Wednesday, August 26, 2009

BIRTH STORY: A Rewarding Experience

(by Kristen Coblentz, about the birth of Shane Michael Dillon, born 3.24.09)
On March 23rd I woke up because Noelle was saying her window was loud. She got up about 3 times and I kept putting her back in bed. She finally fell back asleep and so I got back into bed. As I got in bed I realized I was having contractions. They weren’t too painful and there was no pattern to them so I just went to sleep.

I got up to get ready for work at about 7:00am, and the contractions were still coming. They were about 19 minutes apart. Derek said that I should call Tami just to let her know and to see what she thought. I dropped Noelle off at day care and then called Tami. I told her what was going on and she said it could be early labor or just Braxton Hicks but to keep an eye on the contractions.

I had kept in touch with Derek and Tami all day through email, letting them know how far apart the contractions were. Tami was with the midwife (Alina) all day so they both knew what was going on. At 4:30pm we were leaving work and a co-worker asked me if I would be in the next day. I said of course I would be. He asked if I was sure and I told him that I would let him know otherwise, but I planned on coming in.

On my way home, the contractions were getting a little stronger but they were still all over the place. I started to think, "If I am in labor I need to do laundry, the baby’s clothes and blankets need washed and we need clean towels!" So I got home and started to do the laundry. By the time Derek got home with Noelle I was just finishing folding it. It was about 7:00pm and the Bright House guy was there to hook up our home phone, and when he was looking at my face he looked a bit nervous. Derek started cooking dinner for us and I was sitting on my birthing ball. The contractions were getting stronger but there was no pattern yet.

We ate dinner, and while Derek was getting Noelle ready for bed I took a shower. The shower didn’t really help. It was about 9:40pm and Derek said, "Maybe we should just go to bed in case you are in labor, that way you get some rest." I agreed. I called Tami and told her I was still having the contractions and they were somewhat stronger but we were going to bed to try to get some rest. She said that was a good idea (she told me later, when she got off the phone she thought I would be having a baby that night).

We laid in bed for about 15 minutes and it was like a bomb went off. All of a sudden the contractions were incredibly strong and they were about 5 to 6 minutes apart. We stayed in bed about an hour to see if they stayed in a pattern, and they did. At 11:00pm I called Tami and she said she was on her way over and I needed to call Alina. I called Alina and she said I was in labor, and it would take her about an hour to get to our house. I then called my grandma and my friend Darlin (my grandma was a support person and Darlin was taking pictures).

Tami arrived first. She watched me for a little bit to time the contractions and then she started to get the birth kit together. My grandma got there second and immediately started to help Derek support me. Darlin came next and started taking pictures right away. Alina came last. She started to help Tami and then monitored the baby’s heartbeat to make sure he was doing okay. All was good.

I was okay in between contractions, but I wasn’t so quiet while having them. I don’t know how Noelle slept through it all, but she didn’t wake up the whole time. Derek went and filled our tub up and Tami made sure the temperature was okay. I am not too sure of the time I actually got in the tub, but after a while of having contractions I just wanted to be in there.

I got in the tub and after a few contractions I was able to just breathe through them. Alina then checked to see how far I was, 7 cm. I felt so relaxed and comfortable in the tub I ended up falling asleep with my head on the side of the tub in between them.After a little while I wasn’t able to just breathe through the contractions; they were to the peak and I knew I had to push. I was so much more aware of what was happening with my body, I knew I had to take my time pushing because I didn’t want to tear. I pushed for a little while, trying not to push too hard (I was screaming at this point). I finally felt his head come out. I could hear my grandma saying “Kristen his head is out!” (she was so excited). I pushed a little bit more and his shoulders and body came out. Tami caught him and broke the bag of water off of him--my water had never broken--and put him right on my chest.
He never cried, he just looked up at me with his tongue out. He was so beautiful. Tami got a baby hat and put it on his head to keep his head warm (that’s when he started crying) and then a receiving blanket on his body with the warm water from the tub. After a little while I gave him to Derek because I had to deliver the placenta. I then got cleaned up and got into bed next to Derek and Shane. Alina checked Shane out and then me to make sure we were both okay, and then we went to sleep.

This was such a rewarding experience. I would never want to give birth any other way than this.

Monday, August 24, 2009

Heads Up on Infant Mortality

September is Infant Mortality month, and Orlando Midwife Jennie Joseph is leading an international campaign to raise awareness of this important issue. Did you know that 1,687 babies died before age one in 2007 in the state of Florida alone? The 2009 Campaign for Healthier Babies is drawing attention to infant mortality by knitting one baby hat for every baby who didn't reach their first birthday, in what Jennie calls the 'Heads Up on Infant Mortality' program.

"Too many babies are being born too soon, too small, or too sick to survive," said Jennie Joseph, CPM, Executive Director of Commonsense Childbirth. Please join Jennie in her endeavor to promote early prenatal care and save the lives of our children!

How you can help:

- knit or crochet one or more baby hats
- teach someone how to knit or crochet a baby hat
- donate to the campaign
- encourage all pregnant women to start prenatal care right away - we can help, no one is turned away

The hats will be displayed at a rally in September (date & time TBA). You can help by knitting or crocheting one or more infant hats and bringing or mailing your hat(s) to:

The Birth Place
1130 E. Plant Street
Winter Garden, FL 34787
Call: (407) 656-6938

In Sarasota, you can save shipping costs by bringing your hats to Birthways Family Birth Center by September 1st, and midwives Christina Holmes and Sabrina Zehr will mail them for you!

