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RhoGam Shot in Pregnancy

 

Risks and Benefits of RhoGAM

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Many expecting parents have questions about whether or not to get the Rh immune globulin (RhoGAM) shot if the momma to-be is Rh-negative. This applies to a small number of women, but it is extremely important for them to be armed with all the information prior to making a decision.

If you are among the roughly 10 - 15% of people who are Rh negative, your pregnancy could be affected if your baby is Rh positive.  In this situation, obstetric providers often recommend RhoGAM.


However, it’s not always that simple. If you’re not sure you have all the information for an informed decision, you’re in the right place. Below are some frequently asked questions and points to consider.

What is the Rh factor?

The Rh factor is a protein that can be found on the surface of red blood cells. If your blood cells have this protein, you are Rh positive. If they do not have this protein, you are Rh negative. This is the negative or positive after your blood type: A, B, O or AB. It is simply about different normal variations in red blood cells. For example, you can be A positive or O negative. The negative or positive is your Rh factor. A pregnant woman will get a blood type, Rh and antibody screen as part of the routine prenatal blood tests; if she is Rh-negative, her antibody response will get tested several times as indicated throughout the pregnancy to check for Rh sensitization.

What is Rh incompatibility and sensitization?

Rh incompatibility is when the blood of a fetus is Rh-positive but the momma’s is Rh-negative. In this situation, if baby’s blood gets into mom’s bloodstream, the mother creates a defense system against the different type of blood; it is perceived as foreign by her body, even though it belongs to her baby. She will react against it by making anti-Rh antibodies. When a pregnant mother makes antibodies against the Rh factor on her baby’s red blood cells, it is called sensitization. Once a mom is sensitized, it stays with her forever.

This rarely causes complications in a first pregnancy, as the primary immune response takes time to develop and initially produces IgM antibodies that are too large to cross the placenta. However, it could be dangerous in future pregnancies for the fetus or newborn baby, when the secondary immune response is more rapid and the body has made smaller IgG antibodies that easily cross the placenta. Once these antibodies can cross the placenta, they try to destroy the fetus’s red blood cells.

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How can Rh problems affect the fetus during subsequent pregnancies?  

Rh sensitization can lead to a wide variety of mild to serious health issues in a fetus or newborn of the next pregnancy. The main concern is a severe type of anemia in the fetus, in which red blood cells are destroyed faster than baby can replace them. Red blood cells carry oxygen to all parts of the body. Without sufficient red blood cells, the fetus will not get enough oxygen, and this can result in hemolytic disease of the fetus and newborn causing jaundice, brain damage, heart failure and death.

How can my fetus’s blood get into my bloodstream?

During healthy pregnancy, a mom and her fetus usually do not share blood, thanks to the placenta that keeps the fetal and maternal blood circulation separate. But sometimes a small amount of blood from the fetus can mix with the mother’s blood. Typically, there is no mixing sufficient enough to risk sensitization unless there is are complications like miscarriage, placental abruption or previa, abdominal trauma, or an invasive medical/surgical procedure like chorionic villus sampling or amniocentesis, abdominal surgery and even ultrasound. 

Sensitization is usually associated with a rapid and large volume of fetal-maternal blood mixing. The most common time for Rh-positive fetal red blood cells to enter mother’s bloodstream, is during childbirth, though it can occur at other points during pregnancy - mainly in the third trimester.

Traumatic and difficult births with a high level of invasive procedures increase the likelihood for baby’s blood to mix with mom’s. So can certain routine interventions including use of the synthetic drug Pitocin to induce or augment labor, local or regional anesthesia, forced directed pushing, clamping the umbilical cord too early, pulling on the cord and putting pressure on the fundus to hasten delivery of the placenta.

A gentle birth process with minimal intervention and time allowance for the placenta to separate provides a reduced risk of significant mixing of blood between mother and baby.

While not a guarantee, planning for a natural undisturbed physiologic pregnancy and birth may certainly help prevent the mixing of fetal and maternal blood that leads to sensitization and hemolytic disease.

Can you tell if the baby is Rh-positive?

There is a new noninvasive blood test, which can detect fetal blood type using a blood sample of the pregnant mom. It is said to be highly accurate, almost as reliable as the conventional test, that uses a blood sample of the newborn after birth. It is almost, but not 100% accurate; and it is not available everywhere or covered by all insurances.

I recommend dad getting his blood type and Rh factor tested. If the father is Rh-positive and the mother is Rh-negative, there is about a 75% chance baby is Rh-positive, and providers will probably recommend RhoGAM. But if both parents are Rh-negative, baby will also be Rh-negative; in that case, there is no risk of Rh sensitization, and no need for RhoGAM.

What is RhoGAM?

RhoGAM is a drug made from human blood plasma, that prevents the mother from making antibodies against the positive Rh factor in baby’s blood. It is given via intramuscular injection, to prevent the immune response of sensitization against baby’s Rh positive blood, and subsequent hemolytic disease of the fetus or newborn in future pregnancies.

 
What are the benefits of RhoGAM?


RhoGAM’s effectiveness has been demonstrated in multiple studies around the globe. According to Dr. Murray Enkin et.al of A Guide To Effective Care in Pregnancy and Childbirth , one of the widely respected and authoritative founders of evidence based care, RhoGAM given after birth reduces the rate of hemolytic disease from 15% down to 1.6%.  RhoGAM administration prenatally in the third trimester has been shown in studies to further decrease the incidence to 0.06%.

