Non-Professional Labor Support

NON-PROFESSIONAL LABOR SUPPORT

father in delivery room

 

 

 

 


By the baby’s Father or Partner of the woman:

• Can speak for her, to interpret her needs and desires to the staff.
• Assurances, relaxation, encourage her to drink and eat snacks.
• Assistance in walking during labor, assist in getting in and out of the shower or birth tub, etc.
• If knowledgeable, help with breathing and focus in the 2nd stage of labor

Note: to work effectively, the father needs to be well informed. He needs to know what to expect. If he gets panicky he should leave the room to regain composure and then re-enter. First-time fathers especially need to be informed and may still have need of assurance. This can be assisted by his attendance at the Childbirth Education classes.

By a female relative (Grandmother, mother, aunt or sister):

• [At the hospital] Can speak for her, interpret her needs and desires to the staff.
• If they have experienced a natural birth, their assurances are “gold”. They will know what and when to do things to support the process.  If not, they need to become informed about natural childbirth.
• Assurances, relaxation, encourage her to drink and eat snacks.
• They can assist in labor as well, by walking with and supporting the laboring mother; assist her getting into and out of the shower or birth tub, etc.
• Can help with breathing and focus in the 2nd stage of labor.

RECOMMENDED POSTS To READ:

Let Your Monkey Do It
Overdue Pregnancy


FUTURE POSTS YOU WILL NEED TO READ:

Hospital VS. Midwifery Model of Care
Pain in Childbirth
Normal Vaginal Birth
Optimal Fetal Positions
Positions for Labor
Water Birth
Premature Rupture of Membranes
Fetal Distress
C-Section
VBAC

ProfessionalLaborSupport-Pt3

doula at workMONITRICE /MIDWIFE’S ASSISTANT

The Monitrice can assist in providing a continuity of care, from pre-pregnancy through post-partum. They are trained in all the basic skills that a midwife is trained, but without the certifications to actually “catch” the baby.

At the point of a woman going into labor, the Monitrice/Midwife’s Assistant attends the birth in the manner of a Doula. See the blog post: ProfessionalLaborSupport-Pt1 regarding how a Doula assists in childbirth.

A Monitrice/Midwife’s Assistant:

-Assists women with the pre-pregnancy and fertility issues they may have, along with natural birth control methods.

-Has knowledge of local resources

-Monitors the pregnancy with training in taking the blood pressure, FHT, and urine collection
They enter the labor room in a Doula capacity.

-Assist with neonatal care

-Supports breastfeeding of the baby

-May assist in post-partum care

-Knows alternative complimentary methods for pregnancy and childbirth

 

ProfessionalLaborSupport-Part2

mom and babyChildbirth Educator

The childbirth educator teaches and assists women in understanding the nature of childbirth, from pre-conception through the first year of baby’s life.  The information they give assists women in having a better and safer birth experience.

The professional Childbirth Educator trained at Birth Arts International adheres to the “Midwifery Model” of care, as outlined by MANA. This is where I am training (and near completion of).

Here are some things that may be covered:

  • Nutrition – preparation to conceive, during pregnancy, and post-partum
  • Pre-natal tests: What is required and why
  • Exercise: for optimal health, and to tone muscles in preparation for birth, as well as post-partum exercises
  • Stages of labor
  • Interventions
  • C-sections and VBAC
  • Neonatal care (newborn baby care)
  • Breastfeeding

Even second-time mommies can benefit from classes.  It helps you to have a better / safer birth to review information.

Childbirth Educators can assist in labor, in a much similar way that a Doula would.  They can answer your questions and assist after the baby is born.

 Part 3: Midwifery

ProfessionalLaborSupport-Pt 1

PROFESSIONAL LABOR SUPPORT

On the average during an 8 hour shift a nurse will spend about 15 minutes offering physical comfort measures, provide emotional support, or advocate for her patients. Nursing staff are criticized during their reviews for spending too much time with patients if they DO take more time with laboring mothers.

