Study: Episiotomies are becoming less and less common

Episiotomy is an obstetric procedure sometimes performed during vaginal deliveries, in which a health care provider cuts the perineum to make more room for the baby’s head as it emerges. The procedure was at one point believed to be a better alternative to natural tearing that can occur during delivery. However, research found that it could actually cause more severe tears and lead to increased complications, including infection and incontinence. Over time, doctors began stepping back from its routine use. According to a new report from Journal of American Medical Association, the number of episiotomies is falling after major organizations like the American College of Obstetricians and Gynecologists urged for restricted use of the procedure in the mid 2000’s.

“Research has long supported the judicious use of episiotomies, rather than performing them routinely.  It’s discouraging how much time it has taken for the rate of routine episiotomies to go down in many areas given the evidence, but good to see that the numbers continue to decrease.” – Jocelyn, Ohana Founder / Doula / Childbirth Educator

Read more here and here 

Posted in Research & Articles

Birth Story

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Here is a lovely birth story from one of our recent clients. Shared with permission of course.

FROM CESAREAN TO UNMEDICATED BIRTH

My second son was born October 29th. I’ve been reflecting on his birth ever since trying to sort through everything that went down, everything I felt, and everything that happened after. I wanted to write down my “birth story.” Turns out the whole story isn’t about one day, but takes place over almost 2 years involving multiple people and places. Here I attempt a 30,000 ft view of the events, and I know even that will be too long for most to read! But, I wanted to share anyway.

My first son was born via unplanned cesarean December 2012. I went into that birth pretty clueless. Sure, my husband and I took the class offered by the hospital, which was a big help, but that was it. I didn’t read any books, talk to other mothers, or do any prep on my own other than diligently seeing my OB throughout my pregnancy. I was admitted into the hospital immediately after going in for the stress test 4 days after the baby was due. Overnight I slept best as I could in the hospital bed but periodically nurses rushed in response to the fetal distress shown on the monitors. Finally around 6am the OB said it was time to just take him out. I accepted it, not moved one way or another. I sat calmly while my husband suited up, and I was even calm as the spinal was administered. (And here I skip a lot of stuff…basically cesareans aren’t as easy as one would think) I’ll never forget that alien feeling when I first heard my son cry. “That’s my son,” I thought. In an instant, I was a mom. Mom. What a weird word, especially when it suddenly applied to me.

When I became pregnant with baby #2 I assumed I’d try for a regular birth, since that is how it is “supposed” to happen. But, I was shocked when at my first OB appointment the Dr. started talking repeat Cesarean as if it was a done deal. She told me to go ahead and schedule it because the calendar books up quickly. I left the appointment a little numb. No factors such as my health, my wishes, my recovery, etc were even discussed. Of course I’d have a repeat Cesarean. This didn’t feel right. What was wrong with trying for a regular birth? Shortly after I read an article saying that the assistance of a doula can increase your chances for a successful regular birth. After getting more serious about the hope for a VBAC (vaginal birth after cesarean) and discussing the idea with my husband, we hired a doula we loved to join our team. (Check out Tara’s website here if you are considering a doula! She’s fabulous.)

Once she was on board I got really serious about this birth. I read 4 books about natural or regular birth, the best one being “Birthing from Within” recommended by our doula, Tara. I practiced relaxation techniques daily. I kept a journal to process my fears, thoughts, and emotions about the pregnancy and birth. I even connected with my inner hippie and made birth art. I was eager to hear other women’s birth stories and asked as many moms as I could to tell me theirs. I joined ICAN (International Cesarean Awareness Network) online. I studied the risks, stats, and success rates of VBACs. I spent a lot of time thinking about and drafting a birth plan. I learned more about OBs and why they do what they do and why so many are wary of VBACs. Soon I was talking exclusively in birth lingo in online forums, understanding completely when another woman posted “I had my VBA2C at 40+3 with DH and ds8 present.”

