Where Do Birth Quest Clients Deliver?

Most Birth Quest clients deliver at Hackley, Gerber, Spectrum Health Butterworth, or home.

Here at Birth Quest, a lot of people ask Beth and I where we most often support birthing clients for their deliveries! Here is the answer with some reflections on each from a doula’s perspective:

1.) Mercy Health Hackley: Over 1/3 of our birth doula work is at Hackley. Beth and I were both born at Hackley and we both live less than a mile from the hospital, so this shouldn’t be a surprise. It also makes sense because we strive to serve our community and this is our community hospital! Being located near downtown Muskegon means there are some good food options, like Ryke’s Bakery, near-by. Design aspects we like about the hospital include having separate bathrooms in the hallway for visitors, a waiting room with an ice machine and being able to enter and leave the floor without having to pass through a security door. We’re not crazy about the separate Labor, Delivery & Recovery and Postpartum floors. Hackley is the only hospital on the lakeshore where midwives still deliver and I like how the nurses treat me like an equal. We’re curious to see the new labor and delivery unit that opens in summer of 2019.

2.) Spectrum Health Gerber Memorial: Many of our lakeshore clients travel to Fremont to have their babies at Gerber because of their reputation for supporting natural and patient-centered births. This support is backed up by Certified Nurse Midwives and their Perinatal Nurse Educator and blogger, Samantha Kauffman, who is both Hypnobirthing and Evidence Based Birth certified! Their Director of Clinical Nursing, Beth Coulier, and I worked together on the FIMR Case Review Team when I worked for Public Health – Muskegon County. She brings a lot of experience and compassion to Gerber and this is reflected in the quality of care her staff provides. Gerber gained a national reputation under the leadership of Dr. Tami Michele, who was innovative in overcoming an official ban in order to support trial of labor after cesarean (ToLAC) and vaginal birth after cesarean (VBAC). Dr. Michele currently works at the Butterworth campus. We like that birthing people can labor, deliver, and recover postpartum all on the same floor. Negatives include being located in a small town with few food options, especially late at night, having to be buzzed in and out of the unit by staff and not having visitor bathrooms on the unit. Although the staff are accommodating, it would be nice to have coffee, ice water and a fridge available without having to ask. You know, like a doula station? A doula can dream!

3.) Spectrum Health Butterworth: Although I would love to assist someone in the Natural Birthing Suites, we have not yet had the opportunity. When women we serve plan to deliver at Butterworth, it’s usually because they are high risk or planning a VBAC, making them ineligible for this option. In these circumstances, all of West Michigan is fortunate to have access to the state-of-the-art care provided there. There are pluses and minuses to being in such a large hospital. On the one hand, most of my clients have no idea who is going to be there when they deliver with a practice. On the other hand, when a woman’s care is transferred, there is a good chance that the care she seeks is available. Some of my favorite birth memories as a doula at Butterworth involve supporting women who want to do something that is met with staff discomfort and do it anyway!

4.) Home: There is nothing like the flexibility and comfort of home, even someone else’s home! Whether small or large, the gathering is always intimate, peaceful and festive. When present, I love spending time with other family members, friends and pets. There is never a struggle to support a natural birth plan, especially when it pertains to newborn interventions, at a home. Cost is the biggest barrier to home birth for those who desire it and fit the criteria. I also hope for a future with more diversity among midwives, to help increase access for all women.

Vegetarian & Vegan Diets During Pregnancy in the United States: A Brief History

Beth’s daughters, picking potatoes

— by Faith Groesbeck

Some social scientists believe that human evolution is closely linked to the need for animal protein to meet the nutritional needs of gestating a primate with a very large brain. The nutritional requirements of humans during pregnancy has been studied over time as they relate to nearly every complication of maternal and infant health. Perhaps due to our origins as hunters and gatherers, vegetarian and vegan diets have received a lot of scrutiny as being unnatural and harmful.

The Western history of dietary recommendations during pregnancy has swung like a pendulum of extremes from starvation to overeating and for the moment has landed in the middle. In the 19th C., when maternal mortality was high and cesareans were life-threatening, pregnant people were cautioned not to overeat to prevent large babies. Starting in the 1920’s, maternal weight gain was recorded at every prenatal visit. As late as 1974, text books advised women to gain no more than 25 pounds during pregnancy.

