Monday, July 30, 2007

5 operations you DON'T want to get

from CNN's health reporter.  i don't usually trust CNN to give me the "full picture" when it comes to the world around me but it appears they got this one right. 

i am impressed that they had the guts to (accurately) classify an episiotomy as an operation.  if you're having a baby in a hospital, before you sign ANY paperwork, read it closely to ensure that you're not consenting to an episiotomy or anything else that you might now want.

and speaking of operations, i was just told by a client that a hospital in downtown toronto has a 40% c-section rate for first time mothers!  talk about an operation you should try to avoid!!

"At least 12,000 Americans die each year from unnecessary surgery, according to a Journal of the American Medical Association report. And tens of thousands more suffer complications.

Surgery is a trauma, regardless of the surgeon's skills.


The fact is, no matter how talented the surgeon, the body doesn't much care about the doc's credentials. Surgery is a trauma, and the body responds as such -- with major blood loss and swelling, and all manner of nerve and pain signals that can stick around sometimes for months.

Those are but a few reasons to try to minimize elective surgery. And I found even more after talking with more than 25 experts involved in various aspects of surgery and surgical care, and after reviewing a half-dozen governmental and medical think tank reports on surgery in the United States. Here's what you need to know about five surgeries that are overused and alternative solutions that may be worth a look.



It can sound so simple and efficient when an OB-GYN lays out all the reasons why she performs episiotomy before delivery. After all, it's logical that cutting or extending the vaginal opening along the perineum (between the vagina and anus) would reduce the risk of pelvic-tissue tears and ease childbirth. But studies show that severing muscles in and around the lower vaginal wall (it's more than just skin) causes as many or more problems than it prevents. Pain, irritation, muscle tears, and incontinence are all common aftereffects of episiotomy.

Last year the American College of Obstetricians and Gynecologists released new guidelines that said that episiotomy should no longer be performed routinely -- and the numbers have dropped. Many doctors now reserve episiotomy for cases when the baby is in distress. But the rates (about 25 percent in the United States) are still much too high, experts say, and some worry that it's because women aren't aware that they can decline the surgery.

"We asked women who'd delivered vaginally with episiotomy in 2005 whether they had a choice," says Eugene Declercq, Ph.D., main author of the leading national survey of childbirth in America, "Listening to Mothers II," and professor of maternal and child health at the Boston University School of Public Health. "We found that only 18 percent said they had a choice, while 73 percent said they didn't." In other words, about three of four women in childbirth were not asked about the surgery they would soon face in an urgent situation. "Women often were told, 'I can get the baby out quicker,'" Declercq says, as opposed to doctors actually asking them, 'Would you like an episiotomy?'"

What to do instead

Communicate. The time to prevent an unnecessary episiotomy is well before labor, experts agree. When choosing an OB-GYN practice, ask for its rate of episiotomy. And when you get pregnant, have your preference to avoid the surgery written on your chart.

Get ready with Kegels. Working with a nurse or midwife may reduce the chance of such surgery, experts say; she can teach Kegel exercises for stronger vaginal muscles, or perform perineal and pelvic-floor massage before and during labor."

Friday, July 27, 2007

amniotic fluid embolism and inductions

today i heard a heartbreaking story about a pregnant woman who was a few days overdue and was induced yesterday.  during childbirth she suffered an AFE (amniotic fluid embolism) and died.  her baby survived although she didn't live long enough to meet her.  she was 24 years old and leave behind a newborn and a 14 month old baby.  my heart breaks over this because inductions for 4 or 5 days postdate is NOT a legitimate reason. 
no one tells women about these risks and it makes me mad.




Canadian Institutes of Health Research


Canadian Study Demonstrates Medical Induction Of Labour Increases Risk Of Amniotic-Fluid Embolism

McGill University Health Centre (MUHC)Canadian Institutes of Health Research (CIHR)

Results could affect labour induction practices in Canada

OTTAWA (October 20, 2006) - A Canadian population-based cohort study has revealed that medical induction of labour increases the risk of amniotic-fluid embolism. The study was led by Dr. Michael Kramer, Canadian Institutes of Health Research (CIHR) Senior Investigator from McGill University, and will be published in the October 21st issue of The Lancet.

Amniotic-fluid embolism (AFE) is a rare, but serious and even fatal maternal complication of delivery. While its cause is unknown, it is one of the leading causes of maternal mortality in developed countries, accounting for seven of 44 direct maternal deaths in Canada in the period 1997-2000.

This population-based study examined the association of AFE and medical induction of labour in a cohort of three million hospital births in Canada, for the twelve fiscal years 1991-2002.

