Wednesday, August 13, 2008

The worst position for birth

"Except for being hanged by the feet, the supine position is the worst
conceivable position for labor and delivery." (Dr. Roberto
Caldeyro-Barcia, The Family Practice News, 1975:11

Friday, August 01, 2008

Midwifery becoming mainstream in Canada


Immediately after delivering baby Benjamin, Melissa Boraski's midwife knew something was wrong.

The newborn's colour was quite dusky, his breathing too shallow. An hour after birth into the comfort of his mother's home, he was whisked off to Toronto's Hospital for Sick Children -- the place Boraski had least expected to be.

Little Benjamin underwent open heart surgery and his mother didn't hold him again for two weeks. Two years have gone by and now, he's a healthy toddler. And Boraski is swaddling a second babe, seven-month-old Alice.

Despite the shock that accompanied the arrival of her first-born, she used a midwife again and said she'd recommend it to anyone.

"I felt having a baby wasn't something I wanted to be treated like a medical emergency," Boraski said, acknowledging she did have initial reservations the second time.

"It went really smoothly," she said. "It kind of redeemed the (first) experience. I had a lot of hope for that ideal of having a baby at home. I knew it could be a great experience."

Boraski, 28, is among a growing number of Canadian women turning to a midwife during pregnancy instead of a doctor or obstetrician. She said the more intimate, personalized care, plus the fact it's funded by the Ontario government, made it an obvious choice.

She found her midwife at a practice called Riverdale Community Midwives in Toronto.

"I feel like every midwife I met at the practice was really compassionate and they really loved women and loved the care of women," she said. "Just the idea of birth being a family thing, it can happen in the home, it's safe, it can be a spiritual experience. I felt like the midwives honoured that tradition."

Midwifery's proponents say it's no longer a fringe option. It's also necessary, as a looming maternity care crisis has cropped up in Canada because many family physicians don't deliver babies and there is only a finite number of practising obstetricians -- many nearing retirement age.

There are approximately 700 midwives practising in Canada.

More than half of them are in Ontario, the province that led the charge to install midwifery as a regulated profession.

Regulations took effect on Dec. 31, 1993 and about 60 women were officially recognized as midwives. Seven provinces and two territories have since followed suit.

Secrets: How to have the best care during pregnancy, childbirth–and beyond

Here are five ways to get the help you need for a positive birth experience

by: Sydney Loney

Pre- and post-natal care
Take a childbirth education class, available through hospitals, birth centers or separate organizations, such as Lamaze International.
When choosing a caregiver, decide who can support you best in the decisions that you're making. Ask questions to find out whether they'll respect your personal birth philosophy.
A doula can be your one constant source of support when nursing shifts change and you're suddenly confronted by a new set of faces mid-labor.
Many hospitals offer daily breastfeeding clinics, so find out ahead of time when and where they take place so you're not scrambling post-delivery.

Related stories
1. Creating a Birth Plan
2. Overcoming your fears of giving birth
3. Morning sickness survival guide

From where to deliver to how to choose the best healthcare professional, moms-to-be have a lot of important decisions to make–and it can be overwhelming. "You really need to plan ahead to create the most positive experience for you and your baby," says author and childbirth educator Gail J. Dahl. Here are five things you can do to ensure you get the best pre- and post-natal care possible.

1. Do your homework
"Reading a good childbirth book (and not just a book about pregnancy) is very important," says Dahl. "Women make better choices in birth when they have more information." Find out what all your childbirth options are and decide what makes the most sense for you. Dahl recommends seeking out a qualified childbirth educator. Childbirth education classes are available through hospitals, birth centers or separate organizations or associations (such as Lamaze International or the International Childbirth Education Association).
"You need a tremendous amount of information to be a good medical consumer during childbirth," she says. "Rather than just learning about a procedure, such as induction of labor or episiotomies, you can find out the pros and cons and why you may or may not want it." Childbirth classes usually include information on things such as signs of labor and techniques for coping with pain, but it's important to research the class to ensure it fits your own childbirth philosophy.