The administration of RhoGAM medication to Rh-negative mothers is thought to be a major achievement of modern obstetrics by many in the medical profession. Before RhoGam’s introduction into routine practice in the 1970s, hemolytic disease of the newborn was a major cause of serious illness, death and long term disability in babies.

RhoGAM does not typically benefit firstborn babies unless the mom who is Rh negative has previously experienced a reaction to a mismatched blood transfusion, an abortion, miscarriage or ectopic pregnancy untreated with RhoGam.  

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When is RhoGAM recommended, and why?

For women who are Rh-negative, health care providers routinely recommend a shot of RhoGAM around 28 weeks of pregnancy and then again within 72 hours after birth, in order to protect the baby of a subsequent pregnancy.

Providers must decide about the RhoGAM shot and its dose based on how likely it is for the baby to have Rh-positive blood, as well as how likely it is for the baby and mother’s blood to significantly mix during pregnancy and birth.

Is there controversy around RhoGAM?

This standard approach is not without its critics, especially regarding its routine use during pregnancy, in which only about 1.5% of Rh negative moms with Rh positive fetuses develop antibodies and become sensitized against the baby’s positive Rh factor. Risk of sensitization is significantly higher after birth. Administration of RhoGAM postpartum is much less controversial, where benefits of the medication more clearly outweigh potential risks.

“The problem with routine prescription of prenatal RhoGAM is that many babies who are Rh negative like their mothers will be exposed to the drug, and there has been no systematic study of the long term effects of this product in babies.” - Ina May Gaskin

 “RhIG is not given for the direct benefit of the recipient or even her current fetus. The only beneficiary will be an RhD-positive fetus during a subsequent pregnancy (although the woman would also benefit in the event of a wrongly typed transfusion during the time of birth). Furthermore, prenatal prophylaxis unnecessarily exposes the 35% of fetuses who are RhD-negative to RhIG. These babies are at no risk of RhD sensitization. RhIG is completely unnecessary when a baby is the last child in the family. In the absence of clear answers to these pressing questions, the routine use of RhIG assumes that the birth process for RhD-negative women is inherently flawed.” - Anne Frye

Reliable research and meta analysis of the studies on benefit and harm of routine use of RhoGam in pregnancy are still limited, especially as it relates to who, when and which dose is needed, as well as its cost effectiveness.

Some argue that there may be other factors that contributed to the marked decline in severity and prevalence of perinatal morbidity and mortality associated with Rh incompatibility and sensitization, and medicating healthy pregnant women undermines those who trust the inherent wisdom in the natural process of childbearing. That being said, the issue remains an issue which, still today, impacts babies of pregnant women who are Rh negative.

What are the risks of RhoGAM?

Despite excellent results, the medication retains an FDA Pregnancy Category C: “Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.”

The known possible side-effects to RhoGAM include local swelling inflammation at the site, skin rash, body aches and sometimes hives. Infection from the blood product of modern preparation is rare, but still a possibility.

Expecting mommas should also keep in mind that standard RhoGAM preparation in many countries contains the mercury compound known as thimerosal, which has a litany of health risks.  However, pregnant mommas can request the use the mercury-free RhoGAM, if it is available where they live. In the United States, RhoGam is said to be mercury-free, although it may still contain traces.

So, is the RhoGAM shot absolutely necessary during pregnancy? 

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This is a hard question to answer for each individual person, on a blog.  Although much of the research is compelling, it is dated, was largely funded by the pharmaceutical companies and it is not without bias, flaws and some conflicting conclusions. For an eye opening text analysis of the data though 2001 and guidance from a traditional midwifery perspective, check out “Anti-D in Midwifery: Panacea or Paradox? 2nd Edition”, by Sara Wickham.

As always, pregnant mommas should empower themselves with knowledge and talk with their provider to fully understand the benefits and risks of all medications unique to their situation. 

I encourage my clients to take great care of themselves, be well-educated on their health-related issues, and to be in tune with their bodies.  While I aspire to provide evidence based information about medications and recommended treatments, I also know that there is much we do not know, and I am wary of routine medical and surgical interventions in a healthy natural process Too often they are widely used before sufficiently evaluated or harm has been identified. I feel informed and empowered moms are best able to make decisions for themselves.

Understanding that the vast majority of woman who are Rh-negative will not become sensitized during pregnancy, as it is rare that mixing happens until birth, is an important consideration when balancing the risks and benefits of using a pharmaceutical therapy while pregnant.

If you are Rh-negative and baby’s dad is Rh-negative, no, you do not need the shot. If baby’s dad is Rh-positive, and you choose to refuse the shot in pregnancy, you may still need it later if you suspect bleeding or another reason for sensitization, or if you change your mind. If you have done your research, you believe you are low-risk, and you do not feel comfortable with the shot while pregnant, do not let a provider pressure you. 

