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Question of the Week
Q: A plus-sized woman who has mild cerebral palsy (CP) wonders how the CP will affect her pregnancy and birth. She is concerned she might have a cesarean because of mobility and flexibility issues. She is also concerned that she or the baby might be more prone to complications because of CP. Do readers have experience, information, resources, or hints for women with CP and their births?
SEND YOUR RESPONSE to firstname.lastname@example.org with "Question of the Week" in the subject line.
Question of the Week Responses
Q: What do you consider to be the true beginning of first stage? Why?
A: Onset of labor cannot truly be labeled until the baby is born. The variety of patterns and signals is so great that it is best determined after the fact. I encourage women to tune into their bodies and be aware of changes. Most of the time a woman knows that something is different. For many mamas, the signals aren't dramatic but rather build over time. My first labor began in the waiting room of the doctor's office. At the time I wasn't sure, but in retrospect I know it was the beginning and precipitated by my OB's recommendation that we use prostaglandin gel to induce me since it was my due date!
It really pushes my buttons to hear women tell me their labor began at the time they arrived at the hospital—because it's not REAL until she arrives at the hospital.
It's important to include early first stage labor that culminates in birth into the total time. This would help families preparing for labor to have a longer, more accurate range of normal.
A: First stage labor begins when mom is having regular contractions that are consistently getting closer together and stronger and are not affected by walking, rest, food, drink, or relaxation. It doesn't matter how long they last or how far apart they are. That can vary greatly with every woman.
— Lara Miller
Re: VBAC [Issue 5:07]:
Read, read, and read some more. Silent Knife is an excellent source. I was so lucky it came out soon after my section. I also became involved in Cesarean Prevention Movement (CPM), now ICAN (International Cesarean Awareness Network). They were wonderful and provided lots of information. Seek out others with similar experiences that have had successful VBACs. I did not personally know anyone who had done it before me but was fortunate enough to have a wonderfully supportive midwife.
Even if a VBAC doesn't go well, there can still be emotional healing. I had an awful first birth in hospital and then an unnecessary section for my second son. I planned a homebirth for my first VBAC, but because the baby died and labor did not start, I had to have labor induced and I delivered in the hospital again. As terrible an experience as my daughter's birth was, I was still healed in other ways. My last two pregnancies resulted in fine healthy baby boys born at home. It is well worth the time to do the research and find supportive care from a source that can assure you when you have doubts and support you in your decision. Read everything you can find and surround yourself with supportive people.
The risk assessed to VBACs has always interested me because of my previous surgery and scarring. During the seventh month of my first pregnancy, intestinal blockage required exploratory surgery. My uterus was moved far to the side to allow for the blockage to be found and the repair done. I was stitched and taped and left the hospital three days later with an incision about 5–6 inches long.
Because of IV fluids and hydration, my abdomen was two times larger than when I went into the hospital. At no point was the incision or scar tissue mentioned following the surgery or during labor. I went on to have an unmedicated vaginal birth of a 7 lb 14 oz baby girl. I have to wonder, how can a previous c-section years before the subsequent birth be any more of a risk than major abdominal surgery three months before birth?
On that note, a woman I know has had seven c-secs and plans to have more. How is carrying so many babies and having so many c-secs approved of by a doctor? The reasoning just doesn't seem to make any sense in our current medical policies.
— Chantel Haynes
EDITOR'S NOTE: Responses to any Question of the Week may be sent to email@example.com at any time. Please indicate the topic of discussion in the subject line or in the message.
Birth Works National Conference
by Gloria Lemay, compiled by Leilah McCracken
Gravida and Parity
Gravida ("to bear"): A pregnant woman. Any pregnancy including the present one.
A multiple pregnancy is considered as one pregnancy; the number of births is counted as the babies birthed. Abortions, both spontaneous or induced, are counted as gravida. After 22 weeks, all are counted as para, including stillbirths. The current pregnancy is counted as gravida until the time of birth.
