper for many years. I didn’t start having children until I was 30 and now almost a decade later, I have 4 children of my own. When you work with children full time but they are not your own, it is easy to say you know a thing or two about them. And that’s a fair statement. However, everything changes the moment that baby is yours. You suddenly find yourself as the primary caregiver and you can’t always hand them off to someone else when you want or need to.

Immediately upon bringing them home from the hospital (and maybe from weeks of uncomfortable sleeping in the last weeks of pregnancy) you are sleep deprived. And this isn’t the kind of exhaustion you describe after an extended night of fun out with your girlfriends! Exhaustion means something entirely new to you when you become a mother. Now, take that exhausted mother and force her to go grocery shopping. Her family needs to eat and grocery shopping is a necessity in order to have the food to prepare. But little baby (who of course is along for the shopping trip) is restless and just can’t get settled. She needs to shop and the baby won’t stop crying! I promise you that the only people in the store that have a compassionate heart towards that struggling mama and baby are other moms. The demands of motherhood are real and they don’t go away for a long time. It only changes as the child grows and as the mother matures in her role.

Motherhood is VERY different than babysitting though it doesn’t seem so from the other side. Besides physical, something very psychological happens. You love beyond any capacity you thought you knew you had in you. And in those moments – you know – the ones where you’ll do anything to make them feel better or just to gain that moment of peace and serenity? You will grasp at anything in that desperation to make things well again. The difference here is that this desperation for sanity is predominately motivated by an unexplainable love for this dear child. This again is just something you can’t explain to a woman who has not yet had her own children. It’s something she learns the moment her new baby is placed in her arms after 10 months of backbreaking pregnancy and 12+ hours of maddening labor.

Another important thought to consider is that babysitters get paid….MONEY! Could you imagine if mothers got paid for their work? Might we do our jobs better knowing a paycheck was attached to how well we performed?  According to Forbes.com, mothers would make $115,000 yearly if they were paid for their stay at home work! Clearly, mothers are not motivated by their invisible salary. While babysitters make $10-$20 an hour for their work, moms are motivated and paid in love and the satisfaction of their children’s happiness. I once heard a saying that goes like this: “A mother is only as happy as her saddest child.” Isn’t this so true? A babysitter may be annoyed or frustrated by the saddest child in her care, but at the end of the day, she goes home and moves on, only to long forget someone else’s sad child.

Here’s the hard part for moms. Children don’t come with manuals.  And chances are, the more you have, the more different each of them will be from each other! Take a poll with moms and you will find that most of us are just trying to get through one day at a time, trying to find a routine that involves peace and some sanity; even better if it comes with a meal plan and a house cleaning strategy. The uncanny truth about this is that those same moms will just finally start to find that routine and BAM! Pregnant with the next baby.

My last words to the women out there reading this: If you are the babysitter, non-mother out there reading – Enjoy your peace. Enjoy your sanity. Enjoy your rest.  Do your best not to judge us moms who are in the thick of it. It’s not as easy as some may make it look.  One day you’ll be in the thick of it too and you’ll want that added measure of grace.   Oh!!  I can’t forget to say THANK YOU!  We appreciate you… we really do! You are the ones who help us find our sanity again when you give us those few hours of peace back.
Thank you!

Fellow mamas – the best thing any of us can do to prepare ourselves as a new mama – whether its our first baby or fifth, is to keep an open mind and heart and be willing to try anything if it may benefit us and our little one. Never say never – as in “I would NEVER let my baby cry it out!” or “I would NEVER wear those crazy baby wrap things!” or “I would NEVER use a pacifier!”. It’s usually the things you swear you’ll ‘never’ do, that you wind up needing to do to gain that sanity. Don’t judge other moms. You haven’t lived a day in her shoes and you have no idea why she is making the decisions she’s making or doing the things she is doing.  And you have no idea how you would react if you were in her place because you’re not. Keep on keeping on. Don’t worry about the mess. Enjoy every moment you have because it goes so fast. And lastly, call your babysitter and do something nice for yourself! You deserve it!