According to those who advocate a gentle birth process with minimal intervention and time allowance for the placenta to separate, there is usually less risk of significant mixing of blood between mother and baby. But mixing and sensitization can certainly still occur during healthy natural birthing. Traumatic, highly interventive and difficult births increase the likelihood for fetomaternal hemorrhage and sensitization. So can certain routine interventions including ultrasound, use of the synthetic drug Pitocin to induce or augment labor, local or regional anesthesia, forced directed pushing, clamping the umbilical cord too early, pulling on the cord and putting pressure on the fundus to hasten delivery of the placenta - anything that possibly disrupts the delicate physiology of placental separation or cause tiny fetal blood vessels to rupture and bleed. Planning for a natural undisturbed physiologic birth may certainly help prevent the mixing of fetal and maternal blood that leads to sensitization and hemolytic disease.

If you are feeling overwhelmed, or do not even know what questions to ask, I can help you! Check out my number one international best selling book Natural Birth Secrets and my online course - an online version of how I have helped thousands in my local practice. Both resources are unique, but each provide an in depth, one-of-a-kind holistic approach created by me, a seasoned nurse midwife of over two decades, who has seen everything!

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If you need more personalized guidance and help navigating these and other tough decisions, you can arrange a consultation with me, bundled with my online course. Or I invite you to choose from a variety of services I offer to the global community. Rock Your Journey To Motherhood is my most comprehensive, supportive offering for pregnant mommas anywhere in the world.  You will have personal access and guidance from me as we co-create your joyful journey from pregnancy to postpartum healthy bliss.

 

Beautiful Home Birth Story of Baby 5: Keys to Transforming Fear

 
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“The birth of Ezra was one of redemption and renewed faith in letting go and letting love be our covering. The whole pregnancy I had to ignore toxic fear, and just believe that he was going to be okay and we were going to be okay. With my four previous births, I delivered naturally, at home with a midwife and at a birth center in Norway where my husband is from. Each birth is story written in my mind, body and soul as a testament of faithfulness, strength and lessons discovered through seasons and growth ... separation and fulfillment. Somewhere in the practice of ignoring fear, I became ready for a birth that til this day, I'm at a loss for words on how to describe other than that I was so present that I could anticipate his decent, and catch him in a little less than two hours.                   

On December 3rd, the kids, my husband and I were doing what we had for weeks leading up to that day, preparing to meet the baby. For the kids, preparing was coloring pictures for the baby, talking about him and folding a handmade blanket over and over that my seven and six year old had made for him. For me it was cleaning, resting, eating a good meal and resting some more, going on walks, drinking herbal teas, watching the lunar phases and talking with my birth team. For my husband it was preparing the pool, helping with the kids and cleaning. On the morning of the third he picked up an early dinner for the two of us from our favorite Indian restaurant and when he came home, we sat down to eat. When I stood up, my water broke and we looked at each other with shock. It was 4:15 in the afternoon and this was it! 

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I texted and called the birth team, my family and our friend who was going to keep the younger kids. Gathering the kids, getting into more comfortable clothes and Gaute filling the pool up, I had quickly progressed to contractions that were 3-6 minutes apart… deep, piercing and I would soon have to stop and go into a separate room to cope quietly as the friend arrived to bring the kids to her house. Anelyn stayed with us and I just knew that the baby would be born within a couple of hours. The midwife, Bethany, my friend Amber who's a doula and photographer and a midwife's assistant arrived soon after I had texted. Shortly after they arrived and checked on the baby, I got into the pool to labor through the deeper contractions. So close. 


The sun was going down, the water was warm, as the contractions came, in my mind I whispered and thought comforting and peaceful thoughts… ‘This is good, it's okay, I'm okay, this is good, I love you, baby, you're doing it, I'm doing it, you will be here soon, breathe, he'll be here soon.’ I said that it would be, ‘Just a couple more contractions.’ Sure enough, two more contractions and he was presenting, I reached down and pushed 1,2,3 and he was in my arms. I just wept and wept... It was 6:04 pm and he was in my arms, so perfect and peaceful. I wept a tears of joy and pure shock that I was gifted such a beautiful and empowering birth, I looked at my husband and his face was glowing with tears, my daughter was leaning over to get a look at her new baby brother that she prayed for, a dear sweet baby to love. The birth team surrounded us with love, supporting, documenting, celebrating and serving so peacefully. This was the Birth of Ezra.

Thank you for your powerful and inspiring work and allowing moms share our stories.”

Rockstar Mama: Christan R @mommareveur 

Awesome Photographer: Amber Rhodes IG @amberdenaephotography and @amberhodes 

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There are so many wonderful ways to transform fear so common today, and have a beautiful empowering birth at home, in a birthing center or hospital. Excellent childbirth education and preparation in advance are crucial, and a major reason why I created my Love Your Birth course. It is a comprehensive online course that teaches women what they need to know about planning and carrying out the birth that they want in all settings - the hospital, birthing center or at home. It’s a course on how to have a holistic, healthy pregnancy for the body, mind, and soul - and is how I have guided thousands of women and their families in my midwifery practice for over 21 years. It contains a rolodex of my favorite resources with over 200 of the best books, movies and supplies I use personally and professionally with my clients, family & friends. Even diving into a fraction of this list will have you feeling empowered and prepared for conception, pregnancy, postpartum and parenting...It includes resources on improving and even ensuring ensuring healthier pregnancy and birth outcomes than the status quo, and preventing and healing from birth trauma so prevalent in the modern world!  Be prepared to do some research on your own, but knowledge restores your power. I also help you prepare your mindset for such a task, to debunk myths, and to reframe any current ideas or conditioning about pregnancy and birth that can use a change in perspective or that are simply incorrect and do serve you. After finishing the course, the idea is that you are now able to create and have the healthy, beautiful and empowering pregnancy and birth that you want. 