Odds are better with a midwife. But often hospital based midwives have time constraints. You are going to do best with the support of a professional such as a Monitrice or Doula.

doula at work DOULAS

There are two different types of Doulas. A Labor Doula, who will be with you through the pregnancy, meeting with you several times, supporting you while you are in labor (if you so choose), and the first few hours after the baby is born.

There is a Post-Partum Doula, that will work with you and baby for a period of time after the baby is born.

Doulas do not “catch” babies. They will support you in labor and through delivery if you choose to have a Doula.

TheBirthDoula

It has been documented that with the support of a BIRTH (Labor) Doula:

• Lessens problems with babies born in poor condition, babies are less often admitted into special-care nurseries, the hospital stay is shorter in duration, nor are they likely to have infections.
• Women are shown to have less pain and anxiety during labor, cope better with labor, less likely to have lowered numbers of episiotomies, the use of IV Pitocin is lowered, the use of instruments during delivery is lowered and best of all: C-section rates are lower. The length of the labor is shorter.
• Breastfeeding past the 6 week mark is higher when a Doula is utilized for support.
• Also women who have had Doula support have more positive feelings towards the new baby, a better relationship with the father, and lowered postpartum depression.

A BIRTH DOULA:

• Can accompany you when you go to the doctor the first time.
• Visit with you a few times during pregnancy to:
o Assess your nutritional needs and help you stay healthy through your pregnancy.
o Assist you with good posture and exercises that will keep you strong and help in having an easier delivery.
o Before the time of labor and delivery, discuss your options and help you write up a Birth Plan.
• During labor: assist with pain measures, advocate in your behalf with hospital staff (when necessary), help coach your labor partner during labor, etc.
• Afterwards, will assist you in breastfeeding and baby care (first couple hours after delivery).
• Make a visit Post-Partum to see how you are doing, and assist where necessary.
• Do not “catch” the baby.


POST PARTUM DOULA
:

Generally, they offer some or all of the following:

• Breastfeeding Support
• Mother Care Support
• Cooking meals
• Shopping
• Cleaning
• Caring for infant while mother bathes, eats, etc..
Some also offer:
• Other childcare (not directly caring for newborn)
• Laundry

NEXT WEEK: The Childbirth Educator

Issues Part 4

The issues that affect Lakota Native women during pregnancy and childbirth in regards to: Racism, Sexism, and Oppression?

Infant mortality is higher in teen births, birth weights of their babies lower, the possibility of premature birth and the birth defects more common in premature births. Premature birth is higher in this sector of the population, often due to violence during the prenatal period.
The rise in teen birth Indian country is alarming. “46% of Native American mothers are under 20 when they have their first child, compared with 25% of mothers of all other races . The average age for becoming pregnant has become lowered from mid to upper teenage years down to pre-teen groups of 9-12 year old girls!

“Boys and girls who experience sexual dating violence are more likely to initiate sex before age 11 ”. These issues would not have incurred had the elder women counseled and instructed their younger relatives on traditional women’s roles and young men counseled and instructed by elder males, as was traditionally done.

There were two ceremonies that were traditionally done for young girls, that are now rarely found in today’s Lakota Society. The pivotal ceremony for girls was the Isnati ceremony. This ceremony was done at a female’s first menses. The young girl would have had the instruction given by elder women regarding her role in society, especially as to virtuous behaviors, her place within society, pregnancy, and childbearing. women regarding her role in society, especially as to virtuous behaviors, her place within society, pregnancy, and childbearing.

Sexual Objectification of Native Women

Rape and domestic violence in Native populations have been on the rise, but within the teen population is another aspect to be considered: gangs. Gang rapes and gang violence is high among native youth, and the female population is especially vulnerable. Although there is a high risk, in one study it was reported that those who perpetrated dating violence did not use a condom deliberately despite “high risk activity such as sexual infidelity, involving “trains” and multiple sex partners ”.