"AFE remains a rare occurrence," said Dr. Michael Kramer, principal investigator of the study and Scientific Director of CIHR's Institute of Human Development, Child and Youth Health. "Of the 180 cases of AFE we found, 24 or 13% were fatal. AFE arose almost twice as frequently in women who had medical induction of labour as in those who did not; fatal cases arose 3½ times more frequently."

"Dr. Kramer's research has resulted in a discovery that will benefit physicians who look after pregnant women as they will now be aware of this potential complication should they induce labour", said Dr. Joseph Shuster, Interim Scientific Director of the MUHC. "This is an example of how academic university teaching hospitals improve the quality of patient care."

The research team also found several other factors to be associated with higher rates of AFE, including multiple pregnancy, older maternal age (35 years or older), caesarean or instrumental vaginal delivery, eclampsia (a serious complication of pregnancy characterised by convulsions), polyhydramnios (too much amniotic fluid), abnormal placental position or separation, and cervical laceration or uterine rupture.

"Our findings confirm the hypothesis that medical induction of labour is related to an increased risk of AFE," added Dr. Kramer. "Although the absolute risk increase of AFE for women is very small (four or five total cases and one or two fatal cases per 100,000 women induced) and is unlikely to affect the decision to induce labour in the presence of compelling clinical indications, women and physicians should be aware of this risk if the decision is elective."

Dr. Kramer worked with Drs. K.S. Joseph and Thomas F. Baskett at Dalhousie University as well as with Mr. Jocelyn Rouleau at the Public Health Agency of Canada (PHAC). The research was conducted for the Maternal Health Study Group of the Canadian Perinatal Surveillance System, a program under PHAC auspices.

About CIHR

CIHR is the Government of Canada's agency for health research. CIHR's mission is to create new scientific knowledge and to catalyze its translation into improved health, more effective health services and products, and a strengthened Canadian health care system. Composed of 13 Institutes, CIHR provides leadership and support to more than 10,000 health researchers and trainees across Canada.

One of CIHR's thirteen Institutes, the Institute of Human Development, Child and Youth Health supports research that ensures the best start in life for all Canadians and the achievement of their potential for optimal growth and development.  

About the McGill University Health Centre (MUHC)

The McGill University Health Centre (MUHC) is a comprehensive academic health institution with an international reputation for excellence in clinical programs, research and teaching. The MUHC is a merger of five teaching hospitals affiliated with the Faculty of Medicine at McGill University--the Montreal Children's, Montreal General, Royal Victoria, and Montreal Neurological Hospitals, as well as the Montreal Chest Institute.

Building on the tradition of medical leadership of the founding hospitals, the goal of the MUHC is to provide patient care based on the most advanced knowledge in the health care field, and to contribute to the development of new knowledge.


For further information

Marie-France Poirier
CIHR Media Relations
Tel.: (613) 941-4563

Ian Popple
Communications Coordinator (Research)
MUHC Public Relations and Communications
(514) 843-1560

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Monday, July 23, 2007

the joy of a crazy playdate

i openly admit that i cringe at the idea of playdates.  so often it seems that a playdate becomes a platform for competition and judging other mothers and their parenting skills.  for over 2.5 years i have avoided most playdate opportunities like the plague because of this bizarre behaviour.

today, thanks to a wonderful lady named Dani, over at india, kalden and i went to the biggest playdate ever and it was nothing at all like my previous experiences.

at one point i counted 24 kids in Dani's backyard but i know there were even more kids in the house.  it was pure madness and i loved every minute of it.

everywhere i looked, someone was holding someone else's baby, wiping mud off someone else's toddler and getting food for someone else's child.  it was beautiful to watch strangers become friends with nothing more in common than the fact that they were parents.

today was the perfect example of how things "should" be.  laughter, smiles and co-operation in parenting.  bonding over tortilla chips or the smell of a new baby is a much better way to live life than spending time worrying about who is potty trained and who is counting to 10. 

i even got to chat with a fellow doula, although it was a little hard to have a continuous conversation when there was so much action around us.

i REALLY look forward to meeting up with more of those ladies and having the chance to get to know them better on an individual basis.  i am also really thankful for online communities like mom2mom that translate into wonderful "in real life" experiences. 

Friday, July 20, 2007

keep your butts to yourself

my brother in law is my hero.  he's so funny and never ceases to amaze me with the funny things he does.

i should preface this by saying that we come from a very anti-smoking family.  we also have been taught since birth not to litter.

so today my brother in law was stuck in traffic and the guy in front of him threw a cigarette butt out his window.  my brother got our of his car, picked up the cigarette butt and handed it back to the driver and said very politely "you dropped this."

the was obviously shocked and replied "i meant to drop it."

to which my brother in law responded "oh, well it goes in your ash tray not on the ground."

then he got back in his car.     