4kids

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Buyer Beware…Your Insurance Might Not Cover That Test

More and more I’m seeing people reporting that they had what they considered to be routine medical care during pregnancy, and they were shocked to find that their insurance did not cover the costs. Here are some of the situations that have come up:

  • A woman had routine first trimester blood work drawn at the lab in the same building as her care provider’s office. She verified in advance that this lab was covered by her insurance. But she received a bill for services because the lab was considered to be a “hospital” lab, and since she had not been admitted to the hospital for treatment, she could not use the lab.
  • A woman had a routine first trimester ultrasound at the ultrasound clinic in the same building as her care provider’s office. Like the situation above, she verified in advance that the clinic was covered by her insurance, but again found the services were not covered because it was an “in hospital” clinic, and she had not been admitted to the hospital for treatment.
  • A woman had a genetic screening done that was optional, but she did not know it was optional, nor did she know that she would be billed $800 for it under her high deductible insurance plan. Because her pregnancy straddled two calendar years, she did not max out her deductible the first year.
  • A pregnancy spanning two calendar years will result in needing to meet the insurance deductible twice–a significant consideration for pregnancy timing if you have high deductible insurance.
  • Multiple women have shared about being billed for the newborn hearing screening that is done in the hospital. The company that does the hearing screening was not “in network” for their insurance, even though the hospital was. This screening can be done after hospital discharge with a provider who is in network if the provider in the hospital is not in network. This can happen with any specialist that is not a hospital employee that is involved in a person’s care while in the hospital. I almost had an entire hospital visit not covered by my insurance because the doctor who was on-call for my doctor who authorized me to use the Emergency Room (when I was in excruciating pain from a torn ligament in my knee) was not an “in network” doctor! He wasn’t even involved in my care beyond the quick phone consult to make sure my injury was serious enough for the ER vs waiting through the weekend to go to my primary care doctor on Monday.

I share this with you as a note of caution. You should not expect your medical care provider to be aware of the nuances of how your insurance functions. They are an expert on your medical treatment. I find that in general, the doctors don’t know a lot about the insurance issues. They have an insurance billing person (or persons) in their office…and they trust that person to know everything their particular office needs to know. Once you walk outside of the doors of their office…they don’t know what goes on with insurance unless you go back and tell them.

I even have had doctors express extreme shock at the price of meds…they don’t know what they cost ($75 for a prescription antihistamine, when a $10 box of Benadryl was an acceptable alternative), or know things like dosing amoxicillin tablets 3 times a day (500 mg each dose) costs less than a third as much* as dosing 2 times a day (875 mg per dose). They just write the script for 2 tablets per day, thinking it is easier for a patient to remember to take the pills 2 times a day rather than 3.

Unfortunately, for you, that means that you might need to have an MBA in medical insurance policies…

*In the case I know of where this came up…the pharmacy only had the name brand amoxicillin in the 875 mg dose…at a price of $75 for 10 days’ treatment, compared to $5 for the generic amoxicillin 500 mg dose.

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Labor Induction, Dinner and a Date

pregnant_women_picturesOften when I talk to women in the last weeks of pregnancy, what I hear is a recollection of all the “natural” methods they have tried to induce labor. It’s an experience that I haven’t much experience with. I have to admit, the most after my due date that I’ve gone was 2 days…and I was in denial that I was in labor when it started because “I’m not having this baby for another week–I have things to do!” For the most part, this was my pregnancy experience–it was only my 5th baby when I reached a point of just being D.O.N.E-DONE!, and that wasn’t until I stood in the preschool pick up line in tears the day before I went into labor with her…so I didn’t have much time to try natural labor induction with her.

So anyway, bottom line…I’ve not been one to eagerly pursue induction (though I was induced with my second–water broke but no labor). But I’ve also not gone through the waiting many women experience when they go past their “best before date.” Oh, wait, that’s an “ESTIMATED due date!” I can’t really say if I wouldn’t be in the “what can I do to get this baby out?” camp if I did go much past my due date. But the thing I find most disturbing is the women who are starting the natural induction techniques as early as 37 weeks.