As well as gang related violence and rape, young girls are also vulnerable to date rape. In 1994, “92% who had sexual intercourse reported as having been forced against their will ”. Women ages 16-24 experience the highest rates of rape and sexual assault. The violence that is inherent in this age group limits the ability of teenage girls to manage their reproductive health and also causes them to be vulnerable to sexually transmitted diseases.

1996, the rate of reported rape among Native women was 3.5 times higher than other races. This is just the reported rapes! Add to this population, those who have been subjected to another type of criminal activity: Sex Trafficking. It has occurred since the colonial era. It is only recently that the United States Government has classified Human Trafficking as a form of slavery.

Most of the Sex Trafficking occurs in areas near First Nation Reserves (Canada), Native American Reservations, and Alaskan Native communities. To understand the particular vulnerability of Native women to Sex Traffickers, you only need to look at the historical perspective. In the United States, the military that oversaw westward expansion ‘targeted native women for sexual assault, sexual mutilation, and slaughter’, as seen in numerous accounts of that time.

Compounding all the aforementioned issues is the accumulated impact of the historical experiences creating a “generational trauma” with increased levels of trauma response and stress that passed from one generation to the next, over several consecutive generations. The generational trauma is thought to be the ‘major contributor’ to the level of ‘poverty, violent victimization, depression, suicide, substance abuse, and child abuse’ in Indian country today. It is also thought to be the reason for generational prostitution and child trafficking in the Native families.

Traffickers exploit the areas in which this population has vulnerability. One method is to portray the sex trade as a quick way to become personally empowered and have financial independence. Another is to target those who are homeless or have been impacted by poverty.

Exploitation is done of those with mental illness, have substance abuse issues, FASD (Fetal Alcohol Spectrum Disorder), and those with who are Two-Spirit (transgender) are deliberately sought due to their vulnerability on the streets from violence, and are offered protection (Pierce and Koepplinger,3).

Next:  Part 5 – Conclusion (and references).

 

Issues Part 3

What are the issues that affect Lakota Native women during pregnancy and childbirth in regards to: Racism, Sexism, and Oppression – Part 3

After years of encroachment upon traditional healing practices, the stage was set for an Eugenics movement. This movement “… in the 20th century began as a means of controlling the perceived increase in ‘degenerate’ population and maintaining or protecting hereditarily ‘fit’ members in society from being overrun by the genetically ‘unfit.’ (Forbes, 2)” or groups that were marginalized, such as Native Americans.

Initially, the population targeted was those with low intelligence and those with physical disabilities. But, soon it expanded to “ a program to implement ‘racial hygiene’ in the United States, eugenics essentially entailed taking the principle of natural selection and enforcing it by employing allegedly ‘scientific’ means (Forbes, 2)” The concern was that the white populace were being degraded by the influx of people with racial differences. The classifications included socio-economic, class, status and race.

…policies founded on eugenic theories (sic) started to emerge, forcing procedural sterilizations and other means of population control upon people believed to be unfit (Forbes, 2-3)”. In the late 60s and through the 70s the target was Native American people. Indian Health Services began a systematic sterilization policy.

Women would go to the I.H.S. hospital, told they needed a cesarean section (for a variety of reasons), anesthetized; and when they awoke, these women found they had been given a hysterectomy, which is what happened to my friend. She stated that she was not informed of the need for a hysterectomy. She had gone to deliver her baby, the doctors examined her and stated that she needed an emergency cesarean section. She awoke, finding that she had her uterus removed. My friend’s experience was not uncommon, “…in 1975 alone, some 25,000 Native American women were permanently sterilized – many after being coerced, misinformed, or threatened .

In 1990, a former nurse at I.H.S. reported that tubal ligations were used on women who did not want the surgical procedure. Birth control also was forced upon unsuspecting females such as Depo-Provera, without informed consent, and prior to the FDA having given its approval (this would include the mentally retarded ).

Health risks of the drug Depo-Provera are high in native populations due to Diabetes, obesity, and cigarette smoking. Many who were forced to have it or Norplant administered were not informed of the risk. A secondary aspect is the cultural issues. Irregular bleeding that is caused by these drugs can prevented participation in traditional spiritual practices.