Tuesday, July 17, 2007

perfect guacamole recipe

that's all this post is about.  perfect guacamole.  it's easy.  there is no need to try and make this complicated and there's certainly no need to add things like oil, sour cream or garlic.  it's a simple recipe that takes all of 5 minutes to make. 

  • fresh and ripe avocados mashed roughly
  • green onions (finely chopped)
  • FRESH lime juice (usually 1 juicy lime for every 2 small avos)
  • salt

optional ingredients:

  • pinch of chili flakes OR fresh finely chopped jalapeno (seeds and veins removed)
  • finely chopped tomato
  • finely chopped cilantro (don't use too much because it's overpowering)

just mix all the ingredients and enjoy with your favorite tortilla chips.  i don't give quantities because it all depends on the size and quality of the ingredients you're using.  tasty guacamole needs a fair bit of salt but add it a tiny amount at a time, tasting in between until it's perfect.

TIP - to keep it from turning brown, put one of the avocado pits in the guacamole until ready to serve.

that's just peachy

i try to buy organic whenever possible but i live in north york where shopping is done at loblaw's not farmer's markets. so organic doesn't mean local and it's still mass produced. and of course, my choices are limited by what's on offer and by what's in my wallet.

well here's a helpful guide that a fellow doula shared on a discussion board recently. i was horrified to discover that my beautiful peaches have the highest amount of pesticide residue of any fruit or vegetable tested.

i can't even FIND organic peaches in my local stores right now.

(The numbers listed next to the fruit are the test scores, 100 being the most polluted.)

1. peaches (100)
2. apples (89)
3. Sweet bell peppers (86)
4. Celery (85)
5. Nectarines (84)
6. Strawberries (82)
7. Cherries (75)
8. Pears (65)
9. Grapes, imported (65)
10. Spinach (60)

Monday, July 16, 2007

the evolution of breastfeeding

when i had my daughter 2.5 years ago, i knew that i was going to breastfeed her.  there was no alternative in my mind and i never for one second considered that it might not work out. 

i was lucky.  india latched on like a professional within minutes and was breastfed until she was 18 months old.  i didnt really realize at the time that i was being political in any way; i was just feeding my baby.

i remember feeling slightly uncomfortable as i tried to feed her in a crowded waiting room, or feeding her in the car in a parking lot trying to make sure i was sufficiently covered up.  as india aged i felt even more self conscious and of course, i was faced with questions from family and friends about when i was going to stop breastfeeding my child.

we went on vacation when india was 13 months old to a colombian island in the caribbean and suddenly women everywhere on the island were smiling and nodding whenever i breastfed my daughter publicly.  these subtle approvals were warm and comforting and most importantly they reassured me that i was was doing a GOOD THING for my child. i went on to breastfeed her until she self weaned and i felt good about my accomplishments.

now that i have a son, i am much more confident when breastfeeding and i don't care where i am or who is in the room.  when my child needs to eat, i happily feed him.  i'm less concerned about covering up and making sure nothing is showing.  and you know what?  no one seems to mind one bit. 

so while i realize that what i'm doing is considered political - more importantly, it's just a human act of love.  and since my 4 month old weighs 19 pounds, it seems to be working out perfectly.  :)

Wednesday, July 11, 2007

the ultimate doula booklist

as a doula, i need to stay on top of current research, trends and practises but i also need to understand the history of childbirth around the world. these books are familiar to most birth professionals and they are wonderful resources for any woman.

if anyone who loves me is reading this, please feel free to buy me any of these books! (used is just fine by the way! )

Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First by Marsden Wagner
Homebirth by Sheila Kitzinger
Ina May's Guide to Childbirth by Ina May Gaskin
The Birth Partner by Penny Simkin
Labor Progress Handbook by Penny Simkin and Ruth S. Ancheta
The Thinking Woman's Guide to a Better Birth by Henci Goer and Rhonda Wheeler
Birthing from Within: An Extra-Ordinary Guide to Childbirth Preparation by Pam England and Rob Horowitz
Pushed: The Painful Truth About Childbirth and Modern Maternity Care by Jennifer Block

any other suggestions welcome!

why am i doula? confessions of a birth junkie

after my son was born, i was sitting in bed staring at him and i realized that as my last child, i was no longer going to be a part of the birthing community. soon he wouldn't even be a baby! i felt a deep sadness and the thought of saying goodbye forever to my midwives at Kalden's 6 week appointment illuminated all that i was going to lose.
i LIKE pregnancy and childbirth. i like it so much that i would do it over and over and over if i could. i love talking about babies and if it wasn't socially unacceptable i'd tell everyone i meet all about the births of my children. :)

so back to sitting in my bed - i was struck with the most brilliant of ideas that would allow me feed my birthing habit. i could become a doula! i could be around pregnant women ALL the time that way!