While sitting in bible study at church 4 days after my due date I finally felt them: contractions! For some reason I knew these were the real deal. I happily marked a tally in my study booklet for each contraction, blissfully unaware at the work ahead. Once home I took a shower, shaved my legs, and dyed my hair (because of pictures, duh!). The day dragged on along with the mild contractions. That night I slept on the couch and eventually woke my husband up in the middle of the night during a false alarm. He joined me on the couch where I slept fitfully until the morning. We called our doula over and sent Ashton away to our neighbors for the day. Things didn’t get really going until about 1pm. Suddenly, the contractions took a turn and were stronger and close together. I labored at home with my husband and our doula’s help. I wanted to stay home as long as possible to avoid unnecessary interventions or pressure from the staff at the hospital. But at around 5:30pm I was ready to go. After checking in and going through triage, we set up camp in the labor and delivery room.

Here is where things got interesting. I don’t even know how to adequately describe it, and it will never fully make sense to women who haven’t also been through it. It is like the difference between reading a book about how to skydive, and actually skydiving. You can’t grasp the experience without well, the experience. Active labor is a true force of nature. An amazing, crazy, powerful, unbelievable force of nature. Like a tsunami. Suddenly it just takes you on a ride, with or without you. You are present, but you aren’t part of it. Your body has 100% taken over. Yet, there is this incredible sense of freedom in active labor. You lose control, in the best possible way. You become this powerful, primal creature. There is no past, there is no future, your whole being is focused on the present which is thrown into sharp relief, second by second. Everything else in the room melts away as you shout, moan, and move in submission to labor’s force. Your body knows what to do even though you have no idea. Your body is doing something crazy and beautiful and insane. You are partnered with God bringing forth new life, united with Mother Earth in labor’s power, and brought into this sacred sorority of all other mothers. Labor is hard, then it gets harder. When you can’t take it anymore, it gets even more difficult. When it feels impossible to go on, you somehow do.

I was tired and asked for pain relief. After all, I only got a 45 min stretch then another 1.5 hour stretch of sleep the night before. I’ve been awake for essentially over 36 hours at this point other than a couple cat naps. The nurse checked my progress and cheerfully announced I was 10cm dilated, too late for drugs, it’s almost time to push!

Now that was a crazy moment. When I heard her say there would be no drugs, I was a mixed bag of conflicting emotions. First, I cursed myself for waiting too long to ask seriously for pain relief. Then I thought, wow…I’m actually going to do this. I’m going to achieve something I never thought in 100 years I could do. I was scared and empowered at the same time.

When it was time for the baby to make his debut, the room filled with staff and supplies. The big light was lowered from the ceiling. I was told that when it’s time to push, you will instinctively know what to do. I didn’t. In a panic I asked those around me, “How do I push?” My OB calmly talked me through it. After pushing through a contraction I’d look up into my husband and doula’s faces to gather strength for the next one. After a few more contractions and the appropriately named ring of fire (holy hell that hurt), baby was out. “Look at him, look at him!” the staff exclaimed. Afraid of what I’d see I squinted open just one eye as he was lifted up. And then there it was, that first baby cry as his lungs filled with air for the first time. Suddenly the baby I’ve been day dreaming about for months is real.

The main event was over, but the room still buzzed with activity. My OB stitched me up while a nurse collected linens into the biohazard bag (and it was a big bag. Birth is messy!). My husband stood near the baby, describing to me what he saw as the staff checked him over. Utterly and completely exhausted I was too nervous to hold the baby right away in fear of dropping him. My husband held the baby skin to skin himself. After gathering up what was left of my energy, I finally held my new little boy. It felt completely normal yet bizarre at the same time. Another baby boy! You could see the plates of his skull, and the ridges where they moved during birth. I loved his bumpy head. To me it looked as if he was wearing a crown. A well-deserved crown after what we both accomplished.

Thank You for sharing your story with us Jaclyn Levy. Click here to visit Jaclyn Levy’s blog .  

Posted in Parenting

5 things to think about when choosing a pediatrician – A guest blog post by Dr.Sapna Mukherjee

Choosing a pediatrician is one of the many decisions you will have to make in the months before you welcome your new baby. In the first year of life, your baby will see the doctor at least 8 times for routine visits. Add that on to any visits for illness and you get the idea of how familiar you will be with your child’s doctor’s office! Here’s a few pointers to help with selecting your baby’s doctor.

1. Ask friends that have young children
Chances are that your close friends have similar priorities and values to you. Ask them what things they like and what they would change about their practice if they could. How easy it is to talk to someone on the phone to schedule an appointment or to have a question answered. Ask about waiting times. Does the physician listen to the parents’ concerns and treat them in a patient and respectful manner?

