Category Archives: In the News

Natural Disaster Labor

In the wake of hurricane Irene, the US’s East Coast is riddled with anxiety and fear. It’s been a tough week for us, given that natural disasters really aren’t our thing. The last hurricane to threaten the eastern seaboard was over 20 years ago when Gloria gifted us with a tropical storm in 1985. Add to that Virginia’s earthquake earlier this week that sent risidual tremors along the East Coast and many southern states, and we’re in panic mode here. News reports tell us what we should have on hand in the event of an emergency, but what about women who are full term in their pregnancies?

20110826-015005.jpg

Lakeisha Dennis, of Lighthouse Birth Services @DoulaonDuty, brought natural disaster births up on Twitter this morning. What happens to a mom if she goes into labor during an earthquake, hurricane or snowstorm? What does she do if she can’t get to her support, or if her support can’t get to her?

Here are a few things you should consider including in your emergency birth kit in case you go into labor without the ability to head to your birth place (or have your team come to you).

1. 3 gallons of water – mom will need to stay hydrated during labor, and will need extra water for cleaning both during and after the birth if she desires. Keep an additional gallon of water for each person present.

2. Canned fruit, nuts, vegetable chips, and other non-perishable healthy foods to last at least 3 days.

3. Disinfectant – in the event that you have no running water, you don’t want to waste your drinking water washing your hands.

4. Dental floss – you can use dental floss to tie off the umbilical cord once it stops pulsating if you choose to detach it.

20110826-014611.jpg

5. Large garbage bags – aside from their normal use, plastic bags can be used as lining for your furniture or floor as a protective layer against fluids.

6. Sheets that you don’t mind ruining – you can use these on which to labor, in addition to staying dry and warm. Old sheets are also great for cleanup, because you can toss them when it’s all over!

7. Towels – have several on hand for cleanup and staying dry/warm for both mom and babe.

8. A few sets of clothes – there’s nothing like searching through a dark, flooded or otherwise damaged home to find clean clothes in an emergency. Keeping protected, clean sets with your emergency birth kit will help you greatly in your time of need. Remember to include baby clothes and diapers

9. A mirror to go with the flashlight you’ve already got in your emergency kit. During labor, you may need to see what’s happening around your vulva, especially if you are birthing alone. With a 40-week belly, a mirror will help you get a handle on what’s going on down there.

10. An extra fully charged battery for your mobile phone – in the event that you have service, but no electricity, you’ll be happy that you set this aside to be able to reach out for help!

Although these are some great things to keep in your kit if you can, you’ve also got to be prepared to use them! Check out Penny Simkin’s Birth Partner; she’s got great advice for what to do during an emergency birth.

20110826-015628.jpg

Also, speak with your provider about a contingency plan. If you’re birthing at a hospital or birthing center, what happens if disaster strikes if you are either already there in labor or in labor at home en route to your birthing place? Speak with your midwife about what to do in the event that neither she nor her backup can make it to you during a disaster. Ask your doula about how her services might change during an emergency.

Advertisements

Your Child is What You Eat

In my childbirth education classes I speak with families about the importance of maintaining a balanced diet. We talk about all the goodness and gold awaiting us in vegetables and herbs, and go over the importance of understanding what we put in our bodies to stay healthy. However, where I – and many educators – fall short is in not discussing the implications on our children of how we eat.

Often, care providers will monitor a woman’s intake to make sure that she isn’t put at risk for labor and delivery. However, there may be possible risk to the lives of our children when we aren’t aware of the effects of the foods we eat. For example, most pregnant women are told to avoid salt to reduce the chances of preeclampsia or other pregnancy related illnesses. However, pregnant women who consume excess salt may predispose their unborn children to adult high blood pressure. Likewise, a woman consuming too much sugar may alter her child’s possibilities of being diagnosed diabetic.

20110823-083403.jpg

In the natural birth world I feel like we do a great job of helping parents understand the effects of manufactured medications used during labor on unborn babies. Parents often know THAT they should eat better, but often don’t understand why. We must do a better job of helping our families make better food choices when possible. I read an article in The Huffington Post titled, “To Eat Artificial Dyes or Not?” It would be a great follow-up to this blog to understand how dangerous something as common as an M&M can be.

Bargain With Your M.D About Fees?

One of the longest standing battles in the birthing community is over ducats.  Should we charge, and if so, how much?  Are we obligated to do volunteer births, and if so, how often?  Health insurance in the United States doesn’t cover doula services (although you may be eligible for reimbursement, find out more here) so these discussions will never go away.  One strong argument from experienced doulas draws a parallel to sexism when it comes to doulas setting fees.

