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Estimating the Estimated Due Date
By Trina Hampton for Pathways to Family Wellness

“I’m due on May 27th!” I was told enthusiastically by a friend who just found out she was pregnant. It took more than a little effort to mask my cringe and share her joy.

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Mom w-Clock on Belly 2
Little did she know that within hours of her positive pregnancy test, she had already given in to one of the biggest misnomers of pregnancy—the “due date,” also referred to as the EDD, for estimated due date. This is the very first thing to be determined once a pregnancy has been confirmed. On the outset, this seems like a reasonable practice. Parents want to know when to expect their baby, and healthcare providers need to have a time line with which to measure the baby’s growth and well-being. Please read the entire article HERE.
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You’re Not Allowed to Not Allow Me
By Cristen Pascucci

For most women, pregnancy and childbirth are one of the few times we let other adults tell us what we are “allowed” and “not allowed” to do with our own bodies. It’s time to change our language around this to reflect the legal and ethical reality that it is the patient who chooses to allow the provider to do something—not the other way around—and to eliminate a word that has no place between true partners in care.

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The truth is that women, like all other U.S. citizens, have the right to make decisions about their bodies based on informed consent—a legal, ethical standard which requires the provider to convey all of the information around a suggested procedure or course of treatment, and the person receiving the procedure or treatments gets to decide whether or not to take that advice.  ACOG states clearly about informed consent in maternity care: “The freedom to accept or refuse recommended medical treatment has legal as well as ethical foundations. . . . In the obstetric setting, recognize that a competent pregnant woman is the appropriate decision maker for the fetus that she is carrying” (ACOG Committee on Ethics Committee Opinion No. 390 Ethical Decision Making in Obstetrics and Gynecology; Dec 2007, reaffirmed 2013). Please read the entire article HERE.
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Look at the Baby, Not the Scale
By Jay Gordon, MD FAAP

"In the first 24 to 72 hours after birth babies tend to lose about 3-10% of their birth weight and then regain that weight over the next 2 to 3 weeks."

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Michael Nursing copy
If a mother receives lots of IV fluids during labor, the baby could be born “heavier” because of the increased water. The somewhat higher weight could be measured if a baby were weighed right before it peed for the first time. The difference of this extra fluid retention might only be a few ounces, but some parents are told to be concerned when, at their baby’s two week checkup, the baby is a few ounces under birth weight.

Another common problem at early checkups is a baby that is not gaining what the practitioner considers to be “normal weight gain.” There is not general agreement on normal weight gain and the range in texts are from 4 to 8 ounces a week. Some babies are genetically destined to be a lot smaller or larger than others. Please read the rest of this informative article HERE.
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Cord Blood Collection: Confessions of a Vampire-Midwife
By Rachel Reed

"Cord blood contains magical stem cells, and the idea is that if your baby becomes ill in the future you may be able to use these cells as treatment. My concern with cord blood banking is the inadequate and misleading information given to parents."

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Placenta
"Even the term ‘cord blood’ is misleading – blood is merely collected via the cord. In addition the promotional materials talk about collecting ‘blood from the placenta’ without acknowledging that the baby/placenta are one blood circulation unit. After birth the blood from the placenta transfers to the baby, assisting transition to breathing. Knowledge about the short term and long term health benefits of allowing placental circulation to complete the job is becoming widespread."

Read the entire article HERE.
















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Advice to Expectant Mothers from a Labor and Delivery Nurse
By Carrie Halsey

"Taking a prenatal class is an excellent way to prepare for childbirth. I personally recommend the Hypnobabies course, but there are many other programs available."

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123 Mom and Friend 6
"Your perinatal team has varied knowledge, training, experience, bias, fear, and motivation. They are experts, but they are not perfect! They have seen a lot, but they haven’t seen everything. Some have not read a new research article in years, some haven’t slept in 2 days, and some had a maternal death patient with similar risk factors as yours. Sometimes they just want to go home on time and your labor is taking too long. Some of them are biased towards low intervention; others have never met a patient they didn’t want to take to the operating room."  Read the entire article HERE.
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Evidence-based Birth
By Maureen Whitman

Have you ever felt that some of the restrictions that were in place during the birth of your child did not work in your favor? Did you ever wonder if they had truly been essential? Was that cesarean section medically necessary or planned to fit someone else’s schedule? Are you currently pregnant and uneasy about being told you have limited options because of policies already in place that don’t have clear evidence to support them? If so, read on.