Then, in 1977, Dr. Thomas and Gail Brewer published What Every Pregnant Woman Should Know. Their research showed that preeclampsia was the result of protein deficiency. Subsequently, they advocated for a diet containing at least 100 grams of protein per day. They provided lists of food combinations to obtain “complete” protein that were difficult to comply with for vegetarians and nearly impossible for vegans.

Although researchers who followed were unable to replicate their studies, their teachings became very popular among healthcare providers. The Bradley Method and Childbirth Education Association of Metropolitan New York, where I received my training, both advocated the Brewer Diet for many years. Despite the lack of evidence, many providers believe that a vegetarian diet is dangerous during pregnancy. In fact, I was eating a vegan diet when I became pregnant for my son in 1997 and was advised by my midwife to at least eat canned salmon with the bones!

I had been influenced by books like Diet for a New America, written in 1987. That book’s popularity was followed by the low-carb craze and the Atkin’s Diet. I was working for Dr. Ronald Hoffman at the Hoffman Center for Holistic Medicine in Manhattan in the mid-1990’s. Dr. Hoffman promoted his own diet, the Salad and Salmon Diet, which was a little less extreme, but still focused on increasing lean protein.

Today, the pendulum has swung back again toward a plant-based diet. Thanks in part to the many documentaries in recent years that explore the negative environmental and health consequences of meat consumption, more people in the United States identify as vegetarian or vegan than ever before. Not surprisingly, many of my clients abstain from meat during pregnancy. Unsure of the most current research, I decided to explore the issue to learn the health impact of vegetarian and vegan pregnancies.

I found a systematic review, published in the British Journal of Obstetrics and Gynecology in 2015, that got me up-to-date and answered my questions. What they found was that studies finding poor outcomes in pregnancy did not always distinguish between those that were vegetarian by choice and those whose circumstances forced it upon them. It also found that, over time, in developed countries, food options for vegans and vegetarians have improved, making it easier to eat a well-rounded meat-free diet during pregnancy. Other than cautioning vegetarians to pay some attention to preventing iron-deficiency anemia and B12 deficiency, they could find no other concerns.

Although I’m no longer a vegetarian or vegan, I am a conscious eater and appreciate those who also eat conscientiously in regards to their own health or that of the planet’s. I can provide herbal teas for my vegetarian and vegan clients to boost their intake of minerals, including iron. I can easily modify my lactation cookie recipe by substituting for eggs and butter. Since educating myself, I can also affirm the health of a vegetarian and vegan diet during pregnancy.

How about you – were you vegan or vegetarian during your pregnancies? Did you feel supported by your community and providers? Please share your stories!

Bibliography:

“3 Historical Trends in Clinical Practice, Maternal Nutritional Status, and the Course and Outcome of Pregnancy.” Nutrition During Pregnancy: Part I: Weight Gain, Part II: Nutrient Supplements. Washington, DC: The National Academies Press, 1990 .

Brewer, Gail Sforza. What every pregnant woman should know: the truth about diets and drugs in pregnancy. Random House, 1977.

Milton, Katharine. “The critical role played by animal source foods in human (Homo) evolution.” The Journal of nutrition 133.11 (2003): 3886S-3892S.

Piccoli, G. B., et al. “Vegan–vegetarian diets in pregnancy: danger or panacea? A systematic narrative review.” BJOG: An International Journal of Obstetrics & Gynaecology 122.5 (2015): 623-633.

A Doula as Your Witness

Doulas are witnesses at births.

by Beth Singleton

This is kind of a tricky topic to write on, but one I consider quite valid when it comes to childbirth. When most people think of a doula and what she does (well, for those who know what a doula is!), the primary thing that probably comes to mind is her service and her support. Encouraging women through their contractions, reminding them to breathe, and using touch as a way to help ease discomfort are a few things that doulas are known for doing. But what about a doula as your witness?

During life’s most meaningful moments, we desire to be surrounded by people who care. Weddings, graduations, and funerals come to mind, where the support of others and the power of their bearing witness is paramount. Having people around to witness once in a lifetime moments goes as an unspoken desire that’s fulfilled because others care enough to be there. I mean, in order to get married, you have to have a witness!

