What Do You Think Is Most Important For Your Pregnancy Care?

Help us tell the story of what maternity care is really like for women across New York State! Share your experience by taking our online survey about childbirth care experiences, preferences, and choices. As part of our project exploring midwifery options in New York, we are collecting data to help policy makers and care providers understand your perspectives and better meet your community's needs. You can participate if you received care from a midwife during pregnancy or birth in New York State in the last 5 years. Tell us what maternity care is really like and help us improve care and options for women across New York State.  You can complete the survey here.  Or access the survey at: www.voicesofmothersny.org If you can't fill out the survey, you can still help by forwarding information about the survey to other new parents you know.  Please share this survey widely, so that we are able to capture a wide variety of experiences. If you have any comments, questions, or concerns about completing the survey, please contact Sydney at: 347-389-4721 or by email: gvtm@choicesinchildbirth.org Join us in working to improve childbirth care and options for women across New York State! Thank you for participating and for sharing this survey with members of your communities.

Read More

CiC Awarded $204K Childbirth Education Grant by W.K. Kellogg Foundation

We are excited to announce that Choices in Childbirth has been awarded a grant in the amount of $204,000 by the W.K. Kellogg Foundation to provide childbirth education to expecting, underserved families in New York City. Our workshops aim to shift the tide of New York City’s high maternal mortality rates with education, community knowledge and peer support, and will offer a model program that can be replicated in other communities. These workshops aim to fill the gaps left by traditional childbirth education and reach underserved families who can benefit from birth education. Traditional and modern childbirth education classes are available in New York City to educate women to make informed decisions regarding their maternity care choices; however, childbirth education classes are not reaching most women. In particular, women receiving Medicaid—a group accounting for nearly half of all births in the U.S. and 60% of births in New York City—have the lowest rates of childbirth education. “The best way to help vulnerable families succeed is by reaching them earlier,” says Choices in Childbirth Executive Director Michele Giordano. “It’s essential that women and families become informed and prepared for childbirth—there is little time to weigh the crucial decisions that may need to be made during birth and soon thereafter in the early weeks of parenting. With the right tools and knowledge for managing the pre-natal, intra-partum and post-partum periods, families can feel more supported and empowered to take care of themselves and their newborns.” Choices in Childbirth is grateful for the backing of the Kellogg Foundation, whose generous grant will support expansion of these workshops across New York City. We are excited to tackle the challenges ahead, but require additional support to make the most of this opportunity and ensure that every person who wants this education can not only access it and...

Read More

This Mother’s Day, I’m Honoring Choices

        This Mother's Day, I'm grateful to Choices in Childbirth, an organization that helped guide me to where I am today, and one that I know firsthand never stops fighting to improve birth outcomes and experiences for all moms. But let me back up: When I was pregnant with my first child, I assumed that I would have my baby in a hospital with a doctor. I'd show up after my water broke, have a baby, and go home -- like in the movies. I was only vaguely aware that a "birth plan" was a thing, and that I was in control of it. Then my mother told me to watch The Business of Being Born, which taught me that midwifery care was an option. I wound up birthing my son at home, attended by amazing midwives, and had the most transformative experiences of my life. It was the right choice for me and my family. And that's what it's all about: choices. Being aware that you even have them in the first place, and then being able to take advantage of them. Eager to be part of this community, I took several of Choices in Childbirth's workshops during my second pregnancy. And now I speak at them, because I've become a doula and a childbirth educator myself. I want to make sure that choices are available to all women -- will you join me and support Choices in Childbirth? From day one, I was particularly impressed by how they strive to involve women of color, non-traditional families, and other groups that are often left out of the conversation. This is real-world advocacy that truly changes lives. There's no better time to reflect on how important it is that...

Read More

Ask the Midwife: Can a midwife administer pain medications during labor?

Can a midwife administer pain medications during labor? Midwives who attend births in hospitals are able to order pain medication for clients in labor.  What types of pain relief are available may vary, so it is important to ask your midwife what s/he can offer you.  If you are planning to birth at home or in a free-standing birth center, talk to your midwife about what is available in that setting. In general, there are analgesics, which relieve pain but do not eliminate it, and anesthetics, which take away the pain. Narcotic-based analgesics like Demerol, Nubain, or Stadol can be given as an intramuscular injection, which will begin to ease the pain in about 15 minutes.  If the woman has an IV for some reason, the medication can be given through the IV line and will take effect within a minute or two, but will wear off sooner.  Often these drugs are given with an anxiolytic medication that promotes relaxation, like Phenergan or Visteril.  The combination gives more pain relief without using more of the narcotic component.  This type of pain relief lasts about an hour or two for most women, but people metabolize drugs at different rates, so it is impossible to predict exactly how much or for how long this will help the laboring woman. The timing and dosage of injectable or IV analgesia is important.  We don't want to give this medication too close to the delivery, or in such a large dose, that the narcotic could depress the baby's respiration at birth.  Also, there needs to be 4 hours between doses, to allow the baby to eliminate the drug. Epidural is the most common type of anesthesia for childbirth and is administered by an anesthesiologist or certified nurse anesthetist.  It...