2. Pick your professional
One of the keys to a positive pregnancy and birth is finding a good healthcare provider, says Dahl. "It's important to create a whole health team around you so that you have good support and good information throughout your pregnancy." A lot of women don't realize they have a choice when it comes to caregivers, she says. "You can choose to have either a doctor or midwife and it's up to you to decide who can support you best in the decisions that you're making." Here are some things to keep in mind when making your decision:

Midwives usually take a more holistic approach to childbirth and offer women with healthy, low-risk pregnancies the choice of having their babies at home or in a hospital or birth center.
Midwives offer the same standard tests as doctors, although their appointments tend to be longer (usually about 45 minutes) and some of these appointments may even take place in your home. They are also usually available for questions or concerns 24 hours a day by pager.
Whoever you choose to assist you, find out all you can about them. "We spend more time finding contractors for our homes and researching their qualifications than we do when choosing a person to be in charge of our births," says Dahl. Don't be afraid to ask the hard questions, she says.
If you're interviewing a doctor, find out what their C-section rate is and how they feel about induction and drug-free births. If you're quizzing a midwife, ask her to explain all the alternative options open to you, such as water births or hypno-birthing.
To find the best doctor, interview three doulas and see who they like working with the most, she says. And talk to a midwife's patients about their experiences–word of mouth is often a safe bet.
Regardless of whether you're choosing a doctor or midwife, you need to look at personality. "If you feel you're not being respected by your caregiver, then that is not the caregiver for you," says Dahl. "And you can switch to someone new right up to the time you give birth."
3. Hire a doula
"One of the best ways to have a positive birth experience is to hire a doula, especially if you don't have access to a midwife" says Dahl. A doula is a professional birth assistant who supports you during labor and sometimes post-partum. Many doulas also teach prenatal classes or act as lactation consultants. Unlike midwives, doulas do not have professional standing at hospitals and can't attend births on their own.
"A doula assists you and your partner, helps you stick to your birth plan, is your advocate, friend and birth coach," says Dahl. "Many women think their doctor will be there for them throughout labor only to discover it's just them and their partner in the room for most of the time." Doctors have many patients at a time and your ob/gyn is unlikely to be the person who actually delivers your baby. A doula can be your one constant source of support when nursing shifts change and you're suddenly confronted by a new set of faces mid-labor. If you can't afford to hire a doula, Dahl recommends contacting a doula association as beginning doulas often work for free in order to gain the experience they need to be certified.

4. Create a birth plan
"A birth plan is good because it gives you something to discuss with your caregivers–it's your negotiating document," says Dahl. "When you have a birth plan, you can be confident that the support group around you are all clear about what you want."
Your birth plan may include everything from what position you want to be in during labor to how you want your baby's heart rate monitored. [To create and save your own birth plan, go to] Reviewing your birth plan with your caregiver also helps ensure you're both on the same wavelength. You'll find out what their views are and will discover whether they're willing to respect yours if they differ. "You have to take some responsibility on your own and having it down on paper can help you have the strength to say, ‘that's not the way I want the birth to happen,'" says Dahl.

5. Set up breastfeeding support

If you're planning to nurse your baby, Dahl recommends finding out as much as you can about breastfeeding before you deliver. Many women get through labor and delivery just fine, only to be overwhelmed by the difficulty of breastfeeding. Before you give birth, talk to a lactation consultant, join a breastfeeding support group and even attend one of their meetings where you can watch women nurse. La Leche League ( is a great breastfeeding resource. Many hospitals offer daily breastfeeding clinics for new moms, so find out ahead of time when and where they take place so you're not scrambling post-delivery. Most of all, have a breastfeeding support person lined up (whether it's a doula, nurse or lactation consultant) to make sure you get the best start possible.

Meet our expert:
Gail J. Dahl is a childbirth researcher and educator, an advocate for safe and gentle childbirth and the national bestselling author of Pregnancy & Childbirth Secrets (Innovative Publishing, 2007). She has received the YWCA Woman of Distinction Award, the Woman of Vision Award and the Great Women of the 21st Century Award for her work in women's health and education. Nominated for Community Advocate: Organization and Signature Award for exceptional achievements.

Take a look at this tremendously helpful new website for new moms when you have a moment at "Just the Facts Baby":