The early weeks of pregnancy are fragile—and confusing. Here, the answers to your questions.
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The childbirth educator, doula and author of many books (most recently When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on the Childbearing Woman but probably most famously for The Labor Progress Handbook: Early Interventions to Prevent and Treat Dystocia) recently spoke at the Cedars-Sinai second annual Birth Community Day in Los Angeles. The day was sparked a couple of years ago by a conversation between a Cedars-Sinai Labor and Delivery nurse and a doula (imagine!), with the goal of sharing valuable knowledge and experience about the best ways to ensure a safe, comfortable and memorable birthing experience. In attendance: nurses, midwives, doulas, MDs and press. Bini Birth of Sherman Oaks, CA co-hosted.
Of course, the event drew additional interest because Cedars-Sinai has a reputation for a high C-section rate (currently their website clocks the C-section rate at 22%; in 2008 it was 37.1% — the national average for 2011 was 32.8%). This community, however, is committed to their mission, which includes, as OB/GYN Sarah Fitzpatrick says, making sure that women know about all their options for managing pain and increasing comfort during childbirth: “As new research leads to new best practices, we must continue to transform our models of care.“ I loved her statement that followed: “Too many interventions are bad; what’s most important is safety. We work together, communicate when we’re worried, and it makes us better doctors and nurses. Is the C-section rate high? Maybe, but we’d like to get it lower, but safely, which means customized care, education, and touch. Lots of touch.”
Some of the options already in place at Cedars, or in the works, include walking epidurals (for real!), aromatherapy (for both vaginal and Cesarean birth), doulas for natural, epidural-assisted and even surgical births, immediate skin-to-skin contact. A new program called “Rock and Roll” encourages laboring women to change position every 20 minutes, and even try some labor positions (such as on a birthing ball or squatting), even if they have had an epidural. The aim – to reduce the C-section rate (Cedars reports an 8% decrease) and the length of time in labor, which spokespeople say has gone down by 20%.
Penny Simkin has herself long been committed to reducing C-sections in this country. Simkin has been in practice more than 50 years, and has prepared nearly 11,000 women and families for labor and delivery. She says the #1 reason for C-section is dystocia, or failure to progress, “and many other terms,” Simkin says, “that all mean the baby just isn’t coming out.” The problem with a C-section is that it almost always leads to another, second, or third, and so on. She believes that there are small early steps that can be taken to prevent dystocia and the very first Cesarean.
“There are physical reasons for dystocia, including scarring, intense contractions (often brought on by induction and Pitocin), doctor-caused and man other physical causes,” but the most powerful types, she says, are emotional: fear, stress, suffering as opposed to pain — all can reduce blood flow to the cervix and interfere with dilation.