You can get a free nugget from my course - all about creating your ideal birth plan here. A huge part of having a birth of your dreams is getting clear your birth preferences, knowing the pros and cons about all the tests and procedures, all the interventions your may be faced with, so you can make informed decisions - rather than simply give over your body, your choice and voice to your health care providers and institution you choose.

“Anne Margolis was my incredible midwife. She is practical, science-based, and vastly experienced, but most importantly, she’s an awakened woman here to light the path to your most joyful self. Anne is the incredible midwife who taught me, through this process, how to midwife my own patients’ rebirth experience. Her own educational course is a deep but manageable dive into her accumulated wisdom, packaged for your journey. Forget your childbirth class, and take steps to your most empowering experience. If you are thinking about conception, pregnant, or love someone who is, take it from me that her wisdom is life-changing.Yours in the truth.”    — Dr. Kelly Brogan MD

“Anne Margolis was my incredible midwife. She is practical, science-based, and vastly experienced, but most importantly, she’s an awakened woman here to light the path to your most joyful self. Anne is the incredible midwife who taught me, through this process, how to midwife my own patients’ rebirth experience.
Her own educational course is a deep but manageable dive into her accumulated wisdom, packaged for your journey. Forget your childbirth class, and take steps to your most empowering experience. If you are thinking about conception, pregnant, or love someone who is, take it from me that her wisdom is life-changing.Yours in the truth.”

— Dr. Kelly Brogan MD

I have a holistic approach to life, including healing after pregnancy and birthing. Nothing replaces abdominal toning and exercise for restoring muscle strength and tone - which I encourage for all mamas as soon as they feel up to it postpartum. Nothing replaces touch, slow deep abdominal breathing, and a 'love your postpartum body' perspective that I promote.  But I have found many mamas simply feel comforted by this support garment, especially early postpartum and temporarily as needed....to be used without forfeiting abdominal toning and strengthening exercise, breathing well and touch. I have found Bellefit supportive garments to help like they use belly binding around the world such as in Indonesia. They do aid in early postpartum healing and provide support many mamas feel comforted by. I deal with human beings and the reality is many postpartum mom's struggle with body image, feel frustrated that getting back to themselves takes longer than expected. Being into holistic health and healing includes being sensitive to real human struggles - the mind, body, heart and soul of each person and their unique situation. Having helped countless women with these issues after having a baby as a midwife, I have found many still love that binding and feel better with this support, and ability to fit into their pre-pregnancy clothes comfortably and sooner than they would if they went through a C-section or natural childbirth recovery without it - especially when they have to dress up and fit into a certain favorite outfit for a special occasion or wedding not long after having a baby.

For more info on the Bellefit girdle, check out my blog about it hereHave a Great Postpartum Recovery (with a little help from Bellefit)!

I am thrilled to announce that you get a $20 Off with code: ANNE20 at checkout - if you purchase here.

 

Things You May Find At Your Midwife's Office

 

The list below shares with you 15 wonderful things you may find during prenatal care visits with midwives, especially those who practice in relatively small group private practices, out of hospital - in free standing birthing centers and home settings across the United States. Other countries may have slightly different models, but authentic midwifery practice shares many common core philosophies of care, so I suspect there would not be much difference.  They are:

  1. Time – as in actual time for connecting and developing a relationship with your midwife; so that you can ask your questions and speak about your concerns. Time for the midwife to ask you the questions she needs to make assessments about your health and wellbeing, so she can best guide and support you.

  2. Continuity of care - the midwife (or one of the 1-2 partners, if in a small group practice) you see during your prenatal visits will most likely be the midwife who attends your birth.

  3. A big heart - your midwife will give you every ounce of her heartfelt knowledge, expertise and care for you and your baby. You may just feel so close with your midwife after a while, she is like your best big sister or wise friend, and her office is a safe space for you to share, laugh, or cry about anything.

  4. Education - your midwife will teach you and your loved ones about your body, what’s happening, what to expect along your childbearing journey, and what you can do to make it easier, healthier, more positive. This includes diagrams and models of pregnant moms and babies, placentas, umbilical cords, membranes and pelvises. Your midwife might just have a mirror for anatomy lessons of your own body if you are interested....like in seeing your cervix.

  5. Tea and healthy snacks for everyone.

  6. Inspirational quotes, affirmations and art about pregnancy, giving birth, breastfeeding, baby wearing and parenting.

  7. Pictures of graduates on the wall and/or in photo albums.

  8. A collection of thank you notes and birth stories (I call them love letters) in collages and/or scrapbooks.

  9. Midwifery and holistic health text/reference books and a lending library of books and movies on pregnancy, natural childbirth, breastfeeding and newborn care.

  10. Enough seating arrangements for the whole family and even some friends, as well as toys and books for the little ones.