2. Location and Access
You will want to choose a practice location that is conveniently located – close to home, work, or child care. You will need convenient parking options. Does the practice offer walk-in hours for ill visits or do they keep appointment slots available for same day ill visits. Who answers your calls when the office is closed? Can you leave your doctor a voicemail or send an email? Is there a charge for after-hours phone calls? These things make communicating with your doctor easier.

3. Type of Practice
There are a few different types of practices and each have their pros and cons. There are large practices, small practices and even practices that make house calls. The practices with more physicians are usually able to offer longer hours during the week and may offer appointments on the weekend as well. However, you may not see “your” doctor for ill visits. Conversely, the smaller practices may feel more personal but may not offer as many extended hours.

4. Hospital Affiliations
Which hospital(s) is the practice affiliated with? Will they see your baby in the hospital after you deliver? Where do they admit their patients? This may be important if you need to see a subspecialist or your child needs to be hospitalized.

5. Style
Personality and parenting style plays a role as well. Some parents want a definitive step-wise plan laid out while others want to be given the various options to consider. You may not know which group you belong to until your baby is born but it’s important to know that the practice has practitioners of both variety. You may want to ask about relationships with lactation consultants if you are going to breast feed and the practice’s policy regarding routine childhood immunizations.

Every pediatrician should offer a complimentary prenatal visit during which time you will get to see the office, interact with the front desk staff and nurses, and meet with at least 1 of the physicians. To get the most out of this visit, do your homework ahead of time and read over their website. Look at their list of physicians and if one stands out to you, try to schedule your prenatal appointment with him or her. Have a list of questions ready.
Wishing your family a happy and healthy holiday season,
Sapna Mukherjee, MD
Premium Care Pediatrics
www.PremiumCarePediatrics.com

Posted in Parenting

Study: How Much Newborn Weight Loss Is Normal and How Much Is Too Much?

Most newborns lose body weight in their first hours and days of life. But how much weight loss is normal and how much is too much? A new study conducted at Penn State analyzed hourly weight data from 160,000 babies to conclude that “levels of weight loss that doctors thought were abnormal are ‘actually pretty common.'”

The physicians who conducted the study also created an online tool that physicians and parents can use to assess their own babies’ weight loss. The tool, called the Newborn Weight Tool, or NEWT, allows parents to input weight recordings and compare the percentage lost or gained to the overall weight chart to determine if the loss is normal or cause for concern.

One important note is that the data does not yet account for the fact that babies born to women who receive large amounts of intravenous fluid during labor may lose more body weight than other infants. This is because these babies may have large amounts of water weight on board that they naturally shed after birth, leading to a steeper recorded decline in weight that is not associated with body mass reduction. There have been requests among the medical community to the physicians who developed the NEWT to try to add this consideration to the analysis.

To read the full article about the new study in the Lancaster, please click here.

Photo credit: LancasterOnline

Posted in Parenting, Research & Articles

Ohana Team Holiday Potluck

The Ohana team had a wonderful team meeting and holiday potluck last night. It was so much fun to see everyone together with their families.

In the top photo, team members from left to right are: Back Row – Andy Ross, Tara Van Dyke, Caroline Taromino, Shizue Taerbaum, Joanne Fortuna, Shawna Mertens, Sang Yup Lee. Front Row – Gowri Vishwanath, Cristina Berchez, Jocelyn Alt, Grace Lombardo, Stacey Hoekwater, Margarita Valbuena.

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Team_Ohana

Posted in Ohana News

Does It Matter When In Labor You Get an Epidural?

There is interesting new research out about epidurals.  To date, the research has been mixed about whether getting an epidural earlier in labor leads to more complications and interventions in comparison with getting it later.  This new study, published by the esteemed Cochrane Library, analyzes a number of the existing studies collectively to show that the timing does not increase or decrease interventions.  It is still true that epidurals in general are associated with longer labors and greater use of pitocin, instrumental delivery, and Cesarean sections for fetal distress (but not of Cesarean sections overall).  However, this most recent study found that labor length, and risks of instrumental or Cesarean birth are not increased or decreased based on the timing of the epidural.  Helpful information for expecting parents to use in their decision-making!

