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MIDWIFERY SERVICES OF SOUTH TEXAS

Claudine Crews LM, CPM

Licensed and Certified Professional Midwife 

San Antonio, Floresville, and surrounding areas in South Central Texas

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ABOUT MIDWIVES

·     What is a midwife?

·     What is a Certified Professional Midwife?

·     Midwives Model of Care™

·     Texas Midwives

·     How to Choose a Midwife

ABOUT HOME BIRTH

·     Home Birth - Is it safe?

·     Advantages of Birth Outside of a Hospital

·     American Public Health Association Support

BIRTH OPTIONS AND CHOICES

·     Waterbirth

·     VBAC

·     Cord Clamping

·     Preparing for Birth - Childbirth Education

·     Doulas

 

BIRTH AMERICAN STYLE

·     Induction

·     Continuous Fetal Monitoring

·     Cesarean Section

·     Epidurals

·     Immediate Cord Clamping Vs. Delayed Cord Clamping

PREGNANCY INFORMATION

·     Home Pregnancy Tests

·     Estimating Your Due Date

·     Common Discomforts

·     Warning Signs

·     Prenatal Testing

·     Ultrasound

·     Breech?

·     Induction

·     Childbirth Classes

NUTRITION IN PREGNANCY

·     Why good nutrition

·     Nutritional needs

·     Sample Diet

·     Nutritional values of foods

·     Food Safety

·     Salt - Yes, you do need it!

NEWBORN AND POSTPARTUM CARE

·     Breastfeeding

·     Circumcision

·     Immunizations

·     Childproofing Your Home

PHOTO ALBUM

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Serving the San Antonio, Elmendorf, Floresville, Karnes City, Pleasanton and surrounding areas, including:

Atascosa, Bandera, Bexar, Blanco, Comal, Guadalupe, Karnes, Kendall, Kerr, Wilson, and surrounding counties in South Central Texas.

 

studies comparing hospital and home quote

 

 

 

 

 

 

 

the power of birthing women quote

 

Birth American Style

 State of American Childbirth

The United States has the highest per capita spending on health care in the world, with care for mothers and newborns combined as the fourth largest category of hospital expenses, and childbirth as the most common reason for hospitalization of women in the US - and yet we rank 29th of developed countries in infant mortality! Read this fact sheet based on figures from 2005 - 2006. Note that there has been no improvement in recent years. As of 2006 the Cesarean rate has gone up to 31.1%, while our rates of prematurity and low birth weight are increasing!

 

In order to truly make informed choices about interventions in normal pregnancy and birth in the United States parents need to be informed of the potential risks or complications that can result. This information is often not presented or explained completely to parents, or it is presented during a stressful time, such as active labor. Read about these things BEFORE you need  to make an informed decision.

 


FISH CAN’T SEE WATER:
THE NEED TO HUMANIZE BIRTH

Marsden Wagner, MD, MSPH
International Journal of Gynecology and Obstetrics, 75, supplement s25-37, 2001

INTRODUCTION

Humanizing birth means understanding that the woman giving birth is a human being, not a machine and not just a container for making babies. Showing women---half of all people---that they are inferior and inadequate by taking away their power to give birth is a tragedy for all society. On the other hand, respecting the woman as an important and valuable human being and making certain that the woman’s experience while giving birth is fulfilling and empowering is not just a nice extra, it is absolutely essential as it makes the woman strong and therefore makes society strong.

Humanized birth means putting the woman giving birth in the center and in control so that she and not the doctors or anyone else makes all the decisions about what will happen. Humanized birth means understanding that the focus of maternity services is community based primary care, not hospital based tertiary care with midwives, nurses and doctors all working together in harmony as equals. Humanized birth means maternity services which are based on good scientific evidence including evidence based use of technology and drugs.

But we do not have humanized birth in many places today. Why? Because fish can’t see the water they swim in. Birth attendants, be they doctors, midwives or nurses, who have experienced only hospital based, high interventionist, medicalized birth cannot see the profound effect their interventions are having on the birth. These hospital birth attendants have no idea what a birth looks like without all the interventions, a birth which is not dehumanized. This widespread inability to know what normal, humanized birth is has been summarized by the World Health Organization:.....

To read this article in its entirety: Fish Can't See - Humanizing Birth

 


 

Patient-Choice Vaginal Delivery?

 

An excellent essay written by Lauren A. Plante, MD and published in the May-June issue of Annals of Family Medicine asks the extremely important question: If patients have the right to "choose" a cesarean delivery for no medical indication, why are patients not being allowed to choose vaginal birth?

Patient-choice vaginal delivery? (Full Text)

Ann Fam Med. 2006 May-Jun;4(3):265-8.

Leeman LM, Plante LA.

Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA. lleeman@salud.unm.edu

Patient-choice cesarean delivery is increasing in the United States. The American College of Obstetricians and Gynecologists supports this option, citing ethical premises of autonomy and informed consent, despite a lack of evidence for its safety. This increase in patient-choice cesarean delivery occurs during a time when women with a breech-presenting fetus or a previous cesarean section have fewer choices as to vaginal birth. Patient-choice cesarean delivery may become widely disseminated before the potential risks to women and their children have been well analyzed. The growing pressure for cesarean delivery in the absence of a medical indication may ultimately result in a decrease of women's childbirth options. Advocacy of patient-choice requires preserving vaginal birth options as well as cesarean delivery.

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Listening To Mothers II

from the Childbirth Connection

 

Childbirth Connection issued a press release on October 24, 2006 announcing the release of their second national survey of women's childbearing experiences. In the press release it states that the data show many mothers and babies experienced inappropriate care that does not reflect the best evidence, as well as other undesirable circumstances and adverse outcomes. An Executive Summary PDF can be downloaded free of charge from Childbirth Connection.

 

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Continuous Electronic Fetal Monitoring

 

Has continuous monitoring of the fetal heart during labor resulted in better outcomes for these babies? NO. Study after study has shown it does NOT improve outcomes for babies. It has however, resulted in worse outcomes for the mother! Even the American College of Obstetrician and Gynecologists states that outcomes are just as good using intermittent monitoring of the fetal heart by auscultation (listening with a fetascope or hand-held doppler)  and this is an acceptable method of fetal monitoring during normal labor. However, the practice continues to be routine in all hospitals in the United States, no matter how many times these facts are presented.

 

From:

Field Notes in Obstetrics and Maternal-Fetal Medicine
Unnecessary Testing in Obstetrics, Gynecology, and General Medicine: Causes and Consequences of the Unwarranted Use of Costly and Unscientific (Yet Profitable) Screening Modalities
by Martin Donohoe, MD, FACP

posted April 30, 2007 [on Medscape]
 

"Certain once-broadly accepted monitoring tests that were used routinely have not been supported by outcome data. Examples from obstetric practice include electronic fetal heart rate monitoring and fetal pulse oximetry. Routine electronic fetal heart rate monitoring has not been demonstrated to decrease the rate of cerebral palsy, but has been linked to increases in the overall rate of cesarean delivery.[8,9] It has also been determined that routine use of fetal pulse oximetry is not associated with either reduced rates of cesarean delivery or improvement in the condition of newborns.[10] Although these tests are not recommended for routine assessment, they remain in use in many hospitals in the United States."


 

 

The Lancet 2003; 361:445-446

DOI:10.1016/S0140-6736(03)12465-8

Revisiting the use of the electronic fetal monitor

 

Concerns about the efficacy and safety of routine electronic fetal monitoring in labour have led expert panels in the USA and Canada1,2 to recommend that such monitoring be limited to high-risk pregnancies. The latest systematic review supports that concern;3 yet, the use of electronic fetal monitoring in low-risk pregnancies continues to expand globally. …..

 

It is important to explore new and better uses of technologies in medicine. However, technology must not be allowed to diffuse unchecked. The use of electronic fetal monitoring in low-risk pregnancies is of limited effectiveness and carries an increased risk of interventions including instrumental delivery, caesarean delivery, augmentation of labour, and epidural anaesthesia.3….

 

To read this article:  "Revisiting the use of the electronic fetal monitor"

 

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Cesarean Section

 

A Cesarean Section, or C-Section, is not just an alternative method of having a baby. It is major abdominal surgery and includes risks and side effect you experience with any major surgery. Cesarean section also has certain risks and potential consequences that are unique to this particular surgery - risks to your baby, and to future pregnancies and babies. While a cesarean can be a life-saving surgery when used appropriately, it should never be considered as 'routine' and risk-free. The number one cause of maternal deaths in developed countries (United States) are complications related to cesarean delivery and anesthesia. Figures released on December 5, 2007 report that the national c-section rate for all births in 2006 in the US was 31.1%, and Childbirth Connection's Listening To Mother's II survey found that 1 out of every 3 women delivered by cesarean section.

 

A new study of nearly six million births has found that the risk of death
to newborns delivered by voluntary Caesarean section is much higher than
previously believed. The study included 5,762,037 live births and 11,897 infant deaths in the United States from 1998 through 2001.

Researchers found that the neonatal mortality rate for Caesarean delivery among low-risk women is over 2 1/2 times higher than that of babies born vaginally to low-risk women. Their findings were published in the September 2006 issue of Birth: Issues in Perinatal Care. Read the abstract:

Infant and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women with "No Indicated Risk"

 

Top 15 studies reported in 2006 on cesarean section

What Every Pregnant Woman Needs To Know About Cesarean Section

The C-Section Fact Sheet

19 Ways to Avoid An Unnecessary Cesarean

Vaginal Birth and Cesarean Birth: How Do the Risks Compare?

 


 

News - The latest trend that leaves women caught in the middle - An ICAN press release:

Insurance Companies Rejecting Women with History of Cesarean

- Some Companies Require Surgical Sterilization for Coverage -

 

News - Update on CESAREAN RATE
"Percent of live births by cesarean delivery by race and Hispanic origin of mother: United States, each State and territory, final 2004 and preliminary 2005"
 

 

 


 

Epidurals

 

There are incredible risks associated with Epidurals which are seldom mentioned. If you are considering an epidural you should at the very least educate yourself on the potential and considerable risks to both you and especially your baby. All drugs cross the placenta and affect the delicate developing brain of the of the baby.