Read More

Pelvic Floor Therapy: An Interview with a Pelvic Floor Physical Therapist

Why don’t we hear more about the pelvic floor during pregnancy and birth?   This is a great question that I hear primarily from two groups of women: my peers, physical therapists whose rallying cry has been, “what is pelvic floor physical therapy and why doesn’t everyone know about it?”, and postpartum women, who come to my office seeking help for childbirth-related injuries to the pelvic floor. Most of them feel blindsided by what they didn’t know or understand and blame themselves for not knowing the right questions to ask! If an injury is sustained from the delivery, there is feeling of isolation, of not knowing how to get the care they need. Postpartum pelvic floor therapy is the norm in certain countries where childbirth is less medicalized and midwifery care is the norm. In general, we do not have this culture of collaboration for postpartum care and as a result, postpartum women are tremendously underserved in their needs.  What can we do to change this for women? There needs to be a paradigm shift in the way we view women’s healthcare through the childbearing years and beyond. Despite the need for collaborative care, we cannot rely on the medical profession alone to understand or advocate for the musculoskeletal issues that impact pregnancy and childbirth. Physical therapists are oriented towards evidence-based care, but there are not necessarily evidence-based birthing practices occurring. Empowering women in their journey to motherhood must include information about how pregnancy and birth can affect her pelvic health. Post-partum women have an especially difficult time getting acknowledgement of their birth injuries and then what to even do about it. I find this to be true whether it is a natural, unmedicated birth or a cesarean. Typically, a woman sees her birth attendant 6-8 weeks after delivery and if she reports pain...

Read More

Ask the Midwife: How can I avoid an episiotomy during birth?

"How can I avoid an episiotomy during birth?" Today an episiotomy is no longer a routine procedure - thank goodness - but is performed for cause. Some reasons include a tight perineum which prevents the baby’s head from distending the perineum, prior scarring of the perineum, female circumcision, and/or the baby’s heart beat is low and delivery needs to be expedited. We can decrease the problems with the perineum but not some of the other causes. The other question is how to prevent natural tears of the vagina and the perineum. It is important for women to know that there is a group of muscles in the vagina that support the vagina, bladder and rectum. These muscles need to be strengthened and toned prenatally to increase their elasticity to allow for relaxation of the vagina and perineum during birth. These same muscles need continued exercise for the remainder of our lives. Thank Dr. Kegel for giving us the Kegel exercise!! Proper overall fitness is important so consider walking and squats for toning. Proper nutrition is also key. Make sure that you get adequate protein and other nutrients for your tissues to respond well to the stretching of birth. Keeping the vagina healthy and reporting any signs of an infection to your provider promptly to maintain good vaginal tissue integrity is hugely important. Perineal massage is advocated by many to be helpful in preparing the vagina and the vaginal muscles for birth. This needs to be initiated at 34 weeks and done for approximately 5 minutes 3-4 times per week. When it comes time to push, your position is important, as is the use of warm compresses on the perineum. The lateral position or squatting for birth is protective of the perineum. Finally, a slow, controlled delivery...

Read More

TOP 10 THINGS I WISHED I HAD REALLY KNOWN!

This blog post comes from Ilham Zoughi, Founder and CEO of Duette Foodshed, and mom of two little ones. She recently participated as a panelist for our February 11 All About Birth Workshop, "Prenatal Parenting: Practices for Better Bonding and a Healthy Pregnancy." Her list of top 10 things she wished she had really known about birth and postpartum resonated with the crowd and we asked her to share this publicly. So enjoy! 10. Nurture yourself NOW • Feel good for yourself and for your baby • Massage, Acupuncture, Energy Work 9. Count on old-fashioned nutrition • Good (animal) fats: butter, • Probiotics • Egg yolk • Bone Broth • Organ meats 8. Labour IS (likely) a marathon, management of early labour is critical to a successful delivery • Rest early • Hydrate often • Work with an experienced Labour Doula if possible 7. Breastfeed ASAP to ensure a good start … because 6. … Breastfeeding IS (likely) difficult • Research lactation consultants ahead of time • Invest in a lactation consultant visit ASAP – i.e. call her as soon as baby is born • Do not count solely on other professional that have a certification and can “help with breastfeeding” 5. Breastfeeding clinics are a nice resource • Provides further support and bonding with other new moms 4. Post Partum Nutrition: PLAN AHEAD • No time to think about food post-partum • Solutions can range from pre-made frozen meals to in-house chef • Remember you have a weak digestion so focus on soups, stews, broths, easy-to-digest cooked foods – No gassy foods. 3. 4th trimester – HELP NEEDED! • 4th trimester is much more difficult than 3rd trimester! • Resting –when you can, is important • Organize help for simple things (e.g. running an errand): family members, post-partum doula 2. Recovery is a process – No rush. • Traditionally a “confinement” period of at least a month was observed • Proper post-partum recovery will help you avoid health issues years...