Interestingly, as explained further in a blog post from Science and Sensibility, the study also uncovers additional data showing that different physician groups have widely different rates of Cesarean section or instrumental (forceps or vacuum) deliveries, independent of epidural timing, even among groups of mothers that are scientifically selected to have the same level of initial risk for interventions.  This insight underscores the influence that individual physician or midwife practice patterns have on your likelihood to have a Cesarean birth, and the importance of finding out specific doctor or midwives’ Cesarean and instrumental delivery rates when selecting one.  

For the New York Times’ coverage of the study’s findings, click here.

Posted in Natural Birth, Research & Articles

three new doulas join Ohana team

We are excited to have Tara Van Dyke, Margarita Valbuena and Shizue Taerbaum join the Ohana team as Doulas. A warm welcome to all of them.

Tara witnessed birth for the first time on her 13th birthday while watching her dad do medical work in Kenya, East Africa. This forever shaped her view of birth as a normal and beautiful life event. She went on to earn her BA at Wheaton College in Communications and work as an editor, but after the births of her own 4 children, she developed a strong desire to assist other new and expecting families in their transition to parenthood. Tara became certified as a doula through ICEA in 2008 and completed childbirth educator training as well. Read Tara’s bio here Tara Van Dyke Team Page Photo

Margarita completed her birth doula training with The Organization of Labor Assistants for Birth Options and Resources. She has worked with pregnant women and families of young children in several different countries for nearly 12 years, as a child development and early childhood education professional.Margarita holds a BA in Psychology from the University of Michigan and a MS in Child Development from Erikson Institute. Read Margarita’s bio here Margarita Team Page Photo

Shizue’s path to becoming a doula began in nursing school, where her experience in labor and delivery cultivated a passion and interest in supporting expectant mothers. In addition to her education in maternity and women’s healthcare through University of Illinois’ College of Nursing, Shizue trained as a doula with Doulas of North America. Read Shizue’s bio here Shizue Team Page Photo 1

Posted in Ohana News

Ohana Launches Prenatal Yoga in Evanston

Our prenatal yoga program aims to facilitate a more comfortable and happy pregnancy, while equipping moms with tools they can use throughout their pregnancy, during labor, and postpartum. Classes are held Monday evenings from 6:00-7:15pm at Ohana, located in downtown Evanston at 602 Davis Street, Evanston IL 60201.
To celebrate the launch of this new offerings, we’re offering a coupon through Nov. 7 of $25 off a 10-class or unlimited pass with the coupon code YOGALAUNCH. Learn more here

Posted in Ohana News

October Alumni Club Workshop

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Pic of the cute costumes set up for the Ohana Alumni Club costume swap and social hour last week.

Posted in Ohana News

September Alumni Club workshop on Natural Cleaning for New Families

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Our September Alumni Club Workshop, was led by Kate Jakubas from Meliora K. Kate shared some useful insights on safe, earth-friendly, natural and green cleaning products and even demonstrated how to make our own laundry detergent with everyday products. She even shared a few samples of the laundry detergent with the attendees. Please visit http://ohanaparents.com/alumni-club/ to learn about our upcoming workshops

Posted in Ohana News
Client Reviews
Testimonials
"I have no doubt that Jocelyn Alt made my natural childbirth possible."
"I credit my successful VBAC [Vaginal Birth After Cesarean] at age 39 mostly to the support of Autumn and Jocelyn."
"Having Autumn there with me was an immeasurable gift. She was a deep well of quiet strength, experience, and knowledge."
"Having Jocelyn & Autumn on the team boosted our decision-making and confidence. Their knowledge & experience stands out."
"They were incredible at 'reading the room' and being able to tell how much or how little attention I was needing at the moment."
"Working with Jocelyn and Autumn was a pleasure. They were attentive, compassionate and engaged from the first time we reached out to them, to even now, weeks after the birth."
"Jocelyn has magic hands! My pain just seemed to melt away with her massages."
"It was so great to have been able to meet and work with two doulas."
"The thing I appreciated the most about having Jocelyn at my birth was her natural ability to put me at ease."
"I really can’t rave enough about how Jocelyn helped me help my wife."
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