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LOOKING FOR EVIDENCE

Many birthing women are now taking a greater role in researching, making decisions, and managing their care options. Rather than simply taking their care provider’s word for it, pregnant women are insisting on scientific proof to back up claims that an intervention or procedure is truly necessary.

Organizations that advocate for pregnant women and individuals who are taking more responsibility for their maternity care are actively seeking to identify hospitals and care givers who utilize an evidence-based model.

As more comes to light about how standard maternity care in many places in the US (and internationally) is not always supported by the evidence from best outcomes, consumers are pushing for answers and demanding change. You can read the entire article HERE at peggyomara.com.

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Why Are We Asking Doctors if Women Should Have Midwives?
By Cristen Pascucci

"Shouldn’t women decide if women have midwives?"

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midwife
"Things are better than they were, but nowhere near where they should be.  Today, the American College of Obstetricians and Gynecologists (ACOG) refuses to recognize the midwives who attend around 80% of birth outside of hospitals(8) (“ACOG does not support programs that advocate for, or individuals who provide, home births.”)(9).  They have only recently acknowledged “accredited birth centers” as acceptable locations, as their long-time policy has been that all birth should be hospital-based (a 2008 policy statement actually blustered, “Choosing to deliver a baby at home… is to put the process of birth over the goal of having a healthy baby”)(10). Thus, they do not embrace the position of their maternal health colleagues who believe all birth should be where women decide to give birth.  There is truth to ACOG’s assertion that the training and education for a very small number of these midwives is not standardized, but, really, those midwives and their clients aren’t looking to obstetricians for approval. And pushing those midwives underground certainly does not result in better training or safer births." Please read the rest of this fantastic article HERE.
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Alcohol and Breastfeeding
By Anna Burbidge - Le Leche League GB

With all the holiday festivities in full swing we thought you breastfeeding moms might find this information helpful.

"Reasonable alcohol intake should not be discouraged at all. As is the case with most drugs, very little alcohol comes out in the milk. The mother can take some alcohol and continue breastfeeding as she normally does. Prohibiting alcohol is another way we make life unnecessarily restrictive for nursing mothers." ~ Dr. Jack Newman

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Breastfeeding infant
Breastfeeding mothers often receive conflicting advice about whether alcohol consumption can have an effect on their baby, which can leave them feeling like they have more questions than answers. While women are often warned not to consume alcohol during pregnancy due to evidence that it could cause damage to an unborn child,  the risks of consuming alcohol while breastfeeding are not as well defined. Read all this great information HERE.
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What is the Evidence for Inducing Labor if Your Water Breaks at Term?
By Alicia A. Breakey, MA, PhD Candidate, Angela Reidner, MS, CNM, and Rebecca Dekker, PhD, RN, APRN

Another amazing article from Evidence Based Birth!

"Many people are under the impression that once a woman’s water breaks, she only has 24 hours to give birth or she will automatically need a C-section. Where did this opinion come from? Is it evidence-based?"

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Pregnant belly
What is PROM?

Prelabor or “premature” rupture of membranes (PROM), happens when your water breaks before the start of labor.

Term PROM is when your water breaks before labor at ≥37 weeks of pregnancy.

Preterm PROM, or PPROM, happens when your water breaks before 37 weeks.

Read the entire article HERE.
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The natural caesarean: a woman-centred technique
By Smith J, Plaat F, Fisk N. BJOG 2008;115:1037–1042.

Maybe someday this will be how all C-secctions are performed!

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123 Baby Skin to Skin 1
"Although much effort has gone into promoting early skin-to-skin contact and parental involvement at vaginal birth, caesarean birth remains entrenched in surgical and resuscitative rituals, which delay parental contact, impair maternal satisfaction and reduce breastfeeding. We describe a ‘natural’ approach that mimics the situation at vaginal birth by allowing (i) the parents to watch the birth of their child as active participants (ii) slow delivery with physiological autoresuscitation and (iii) the baby to be transferred directly onto the mother's chest for early skin-to-skin. Studies are required into methods of reforming caesarean section, the most common operation worldwide."