Just because it is “natural” does not mean that it is “risk free,” which I think is a distinction that many people fail to make. Poison Ivy, Oak, and Sumac are all natural. So is a bite from a Viper. Blue and Black cohashes have been linked to heart problems in the infant. Castor oil usually causes the mother to feel nauseous after just one dose, causes diarrhea, and has limited research as to it’s effectiveness. Nipple stimulation and walking really don’t seem to work to induce labor so moms may needlessly tire/discourage themselves trying these methods (but they can be very effective for augmenting labor). Most importantly, if the natural method does trigger labor a few days sooner than it would have started on its own, who is to say that the baby is quite ready yet? Or the mom’s body? My own experience with having my membranes stripped in my first pregnancy (without my consent) was that I had a very long labor–I think in part because my body was not quite ready to labor yet. There were other factors too, but I think that one was high on the list.

So when moms ask my opinion on labor induction, my first advice is that they try to hang in there…the average nulipara (woman who hasn’t given birth before) will be pregnant for 41 weeks 1 day, while the average multipara goes to 40 weeks 3 days. So for many women, they are stressing about being “late” when they haven’t even reached the average gestation for their situation. Further, for there to be averages, some moms have to go even longer than that. Adding to the reasons to avoid induction is research that indicates that induction in a first time mom may double or even triple the risk of having a cesarean.

Beyond that, I encourage moms–really and truly–to QUIT trying to start labor. Try to take their minds off the question of “will I EVER have this baby???” I know…hard to do. With my 4th pregnancy I experienced for the first time being tired of being pregnant…and I was only 6 months along–LOL!

But seriously, adrenaline, created from stress, can inhibit labor. So I think that trying to relax and just giving the whole “I’ve got to get labor going!” thing a break may be very helpful.

I encourage expectant women to take a day for some pampering. If she has older kids, she might want to get them involved in this, though she should use her own judgment on whether they would relax her, or keep her “on the ready.” Anyway…I encourage a woman to take a nice long soak in a tub complete with dim lighting, scented candles, and some soft music. When she gets out, perhaps her kids or partner can have heated towels waiting, and maybe they could have been preparing the master bedroom to be a haven while the woman was bathing–putting fresh sheets on the bed, setting up a light snack and some candles, music, and dim lighting. Let the kids (if they can do it well) give a foot massage. Let partner give a full body massage (kick the kiddos out of the room for this of course–LOL!). If the massage leads to something…hey, go for it. But if it doesn’t–a woman shouldn’t stress herself and think “I need to have sex, it might kick start labor.”

The woman should then take a nap. A nice, long, deliciously decadent one. One of those ones that the woman wakes up feeling kind of like a cat who was basking in sunlight, and wonders with thankful amazement at how the kids didn’t wake her up (because they were sent outside or to friends to play, or her partner kept them busy reading books).

When she wakes up, her kind partner will have dinner ready for her (yes, he will, let him know that is his job. 😉 ), or will have made arrangements to take her to a restaurant that makes her feel relaxed & pampered. This is not the time for a buffet or fast food. The woman should let someone else serve her.

The woman can tuck her kids into bed to get those nice maternal hormones going. Then more massaging if she is in the mood–at the very least, a nice cup of chamomile tea, and off to sleep early.

If calming down the adrenaline in her system allows labor to begin–GREAT! She is well rested for the task. And if it doesn’t–GREAT! When is she going to get a chance to rest like that after the new baby comes? Taking the break will allow her to be more energized to pick back up on trying some way to give labor a kick start.

And that’s it. It’s worked for several of my clients. 😉

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The Problem with Lead Based Paint in Allentown

houses3Knitted in the Womb is happy to share this guest post from Steve Riedy of Steve’s Painting Service, LLC. Steve’s Painting Service, LLC is a Residential Re-Paint (RRP) Lead Free EPA Certified Firm.

Social media is buzzing with concerned parents who saw a report that 18 cities in Pennsylvania have more kids with elevated lead levels in their blood than Flint, Michigan.