Our profession has historically been and is currently largely made up of women.  We’ve been socialized to meekness, to always seek acceptance, ever offering apologies, and not wanting to rock the boat.  We give of ourselves before giving to ourselves, leaving us burned out too fast and too often.  Pregnant women are comfortable asking doulas to lower their fees (or to provide free service), or to throw in a few extras; seldom do women (or men, for that matter) ask this of men who provide services.  No one expects their mechanic to voluntarily change their oil because they’re going through a rough patch.  In fact, people would run away from a volunteer mechanic thinking, “Something’s gotta be wrong!”  Part of the paralleled sexism argument is that we don’t haggle with our care providers.  At least we didn’t.

According to Dr. Jeffrey Kullgren, we should try!  Dr. Kullgren is, “an internist and clinical scholar at the University of Pennsylvania, [and] specializes in research on the impact of consumer-driven health care.” Now that insurance companies are cutting back on what they cover (not to mention the increase of uninsured in the US), more folks are left paying for health care out of pocket.  Dr. Kullgren suggests that patients be upfront with their care providers about their financial situations, and ask for the discounted rate whenever and however they can.

Where does this leave women during the perinatal period?

Some care providers are so used to ordering tests and writing prescriptions without thinking about cost because 1) their assumption is that insurance will pay, and 2) they’re not trained to even think about the business aspect of medical care!  If you have to pay a portion (or all) of your health care out of pocket, ask your provider if each ultrasound that’s ordered is necessary; or ask to be checked with a fetascope or doppler if possible.  If your provider is prescribing prenatal pills, ask for the generic brand.  You can also ask which over-the-counter prenatal pills or herbal supplements are recommended.  If you’re facing an induction or surgical birth, find out what your insurance covers and what it doesn’t; some companies are refusing to cover elective cesarean surgery because it is so expensive.

You can also seek a midwife during pregnancy.  Midwives aren’t just for home birthing families; midwives work in hospitals and birthing centers as well.  A midwife’s fee is far less than an OB/GYN’s fee, and their care tends to be holistic more often than not.  So there you have it, ladies – grab your ovaries with gusto and don’t shy away from speaking about finances with your OB.  If you’ve come to expect volunteer or low-cost doula services, don’t let your care provider off the hook for billing you up the wazoo.

Read more from The New York Times here.

Do Pregnant Women Lie About Smoking?

I’ll never forget the day that I walked by a student of mine who was about 6 months pregnant, yet smelled of fresh cigarette smoke.  I asked her if she had been smoking before coming into the building, and she honestly responded that she had been.  However, she assured me that she was trying to quit for the sake of her baby.  It became an unconscious habit of mine to inauspiciously sniff her each time we came into contact; she hadn’t quit by the time she went on  maternity leave.

These days, smoking is highly stigmatized.  I remember being in elementary school and buying cigarette gum from the ice-cream truck, or pretending that pretzel sticks were cigars on the school yard during recess.  I smoked my first real cigarette at age 12.  The tide slowly began to change, and adolescents began to see smoking not just as a health risk, but as simply not cool.  Throughout my twenties I struggled with quitting; I could go a few months here and there without buying a pack.  And, I must admit that New York’s no-smoking law kept my habit from spiraling out of control.  Even still, as a non-pregnant woman, I did everything I could to hide that I was a smoker.

A recent study shows that 13% of 994 surveyed pregnant women were active smokers, and 23% of that 13 reported that they didn’t smoke.  Researchers tested levels of cotinine, “a biological indicator of tobacco exposure,” in pregnant women revealing their exposure to cigarette smoke.  The sample is nuanced, however, because there’s no way to distinguish between first and second hand smoke based on levels alone.

One thing is clear, there’s definitely help for smokers trying to quit – pregnant or not.  Smoking while pregnant isn’t a crime (at least not yet!), so lying about it does no good.  If you’re pregnant, addicted, and struggling to quit reach out for help.  Many (all??) states have free cessation programs, so seek support not just for your baby, but for you!

Read more here from The New York Times

Breastfeeding Beneficial for Brain Development

For “Breast is Best” enthusiasts, this Australian study is nothing new.  However, for those still sitting on the fence about the benefits of breastfeeding, here’s further evidence that highlights why formula just doesn’t measure up.

According to an Australian study that followed 1,038 breastfed babies, boys performed better on standardized assessments testing skills in mathematics, reading, writing and spelling at age 10.  The youngsters were from a controlled family group for mother’s age, education, marital status, family income and other factors; they were exclusively breastfed for 6 months, attributing to their superior performance in all 4 academic skills.

Although exclusive breastfeeding had no effect on girls’ academic performance in this particular trial (we’ve always known that females are naturally intelligent, no?), the study, “add[s] to the strong evidence that breast-feeding as long as possible is beneficial for child health,” said Dr. Oddy, lead author and associate professor of nutrition at the University of Western Australia.