Wednesday, August 19, 2009

Sarasota Healthy Start Celebrates World Breastfeeding Week 2009

The following is reproduced from the 08.17.09 Healthy Start press release:

Emergencies can happen anywhere. In Southwest Florida, we know all about hurricanes, tornadoes, and fires. Whatever the emergency, breastfeeding is a lifeline and a shield that protects infants.

During emergencies and catastrophes, infants and young children are especially vulnerable to malnutrition, illness, and death. The American Academy of Pediatrics’ breastfeeding recommendation—early initiation and exclusive breastfeeding until six months of age and continued breastfeeding for at least one year—is even more critical in emergencies.

Breastfeeding is the one safe and secure source of food and fluid for infants: it is instantly available, clean and ready, and it protects infants against illness, particularly by eliminating the need to mix formula with water that may be contaminated with fecal bacteria or other hazardous substances. For mothers who deliver their baby during an emergency, immediate breastfeeding can reduce the risk of post-partum hemorrhage after the birth.

As part of this year’s World Breastfeeding Week activities in August, the Healthy Start Coalition of Sarasota County, Inc., conducted its Annual Door Decorating Contest for local health care providers and others to promote and support breastfeeding in a public display. This year’s theme was “Breastfeeding: A Vital Emergency Response.”

The 2009 winners were:

* Sarasota County Health Department, Children’s Health Center – Best Pediatric Display
* Comprehensive Childcare Associates – Most Creative
* First Step of Sarasota, Mothers and Infants Program – Most Beautiful
* Sarasota County Health Department, Women’s Health Services – Best Obstetric Display
* Sarasota Memorial Healthcare System, Lactation Services – Best Educational Display
* Sarasota County Health Department, Women, Infant and Children Nutrition Program (WIC) – Best Use of Theme

If you need more information about breastfeeding, please call the Healthy Start Coalition office at 941-373-7070 to request a list of Breastfeeding Resources in Sarasota County.

About the Healthy Start Coalition of Sarasota County, Inc.: The Healthy Start Coalition of Sarasota County, Inc. is a not-for-profit 501(c)(3) organization whose mission is to improve the health and well-being of pregnant women, infants and young children. For more information, contact Jennifer Highland, Executive Director of the Healthy Start Coalition of Sarasota County, at 941-373-7070.

Wednesday, August 12, 2009

Reducing C-Sections: Incentives and Precedents

The Washington State Legislature has just passed what I hope will be a landmark measure to reduce their state's cesarean section rate. Beginning this month, Medicaid will reimburse Washington hospitals the same amount for uncomplicated c-sections as for complicated vaginal births. Just as in Florida, about half of all births in Washington are paid by Medicaid. The impetus of this measure is to effectively remove the financial incentive to perform a c-section. The theory is that this will impact the economics of birth so drastically that there will be a directly correlated reduction in c-section rates.

Should Washington set a precedent for tremendous cost savings through a return to normal birth, I would certainly expect Florida to follow suit, and will be urging our representatives to take a close look at this initiative in the coming months.

Sarasota can reduce our c-section rates effectively, quickly, and without compromising outcomes. It has been done in hospitals elsewhere with dramatic results.

In January 1996, The 'First Births Project' began at the Children's and Women's Health Centre in Vancouver, British Columbia, as part of the hospital's Continuous Quality Improvement Program. The project's objective was to lower the c-section rate by 25% within six months of implementation, without sacrificing outcomes to mother or baby. To begin the project, the staff of the hospital agreed upon four factors that contributed to high c-section rates:

1: Early admittance to hospital (defined as prior to 4 cms dilation);
2: Fetal surveillance by electronic fetal monitoring (continuous electronic fetal monitoring has been proven to increase the cesarean rate with no improvement to the health of the baby);
3: Early use of epidurals (women who get an epidural before 8 cms dilation are at increased risk of surgery);
4: Inappropriate induction (inducing birth before 41 weeks gestational age with no medical indication).

Task forces were created in each area to use the best evidence and existing guidelines, as well as solutions from other hospitals to improve care at the British Columbia hospital. Guidelines and other strategies in all four target areas were implemented in the spring of 1997.

The results, published here, show that the cesarean section rate was reduced by 21%. The number of epidurals initiated before active labor was 64% lower, continuous fetal monitoring was used 14% less, the induction rate had dropped 22%, and admission at 'early' cervical dilation had dropped 21%. 'All changes were statistically significant. Newborn outcomes were unchanged post implementation.'

Other cases which I've sited on this blog show results of emergency c-section rates and NICU admissions being literally cut in half in a matter of months. The common thread in all of these initiatives is will, leadership, and commitment of the entire obstetric community.

Tuesday, August 4, 2009

Hospital Board Presentation on Access Sarasota

The five minute presentation I shared with the Sarasota Public Hospital Board urging their evaluation of Sarasota Memorial Hospital's cesarean section rates will be aired on Access Sarasota this week. Show times are as follows:
  • Tuesday, August 4th: 10:00am - 11:45am
  • Wednesday, August 5th: 4:15pm - 6:30pm
  • Sunday, August 9th: 3:00pm - 4:45pm
The presentation came during the public commentary section of the meeting and will air approximately an hour and fifteen minutes into the program. If you happen to catch it, please comment on this post with feedback. Improving this health crisis takes the involvement of a community willing to work together on many different levels.