City Lead Levels

Understandably, this has people concerned, especially here in the Lehigh Valley. As a father and a professional painter, I understand this concern. Lead poisoning in children can lead to symptoms that resemble ADHD, can impair a child’s ability to learn, and has even been linked to an increased tendency to commit crimes as an adult. None of us want that for our children!

Why does Pennsylvania have so many cities where many children have elevated lead levels? Well unlike Flint, Michigan, where the source of the lead contamination was the water pipes; the primary source of lead contamination in PA is lead based paint. Data from the 2010 Census showed that Pennsylvania ranks third in the nation for having the most housing units built before 1950 (36%) and fourth in the nation for having the most housing units built before 1978 (70%). Many people mistakenly think that the only risk is when paint flakes off, and young children eat the chips directly. However, the paint can slowly wear off as doors and windows are opened and closed, creating a dust settles onto the child’s toys where it again is consumed, or onto the floor where it gets onto crawling children’s hands that they then put into their mouths. Exposure to lead is usually a long term cumulative problem, not a single event of eating a few flakes.

So what can you do if you think your child is at risk of having elevated lead levels? First you should contact your pediatrician to discuss testing. Testing involves taking a small sample of blood, and is relatively inexpensive. Children’s blood lead levels tend to peak when they are about 2 years old, then will naturally decline since they aren’t putting as many non-edible objects into their mouth, and the body will naturally remove lead.

Proactive things you can do to prevent elevated levels in your child are:

  • Check your home for lead based paint using test swabs that you can obtain from a home improvement store or Amazon.
  • Feed your child a balanced diet including plenty of calcium and iron, as this can reduce absorption of lead.
  • Remove your shoes when you enter your home to avoid tracking contaminated soil inside. Also wash your hands after working or playing outside.
  • If your home was built before 1978, be very diligent about changing the filter on your heating/cooling system monthly if you have forced air, and be sure to use HEPA filters. (Little known fact…if you don’t change your filter frequently enough, it may cause your blower to completely seize up and get distorted, leading to a very expensive repair. Don’t ask me how I know this… 😉 )
  • In some cities in PA, including Allentown and Bethlehem, you may be eligible to get funding to help reduce lead hazards in your home through the Lead Hazard Control Program.
  • If your home was built before 1978, when you are doing any home remodeling projects, it is best to wet down any surfaces that might contain lead prior to cutting or sanding them. Even carpets should be misted with water prior to ripping them up. Be meticulous about cleaning up any dust using damp cloths, or a vacuum equipped with a HEPA filter. Avoid sweeping up dust, as this will make it airborne.
  • epa_leadsafecertfirmIf your home was built before 1978, hire only home improvement contractors who are certified to work with lead based paint. A painting contractor who has this certification is allowed to use this logo in their advertising materials:

 

This is Jenn taking over now to tackle something I love to do–plugging & chugging numbers, and evaluating the quality of data behind research or media reports.

Most of all, I would encourage most parents to remember that the media makes their money out of creating a strong emotional response, when a thoughtful response might be less distressed. It is said many times that there are three types of lies: Lies, Damn Lies, and Statistics. I think in this situation, misuse of statistics are getting things all messed up.

Yes, 1 in 4 children in Allentown who were tested for lead levels showed elevated levels, and for those children, we are concerned, and in fact those of us who are so privileged as to be taking the time to read social media stories should realize that we need to speak up on behalf of these children. But the little details in that statement are important. Is this data REALLY comparable to the reported rate of 3.21% of children in Flint Michigan having elevated blood lead levels? It turns out that its not, and that with the data available, it is impossible to make an apples to apples comparison between Flint and PA data.

The first problem is that the 3.21% figure used by the Vox reporter Sarah Frostenson is data that was released by the State of Michigan specifically to refute a “whistle blower’s” claim that children in Flint were experiencing increased cases of elevated lead levels. In other words–this data was specifically mined–mixing high and low risk neighborhoods–to make it appear that FEWER children had elevated lead levels than really did. Further, this data was for children ages 16 and younger, while the data Frostenson used from PA is for children 7 and under. This is a significant error, because as children age they are less likely to consume lead dust from toys or their hands, so their lead levels drop.

