Fertility and technology

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Alma’s director Laura Erickson holding baby Liam in BelleTaine Lake.

Most of the clients that we see here at Alma are already expecting a baby. We do see some clients hoping to get pregnant, and are glad to offer pre-conceptions consultations to discuss herbs, supplements and other holistic ways to enhance fertility.

If you have an iPhone (or other phone that can run apps, excuse our bias) we have found a great new app that can help track fertility. It’s called MyDays, and lets you enter information about your cycle length and figure out your fertile days to better plan around them. Here are some screen shots of the app:

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Having this (or a similar app) can help keep track of your fertile days with something you have with you all the time anyway-your phone! This also works in the other direction– if you’re trying not to get pregnant.

Several clients have asked us how they can continue using the fertility awareness method of birth control while breastfeeding, because some of the signs you are used to looking for may not be there. There are a couple of resources on the web to help figure out how best to do that, and this seems to be a helpful one.

Have any of you used your iPhone to try to get pregnant (or not get pregnant) and have a story to tell? Let us know in the comments!

Also, if you or anyone you know is trying to get pregnant using alternative insemination, send them to our sister business Conceptions! We are thrilled to offer inseminations using the same approach as we have to births: low-intervention in a homey and comfortable setting (here at Alma or in your own home).

The question of continuous fetal monitoring

Evidence-based care is a topic that comes up often in obstetrics. Every year, countless studies are done to examine the way birth is managed in the hospital. Some changes and technological advancements are based on evidence: what is the best practice, and does it improve outcomes for moms and babies? Others are not evidence-based, and are based on risk management, financial planning, ease for the practitioner, or other reasons that may not be in the best interest of the client/patient.

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Continuous electronic fetal monitoring is one of the latter. When having a baby in the hospital, this is standard procedure unless you’ve requested otherwise: a stretchy strap is wrapped around the laboring woman’s belly with a monitor positioned over the baby’s heartbeat. Another monitor and strap are attached up nearer to the top of the uterus to monitor contractions. The picture above is of a typical strip. The top shows the baby’s heartbeat, and the bottom shows contractions.

The hope was that by continuously monitoring babies and their response to contractions, more babies could be saved– and cerebral palsy (at that time, thought to be linked to lack of oxygen during birth) would be prevented. Those of you reading may already know the downside to this, in terms of physiologic birth. Getting up, changing position, and moving around, are all incompatible with continuous monitoring–it can confuse the reading. If a laboring woman can’t move during contractions, those contractions can be exponentially harder to handle, and thus begins the cascade of interventions. And if a baby is positioned in a way that makes it challenging to hear the heartbeat, or a mama is obese–or any number of other things that can make continuous monitoring impossible–a fetal scalp monitor is introduced: more interventions.

Even so, one might argue that these interventions were worthwhile if they kept babies healthy and alive. Unfortunately, over the years since this has been commonplace, continuous electronic fetal monitoring has not reduced infant mortality or cerebral palsy. The only number that has significantly changed since its introduction are the number of cesarean sections.

In the Philadelphia Inquirer last month, Alex Friedman, a fellow in maternal-fetal medicine wrote about his experiences with this, and his feelings when performing an “emergency” surgery based on the strip, only to find a vital, screaming baby inside. “No test is perfect. But almost every time we whisked a mother back to the operating room, and I cut through skin, fat, fascia, and finally the muscle of the uterus, expecting a blue, floppy baby, the child I delivered emerged pink, healthy, and a little bit angry,” he writes.

Dr. Friedman also cites several studies in the past few years, all supporting the evidence that continuous fetal monitoring is not a foolproof screening tool.

“A 2006 analysis by the British Cochrane Collaboration, evaluating all available research, found that fetal heart monitoring failed to reduce perinatal mortality – the risk of a baby’s dying late in pregnancy, during birth, or shortly after birth – and increased cesarean section rates and forceps deliveries, compared with listening to a baby’s heart rate intermittently.”
Read Dr. Friedman’s article (and the inflamed comments below it) to learn more about what he has found. It’s always nice to find someone from the medical model questioning the status quo and trying to practice in an evidence-based way.

Here is the full article.

Protecting the sacred space

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Sometimes it’s surprising to clients (and their partners or support people) how little we actually do at births.

As midwives, we are experienced in supporting the birth process and helping women to give birth to their babies with as little intervention as possible. Sometimes, that intervention is intense: we treat respiratory distress, hemorrhages, and other complications that can arise in the birth process. Most of the time, however, birth can be just how you see it in the photo above: a woman laboring in the water, connecting with her partner, and the midwives surrounding them to protect that sacred laboring space.

The picture above was given to us by a client who gave birth to her baby in that very birth tub a few minutes after that photo was taken. There are so many things to love about it, and to know about the situation from just that one photo. The three women sitting around the tub are the midwives. The fact that all three of them have gloves on means they think the baby is coming soon– and even so, they are choosing to not to stare at the mamma, not to be in her space, but to be nearby and ready when and if they’re needed.

There has been so much written about the importance of giving women the space– physically, mentally, and emotionally– to be able to open up enough to let their babies out. When women birth naturally, they access the mammal part of themselves. Most ammals need to feel safe, and be in a dark and quiet space to let the natural physiologic process occur. If an animal is surprised while giving birth, their labor may grind to a halt–something that happens often to women if they move to a place with strangers, bright lights, beeping monitors, and everything that comes with an environment that isn’t home or home-like.

If you’d like to read more about this concept, read Michel Odent’s “The Farmer and the Obstetrician”. We’ll post lots more about biodynamic birth in the coming months.

Hello there!

Welcome to the Alma blog! We’ve been looking forward to this for a while. The blog will be used to share ideas about birth, midwifery, and family life in Portland. Please come often!