Please read the rest of this informative article HERE.
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Choosing Your Women’s Health Care Provider
From www.midwife.org

Great information on how to choose the best prenatal health care provider for you!

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Midiwfe Mom Birth Center Doppler
Questions to Ask Your Potential Provider


When choosing a women’s health care provider, it’s important to know your full range of options so that you can make an informed decision. Your health is too important to rely on other people’s recommendations, or to just “go where you have always gone.” Your health care provider’s services and approach to care should match your unique goals and values. Asking potential providers questions about their education and type of care will help you decide who will best meet your needs. Below are sample questions to ask women’s health care providers that may help you in making your decision.

Questions to Ask a Women’s Health Care Provider or Maternity Care Provider

General Questions:
Did you graduate from a nationally accredited midwifery or medical education program? What is your degree?
Are you licensed to practice in this state?
What is your certification? (For midwives: Have you completed a national exam to earn a midwifery certification? What is that certification? (Click here for more information on the different types of midwives.)(For physicians: Are you board certified? In what specialty?)
How will you determine if the care you specialize in is the right care for me?
If I choose you as my health care provider, who else will be involved in my care?
What types of health care services do you provide? Can you provide care for more general health needs like flu shots and minor illnesses?
How long does it take to get an appointment and how long are typical waits at the office before I see you?
How long will my appointments be when I come for my yearly checkups and pap tests?
Do you offer family planning resources and birth control options?
How can you help me understand health care information and make good health care decisions?
Can my family members come with me to my appointments?
At which locations can I receive my care?
Who do I call when the office is not open?

You will find the rest of this article HERE.
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Twelve Signs You Can Trust Your Prenatal Care
By Cristen Pascucci

How do you know you’re getting good care? In the U.S., there is a vast range of maternity care practices.

Improving Birth is talking about what good care looks and they have put together a list of some signs you can trust the care you are getting.

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midwife
You are treated like an individual 
Every woman, baby, and birth is different. You may go into labor at 38 weeks or 42 weeks, and it might last four hours or forty. This is all normal. As the baby is coming, you may want total silence in a bathtub or you may need tons of support while you walk laps around the room. No one can predict these things. Birth is about what each pair of mothers and babies needs to be most safe and supported.

Your provider uses language like, “We encourage you to…” and “We support you in…” —not “You’re not allowed” or “We will let you.”

Language is important. It is an indication of how you will be treated in labor: as a respected adult or as a wayward child. It is a truly scary thing to hear in the delivery room, “That’s not how I do it,” when you’re saying you need more time or that you don’t want to be cut.

You can find Improving Birth's entire list HERE.
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Establishing Your Milk Supply
By La Leche League Canada

"Milk is produced almost continuously: the more often the baby nurses, the more milk there will be."

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Breastfeeding infant
The delivery of the placenta tells the body to start producing milk. This happens whether a mother is breastfeeding or not. By day 3-5, mother’s milk comes in and volume increases. Frequent nursing and regular removal of the milk stimulates the breast to produce more milk. Milk changes through a feeding and throughout the day to meet a baby’s changing needs. Foremilk, at the beginning of a feeding session, contains less fat and more water. Hindmilk, later in the feeding, contains more fat and is higher in calories. Babies need both foremilk and hindmilk to provide total nutrition

Breastfeeding early and often is one of the most important factors in getting breastfeeding off to a good start. Babies who are allowed to breastfeed within an hour of birth and then at frequent, unrestricted intervals, help mother establish a good milk supply sooner than those who are put on a strict feeding schedule. Newborns usually nurse about every two hours, or at least 8-12 times per day; some may nurse even more frequently. Feeds may not be spaced evenly throughout the day. Some babies cluster several feeds together and then sleep for a longer stretch.  The rest of this informative article can be found HERE.
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Magic Umbilical Cords
By Stephanie Soderblom

"Aaahhhh….that umbilical cord. That magical connection that grows life. It filters, it provides, it knows when to start and it knows when baby no longer needs it."


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Umbilical cords have two arteries and a vein that run the length of it. Those three vessels are surrounded by a special substance called Wharton’s Jelly. This jelly is thick and gelatinous when functional – this is to prevent the baby from accidentally causing it to kink and stop functioning (even true knots in the cord rarely cause problems because the Wharton’s Jelly prevents it from being able to tighten down and occlude blood flow to baby!)