  11. Hands - your midwife’s hands are skillful both in their assessment AND the supportive touch they offer.

  12. Tools - all the supplies and knowledge of how to use them, that could possibly needed for your journey. These include equipment such as blood pressure cuff and stethoscope, fetoscope, Doppler and gel for checking baby’s heart rate, scale, measuring tape for assessing the height and growth of your uterus, and lab supplies for checking your blood, urine, screening for infection and pap smear AND so much more! If she uses an exam table, the stirrups will be covered with oven mitts, and it will probably have a nice comfortable and decorative sheet and pillow on it, with a stool for climbing up and down or for the little ones to be involved.

  13. A boutique, where you can buy needed items like supplements and natural remedies, books, affirmation cards, birth kits, and rent a birth tub.

  14. Office and birth assistants - your midwife may also have students, apprentices, and even have a doula or two to choose from; she may have space to host childbirth classes, pregnancy and postpartum support groups, prenatal and postpartum yoga, parenting groups and all sorts of relevant helpful workshops and community events.

  15. Needed medical and midwifery knowledge and clinical skills; and she will also be familiar with and use a variety of holistic, alternative and natural modalities that can help you during and after pregnancy, birth and beyond.

As you go about choosing your midwife and planning for your birth, you might want to ask yourself what is important for you from the above list. Does your midwife or obstetrician offer some of these things, or what you feel you want and need?  Start writing down your questions and your preferences now in a journal, so when you meet her - you have them handy. My online Love Your Birth course will not only help you prepare for having optimal health in pregnancy and beyond, but will also help you to hone in on your own inner calm, joy and strength, as well as empower you with ways to speak your voice, and ideally avoid unnecessary interventions, medications or surgery. It will guide you get clear on what you really want, and make informed decisions given all your available options.

 

Healing VBAC Birth Story

 
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“My first birth was a natural birth gone wild - my sons leg came out after 24 hours of natural labor - - so this VBAC was soooooo healing for me!!!!

I still cry thinking about both births!” Kimberly Spair of Reclaimers of Health

Here is a glimpse into my birth story, written by Birth Doula https://philadelphiabirthdoulas.com/ 

VBAC baby girl arrived on November 9 after 48 hours birthing!! (Vaginal birth after cesarean!) Past her October guess date it began November 7 at 8 pm and after exactly 48 hours of unmedicated birthing, Hypno-baby Braelyn Mae arrived our world at 7:55 pm naturally at 9 lb 4 oz. After over a day of consistent pressure waves (contractions) exhausted still at 4cm, mom released her emotions and fears about a repeat cesarean. Her first birth was scary and traumatic. She expressed her fears and replayed trauma of her first birth with us. We honored her, we reminded her that this is a new beautiful birth, and that she was doing it.

Birth was filled with beautiful intense emotions, physical challenges, consistent counter pressure, and mom continued to change positions, in and out of the birthing tub, using her natural instincts and accepted every suggestion to birth her baby. Mom pushed for 4-5 hours and then her moment was here… she reached down and their beautiful baby girl was in her arms.

“Fear is what got me through. I was MORE afraid of a c-section and more trauma. My birth was extremely hard-but not traumatic! I guess I can say “old fear” because I had very little fear of going naturally.” She shared and released her fears with us although what WE saw throughout her entire birth was fear that she overcame with COURAGE, STRENGTH, DETERMINATION, AND CONFIDENCE.

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It was an honor and joy to be part of this special family’s beautiful birthing. They mean so much to me. We were fortunate to have a calm, supportive environment and to work with an incredible midwife. All birth is beautiful, all birth is unique. Going on 6 years as a doula this birth experience was truly unique to any birth I’ve had the opportunity to support. I can’t possibly describe this 2-day birth in an announcement. One strong mama! Mama, You inspire me and I thank you for inviting me in to be a small part of your pregnancy and birthing journey. So proud of you. You did it! Thank you for sharing your birth as I know you inspire many other families. Congratulations to a very special family of four. #VBAC #Hypnobabies #unmedicatedbirth #VBACaccomplished #VBACthat #wowbirth #ilovewhatidoula

Was your birth upsetting or traumatic? Do you have more questions about processing your birth and need help healing? Arrange some time to chat with me. I’d love to answer your questions and help you heal and get yourself back - I have a program specifically for you, that can also include this revolutionary and profound natural healing modality called Clarity Breathwork.  Helping women heal from birth trauma is one of my passions and areas of expertise. 

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This is why excellent childbirth education is a must, why planning for your birth is so important today, and is a major reason why I created my Love Your Birth course. It is a comprehensive online course that teaches women what they need to know about planning and carrying out the birth that they want in all settings - the hospital, birthing center or at home. It’s a course on how to have a holistic, healthy pregnancy for the body, mind, and soul - and is how I have guided thousands of women and their families in my midwifery practice for over 21 years. It contains a rolodex of my favorite resources with over 200 of the best books, movies and supplies I use personally and professionally with my clients, family & friends. Even diving into a fraction of this list will have you feeling empowered and prepared for conception, pregnancy, postpartum and parenting...It includes resources on improving and even ensuring ensuring healthier pregnancy and birth outcomes than the status quo, and preventing and healing from birth trauma so prevalent in the modern world!  Be prepared to do some research on your own, but knowledge restores your power. I also help you prepare your mindset for such a task, to debunk myths, and to reframe any current ideas or conditioning about pregnancy and birth that can use a change in perspective or that are simply incorrect and do serve you. After finishing the course, the idea is that you are now able to create and have the healthy, beautiful and empowering pregnancy and birth that you want. 

