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Vol. LXI, No. 26
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Wednesday, June 27, 2007
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Vol. LXI, No. 26
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Wednesday, June 27, 2007
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Since Demi Moore bared her pregnant belly on the cover of Condé Nast's Vanity Fair magazine in August 1991, much has changed in women's attitudes to pregnancy and childbirth.
Amongst the magazine's most famous covers, the iconic image formed a stepping stone toward to-day's designer-trendy, and even sexy, mother-to-be clothes that are a far cry from the voluminous smocks that attempted to disguise but instead advertised the "bun in the oven."
Attitudes to pregnancy, child-birth, and breastfeeding have come even further still from the days of a "woman's confinement," when giving birth was an activity swaddled in euphemism.
Women approaching child-birth today are more likely to be working out than lying supine with cold compresses held to their brows.
Today's mothers want their partners to be with them for the labor, delivery, and recovery. They want immediate contact with their newborns, and they want their other children to visit them and to see and hold the new baby.
Today's mothers, many of them older than in previous generations, face a plethora of low- and high-tech choices: prenatal testing, electronic fetal monitor during and sometimes before labor, hand-held fetoscopes, routine ultrasounds, scans, Dopplers, and external EFMs, routine IVs, labor induction, and pre-scheduled caesarean sections. They can choose support from La Leche League leaders, midwives, nurses, and doctors. Chances are they will also have a birth plan, worked out in advance, that specifes their preferences during labor, birth, and hospital stay.
But, according to Diana Korte and Roberta Scaer, the authors of A Good Birth, A Safe Birth: Choosing and Having the Childbirth Experience You Want, unless the birth plan coincides with the hospital's usual obstetrical routine, it will have little clout.
After surveying over 2000 women, the authors contend there's a growing emphasis on tests and procedures of all kinds and c-sections have increased from one in five births to nearly one in four in the last eight years.
The authors found that most women give birth in traditional hospital settings with obstetricians. They identified two opposing trends: one toward the high-tech and the other toward a more natural option, facilitated by midwives and doulas.
Midwives and Doulas
From the Greek meaning "mothering the mother," a doula supports the mother throughout labor, rubs her back, soothes, and encourage her, providing companionship, and more.
In Mothering the Mother by John H. Kennell, Marshall H. Klaus, and Phyllis H. Klaus, a doula is described as "a woman experienced in childbirth who provides continuous physical, emotional, and informational support to the mother before, during and just after childbirth."
According to the Centers For Disease Control and Prevention, the caesarean section delivery rate rose 4 percent in 2005 to 30.2 percent of all births, a record high. In New Jersey, that number is closer to 37 percent. Research cited in Mothering the Mother suggests that hiring a birth doula decreases the overall c-section rate by 50 percent.
A birth doula understands the physiology of birth as well as the emotional needs of a woman in labor. Her role is to help the mother and her partner prepare for and carry out their plans for the birth. She will stay by the side of the laboring woman throughout labor to provide assistance in getting the information needed to make good decisions by facilitating communication between the laboring woman, her partner, and the clinical care providers.
After the birth, a postpartum doula offers physical and emotional support for the mother as well as breastfeeding advice, care for the newborn and older siblings, and light home care.
Mother and Newborn, Inc. in Lawrenceville, a doula service founded by Elaine Gerber and Joy Cutty, specializes in postpartum care. Trained through the University of Pennsylvania and at Princeton Medical Center, Mother and Newborn also offers baby massage classes and home safety and baby care instruction packages.
"Joy and I have been doing this work for seven years now and we work with four hospitals in the Princeton area: Robert Wood Johnson in Hamilton, Capital Health Care in Trenton, the University Medical Center at Princeton, and St. Peter's in New Brunswick," said Ms. Gerber. For more information, visit www.motherandnewborn.com.
According to certified nurse midwife Ursula Miguel CNM, director of Princeton Midwifery Care in Lawrenceville and Plainsboro, the sole midwife practice at University Medical Center at Princeton, doulas are also used in Princeton. "Women want more choices and for low-risk pregnancies they are seeking midwives and doulas," said the founder of the practice that currently has three midwives on staff. With 30 to 40 deliveries per month, another will join them in January.
Born in Germany, Ms. Miguel is used to a mode of birthing that is more common in Europe and in countries in South America and is a growing trend in the United States.
"We have seen a great influx [of demand] for midwifery services in our practice," she said. "Princeton is a very international community and many women come to us who have had midwives attend their previous births. We also see many women who are new to midwifery care and just love the personalized services we provide."
"Princeton is somewhat conservative," she said, but even so she has observed an exponential increase in the numbers of women wanting a more natural choice for their childbirthing experience. "They want choices such as the natural onset of labor without being induced, as well as the option of having an epidural. They want the option of remaining upright, of being able to walk about, or use a whirlpool bath."
Ms. Miguel said that most of the state's midwives came to the practice after years as registered nurses. The members of her practice all have master's degrees in either nursing or in midwifery with degrees from the likes of University of Penn and Columbia University. A nurse-midwife is typically educated in an approved midwifery school, certified by the ACNM (American College of Nurse-Midwives) and licensed by the state.
CNMs practice within a health care setting that provides for consultation, and/or collaboration if the birth becomes medically or obstetrically complicated.
Women are seeking midwives because of their attitude toward pregnancy, childbirth, and breast feeding as normal bodily and family functions rather than medical procedures and because of their belief that labor support is essential for a positive birth experience. Midwifery care is more family-oriented, woman-centered, and personalized, focusing on wellness and health, and informed decision-making. Women working with midwives are usually confident that they can give birth without unnecessary medical intervention and with the understanding that in the case of a high-risk delivery physicians will be at hand.
Princeton Midwifery Care is a service of Delaware Valley OBGYN & Infertility Group, PC. For more infirmation, visit www.delvalobgyn.com/princeton_midwifery_care.htm.
Chiropractic Care
Princeton chiropractor Ari Cohn of the Princeton Chiropractic Wellness Center has observed an increase in the number of pregnant women seeking and continuing chiropractic care, an increase he attributes to a growing appreciation that chiropractic care is not just treatment for back pain but for keeping the body balanced.
The author of "Chiropractic Care and Ear Infections," Dr. Cohn finds that clients are looking for an easier and more natural childbirthing experience. "Adjusting tables are designed to accommodate pregnancy at any stage and the treatment is light because of the assistance of a naturally occurring hormone in the bodies of pregnant women that relaxes the ligaments in preparation for the body to give birth."
Dr. Cohn, who also has a number of clients coming for chiropractic adjustments as a treatment for infertility, said that his clients describe their first postpartum adjustment as one of the best. They are also introducing their children — the youngest he has adjusted was just 3 days old — to the practice. "Chiropractic care can benefit even the very young since birth is hugely traumatic for babies," he said. "Chiropractic care resets the nervous system and allows the body to develop. The treatment is very gentle and is typically a calming experience for both mother and child." And, he said, there's research to support the view that children who are regularly adjusted have fewer common childhood ailments such as ear infections.
Moms Online
New mothers are also looking for support and connections online and finding it at sites such as CafeMom (www.cafemom.com), an online community created especially for moms. Since its launch in 2006, thousands of moms have come together to swap stories and advice on a range of topics.
Founded in 1999 by Princeton native and actor Andrew Shue, television host Meredith Vieira, and others, CafeMom allows its users to customize their own homepage, share photos and talk with other moms about common interests. Recent posts considered topics ranging from true and false signs of labor to baby money saving tips.