Gloria Lemay is a private birth attendant in Vancouver, BC, and is a contributing expert at BirthLove, www.birthlove.com
Exclusively on the BirthLove Site
Gloria Lemay, celebrated midwife and teacher, is offering advanced online doula education. She covers a vast amount of topics that today's doulas and student midwives need to know: herpes simplex II, medical terminology, pediatric exam of the newborn, prenatal diagnostic tests, business and professionalism, pregnancy-induced hypertension, gestational diabetes and so much more. The course is free for all BirthLove members. Check it out!
I am a graduate student researching the stories of lesbian birth mothers. I read a small study by an undergraduate student who interviewed a midwife who claims that lesbians have a higher cesarean section rate (about 50%!). Has anyone else heard this? Also, have you noticed that lesbians have a higher home-to-hospital transfer rate for planned homebirths?
— Heather Richard
Re: bachelor of midwifery course, Australia [Issue 5:07]:
This course is offered by Australian Catholic University, Monash University Peninsula Campus, and University of Victoria, St. Albans campus. Together they make up the "Werna Naloo Bachelor of Midwifery Consortium." The course is three years, full-time. Eighteen of the 24 units are specific to midwifery. At least 11 units are available online from members of the consortium. This allows some time flexibility. There is a large practice component to meet the requirements of ACMI for registration. Application is via VTAC. There are huge waiting lists each year. For further information see university sites and go to courses. I am in the first semester of the course. It's really enjoyable but a lot of work.
I live in Adelaide and have completed the two-year part-time BA of Midwifery at University of South Australia. I am a general nurse, hence why the course was only two years part-time. I have just commenced my graduate midwife programme at a public hospital, and for someone who did not know if I wanted to do midwifery after I completed the course, I am having a ball! The course had four subjects, and I worked from reproductive medicine, antenatal, postnatal, special care nursery and delivery suite. In South Australia, you only have to witness three natural births, assist with four, and complete at least 10 births independently. You also have to care for 20 other women in labour. I know in the eastern states and Queensland the number is higher so registration with the Nurses Board in each state can occur. If you are not a registered nurse, a three-year full-time degree has commenced, and you achieve a BA of Midwifery and can practice as a midwife. A one-year "bridging" course to register as a RN is being brought in with this degree if you want a double degree. I found the course to be a good grounding for midwifery but is complemented with a graduate programme once you have completed the degree.
Do you have information about Arab cultures and their practices regarding pregnancy and birth? I am a nursing student, and I am doing an oral presentation about this subject. Although I have a friend whose family is Arabic, I am looking for additional info.
— Tiffany Dotson
I am a nurse-midwifery student presently studying at a community college. Do readers have information about the evolution of midwifery, how it has progressed, ethical issues in midwifery practice?
— Sharon Norbal, R.N.
I experienced the beautiful birth of my first child with a midwife. However, my second child was born in a hospital because of location. I was allowed to go over 42 weeks gestation, thus I gave birth to a LGA baby. She had shoulder dystocia. I was forced to get off my hands and knees and on to my back for delivery. It was a nightmare. I was given an episiotomy that was not repaired correctly. I left the hospital without stitches. The doc assured me I would "fill in." I am recovering physically, but I am scared to death to deliver another baby. The doc told me I would never deliver another baby vaginally. My husband, who is a nurse, thinks I have post-traumatic stress disorder. Is there a support group for stressful birth experiences? Can readers recommend reading that could help me? How does one recover from a "mangled episiotomy repair"? I know I could do an episiotomy revision, but is that necessary? Will the discomfort ever lessen? I would love to have another child and trust my body again.
— Nanette Stark
Can readers guide me about myeloproliferative syndrome disease—remedies, natural food diet, and supplements to control the situation? Can someone recommend Internet sites?
— Bharat Sheth
I am trying to get some information about mucus plugs and their role in pregnancy and labor. After recently losing a baby at 31 weeks I am looking for many answers.
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