You can get a free nugget from my course - all about creating your ideal birth plan here. A huge part of preventing birth trauma is getting clear your birth preferences, knowing the pros and cons about all the tests and procedures, all the interventions your may be faced with, so you can make informed decisions - rather than simply give over your body, your choice and voice to your health care providers and institution you choose.

In looking for that supportive birthing space I talked about earlier, seek care providers and settings that have a low intervention rate (low rates of medical interventions like inductions and epidurals, low rates of cesareans, etc.)—their practices are more likely to be in line with your goals.

I have a holistic approach to life, including healing after pregnancy and birthing. Nothing replaces abdominal toning and exercise for restoring muscle strength and tone - which I encourage for all mamas as soon as they feel up to it postpartum. Nothing replaces touch, slow deep abdominal breathing, and a 'love your postpartum body' perspective that I promote.  But I have found many mamas simply feel comforted by this support garment, especially early postpartum and temporarily as needed....to be used without forfeiting abdominal toning and strengthening exercise, breathing well and touch. I have found Bellefit supportive garments to help like they use belly binding around the world such as in Indonesia. They do aid in early postpartum healing and provide support many mamas feel comforted by. I deal with human beings and the reality is many postpartum mom's struggle with body image, feel frustrated that getting back to themselves takes longer than expected. Being into holistic health and healing includes being sensitive to real human struggles - the mind, body, heart and soul of each person and their unique situation. Having helped countless women with these issues after having a baby as a midwife, I have found many still love that binding and feel better with this support, and ability to fit into their pre-pregnancy clothes comfortably and sooner than they would if they went through a C-section or natural childbirth recovery without it - especially when they have to dress up and fit into a certain favorite outfit for a special occasion or wedding not long after having a baby.

For more info on the Bellefit girdle, check out my blog about it hereHave a Great Postpartum Recovery (with a little help from Bellefit)!

I am thrilled to announce that you get a $20 Off with code: ANNE20 at checkout - if you purchase here.

 

Understanding Epidurals and the Benefits of a Natural Birth

 
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We’re discussing the pros and cons of epidurals! What is their place in the medical world and should they be as commonplace as they are?

Modern medicine today encourages epidurals like water. This doesn’t make epidurals inherently bad - they are simply being misused and overused. It is time we tell the truth about epidurals. Physician, neonatologist and researcher Dr. Michael Klein, points out in his three part Science and Sensibility blog analysis of the evidence

on epidurals, “Women need to be accurately and completely informed of their choices for pain relief in labour before they can provide their true consent. No matter how well intended, epidural analgesia increases the likelihood that women will have a variety of other interventions, especially if the epidural is given without specific medical indications….When used routinely as a first line agent, epidural analgesia can create problems that could have been avoided.”

Epidurals can be literally life-saving in a dire situation when a cesarean birth or medical induction of labor is needed, and there are times when they are indeed warranted, but there are serious concerns about their use in a childbirth process that is proceeding normally and healthily - when their risks outweigh their benefits.

I will hopefully give you an enlightening look at the different sides of epidurals, including the situations when they are very necessary. You making an informed decision for yourself, is what’s important here. But do your research.

Learn more about the intricate process of labor and delivery, as well as what your mind and body are doing during each stage, the purpose of its sensations and how to best cope with them. I go into this thoroughly in my online Love Your Birth course. The more you really understand what is going on, the less you will fear it, the more you will trust and lean into it. And know your strength and capabilities. You’d be surprised at what you’re able to withstand and overcome!

It is crucial to prepare for coping with natural labor, even if you think you will want or need an epidural, as you will still have to experience parts of labor, it is not always an option depending on your health history, the anesthesiologist does not often come right away, and the epidural does not always work adequately.

How do Epidurals Work?

An epidural is an injection of a large needle in the lower back that pierces the covering of the spinal cord. Medications are injected through a tiny catheter threaded through the needle, into space surrounding the spinal cord and then they infuse the nerves nearby. These medications consist of usually a regional anesthetic and an opiate.

The anesthetic drugs temporarily block the sensory nerves which usually create the numbing and this, in turn, inevitably blocks the motor nerves with some degree of paralysis. The opiates are included because they increase the effectiveness of the anesthetic, allow for less dose required, while working to decrease the blockage of motor nerves at the same time.

The Cons

The true downturns of using an epidural occur in a birth that is perfectly healthy and normal are many, according to the research. This will then lead to a cascade of other risky and dangerous interventions just by taking a drug in which there was no need in the first place. In fact, epidurals increase the risk of requiring a C-section, especially when given too early - but there are plenty of other reasons for this.

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According to Dr. Kelly Brogan’s research, there’s been a 60% rise of C-sections since 1996. A study has shown that a prolonged second stage of labor is the main reason for most C-sections. This prolongation can be directly linked to the use of epidurals, for many reasons, including a mom’s decreased ability to push effectively and her needing to be in supine positions that make birthing more difficult, as it goes against gravity and pelvic capacity is at its smaller dimensions.