The data from the whistle blowers–Hurley Children’s Hospital and Michigan University, found that in high risk neighborhoods, up to 6.2% of children ages 5 and under measured had elevated lead levels; but this was likely a significant underestimate due to formula fed infants who consume a large amount of tap water not being tested because they weren’t “old enough” to have been tested yet.

Using the same PA Department of Health report that Frostenson used, I was able to calculate that in the 20 cities she featured, 3.8% of children under the age of 7 who were tested had lead levels above 10 microgram per deciliter, while only 2.2% of children aged 16 and under had this elevated level–a decrease of 42%. Unfortunately there is not similarly comparable data given at the 5 microgram per deciliter level, but I think it would be a reasonable expectation that we’d see the number of children diagnosed at that level drop a similar amount.

In addition to this, the PA Dept of Health report does not specify how the 5 microgram per deciliter numbers were measured. Based on comparisons of various charts in the report (page 45 and 50), it is a reasonable guess that they come from single “finger stick tests,” which have been shown to have an up to 70% false positive rate.  What this means is that finger stick testing is merely a screening test, and that when children test positive to this test, they should then be re-tested via a more accurate venous blood draw, significantly reducing the number that show an elevated blood lead level.

Finally, this consideration applies to the data for both Flint and PA. Not all children are tested–in fact, only about 1 in 5 children in Allentown are tested. In addition to this, the children tested were nor a “representative sample” of all children in the region. Lead Poisoning Lehigh County Map2Because Medicaid rules* in PA require lead testing of children on Medicaid at ages 1 and 2, children who are tested are more likely than the general population to fall into the highest risk group–that is, children who are more likely to live in poorly maintained older homes–usually rental units.  We should also realize that this finding was a clustered finding. Overall, in PA, of these high risk children who were tested, fewer than 1 in 10 had elevated blood levels on initial tests, and less than 1 in 7 children were tested.

The bottom line as I see it, is that once we get accurate levels of exposed children in Flint, we will be horrified at how many are affected. As for the real numbers of children exposed in PA…they are MUCH lower than reported in the chart in Vox.

morningcallBe sure to contact Steve’s Painting Service, LLC for all your painting needs! Steve’s Painting does commercial and residential painting jobs, interior and exterior, and always offers free quotes. Call 610-762-6049 now!

*Though this is the “official” rule, it is often not implemented as mandatory testing, but rather testing that is offered. As a result, the total number of children tested is lower than the total number of children on Medicaid in PA.

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What is a Doula Doing in the OR?

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Outside the OR in scrubs, waiting to be called in.

The role of a birth doula is quite simple, yet versatile. Breathe, encourage, massage, listen, serve… There’s not a whole lot of non-medical support tasks that a doula won’t do. Our main goal is to fully support the birthing mom, alongside her partner, by helping to create an atmosphere that accommodates the birth goals and experience the mom is looking to achieve. The ultimate end goal of a doula is a supported mom and partner.

While it has been most common that doulas are hired by women looking to birth in a low intervention environment, the tides have changed. The use of a doula has been found to be applicable in all birthing scenarios. More and more women are hiring doulas even as they plan for an epidural, medical induction, or even a cesarean birth.

Abbey Quote 1It’s not that the spouse, mother, sister or nurses aren’t enough. That’s not the case at all! It is that there is something invaluable about having a personal advocate who is educated and trained, who can be objective and supportive. Family members often find it hard to be objective when their loved one is in pain. While expectant women may have read every pregnancy book and website recommended; most women will report that in the moment of decision making, exhaustion, and discomfort, they forgot nearly everything they studied.

A question is often also asked about whether the nurses can fulfill the role of a doula. The nursing role is to be a patient advocate, and as part of that role they provide emotional and physical support. They also fulfill an important medical role that doulas are not qualified or trained to do. However, many times the birthing mother is not a nurse’s only patient; and so the nurse cannot be dedicated to providing continuous emotional, physical, and medical support to just one person.