In my own research of the issues of native women in the child-bearing years I was shocked by the high numbers of cesarean sections done on this sector of women. The rate of C-Sections nation-wide is 32.8%; whereas South Dakota is around 25.3%. But, I.H.S. rates are higher than the state average, last internet search showed it at 34%.

Why is this of concern? The health risks of women in the child-bearing years due to unnecessary surgery being conducted. Childbirth is treated by the modern medical doctors as though the baby a ‘disease’ that needs to be cut-out, rather than a natural biological reproductive process. Had the traditional practices of midwifery had been continued within the native culture, allowed to flourish, there would have been very few cesarean sections necessary in our modern times.

Other Factors Regarding Childbirth in Indian Country

Next below the black woman, the native woman is recorded as 2nd to the highest in infant mortality rates . This is due to living in rural areas with poor access to proper care during pregnancy. “Poverty is an important risk factor for poor health outcomes ”.

Compounding the issues mentioned above are those of teen and pre-teen births. A female who is younger than 18 or 19 years of age are not fully developed, in other words are still growing themselves. Teenagers tend to eat poorly, are more prone to drink alcohol, smoke, and take drugs during pregnancy.

Next: What are the issues that affect Lakota Native women during pregnancy and childbirth in regards to: Racism, Sexism, and Oppression – Part 4

Issues part 1

The issues that affect Lakota Native women during pregnancy and childbirth in regards to:
Racism, Sexism, and Oppression

In this report, I will discuss the diminishment of access to information for native female populations of traditional cultural / spiritual values regarding reproduction, healthy pregnancies, and child-birth. As well as cutting the ties to cultural education for young native females (and males/but not discussed herein) directly addressing gender-related socio-cultural information.
Today young native females in Lakota country find they are alienated from the cultural concepts of reproduction and childbirth practices that once were available from the elder women within their family groups.

The path of traditional information is fractured, if not completely broken in Lakota country. Also access to traditional midwifery is not available in many areas.

Young women find themselves (by necessity) having to deal with doctors and hospitals that are a part of the system of oppression that conquered their people and that had forced assimilation practices upon their elders. They have also heard about Eugenics Policies to eradicate native populations, by means of the sterilization policies enacted in the 70s through Indian Health Services.

Due to historical trauma, these young women find themselves re-living much of post-traumatic effects during the pregnancy time-period and at birth. The trauma affects the decision-making process as well.

Historical Background

Initial contact with European colonists was tenuous at best. The European white settlers had asserted its dominance from the onset of settlement. Through the lens of the European settlers, these indigenous people were inferior, only due to the differences in cultural systems of governance. Almost immediately the settlers asserted dominance and control over tribes in which they had initially contacted. The tribes were left with two choices: to conform or to resist.

The colonists viewed the encountered indigenous people as an inferior / savage group. This view was based upon the fact the tribes were not Christian (hence “savages”) and technologically not as advanced as their own (incoming) settler populations. The lens of the white populace was Eurocentric/ethnocentric due differences in ideological concepts such as the differences in view, regarding ownership of land.

The indigenous people did not cultivate the land in the same manner as the Europeans settlers. The settlers could not understand the concept of joint stewardship of lands by the native populous. In their ethnocentric mental lens white settlers conceived this ideology as a waste of good farming land, and of course their ideals were superior in that the land would produce food. Land to the settler, was a resource a non-movable commodity.

From this mental idea of superiority, the desire for lands in which to cultivate both their crops and cattle, the European settlers began to broker deals with nearby tribes through treaties . If they could not gain the land through a treaty, they forcibly took what they desired.

Next week: Part 2 – The issues that affect Lakota Native women during pregnancy and childbirth in regards to: Racism, Sexism, and Oppression.

Culture Part II

Cultural Perspectives on Childbirth

Achomawi mother and childMulti-cultural Beliefs (Continued)

Last week I ended with discussion about the Lakota belief in a spiritual being who assists the souls of the unborn in their journey to human existence. It is thought she “marks” them before entry into this world.  This “mark” is what the medical field calls a “Mongolian” mark.