Related: The Unnecesarean Birth Story - How It Might Have Been Prevented

What happens after this prolonged stage? A myriad of interventions to “help” induce the birth: “food and drink restriction, immobilization, IV fluids, bladder catheter, medications to augment labor, and continuous monitoring.” All of these will only encourage the need for even more intervention, like vacuums, forceps, episiotomy and increased probability of more severe perineal tearing into the anal sphincter and rectum, or major abdominal surgery. All medications, invasive interventions and operative deliveries risks birth trauma and injury to the baby as well as the mother.

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Epidurals prolong all stages of labor. They increase the incidence of fever for mom, which leads to IV antibiotics in case of infection that most likely is non-existent. Antibiotics disrupt the microbiome and lead to all the associated health risks of interfering with the healthy balance of bacteria within the body for both mom and baby. It can also lead to signs of fetal distress, which then lead to other interventions from needing oxygen to emergency surgical delivery.

This drug administration does upset the normal hormonal balance during labor. While the very nature of an epidural is to alleviate at least some of the pain and so easing a good chunk of stress, some stress during labor is actually quite good for both mother and baby.

Cortisol (the stress hormone), for example, lessens mom’s exhaustion; it gives the mother energy to push, and heightens her euphoria and sense of excitement—a big part of the natural birth experience which we’ll get into a bit later—and this euphoria actually increases bonding with the baby. For the baby, the healthy “stress” of being born turns many biological processes on during the whole birthing process, like the breathing instinct at birth, which eases transition to adjusting to life outside the womb. No surprise that babies may need more assistance to breathe.

There are so many effects that also take place in the aftermath of the birth since an epidural is a narcotic that’ll pass from mother’s circulation, through the placenta into the baby’s bloodstream.

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Evidence supports risks to the baby from epidurals, that include reduced muscle tone, poor feeding, jaundice, withdrawal, and sensorimotor impairment. Epidurals have been linked to failure to establish breastfeeding and this is not to be taken lightly, as breastfed babies have much healthier outcomes and less health risks than formula fed babies. Newborns also can get a fever and increased heart rate from the epidural, without having an infection, but separation from mom and extensive work-up in the neonatal intensive care unit ensues for evaluation, including blood tests, spinal tap, and precautionary IV antibiotics.  Renowned childbirth educator Penny Simkin highlights that “epidurals can result in short - term subtle neurobehavioral effects, such as irritability and inconsolability and decreased ability to track an object visually or to shut out noise, bright light. There are no data on potential long-term effects....Decreased infant responsiveness may lead to long-term consequences for the parent-infant relationship... (risking) labels of “difficult child” or “incompetent mother” (self imposed or by others).” 

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The mother can experience some annoying but distressing side effects - mostly from the medications entering her bloodstream and/or administration error, like itching, nausea, shivering, spinal headache, residual numbness, tingling and weakness, backache, as well as alarming side effects, like difficulty swallowing and breathing, rare permanent nerve damage, convulsions, respiratory paralysis, cardiac arrest, and even death. Evidence based care expert Henci Goer points out in her ongoing evaluation of risks and benefits of maternity care, that epidurals cause, “Somewhere between 1 in 1,400 and 1 in 4,400 women to experience a life-threatening complication.”

This is some very scary stuff! And yet, epidurals aren’t so much the problem as are our society’s tendencies to consider them such a benign and advised common practice for the majority of laboring women.

Epidurals necessitate hospital birth, and eliminate the home and birth center option, which are associated with better health outcomes physically and emotionally for mom and baby, when it comes to low risk healthy childbirth. Dr. Klein poignantly elaborates on the concerns that epidurals have medicalized birth so much so, that they increase the demand on the nurse to pay greater attention to the technology of all the resulting interventions, and consequently have less time, experience and skill to provide needed hands-on and emotional support for the laboring woman.

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Disruption of the normal hormones of labor with epidural use can cause the laboring mom to feel detached from her own childbirth process and to becomes more of an observer than a participant. Studies indicate that women who had an epidural may have had less pain, but were most dissatisfied with their experience even up to a year later. The provider and nurse can no longer assess labor progress by observing the mother and must rely on the monitor - which makes the experience more impersonal - and vaginal exams - which are invasive and increase risk of infection. Use of epidurals and the anesthesiologist alone raise the cost of care, and it increases exponentially with the cascade of hospital interventions that result.

So, when are epidurals medically appropriate? In an urgent or concerning health situation when there are serious complications, but not in a normal, healthy, natural birth. They can be also psychologically appropriate, in individual cases.

The Pros

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One of my founding philosophies in helping women to have a safe, healthy and transcending birth experience is that a birth (of any kind, in all settings!) isn’t a medical procedure—it’s a natural and miraculous process of life. It’s not in and of itself a dangerous crisis.

That being said, I’d like to affirm that an epidural has its place in childbirth.

When a labor isn’t proceeding normally, when there’s a prolonged or arrested labor or the mother is experiencing exhaustion, extreme pain and/or anxiety, the compassionate use of an epidural could be the answer, and can enable her to relax, rest and progress to vaginal delivery. There could be a real medical need for medications to help induce or augment labor, which make labor sensations much more painful.  As a last resort, an epidural can help relieve the pain and stress from an emergency situation.