When baby is born, this cord continues to function, providing the baby with not only blood and oxygen – but providing baby TIME! Time to transition to air breathing, experiencing the changes that babies go through at birth. As long as that cord is pulsing, it’s working for the baby the exact same way it did before the baby came out.

Once baby’s breathing and the cord is no longer needed, it goes through its own transformation. The Wharton’s Jelly in the cord begins to liquefy…tightening down on those vessels…clamping them off naturally. The cord slowly becomes thin, white, limp – dramatic changes from the thick purple pulsing entity it was when the baby was born!

Not clamping or cutting the cord until this transformation has occurred provides the baby with the benefit of extra blood, oxygen, gentleness and time!

Here you can see the magical changes of the cord! These pictures are ALL of the same umbilical cord…progressively taken over time.

THE FOLLOWING PICTURES WERE TAKEN OVER A PERIOD OF ABOUT 15 MINUTES – BABY WAS ATTACHED THE ENTIRE TIME… See the rest of this informative article HERE.
allcords1. Brand new! Right after birth the cord is thick, pulsing. We could actually SEE it thumping with the baby’s heartbeat.


2. There’s already a difference!! Look at how much thinner it is – less purple, less ‘tight’…


3. Less purple…thinner….


4. same piece of cord, same angle….now MUCH whiter, much thinner. But still not done with the transformation! You might think so though, huh! No…just wait.


5. NOW we are pretty much finished with the transformation. Compare this to the top picture of the same piece of cord….


6. Completely done, Wharton’s Jelly has liquified, the cord is not pulsing…it is thin, white, and very limp. Amazing!


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Twin Birth Study Finds No Benefits To Planned C-Section
By Society for Maternal-Fetal Medicine

This randomized study The Twin Birth Study: a multicenter RCT of planned cesarean section and planned vaginal birth for twin pregnancies 320 to 386/7 weeks, should help women understand that a planned vaginal birth is as safe as a planned cesarean section as long as the first twin is situated head first.

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Twins
"The results of the study show that vaginal birth is safe and should continue to be offered to women who are pregnant with twins," said Dr. Jon Barrett of Sunnybrook Health Science Centre, University of Toronto, Women and Babies Program, and one of the study's authors. "There's no evidence that a cesarean section is better for the babies or you."  The entire study can be seen HERE.


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What is the Evidence for Induction or C-section for a Big Baby?

by Rebecca Dekker, PhD, RN, APRN
© Copyright Evidence Based Birth.

"Researchers have consistently found that induction for suspected big babies does not improve the health of moms or babies."

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What is a big baby?


The medical term for big baby is macrosomia, which literally means “big body.” Some experts consider a baby to be big when it weighs more than 4,000 grams (8 pounds 13 ounces) at birth, and others say a baby is big if it weighs more than 4,500 grams (9 pounds, 15 ounces). A baby is also called “large for gestational age” if its weight is greater than the 90th percentile at birth (Rouse et al. 1996).

How common are big babies?

Big babies are born to about 1 out of 10 women in the U.S. Overall, 8.7% of all babies born at 39 weeks or later weigh between 8 lbs 13 oz and 9 lbs 15 oz, and 1.7% are born weighing 9 lbs 15 oz or more (U.S. Vital Statistics).

What is routine care for suspected big babies in the U.S.?

Although big babies are only born to 1 out of 10 women, the 2013 Listening to Mothers Survey found that 2 out of 3 American women had an ultrasound at the end of pregnancy to determine the baby’s size, and 1 out of 3 were told that their babies were too big. In the end, the average birth weight of these suspected “big babies” was only 7 lbs 13 oz (Declercq, Sakala et al. 2013).  Read the rest of Rebecca's informative article HERE.
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Ever wonder exactly what a midwife does?  Here is a great video explaining it all!

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Group B Strep in Pregnancy: Evidence for Antibiotics and Alternatives

This article was published on April 9, 2013 by Rebecca Dekker, PhD, RN, APRN, and updated June 6, 2014
© Copyright Evidence Based Birth.

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What is Group B Strep?