That’s the beauty of a doula. A doulas is your personal helper that you handpick for yourself. She is objective, educated, trained; has experience in different birth settings and scenarios; and will remain with you from start to finish. We can’t make decisions for you, and we definitely can’t perform medical tasks; but we can coach you, encourage you, and offer you guidance through your birth so that you feel like you made educated and informed decisions to achieve the birth you desired.

Sometimes birth doesn’t go as planned, and emergencies happen. Cesarean births are now the most common procedure performed in US hospitals. So how does a doula work in the OR? Why would one belong in there if they are a non-medical support person?

I will tell you truthfully – up until recently, my answer may have been more apathetic. But about 6 weeks ago, I attended a cesarean birth that I will never forget.

It was a planned surgery. The baby was transverse in presentation and so we knew going in that if the baby hadn’t moved, there was no hope for a vaginal birth. Both the obstetrician and the anesthesiologist were happy to have both myself and the baby’s father attend the birth in the OR. This is not very common in our area – but we were all glad that everyone was in agreement.

The medical staff wheeled the mom into the OR. Her husband and I put on our gowns, masks, hats, and booties; and waited for them to get us.

As we entered the OR we saw the mom laying on the operating table, and her arms stretched out. The medical staff placed two small stools to the right of her head where her husband and I sat while we waited for the baby to be born. At this moment the mom was in pain. She could feel tugging, pulling, and pressure; and she was visibly upset. Her husband whispered encouragement to her as I held her hand.

Within a few minutes the baby was born!

IMG_3826The mom was able to have skin to skin contact with her baby for almost 20 minutes, which is something I have never witnessed in the OR before.

I pause here and reflect on this precious time because so many cesarean births do not offer this significant opportunity. Research shows that the first 2 hours of a baby’s life is a time where the baby is very aware of the mother – taking in her voice, smell and making meaningful eye contact. This makes this time a very important bonding time.

Many women who birth via cesarean section have missed some, most, or all of this vital time; and it often results in mothers feeling sad, unfulfilled, and regretful. So, for me, witnessing this moment was beautifully epic!

IMG_3811About 20 minutes after birth the mom was in a lot of pain. This was the same time the dad went with the baby to the nursery, where he was able to continue skin to skin until the mom was moved to recovery. This is where I really came into good use! The mom needed significant encouragement and support through the pain and fear she was experiencing. She knew me and felt comfortable with me. I spoke encouraging words to her; brushed her brow with a cold cloth; held her hand; and when the moments were just right, would crack a personal joke or two to take her focus off her fears. I stayed with her throughout the entire time in the OR.

Even though both parents knew they were going to have a cesarean birth that day, neither one would realize until afterwards that the mom would need hands on support during the surgery. Had the mom known in advance; she might have been conflicted between wanting her husband to stay with their baby, and not wanting her husband to leave her side. Had her husband known how much pain she would be in, he would have felt terrible for leaving her. But with their caring doula by her side, she wasn’t left alone. The dad was able to tend to the baby, and knowing that his wife was loved and encouraged by someone who knew her, and someone she bonded with before the surgery. This made a significant difference in the way she felt supported. In her words

I can’t say enough about how grateful I am that Danielle was a part of my birth experience… I felt so grateful to have someone so supportive and experienced to go through the journey with me.  At my c-section, both my husband and Danielle were allowed in the OR. I didn’t think I would “need” a doula with me during a short surgery, but after my husband left with the baby, I experienced a considerable amount of pain and fear for the next hour that I wasn’t expecting at all. …I’m so glad I was able to have her with me during this time in my life. Her sense of humor, warmth, strength, and birthing knowledge were invaluable to me.

Everyone in the OR was needed, and their jobs were done best when they fulfilled their specified roles. I am glad to see more OB’s recognizing the benefit of allowing doulas in the OR. I firmly believe that any birth – natural or medical – outcome is improved when the mom feels completely supported. That’s what doulas strive for! It’s what they add to the birthing environment and team. Sounds like a win-win situation to me!
IMG_3835

Congratulations A & C! Story and photos used with permission.
Abbey Quote 2Do you want to learn more about having a Knitted in the Womb doula at your birth? Call or text us now at 484-619-3606

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Is Nursing in Public Disgusting?