Childbirth really isn’t any different. While it’s certainly a more private affair than the public vows of marriage, it definitely tops the charts of once in a lifetime moments. During my training through DONA, I remember hearing the word witness more than a few times by the other women there with me. I wasn’t the only one who viewed doulas this way or who knew the need was there!

Why doulas make great witnesses

A doula is with you continuously throughout your labor. That’s not to say that your partner, friends, or relatives (whoever you’ve chosen to be present) aren’t with you; but, more often than not, they need to take breaks. It’s also very common for people, if they aren’t actively supporting a woman in labor, to get involved in conversation or a good book. Not the ones faced with the demands of labor, people can’t help but find ways to pass the time. Books or phones in the hands of those who are with a laboring woman are a very common sight, and there’s certainly nothing wrong with it. Labor can take awhile! Your doula, however, knows things can change in an instant; so unless mom is taking a much needed rest and fast asleep, no book or phone will be in the doula’s hand. Her eyes, ears, and intuition are all focused on mom. In a hospital setting, shift changes mean that a new set of eyes, ears, and hands will be taking over care. It’s not uncommon for the nurse who cared for you in the early stages of labor to not be the one there when baby finally arrives. Your doula, on the other hand, is there for from start to finish. If you aren’t sure or can’t remember exactly what happened or when, just ask your doula.

A doula can help validate your experience and your feelings. This is HUGE for most women, regardless of whether or not they had a positive birth experience. As doulas, we are trained to pay attention. This really matters when it comes time for mom to process her birth, especially if it was traumatic for her. During a tender period of time afterwards, women need to go through and piece things together. When there are pieces missing, a doula can help fill them in. Sometimes women have questions about specific things that happened, like procedures or even something someone said. Was the nurse really being mean? Did my doctor really say that? Your doula can help you shake that feeling of “Am I crazy or did that really happen?” by either confirming or clarifying the moment in question. She can also help to paint a visual picture for parents. Pointing out relevant moments that were possibly overlooked because of the intensity of labor, a doula can provide insight on the experience by highlighting those details.

A doula works for you. They answer to no one else. Their focus is on you and what you’re experiencing, without letting emotions get in the way. That’s not to say your doula isn’t emotionally vested because she is; it’s impossible not to care! But your doula isn’t your partner, your mom, or your best friend…and that’s really important. The people closest to you are probably as emotionally involved in your birth as you are. They can’t help it! Needless to say, it’s reassuring to labor and give birth knowing someone was there attuned to you, your wants and needs, and paying attention. Your doula is filing everything away in her brain and in her notes about your labor and birth. She knows how much it matters to you to have this information later. Even if questions pop up months down the road, your doula is the one you know you can turn to for answers because she was there as your witness.

Special circumstances

For some women, having a doula present at their birth is critical because of special circumstances. Some of these circumstances include, but are not limited to:

• the absence of a supportive partner
• the absence of supportive friends or family
• women with anxiety
• women with previous trauma
• women with a fear of labor and/or childbirth
• women with doubts about their abilities to labor and give birth
• women who know they will need someone to process the birth with
• women who struggle with trust

On the flip side, some of these reasons might also apply to a woman NOT wanting a doula present. Depending on her specific situation, some of the reasons listed above may stand in a woman’s way of even reaching out for the support of a doula.

As with all things, any number of factors play into whether a woman wants support, to what degree she wants it and what her specific needs are. As doulas, we understand.

If you’re considering hiring a doula to support you throughout your pregnancy and birth, Birth Quest is
here to help. For more information about our services or to set up a free consultation, contact us.

5 Ways to Prevent the Need for Induction of Labor – A Response to the ARRIVE Study

— by Faith Groesbeck, BA, CCCE, CD (BAI)

This month, the results of the ARRIVE study, or A Randomized Trial of Induction Versus Expectant Management, were presented at the Society for Maternal-Fetal Medicines annual meeting, called the Pregnancy Meeting™. This study is explained in more depth on the Evidence Based Birth® website, in the article on due dates.

The research showed that in over 6,000 women, inducing labor at 39 weeks without any other medical indication, reduced the overall risk of cesarean, developing pregnancy complications and harm to the baby. While advocates warn that this may mean that we face a future in which all pregnancies will be forced to end before reaching their due date, I’m a little more optimistic. In my experience, I’ve found it more likely that the pregnant person will choose an induction once this becomes an option for them rather than their healthcare provider imposing it on them. Provider practices vary greatly across the country, so I’m not sure this is the case everywhere, but to date, no professional organizations have said that this should become the standard of care (SMFM).