Read More

Ask the Midwife: What kinds of preparations can I take for breastfeeding while I’m still pregnant?

"What kinds of preparations can I take for breastfeeding while I'm still pregnant?" Congratulations on your plan to breastfeed your child!  This will probably be one of your most special times spent with your newborn/toddler but sometimes it can be a very challenging commitment.  There are many things you can do while you are pregnant to help you prepare for some of the obstacles that might confront you in the months/years ahead. Initially, think about your philosophy of breastfeeding and what it means to you (the importance of human contract, benefits of breast milk, health benefits to mother and baby).  Perhaps write these down to help renew your commitment any time you experience doubt. Knowledge is extremely helpful for success.  Learn as much as possible about breastfeeding before the birth.  There are numerous, up-to-date books, online sites and classes that discuss the benefits, process and pitfalls of breastfeeding.  Classes are offered at most hospitals, birth centers, WIC offices, as well as provider officers (OB, pediatrics, family medicine and midwifery).  Stores that sell and rent breast pumps and other breastfeeding supplies and La Leche League meetings also offer classes and welcome women who are currently pregnant.  Ideally, the class should be led by an IBCLC, fully knowledgeable with accurate, evidenced-based and experienced information.  If unable to attend a class prior to your birth, purchasing a reference book is a great idea.  Books such as The Womanly Art of Breastfeeding from the La Leche League, or Breastfeeding Made Simple, (Mohrbacher and Kendall-Tackett) are just two great resources.  It always helpful to review knowledge when given sometimes conflicting instructions by various individuals after the birth.  These resources can help prepare you ahead of time for issues regarding nipple care, milk supply, and other challenges to breastfeeding that may occur related to your birth experience and...

Read More

Birth centers can give women a new choice

Michele Giordano and Nan Strauss wrote an op-ed in today's amNY about the push to increase the number of birth centers in the state of New York. "Birth centers have not been able to keep up with demand. Women in New York State are seeking alternatives to hospitals, with data showing that out-of-hospital births have risen by 68 percent between 2005 and 2013 -- 1,085 more out-of-hospital births. With birth-center care sought by women and research showing that centers provide quality and cost-effective care, it's time to make more options available to the 230,000 women giving birth a year in our state. New York lags behind other states, with just two existing freestanding birth centers -- one in Brooklyn and one in Buffalo. California has 24 freestanding birth centers, Texas has 62, and Florida 29."    

Read More

Ask the Midwife: Can a midwife do my well-woman care?

“Can a midwife do my well-woman care after I give birth?” Yes! Midwives, who have been certified through the American Midwifery Certification Board and licensed by New York State, can provide well-woman care throughout the lifespan. A midwife is a good choice for both young women having their first gynecologic office visit and for women in their post-menopausal years, and for every woman in between. Midwives can perform annual gyn exams including pap smears, diagnose and treat routine female infections like vaginitis and cystitis, discuss and prescribe birth control options, including intrauterine device insertions, diagnose and treat sexually transmitted diseases, and discuss hormone replacement and its alternatives. Midwives consult with gynecologists, breast surgeons, radiologists, dermatologists, and other specialty physicians if a woman’s care is more complicated than within the midwife’s scope of practice. Many midwives are also interested in alternatives to routine gynecologic care and suggest or incorporate modalities like herbal medicine, homeopathy, acupuncture, and physical therapy in their practice. Midwives are with women for a lifetime. Best, Nancy Kraus LM, CNM   Nancy Kraus LM, CNM has an office-based practice at Downtown Women Ob-Gyn in Soho where she provides prenatal, postpartum and well-woman gyn care. She is the mother of two grown sons. She is active in midwifery politics and has been an officer of the New York State Association of Licensed Midwives. Submit your questions to askthemidwife@choicesinchildbirth.org.

Read More