Because of the spiritual forces in play, many indigenous cultures had and still practice rituals at the birth of a child. This is due to the understanding that childbearing and childbirth are a sacred act.

This may not necessarily be understood by present-day women within the culture, but in their soul and spirit the women do recognize that modern medicine’s “managed care” works against the traditions and ageless wisdom of their tribe. This is true whether they have a traditional spiritually based upbringing in their lives or they have adopted non-traditional religious practice. Their sense of “knowing” from their soul, speaks out against what is not natural and spiritual in the birthing process.

Western culture encourages reading and the attendance of Childbirth Education classes, along with other strategies for birthing. In traditional cultures women “…prepare more symbolically. They avoid all actions and thoughts that have anything to do with ‘getting stuck’ or ‘closing up’ and ‘letting go’…  In traditional societies, women often go to midwives to confirm the pregnancy and then again only if there are special problems… (145)” prior to childbirth.

Another aspect is that most women within many traditional cultures would have been directly involved in the childbearing and child birthing aspects from a young age. Her mother or aunts and grandmother would have taught her about the processes of childbearing and childbirth during childhood and/or adolescent years. The concepts would have “…been integrated into her maturity into adulthood (Ibid.)”. It would have come from her experiential life and stories told to her instead of a class or books.

Unfortunately, much of this kind of experiential life and tradition has been lost or no longer practiced today by local tribal women. Some of the other women will talk about this or that grandma who was a midwife, and who may have been allowed at IHS for a birth. When I have asked women, they mostly talk about a more negative experience for their childbirth if they speak up at all.

Traditionally, the birth of a baby was in the home, not a hospital. Some cultures used “a special hut [that] is constructed for that purpose ;…(Ibid)”. But today in the local area, birthing mostly takes place in a hospital setting, here on the reservation. Locally, there is the IHS. There also is Winner Regional, in Winner South Dakota (45 minutes from Mission, SD) or Cherry County Hospital in Valentine, NE.

Due to past experiences with IHS (the “Eugenics Project” of the 60s and 70s, for one), many women may opt to not have their babies unless there is an emergency. Both Winner and Valentine have doctors that have demonstrated certain biases against native women. Without midwives to deliver locally, this is what women on the Rosebud (Sicangu Oyate) Reservation face today (with the exception of one community).

Each of these three hospitals has their own regulations as to who may attend the birth. They also decide on whether a woman can have assisted births (Nurse-midwives/doulas/etc.).  My attempts to discover these policies, and the reasons for them, have been futile.

– Next week will be “Part 1 – The issues that affect Lakota Native women during pregnancy and childbirth in regards to: Racism, Sexism, and Oppression”

 

Culture Part 1

Cultural Perspectives on Childbirth

 cropped-na-mother-and-child.jpgEvery aspect of who we are from our behaviors to our learning processes is framed by our culture. The whole idea of a “melting pot” in America where many cultures blend to become one culture, is a fallacy. People of like cultural and ethnic background tend to gravitate towards what is similar and familiar. It shapes their identity.

This is particularly true of treaty nations (indigenous peoples) who struggle to keep their own tribal identity. Even in the cities, away from reservations, native people gravitate toward what is familiar and comfortable (besides where else would they get some Indian Tacos?).

Every indigenous group has their own cultural beliefs, rituals and traditions. Even for pregnancy and childbirth. How childbirth took place was shaped by cultural values, ways of knowing, and framed within ritual and belief.

Unfortunately the cultural aspects were not all preserved and kept in all tribal groups, due encroachment from white society. This encroachment has created a rift in fabric of cultural life. “The culture in which people grow up is one of the key influences on the way they see and react to the world and the way they behave (139).”

For many cultures, including the Lakota, pregnancy and childbirth is much more than just a physical act. It is believed that a spiritual force is at work. Concepts, customs, and traditions develop around these spiritual beliefs.