This research brings attention to two sides of the coin when it comes to the induction debate between those who advocate for physiologic birth versus those who seek better outcomes through technology. On the one hand, birth is a normal process, best left unhindered when possible. On the other, the longer a person remains pregnant, the more likely they are to develop pregnancy complications and the more time the fetus has to grow inside the uterus. I’m not saying our bodies are not marvelous and capable of birthing babies much larger than average, which is around seven and a half pounds.  I’m sitting somewhere in the middle of do nothing and intervening thinking, is there a way to prevent the need for induction and still have good outcomes?

While I realize the tremendous pressure parents are under to do everything “right,” I’ve also spoken to a lot of women who have said that if they had known that there was any chance that they could have possibly prevented the need for an induction or a cesarean, they would have gladly made changes in their lifestyle to at least reduce the risk.

So, here are some tips that may help to reduce the need for induction. I’m not saying that if everyone follows these ideas that they are guaranteed the outcome they desire or that women who do not do these things are at fault if intervention is necessary. I am saying that we may have some control over outcomes if it is our desire and within our means to explore these options. As always, please consult with your healthcare provider before making dietary or fitness changes during pregnancy.

  1. Hire a doula. Having a doula present at your birth increases the likelihood of having a spontaneous vaginal delivery (Hodnet). A spontaneous vaginal delivery is when the pregnant person goes into labor on their own, without the use of drugs and that the baby is born without the use of forceps, vacuum extraction or cesarean.
  2. Eat Dates. Several studies have shown that eating dates at the end of pregnancy, can reduce the need for an induction (Al-Kuran; Jadidi and Kordi). The general recommendation is to eat 6 dates per day, starting at 36 weeks.
  3. Practice Yoga. While yoga has many health benefits throughout a person’s life, a study done in Iran found specifically that doing one hour of yoga, six times per week, starting at 26 weeks, reduced the need for induction and resulted in fewer cesarean births (Jahdi).
  4. Quit Smoking. Smoking is a risk factor for having a smaller than expected fetus or having the amniotic sack, or bag of waters, break before their due date. Both may, under certain circumstances, be indications for induction of labor.
  5. Eat a Low GI Diet. While early induction for those who develop diabetes in pregnancy is not evidence based, gestational diabetes does increase the risk of developing other complications which may then make induction the safest choice. Eating a low glycemic diet during pregnancy decreases the risk of developing gestational diabetes and thus the risk of developing further complications (Brand-Miller).

As a doula, I’m here to support families, often with otherwise healthy pregnancies, who face decisions around inductions. I’m also glad that through childbirth education, families can adopt healthy lifestyle practices that may be able to prevent the need for an induction in the first place.

*** *** ***

Al-Kuran, O., Al-Mehaisen, L., Bawadi, H., Beitawi, S., & Amarin, Z. (2011). The effect of late pregnancy consumption of date fruit on labour and delivery. Journal of obstetrics and gynaecology31(1), 29-31.

Brand-Miller, J., Marsh, K., & Moses, R. (2013). The Low GI Eating Plan for an Optimal Pregnancy: The Authoritative Science-Based Nutrition Guide for Mother and Baby. Workman Publishing.

Hodnett, E. D., Gates, S., Hofmeyr, G. J., Sakala, C., & Weston, J. (2012). Continuous support for women during childbirth. Cochrane Database Syst Rev10.

Jadidi, M. Y., Sang, S. J. B., & Lari, H. (2016). The effect of date fruit consumption on spontaneous labor. Journal of Research on Religion & Health1(3).

Jahdi, F., Sheikhan, F., Haghani, H., Sharifi, B., Ghaseminejad, A., Khodarahmian, M., & Rouhana, N. (2017). Yoga during pregnancy: The effects on labor pain and delivery outcomes (A randomized controlled trial). Complementary therapies in clinical practice27, 1-4.

Kordi, M., Aghaei Meybodi, F., Tara, F., Nemati, M., & Taghi Shakeri, M. (2014). The effect of late pregnancy consumption of date fruit on cervical ripening in nulliparous women. Journal of Midwifery and Reproductive Health2(3), 150-156.