Read more here from The New York Times

Outsourced Womb

Call centers, customer service, adopted North American names and conversations about the weather from around the world. Outsourcing, no matter how you feel about it, is part of our lives and looks like it’s here to stay. But I’ve never, in a million years, imagined that we’d be outsourcing wombs. story deliverying test tube

International adoption is, by now, old news in the U.S. Adoption is, after-all, a long and tedious process here. Not to mention the many states that make it impossible for would-be LGBT parents to adopt. Going overseas to make one’s dreams come true is sometimes the only option. But now we’ve taken our import/export endeavors a step further, and international surrogacy is on the rise.

Bargain Birthing

Instead of call centers, India is seeing an increase in boarding homes for women who have wombs for rent. Compensation of about $5,000 is the exchange for becoming a surrogate mother in India. International surrogacy is becoming popular in the Ukraine as well for North American families looking for women to carry their babies.  Compare that to the $20,000 to over $100,000 it can cost to attempt IVF or surrogacy in the United States.

Baby in a tubeBecause the trend is so new, little legislation exists to regulate the process. Who would be deemed responsible, for instance, in a case of infant or maternal mortality? Or biological parents who, for whatever reasons, decide they no longer want the baby? Such was the case of an abandoned child of Japanese parents born in India. The parents divorced while the surrogate carried their child, and neither party wanted to care for their baby. Luckily, India will begin to regulate international surrogacy.

Although LGBT relationships have been decriminalized in India, hopeful LGBT parents will not be able to pursue parenthood through international surrogacy.

One other aspect of regulation will be placing a limit on how often a woman can rent out her womb. Most outsourced babies are born via cesarean delivery, putting the surrogate mother at risk. Cesarean birth is major abdominal surgery that becomes more dangerous and risky with each new pregnancy/surgery.  Sometimes, when we want children and can’t have them without medical intervention we’ll attempt whatever is possible to bring us that bundle of joy.  There’s still so little known about the long term effects of the drugs involved on both the surrogate mother and the baby, that I’m not sure I could take the risk.

Zippi Brand Frank’s HBO documentary Google Baby delves into the issue and sheds much needed light.

Get Your Insurance to Pay for Your Doula!

Every once in a while I get a call from a mom who is really interested in having a doula attend her birth, but she doesn’t think she can afford it.  In NYC the average experienced doula charges around $1,000 per birth.  There are doulas who do frequent volunteer births, and others who work on a sliding-scale or a flat-rate low fee.  Wouldn’t it be great if women could interview doulas and not have to worry about money?  There are tons of lists floating around online about the questions you should ask your prospective doula, but very few remind you to ask if she has an NPI number.

What’s an NPI?

It’s been about a year since doulas have been able to apply for National Provider Identification (NPI) numbers.  The NPI number tells insurance companies that an individual is an actual service provider, and is used to process payments and/or reimbursement.  If you interview with a doula who is out of your price range, ask if she has an NPI number.  Having the NPI number alone doesn’t guarantee reimbursement, but it’s one major step in the right direction.  If you’re searching online and have come across doulas with whom you’d like to set up consultations, you can check to see if they have an NPI number here.

How do I know if my insurance covers doulas?

With this big advancement in the doula profession comes big confusion.  Coverage and reimbursement by insurance companies are different areas.  Coverage means that your insurance company will pay your provider’s fee when services are rendered.  I’m not aware of any insurance companies that cover doula services.  Reimbursement, on the other hand, requires that you pay your provider’s fee when services are rendered and your insurance company sends you a check after the fact.  Reimbursement can be in full or for a portion of what you actually paid.  I’ve heard of moms being reimbursed $375 of the $400 their doula charged, and a few other instances where reimbursement was within $200 of the doula’s fee.

Getting reimbursed

Get in touch with your insurance company and ask what the process is for reimbursement.  Your doula may be able to give you this generic form, but if your insurance company prefers that you use their forms it would be good to know that beforehand.  Your doula will provide you with the necessary information like the NPI number, and her S.S.# or EIN to help you complete the form.  In addition to the claim form, ask your doula for an invoice and a letter that describes her services.  The letter is helpful, because it shows the insurance company how the doula may have actually saved them money.  Many moms report having to submit twice before being reimbursed, so don’t desist in the process if you’re not approved the first time around!  Your doula does not have to be certified by any organization in order for her services to be rendered reimbursable.  However, if she is a member of a certifying organization she may be able to get advice from them with regard to helping you get some money back.

When expectant moms get in touch with me, but have concerns about how to pay for a doula, I remind them about the possibility of being reimbursed by their insurance.  Usually, they feel more at ease knowing that they may be able to get their insurance to pay for their doula!