Group B Streptococcus (GBS) is a type of bacteria that can cause illness in people of all ages. In newborns, GBS is a major cause of meningitis (infection of the lining of the brain and spinal cord), pneumonia (infection of the lungs), and sepsis (infection of the blood) (CDC 1996; CDC 2005; CDC 2009).

Group B strep lives in the intestines and migrates down to the rectum, vagina, and urinary tract. All around the world, anywhere from 10-30% of pregnant women are “colonized” with or carry GBS in their bodies (Johri et al. 2006). Using a swab of the rectum and vagina, women can test positive for GBS temporarily, on-and-off, or persistently (CDC 2010).

Being colonized with GBS does not mean that a woman will develop a GBS infection. Most women with GBS do not have any GBS infections or symptoms. However, GBS can cause urinary tract infections and GBS infections in the newborn (CDC 2010), and women who have preterm births are 1.7 times more likely to be colonized with GBS during labor than women who do not have preterm births (Valkenburg-van den Berg et al. 2009).  Read the rest of this very informative article HERE.


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Symphysis Pubis Discomfort ... More Common in Supine Position

Dorsal Lithotomy Position vs. Non-supine Positions During 2nd Stage of Labor: Quadriped
by Amanda Blaz DPT

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pushing-lying-downConvenience vs. Functionality
The position of the pelvis when in dorsal lithotomy places the birth canal at an angle that actually makes the baby travel upward. There are many texts and articles that cite this position as the “gold standard,” suggesting that it is the most widely used and, therefore, the most satisfactory position for second stage. However, the reason dorsal lithotomy has long-been considered “most satisfactory” is never delineated. In fact, many well-known books, such as Human Labor and Birth by Dr. Harry Oxorn, suggest that second stage dorsal lithotomy positioning is the favored position because it is easier for the attendant to access the birth canal and perineum, and take care of any complications that may arise. This doesn’t necessarily prove the position as the most satisfactory for maternal outcomes.

The Benefits of All-Fours
When a woman in is the quadruped (hands-and-knees) position, she has many advantages on her side: For one, the birth canal curve is in a downward orientation, allowing gravity to aid in descent of the baby—promoting a gentler passage rather than a forced upward journey that involves significantly greater pressures and level of effort for the mother. Secondly, the woman is able to sway side to side as well as flex and extend her spine to aid in pain/discomfort during and between contractions. Similarly, quadriped is a favorable position when sacroiliac joint dysfunction, pubic symphysis dysfunction, coccydynia, spondylolisthesis, discogenic pain, or spinal stenosis is present. This is due to the fact that joints are not placed in a position that places a large amount of compression or stress on them and can be easily adjusted by the mother to increase her comfort level. Also, when in this position, a woman is more amenable to manual prompting by birth attendants to contract abdominal musculature and relax/contract the pelvic floor to aid with pushing. Lastly, Soong (2002) showed that when giving birth in the quadruped position, a woman may have less need for perineal suturing when compared to the dorsal lithotomy position. With a sample size of 3,756 women who had a spontaneous vaginal delivery, 61% of those giving birth in the hands and knees position had intact perineums. Read the full article HERE.
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Amniotic Fluid Volume: too much, too little, or who knows?

By MidwifeThinking

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Is low amniotic fluid volume a valid reason for induction and is Ultrasound a reliable test to determine this?

pregnant beauty flower compressedAccurate Measurement?

"Here is the first problem… there is no accurate method for measuring AFV." The two ultrasound tests aimed at assessing AFV are:

Amniotic Fluid Index: four ‘pockets’ of fluid are measured by ultrasound and added up resulting in an Amniotic Fluid Index (AFI) eg. AFI = 10cm.
Maximum Pool: The ‘single deepest vertical pocket’ of fluid is identified by ultrasound and measured in centimetres.
Neither of these methods are supported by research (that I can find). However, studies comparing the two conclude that the ‘maximum pool’ measurement is the ‘better choice’ (Nebhan & Abdelmoula 2008; Magann et al. 2011). The reasoning for this is interesting… AFI increases the detection of oligohydramnios resulting in increased rates of induction without improving outcomes for babies. So the best method is the one that does not detect the ‘problem’ you are looking for?

Please read the rest of this informative article HERE.
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