Society for Maternal-Fetal Medicine. (2018, February 1). Induced labor after 39 weeks in healthy women may reduce the need for cesarean birth: More information is needed before changes to clinical practice are made. ScienceDaily. Retrieved February 16, 2018 from www.sciencedaily.com/releases/2018/02/180201115718.htm

West Michigan VBAC Access Update

Source: 2015 Geocoded Michigan Birth Certificate Registry.
Division for Vital Records & Health Statistics, Michigan Department of Health & Human Services

A year ago, I wrote a blog about how hospital bans against vaginal birth after cesarean (VBAC) limit options for Muskegon families. I used birth data from the Michigan Department of Health and Human Services to compare percentages of people with low-risk pregnancies who have a cesarean after a prior cesarean in Muskegon and surrounding counties. Not surprisingly, VBACs are more common where hospitals support them.

The data available that I used was from 2008 to 2014. Since then, 2015 data has been released. I wanted to update this information to see if there were any changes, explore what might be impacting this change and predict how this situation might change in coming years based on current developments in healthcare policy and services.

Statewide, there has been improvement. In 2015, a total of 2,006 people had VBACs, compared to 1,882 in 2014, an increase of 124. When we look at West Michigan counties, however, only Muskegon County and District Health Department #10, which includes Oceana, Newaygo and eight other counties, saw an increase. Kent county births included 40 fewer VBACs and Ottawa county had 3 fewer than the year before.

There are a few issues with this data and that make it difficult to draw conclusions from. First, the two-to-three-year lag time from when the year ends until the data becomes available makes it less useful. We can reflect on what may have happened two years ago to impact these changes, but it is less relevant than being able to access real-time data. Secondly, the online database only provides this particular piece of information by county. In a large county, like Kent, it would be interesting to see how being in an urban, suburban or rural area or proximity to a specific hospital may impact access.

When applying this information to our doula practice, we see clients make a lot of different choices when it comes to choosing a provider and location for their planned VBAC. While some Muskegon area families are happy to travel to Spectrum Health Butterworth in Grand Rapids to deliver, others prefer the intimacy of the small practice at Gerber Memorial Women’s Health, also under Spectrum, in Fremont. Still others have decided to stay in Muskegon and show up in labor at Mercy Health Hackley, while home birth after cesarean (HBAC) is a clear choice for others.

Things may change in 2018. Dr. Tami Michele, who has practiced at Spectrum Health Gerber Memorial for many years, is switching over to Spectrum Health Medical Group Ob/Gyn, with locations on 68th St. and on Mid Towne in Grand Rapids. Some say the move is to help increase the access to VBACs at Butterworth, which serves more patients. Dr. Michele is former doula, whose advocacy for those who wish to plan a VBAC has earned her a national reputation. What is less known at this time is how her moving from a small, rural hospital to a large metropolitan one will impact access to VBACs for those outside of Grand Rapids. Some will surely follow her, while others may feel that they lost a resource.

Another recent change on the national landscape was the publication of the American Congress of Obstetricians and Gynecologists updated guidelines on VBAC, which appeared in the November issue of Obstetrics and Gynecology. According to Mark Turrentine, MD, chair of ACOG’s Committee on Practice Bulletins-Obstetrics, the guidelines are meant to ensure delivery at the safest facility, “However, this absolutely should not result in women having limited access to VBAC.”

According to Jen Kamel, founder of VBACFacts.com, the guidelines are an improvement over those released in 2010. She quotes the new guidelines, “Available data confirm that TOLAC [trial of labor after cesarean] may be safely attempted in both university and community hospitals and in facilities with or without residency programs.” She interprets this to mean that if a hospital can handle deliveries, they should offer VBAC, because an emergency cesarean may be required in any birth, even a low-risk one.

How local staff changes and changes in the ACOG guidelines will impact local access remains to be seen. Will more people be able to access VBACs at Butterworth, or will support at Gerber decline? Will the 2017 ACOG guidelines result in a reversal of bans at Mercy Health Hackley, North Ottawa Community Hospital and Spectrum Health Gerber Memorial, or will the liability concerns prevail? Time will tell, but we won’t be able to see the data until 2020!

In the meantime, we will continue to support families in all their choices, whether they choose a repeat cesarean, a VBAC at a hospital or birth center of their choice, or at home.