TJoey Salads NIPhe internet is buzzing with videos of people reacting to women nursing their babies in public. Or pretending to nurse a doll, as is the case with the Joey Salads video that has gone viral. Many new moms might be concerned by these videos, thinking that if they nurse in public, they might face the same kind of scorn as is displayed in them.

This concern is far from new. In 2006 the August issue of Baby Talk magazine ran a cover that featured a baby latched up onto the breast, and looking up at his mother. Before the end of July (and remember, this was the AUGUST issue), the magazine had received 700 letters to the editor about the cover, and ultimately the magazine would report getting 5000 letters to the editor about the cover. I thought those baby eyes gazing up at his mother were just adorable, but apparently some people are more concerned about the exposed breast.babytalk 2006 cover

Never mind that many of the people who were so concerned are likely the same ones who stay up to watch the Victoria’s Secret special on TV.

CBS Channel 3 News out of Philadelphia covered the story at the time. Of course they talked to some newly minted moms (still in the hospital) to get their take on things–one supportive of the cover, the other not so supportive. The “not so supportive” mom claimed that she had tried to breastfeed, but it was just too hard. That is really sad that she didn’t have the support she needed to even make it a couple of days!

She then went on to pontificate on how she feels that breastfeeding shouldn’t really be pushed on moms so much because society really doesn’t accept nursing in public:

“There’s alot of pressure to breast feed,” said Agnes. “In today’s society, you can’t do it anyway. People look at you like you’re disgusting,” she continued.

I’ve breastfed 6 kids in public, and never once got asked to move. I would guess that half of the time no one even noted what I was doing. At least 5% of the time I actually got positive comments or encouraging looks. I know there are some moms that do get asked to move…but come on…here is a mom with her first baby not even out of the hospital yet, and she thinks she knows that society at large is going to make her feel uncomfortable if she were to breastfeed in public?

This is a problem, and one I think that in a way, “lactivists” have created. And continued to nurture for well over a decade. What is the problem they have created? A problem where new mothers are scared to breastfeed in public because they are scared of facing humiliation. I think that making a huge issue out of every situation where a store clerk who likely doesn’t even have children asks a nursing mom to move really isn’t helping paint a portrait of nursing as a natural part of public life.

I think that moms who have nursed in public and not had it be an issue need to speak up more to let the next generation know that it really isn’t that big of a deal. Recently in a Facebook group of mostly Lehigh Valley area moms, someone asked the question of whether moms have had problems nursing in public. Of over 50 women responding, only 6 reported having ever had any kind of a negative response to them nursing in public, and those negative responses were very mild. This certainly makes one wonder how Joey Salads was able to spontaneously get multiple people to make negative remarks about a woman nursing in public.

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Will Your New Year’s Eve on the Town Hurt Your Baby?

Keeping in mind that I drink a glass of wine MAYBE once every month (the Cranberry Wine from Sorrenti is a seasonal favorite in our house), and I’ve got some “sparkling cider” chilling in the garage to ring in the New Year with…so its not like I’m some kind of a lush…

It’s New Year’s Eve Day and if previous years are any indication, the internet will be awash in what else…articles that intend to instill fear in breastfeeding mothers who just wanted to enjoy a toast to the New Year…

Mother Kills Son While Breastfeeding Him Drunk” reads the headline…which is of course eye catching. But the story its self is full of holes. Continue reading

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I Want to Potty Train My Child…But How???

My husband and I like to joke that our firstborn child spoiled us as a small child…really, she’s been pretty easy all along. Potty training was no exception. One day I was out shopping with Jessica and Katie, and Jessica saw a colorful potty seat that she decided she wanted. She started pointing at it and yelling “potty, potty!” I had the exact same potty seat at home–but it was all white. But you had better believe that I bought the colorful seat! Once I had it home she basically potty trained herself. I just dressed her in sundresses with no panties for a few days, and cheered her on.