 

Epidurals cross the placenta and cause the following effects in the newborn:

  • less alert at birth, cry more, poorer visual skills, all resulting in interference with maternal-infant bonding - these affects frequently last for up to 6 weeks

  • poor sucking

  • increased likelihood of breastfeeding failure

  • decreased muscle tone

  • lowered neurobehavioral scores

  • increased incidence of jaundice

  • risk of damage to the central nervous system

There has even been a high correlation found between mothers who received some drugs during labor and later drug abuse in their teenagers. ("Opiate addiction in adult offspring," Jacobson et al.)

 

Epidurals have been shown to:

  • slow down labor

  • lead to an increased use of pitocin to strengthen contractions

  • lead to an increased incidence of the baby in a posterior position

  • increase the likelihood of forceps or vacuum extraction

  • increase the chance of having a cesarean section

  • increase the mother's body temperature, resulting in her and the baby receiving antibiotics and invasive tests

  • cause the mother's blood pressure to drop, sometimes to dangerous levels

    • lowered blood pressure may lead to fetal distress

  • cause other complications including long-term chronic problems such as headache, and even death

For more information:

 

Everything you want and need to know about epidurals - benefits, risks, side effects. A great article by Henci Goer.

Epidurals For Labor Pain

Epidurals and Breastfeeding

 

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For a free consultation contact:

 

  Midwifery Services of South Texas

midwifeservices@gmail.com

 

 

© Copyright 2007 Midwifery Services of South Texas

Permission to reprint pregnancy and childbirth information contained within this website with attribution

No photographs may be copied or used without written permission

 

What Parents

Need To Know

 

 

 

Birth American Style - confined to bed, no food or drink, hospital gown

 

Induction of Labor

Induction of labor is often the first intervention used in an otherwise normal pregnancy and labor which leads to a long line of more interventions, each with their own set of risk factors.

 

Induction of labor has become routine and epidemic in the United States. Reports on the rate of induction vary widely. The reported rate is about 20% of women admitted to Labor and Delivery. However, the rate is much higher with some physicians. The Childbirth Connection's new Listening to Mothers II survey reports more than four out of ten mothers (41%) reported that their caregiver tried to induce their labor. When asked if the induction caused labor to begin, more than four out of five of those women (84%) indicated that it did, resulting in an overall provider induction rate of 34%. Among all survey mothers whose providers tried to start their labors, 79% cited one or more medical reasons for being induced, while 35% cited one or more non-medical reasons. Overall, 11% of mothers reported experiencing pressure from a health professional to have labor induction, and those reporting pressure were more likely to have had it.

 

I can't begin to count the number of times I have had pregnant women tell me they were going to have their baby on _______ (fill in the date.) When I ask why, the most common response is "I don't know. My doctor just scheduled it," or a close variation to that answer.  I have heard comments from hospital staff that 90% of women admitted to L&D are being induced. Almost all of these inductions are for non-medical reasons, meaning they are done for convenience - convenience of the obstetrician, the mother, or both. While there are instances when induction is medically indicated for the health of either mother or baby, most of the "medical" reasons given are dubious at best, with little or no evidence to support the supposed indication for induction. Unfortunately, most women do not have the risks associated with induction of labor fully explained to them. Many of the risks are to the mother, but not all. The baby is also exposed to the same risks, and risks that are unique to him or her.

 

Risks of Induction Fact Sheet

 

A previously suspected risk of induction was finally confirmed and reported on in October 2006 in The Lancet medical journal (Kramer MS et al. "Amniotic-fluid embolism and medical induction of labor: a retrospective, population-based cohort study." The Lancet 2006; 368:1444-1448.) Women who are induced are 1.8 times more likely to experience a rare but serious complication known as Amniotic Fluid Embolism, and women who experience this are 3.5 times more likely to die from it if they were induced. Another finding reported is that women who have cesarean sections are 12.5 times more likely to experience AFE.

 

Bishop score and risk of cesarean delivery after induction of labor in nulliparous women

Report on a study of risk of cesarean in women who have never given birth before (nulliparous) who have their labors induced. Note: The bishop score is a rating system to assess suitability of the cervix for induction of labor.

 

CORD CLAMPING

Immediate or Delayed?

A More Important Issue Than You Know

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Birth Statistics

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For Texas

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“Unfortunately, the role of obstetrics has never been to help women give birth. There is a big difference between the medical discipline we call “obstetrics” and something completely different, the art of midwifery. If we want to find safe alternatives to obstetrics, we must rediscover midwifery. To rediscover midwifery is the same as giving back childbirth to women. And imagine the future if surgical teams were at the service of the midwives and the women instead of controlling them.”

-Michel Odent, MD (an obstetrician with the
heart of a midwife)