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A woman suffering from preeclampsia, for example, who receives an epidural anesthetic, will likely not have a prolonged second stage of labor. Epidural tends to lower blood pressure, which is a benefit in cases of hypertension.

An epidural could also be an advantage during a major operation like a cesarean;  in most cases, it carries much less risk than general anesthesia and is a great alternative to being unconscious from the high doses of those medications.

Epidurals can provide relief or reduction of pain without impacting mother’s mental state. Since birth by C-section is still a birth, an epidural can help the mom stay fully alert and pain-free during this operation. She’ll be involved, fully capable of holding and bonding with her baby even after a C-section operation, as opposed to being put out from a general anesthetic.

Keep in mind that I’m speaking of C-sections that are necessary because of endangering complications and serious issues. This is not the same as C-sections that are caused by epidurals themselves like we spoke about before. Cesareans in and of themselves are supposed to be the last resort, and indicated for serious life threatening health problems —the fact that we have them more and more often in America and that they are treated as a normal procedure during a labor is a sore reflection of our society’s ideas of pregnancy and birth.

Related: How to Plan, Have, and Rock Your VBAC

How do You Prepare for an Epidural-Free Birth?

Photo by @senhoritasfotografia

Photo by @senhoritasfotografia

Not only is a natural birth the healthiest way to go but science is more and more discovering ancient truths about birth.

The women who come to me want to have their pregnancy and labor in their own way and they don’t want to numb themselves to the healthy and normal sensations of giving birth. It is, in fact, your own birthright as a woman to have this right of passage into motherhood. The women I work with want to feel that empowerment and the high of successfully bringing their child into the world on their own.

Understanding what your body is capable of can begin to give you the confidence you need to begin planning your natural birth. My Love Your Birth course can help you prepare for the entire process from beginning to end. You’ll equally learn how to cope with and handle labor pains...so much so that you can love your experience no matter how challenging. The right preparation really begins with a shift in mindset, not just about labor but in what your body is capable of doing.

“In labor, such high-levels [of beta-endorphins] are released and help the laboring woman to transcend pain, as she enters the altered state of consciousness that characterizes an undisturbed birth. In the hours after birth, elevated beta-endorphin levels reward and reinforce mother-baby interactions, including physical contact and breastfeeding as well as contributing to intensely pleasurable, even ecstatic, feelings for both.” -Sarah Buckley, MD.

Photo by @senhoritasfotografia

Photo by @senhoritasfotografia

My rate of successful women having natural births is 93%--the other 7% of cases had complications that required medical attention or surgical intervention. But, in over two decades practice as a homebirth midwife, I’ve never once had  transfer a mother to the hospital for an epidural or any other pain medication because she couldn’t cope with sensations of normal labor. Never once! It is not that women who come to me have different bodies. It has more to do with how well they prepare themselves in advance, their attitudes and mindset, and how they are cared for and supported during birth.

Women are able to do what comes naturally when they are prepared, supported and encouraged to follow their own desires for their birth. Women have been giving birth naturally around the world since the beginning of time. Today we interfere more with it, and sometimes we get in our own way. Have faith that your body and nature both have your back—they were designed to know what to do! We just need to step aside. That takes advance preparation in the modern world, as well as care providers and settings that will have the same philosophy and expertise.

The physicality that is required to give birth has been compared to the performance of an endurance athlete! There’s an inherent strength in every woman to go beyond what she knows herself to be capable of. And when she does that, she is darn proud of herself; she has discovered her strength and capacity she can draw on for the rest of her life.

Learn as much as you can about what that is, about yourself and your body. The pride and joy that a woman experiences after giving birth naturally is overwhelming. So many mommas are overcome with their own capability to bring their child into the world.

Don’t deprive yourself of the sensations and transcending experience. You are able and you are supported!

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I have a holistic approach to life, including healing after pregnancy and birthing. Nothing replaces abdominal toning and exercise for restoring muscle strength and tone - which I encourage for all mamas as soon as they feel up to it postpartum. Nothing replaces touch, slow deep abdominal breathing, and a 'love your postpartum body' perspective that I promote.  But I have found many mamas simply feel comforted by this support garment, especially early postpartum and temporarily as needed....to be used without forfeiting abdominal toning and strengthening exercise, breathing well and touch. I have found Bellefit supportive garments to help like they use belly binding around the world such as in Indonesia. They do aid in early postpartum healing and provide support many mamas feel comforted by. I deal with human beings and the reality is many postpartum mom's struggle with body image, feel frustrated that getting back to themselves takes longer than expected. Being into holistic health and healing includes being sensitive to real human struggles - the mind, body, heart and soul of each person and their unique situation. Having helped countless women with these issues after having a baby as a midwife, I have found many still love that binding and feel better with this support, and ability to fit into their pre-pregnancy clothes comfortably and sooner than they would if they went through a C-section or natural childbirth recovery without it - especially when they have to dress up and fit into a certain favorite outfit for a special occasion or wedding not long after having a baby. For more info on the Bellefit girdle, check out my blog about it hereHave a Great Postpartum Recovery (with a little help from Bellefit)! I am thrilled to announce that you get a $20 Off with code: ANNE20 at checkout - if you purchase here.