Here are some of the sites I found, for other cultures:

http://www.midwiferytoday.com/articles/immexico_healing.asp
http://www.louisianafolklife.org/LT/Articles_Essays/main_misc_wait_babies.html
http://ihst.midwife.org/ihst/files/ccLibraryFiles/Filename/000000000004/IHS%20Midwives.pdf

Multi-Cultural Beliefs

Within each indigenous culture are the ideas and concepts that surround the actions of the pregnant woman, her diet, how others should act when around her. Some ideas and traditions actually carry across into multiple cultures around the world.

One concept has to do with knots and ties. That if these were within view of a pregnant woman, or she stepped across them, it would cause the umbilical cord to be tangled at birth. Another has to do with actions of others. If you fight around a pregnant woman or with one, it causes problems with her pregnancy.

For most indigenous cultures there are concepts taught regarding the spiritual aspects of birth and early childhood. There are beliefs in a female spirit that assists in childbirth, and also assists the soul of the child in “picking” the family in which they will be born. Infants and young children are often considered “sacred beings” and our actions with them must be tempered by this belief.

-More next week, in Part 2.

OverduePregnancy

“Overdue” Pregnancy

silhouette of pregnant womanThe word “overdue” is not really a correct term to use. The concept of the length of a pregnancy being a 40-week period of time was just a random time-frame that was chosen.  A German obstetrician in the early 1800s announced strongly that pregnancy should last ten lunar months of four weeks each.

The timing is relative.

The current standard for determining due dates, ultrasonography, does not do so accurately. In the first trimester it can give a time frame of plus or minus 5 days, a ten-day window. Sonograms done later in pregnancy are even less accurate than early-on.

These types of tests have been proven to have “poor predictive outcomes ” or better said, false-positive/non-predictable results. Yet it is exactly what the doctor uses to determine if a woman or/ and her baby are in need of intervention.

The tests are run at the 42-week mark. Usually, these tests are not accurate, but the doctor rushes to “rescue” the baby. Ironically, when the baby turns out to be just fine, then it reinforces the doctor’s belief that the baby needed “saving”.

Babies come when they are supposed to be born.

Just as doctors use the “average” for determining the length of labor, the “average” is what determines whether or not your baby is late, or not. That average does not take into consideration your own cycles (for date determination) or whether you even kept track of your menstruation cycles.

Doctors become concerned about the well-being of your baby if you have hit the 40 week mark and you have not begun labor. Their concern is not always justified. Below you will find some tests used to determine if your baby is well.

TESTS OF FETAL WELL-BEING

The false positives of these tests have begun to shore-up the idea that it would be a dangerous thing to allow a pregnancy to continue. When induction is started, there is an increase of fetal distress and with that, increased cesarean sections.

A test you can do:

Fetal Movement Counts: Beginning a few weeks before the “due-date”, pick a time in the day when baby is awake. Then begin counting 10 movements, doing this several days in a row. If there is marked drop in movement, seeing the caregiver who will follow up with one of the next few tests.

Tests the hospital may do:

Non-stress test: Using an external fetal monitor to track the baby’s heart rate when baby moves or during pre-labor (Braxton-Hicks) contractions. The heart-rate of baby should increase. But, sometimes it will not, because baby is asleep.

Vibroacoustic stimulation: A slightly different method than the previously mention one. Basically, a buzzer is sounded against the belly, which is supposed to startle the baby. There should be a resulting heart-rate increase.

Oxytocin Challenge Test: You get hooked up to the fetal monitor, an IV is started with oxytocin to check the baby’s heart rate when contractions have been stimulated.

Biophysical profile: An ultrasound scan that is for the evaluation of the placenta, the movements of the baby, and how often the baby does a “practice breath”. When a baby is having problems, the baby slows-down his/her movements and will stop the “practice breath”. This test is done on a 0-10 scale (“0” being the worst).

Amniotic Fluid Volume measurement: Ultrasound is used to estimate the amount of amniotic fluid in the uterus. The idea is that too little amniotic fluid creates a probability of stress during labor.