it's sort of a selfish career choice - i get a high when i see a pregnant belly and just the thought of supporting a woman through labour makes me giddy. i know it sounds weird but since becoming a doula i've discovered that there are lots of other "weird" women out there who feel the same!

in toronto, i am lucky that the birthing community is progressive. midwives are highly sought after and homebirths are becoming more popular than ever. it all makes me smile.

doula links:

Monday, July 9, 2007

sex in a pan

well contrary to everything i believe about cooking healthy food with processed ingredients - this recipe is too delicious to pass up. as shared on a parenting board - this recipe is simple, quick and beyond heavenly.

1 box of Ritz crackers
1 package of Skor Bits
1 can Condensed Milk
handful of chocolate chips

Crush Ritz crackers in a large bowl. add all other ingredients and mix well.

Pour into greased 8 x 8 pan. bake at 300 degrees for 20 minutes or until lightly browned.

Let cool slightly then cut into squares while still in pan. let cool completely and enjoy!

note: there a million different recipes for this dessert some way more elaborate but this one is by far my favorite! i've noticed a lot of other recipes call for cool whip which i simply refuse to eat because i have no idea what that stuff is. :)

Friday, July 6, 2007

being a doula in the 21st century

i'm sure that there was a time when being a doula meant having a pen and paper to write down your clients info, and having a phone at home so that your client could call you when she went into labour.

that CERTAINLY isn't how things are now. especially not for doulas in the greater toronto area or in any booming metropolis these days. being a doula is a business now like anything else. you need business cards, pamphlets, a cell phone, a website ( and a high speed internet connection. i never imagined that becoming a doula meant that i needed to understand SEO and CSS stylesheets. eek! what have i gotten myself into.

most recently i've been wondering how i can best keep track of my clients information. at home it's easy because i use my laptop. but what about when a client calls me with a question while i'm at the zoo with my kids? i am pondering the neccessity of something like a blackberry but i simply can't afford it yet.

and even the doula certification courses have jumped on board with the modern day doula needs. they have sections about networking, advertising and marketing and about keeping your books. BOOKS?!? are they serious?!!?! (note to self : be really nice to client who is also a bookkeeper)

so between handing out pamphlets to local stores and businesses, reading medical journals, networking with other doulas, and searching online for the perfect doula bag - when exactly do i have time for my clients?

i'll have to get back to you on that one....

Thursday, July 5, 2007

the myth of mommy guilt

everywhere i go online i see postings or articles about "mommy guilt" and why we shouldn't feel guilty about the choices we make for our kids.

it's all nice and sweet and leans towards patting everyone on their back about what a great mommy they are. well i'd like to challenge this whole notion of "mommy guilt".

if your kid is watching 4 hours of tv a day - then you SHOULD feel guilty. it doesn't make you a terrible mom but you should address the TV issue.

if you feed your kid mcdonalds 3 times a week then you should feel guilty. and stop taking them to mcdonalds!

as a personal example, last week i put kalden (my 4 month old) in his carseat and placed him on a stool. the whole thing toppled over and kalden fell. it was horrible and horrifying and thankfully he was fine but it was MY mistake and i felt guilty about it. and that's OKAY.

i will be more careful next time.

so i'm not a big fan of the sentiments that tell us that all out kids will end up the "same" by high school and to stop feeling guilty for the choices we make now when they're little. only YOU can take responsibility for your choices and so you as a parent should make them carefully. we all make mistakes. it's part of being human. but the whole "say no to mommy guilt" trend is just a cop out to make us all feel better about those bad choices and it gives us an excuse to keep making them.

i support making informed choices and learning about what it best for your own family. then stand by those decisions. and if you made a mistake, then feel a bit guilty and move on. it's FINE.

Sunday, July 1, 2007


that's where my daughter says that my aunts have moved.

"caleeeefornya". she kept asking me for lisa and cindy this morning while we were getting ready for our weekly breakfast at my grandparents. i kept telling india that they are in california but she didn't get it. then i explained that california is far away and that we have to get there by plane. so of course a plane flew by us and india pointed up and said "mommy let's use that one".

i hid my tears behind my sunglasses and explained that she'll have to wait a few weeks at least before we take a plane to california.

she is going to miss them so much. and so am i.

and then my sneaky aunt left me a card at my parents house that sent me back into tears AGAIN. it's just lucky i wasn't wearing mascara today.

(hope the drive is going well so far guys!)