Needless to say…I was pretty self assured that I had the parenting thing–and the potty training thing–all down pat.  Until my second daughter humbled me. As she so enjoys doing. 😉 Let’s just say that she was NOT easy to potty train, and I had to eventually realize that I could not control her…that she needed to decide when she was ready to potty train. She also had the pleasure of saving up her allowance money to buy her own new panties since I started throwing soiled panties in the trash. One trip to the store where she bought panties while her older sister bought a Barbie was pretty effective.

I’ll admit, I struggled with potty training children 2-5. Pants or no pants? My boys answered the front door with their family jewels on display more than once! Pull ups, or no Pull ups? I felt that was answered pretty definitively when my second son kept calling them diapers.

By my 6th child I had been introduced to the “dry pants reward” system. I found it to be the quickest and most effective way to go with potty training. Basically what I did was get some books about potty training and start reading them to my son a couple weeks before I planned to start training him–which was when he was about 2 years and 9 months old. Two of the books had buttons he could push to flush the toilet, he loved that.

The first day I started, I put him on the potty and read one book to him, then let him off. 15 minutes later I checked his pants, and because they were dry, I gave him a treat–one fruit gummy or one chocolate chip–and congratulated him on being dry. Then I put him on the potty and read another book. I kept repeating that. When he peed or pooed in the potty, I congratulated him a whole bunch, and gave him treats. When he went in his pants, I didn’t make a big deal of it, I just cleaned him up and said stuff like “oops! you’re still working on learning this, huh?”

The second day I spread out the trips to the potty to 20 minutes, then 30 minutes the next day, then 40, 50, 60. I stayed at 60 until he was consistently using the potty and even telling me when he had to go before his time was up. Then I slowly moved the dry pants checks to 2 hours apart. I stayed at 2 hours–or before leaving on an errand–for a long time.

He’s been potty trained for almost a year now, and I’ll admit that I still give him poopy snacks. Mostly because I swipe a few snacks for myself as well while I’m getting his out–2 Gihradelli dark chocolate chips. LOL! He doesn’t get pee pee snacks though–but he still asks for them!

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Should I Let My Sleeping Baby Lie?

Often new moms ask some variation on the question:

I’m curious as to how you ladies handle breastfeeding a brand newborn. One of the visiting lactation consultants said that if he’s sleepy we should let him sleep. He slept 6 hours in the hospital and the nurses said let him sleep. We are off to a great start so far nursing, but I want to do this right. What should I do? Let him sleep and feed on demand, or wake every 2-3 hours?

So what do I think? In the first 24 hours newborns sleep at lot, so what you are told in the hospital is not necessarily what you should continue long term. I’ve seen too many babies who did not wake to feed frequently in the early weeks, and this led to weight gain or milk supply problems. In order to make sure baby is getting enough milk AND you are developing a good supply for long term nursing, it is very important to make sure you are nursing a minimum of 8 times in every 24 hours, but often more than that is needed in the early weeks.

Because “non-demanding babies” are often “content to starve,” the American Academy of Pediatrics statement on breastfeeding recommends that non-demanding newborns should be woken to nurse at least every 3 hours in the daytime (measured beginning of feed to beginning of the next feed), and every 4 hours at night. But again, remember that baby should be getting a minimum of 8 feeds per day, so if you are getting 4 hour stretches between feeds at night, you need to have some feeds that are closer together than 3 hours in the daytime.

Though the AAP doesn’t say this…my general rule of thumb is that as long as baby is gaining weight well, once he reaches 5 weeks you can start going by age to determine how long you will allow him to sleep at night…5 hours at 5 weeks, 6 hours at 6 weeks… If you are lucky enough to have a baby who will go that long. Most breastfed babies stick at 4-5 hours between feeds at night for a while. New moms should also keep in mind that once they are consistently having a period of 6 hours or longer between nursing sessions, ovulation prior to the first menstrual period is likely, so “lactational amenorrhea” should not be relied on for birth control in that case.

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