Informed Consent

People in the medical profession are taught that patients must always give INFORMED consent. All too often, that is not done.
What exactly is informed consent? It is the patient giving their consent for a procedure, surgery, medication, whatever after they have and understand the pros and cons and have all their questions answered.
One prime example of this in the maternal child field is the AFP (alpha-fetal protein) test that is done between week 16-18 of pregnancy. It is a blood test that detects a protein in moms’s blood that can indicate a higher probability of the baby having a neural tube defect or Down’s Syndrome.
Unfortunately, there can be false positives with this test. Lets talk about what happens if the test comes back positive:
1. Mom gets a call from the doctors office
2. Mom is told the AFP is positive and baby may have a birth anomaly.
3. Mom is told that to find out for sure, she needs an amniocentesis.
4. From that moment on, mom will worry for the rest of the pregnancy and after. It will stay in her mind that her baby is not ok.
5. There are risks to an amniocentesis, though small.
6. Mom then has to wait for the result.
7. If the test shows the baby may have an anomaly, parents then have to decide if they want to continue the pregnancy.
8. As I said, even if the test comes back normal, the joy of the pregnancy is taken away, at least a bit.

Mamy people say that the test should be done so the parents can be prepared. As the parent of a mentally and physically disabled child – you can NEVER be prepared.

There are many moms who ask questions or do research and decide against this test. These parents have made the decision to have their baby – no matter what.

My point – informed consent is very important and the responsibility of the medical profession. And patients need to ask questions and get answers they understand.

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A Few Tips to Avoid Sibling Rivalry

Just a couple quick thoughts today. To attempt to avoid sibling rivalry from the start:

1. When big brother or sister visits the hospital to meet the new baby, mom should not be holding baby. Leave baby in bassinet, off in the corner. Allow big brother/sister to hug and kiss mom and wait for him/her to ask about baby. If baby is in moms arms, it is an instant intruder – and someone will say “be careful of the baby”.
2. Babies are pretty durable. Everyone needs to stop saying “be careful”. After hearing this over and over, big brother/sister will give up!!
3. Before baby is born, go to the Dollar Store and buy lots of inexpensive gifts for older child. Wrap them and keep in a box by the door. When a visitor brings a gift for baby, hand them one of the small gifts for older child. Cuts down on gift envy.
4. Buy a few items for the older child that you can play with while breast feeding. Make a breast feeding box. The toys in the box (books, flash cards…) can only be played with while baby is nursing. This gives the older child one on one time with mom while nursing. Instead of mom worrying about what older child is doing during feeding time, it becomes quality play time.

Induction of Labor

There are many reasons to induce labor. Unfortunately, the most common reason is “I am tired of being pregnant”.
First, can labor be induced anytime? The answer is no. The cervix has to be ready. In medical term: the cervix has to be “ripe” – during pregnancy, the cervix is firm like the tip of your nose; when labor is near, the cervix softens, like your ear lobe. In order for induction to work, the cervix must be soft and stretchy.
There are ways to medically soften the cervix – with medication called cervidal or cytotec. These medications are sometimes inserted into the cervix the night before an induction to get the cervix ready.
Sex can also soften the cervix. There is an “ingredient” in semen that softens the cervix and oxytocin is released when a woman orgasms – oxytocin is the hormone that brings on contractions. Nipple stimulation also causes release of oxytocin.
Medical reasons for induction: baby is not growing, mom has PIH, membranes are ruptured.
Many times, physicians suggest induction if pregnancy goes over 40 weeks. The logic…..the placenta is only meant to last for 40 weeks. After that, the placenta may start to deteriorate. If this happens, the baby would be deprived of oxygen and nutrients and would be better off outside than in.
The fetal activity test is one way to check baby’s status. Monitors are put on mom to check baby’s heart rate. Mom is asked to push a button when baby moves – this makes a mark on the monitor paper. Baby’s heart rate should increase after movement – just like ours does when we go up stairs. If the heart rate does not increase, it may mean that the placenta is not able to supply the need. If the fetal activity test is not reassuring, there are additional tests such as a biophysical profile to check further.
The moral of this: induction should not be done just because the 40 week mark has been reached. Testing is non invasive and allow for time for the cervix to ripen naturally. Too often, induction is attempted too soon and does not work, and ends with a cesarean section for failure to progress.
I know the end of pregnancy is exhausting, but baby needs those 40 weeks or so to be ready to make their appearance healthy!!

Role of the Childbirth Coach

Definitions:

Coach: yells the plays, runs up and down the sidelines, knows the rules and the game plan. 

Partner: supports, offers encouragement, is present

Our society puts a lot of pressure on the significant other (S.O.). We expect them to attend expectant parent classes, learn how to help mom relax, know the breathing techniques for every stage of labor and watch their baby come into the world. 

I am a believer that the S.O. should be in the birthing room if that is what the couple wants. But many S.O.s are not meant to be a coach. 

So, who should be the coach? Maybe a female relative or close friend, or maybe the nurse.  Someone who is available to practice relaxation and breathing techniques during the pregnancy and knows mom well enough to be there for her during labor and birth. 

I have been a nurse for 40+ years, worked labor and delivery, taught childbirth classes for 25 years, was a doula/labor support and post partum support. I remember the many times I talked about the role of the coach and saw the look of relief on the S.O. faces. And many told me that giving up the role of coach and being a partner during their child’s birth allowed them to relax and be totally there to support their partner and marvel at their child.

so, if you are pregnant right now, think about who fits these roles for you. 

 

Breast feeding – The First Few Days

New moms are so vulnerable. And most of the medical community does not know how to support breast feeding. I hope this blog will offer information and support. 

Babies are NOT born hungry. They do like to suck. There are two reasons for a newborn to suck – nutritive and non-nutritive. Remember seeing babies during an ultrasound sucking their thumb?  They are not hungry, they are sucking though. Sucking to calm themselves, to relax. This sucking will continue after birth if the infant is allowed, either on their thumb, a pacifier or the breast. 

a side note here – do not cover a newborn’s hands. If their nails are long and you are worried about them scratching their face, get an emery board and gently brush off the sharp edges. Newborns have their hands for the whole pregnancy, do not take away that comfort in those first days after birth. 


Babies have enough nutrition in their body to last 24 hours without eating. I think this is to allow new moms and babes to rest. Babies will root and suck on their hands. Remember non-nutritive sucking. If they are offered the breast at that time, they might suck a few times, then relax, snuggle and fall asleep. I tell moms, two licks and a suck in the first 24 hours is successful breast feeding. 

the only exception to this – if the newborn is born with low blood sugar, it may be necessary to give some calories. This can be done by putting baby to breast or cup feeding a little formula. More on cup feeding in future blog entries. 

Babies should eat 6-8 times a day for about the first 6 weeks. I suggest moms count feedings for 24 hour periods. Baby may eat every hour for 4 hours and then sleep for 4 hours. As long as there are 6-8 feedings in 24 hours, it is ok. 
Baby should have one wet diaper and a bowel movement for each day they are old for about the first week. Pooping is more important than peeing.
Colostrum lasts for about a week to 10 days. Babies stomachs are about the size of a golf ball and colostrum amount is about a tablespoon. Perfect.
Pumping to find out how much milk you have is useless. Pumps are all different, some work better than others but none are as effective as a baby. On average, a baby gets about 3 times as much as a pump.
More info to follow. Contact me with questions: dkemp4586@att.net or write comment.