Tuesday, 28 November 2017

Ruth Ehrhardt's The Basic Needs Of A Woman In Labour : Book Review by Athulya Sekhar

Ever heard of the adage “Good things come in small packages”? The book, The Basic Needs Of A Woman in Labour by Ruth Ehrhardt is a testament to that. At a mere 32 pages, this book leaves a deep impact on the reader with its honest and loving, yes loving!, look at the miracle that is pregnancy and labour.

I’m currently in my 2nd pregnancy and I’m trying really hard to have a natural, intervention-free delivery that I was not able to experience the first time around. As a first time mom-to-be I let myself be talked out of something I really wanted, out of fear and the lack of empowering information. So this time around, I’ve been determined to do everything I could to fix things. That’s when I saw this book mentioned as a must-read for expecting moms on an online forum, and I was lucky to find myself a free Kindle copy from Amazon India during their sale.

I read the book in flat 15 minutes. And though I have read reams and reams of words on the beauty and essence of a natural labour and delivery, Ruth Ehrhardt struck a chord with me, unlike the others.

Ruth Ehrhardt, according to the book, grew up in a protea farm in South Africa, where she and her mother ‘fell’ into the profession of ‘catching the babies of the local farm labourers’. Now a trained Doula with 4 home birthed children herself, Ruth’s childhood seems to have influenced much of her life’s work. And the book reflects that. Much of the book focuses on how essential it is to respect the body’s physiological ability to do something that it is meant to do. Labour is talked about as being a ‘state that cannot be forced’ and how a woman in labour, when allowed to do her own thing, needs nothing more than an attentive ear and calm hands.

Oxytocin is an important topic in this book. I was absolutely delighted at how Ruth describes Oxytocin as the ‘hormone of love’. She goes on to explain how the hormone works during labour and how the natural hormone differs from its synthetic counterpart. One of my favourite quotes from the book says:

The baby, when he or she is ready to be born, will send a message that tells the   mother’s body that it is ready.The mother’s body can then begin labour by slowly     releasing oxytocin, the hormone of love.The mother and baby work together to bring the baby into the world.”

We are also told about the importance of surrounding a pregnant woman with positivity. From medical professionals, to family and other support systems, everyone around a pregnant woman should be mindful of their effect on her mind and wellbeing. One of the many interesting things the book brings up is how pregnant woman should not worry herself with the numerous logistical things surrounding her labour, and should be allowed to switch off her ‘thinking brain’. The reasoning here is based on how adrenalin and oxytocin play off each other. This makes so much sense if you think about it. Labour is an intense experience that involves both the mind and the body in equal measures.

The book draws to a close with a discussion on ‘modern day rituals’ which often involve keeping the mother and newborn apart for several hours, when traditionally the baby was always given to the mother for that oh-so-important first contact. These rituals take away the intimacy of the moment, where a newborn ‘finds’ its mother. And a mother ‘becomes’ a mother.

So much of what is shared in the book resonated strongly with me, and I suspect it will with most readers. An emotional and beautiful read, this is one book I will be recommending to every expecting woman!

 Editor's Note:
 Every woman needs to be educated about having an empowered and positive birth. It is absolutely necessary that women are surrounded only about positive thoughts especially during labour and should not be made to worry about other less significant things. For this, women need to be prepared about their birth choices and preferences. Bangalore Birth Network, for the last ten years, have been doing exceptional work in ensuring safe, respectful birth for all women. If you would like to know more about us and our campaign, click here.

Thursday, 19 October 2017

Why You Require A Doula By Your Side - Divya Hegde

A woman is at her most vulnerable yet incredibly powerful space during the moments that her baby is born. A doula by her side at this time helps her in this passage without being judgemental and offering her unconditional support - helping her focus on the process, filtering out distractions and encouraging her throughout. She is a sister, a friend, a guide, an aunt, a mother figure who has gone down that path herself and/or has supported other women at this important juncture. She supports the mom and her partner with compassion and helps them make informed decisions while respecting their choices. A doula is someone who keeps in mind the mother and child’s best interest, and is on the same page as the couple, aware of their wishes and without any personal agenda. 
By getting to know the parents-to-be in depth during prenatal meetings, she builds trust and connection. She educates them about the various birthing options and ways to facilitate a natural birth, assists the couple in making their birth plan, and is present with them during labor and birth. During birth, she provides invaluable emotional support and ensures that the mother is relaxed, has sufficient energy, and is well nourished and hydrated. 

A woman never forgets the way she is made to feel at the birth by her care providers – for the hospital staff it may be just another woman in labor and another child born, but for the mother it’s a very sacred, special and empowering moment. Especially today, where families are smaller and are living further away, it’s not often that women come in close contact with moms who have had an intervention free, positive birthing experience let alone seen one! Others in the family may be too emotionally involved to rationally think at the time or even know what to expect. A doula fills this gap. A doula believes in the woman’s body and its capacity to bring forth a baby and she reminds you of it at the moment when you need to hear it the most. She will not provide any medical support to deliver the baby but empowers you respectfully, compassionately and, if needed, firmly too. She provides the much needed emotional support to the mother and her partner. 

After being nurtured and nourished for almost 10 months a new little human begins his/her life as an individual, separate from it's mother, from the moment of birth. A doula nurtures the mom through this transition of being pregnant, birthing the baby and then beginning to care for the little one. She checks in on the mom-child duo postpartum and provides any support needed for establishing breastfeeding or to smoothen the mom’s recovery and healing. Overall having a doula by your side can provide some invaluable 'mom and child centric' support. No matter what the birth outcome is, the emotional connect and the empowered decisions she facilitates leaves a lasting impact. As one of my favourite quotes goes “We have a secret in our culture and it’s not that birth is painful, it’s that women are strong”. In my experience a doula helps in harnessing and passing on that collective strength and courage at the most precious moment of birth.

For me personally, having a doula with me during my VBAC was like having ONE person who was batting for me. Someone who really “got it”! Someone who could finally understand and connect to my belief that a natural birth is what was best for me and my baby. I lost my mom when I was very young and I never really got to know about her birthing journey or even my own birth in details. But my doula helped me feel my mom's presence at every stage of my pregnancy and birth.

My doula didn't ‘do it’ for me, that's not what she was meant to do in the first place. Nor did she do anything ‘to me’, unlike what the doctors or nurses did especially during my first child’s c-section birth. But she played a very important role in materialising what we – my baby, me, my husband and my first born toddler - could do together and for each other as a team. And for that I owe her my gratitude.

Editor's Note

BBN is proud to have in our team, Celestina Cavinder - a BBN Veteran and a board member, who is a certified CAPPA Labour Doula. Tina has been supporting parents to be have an empowered birth experience by being there for them before, during and after the birth to provide them with whatever is needed to encourage the mother and her partner to prepare and execute their birth plan. You can read more about her here.

Thursday, 5 October 2017

Benefits And Joys Of Skin-To-Skin Bonding With Your Newborn - Uma Bhalerao

Skin-to-skin is the practice of holding a newborn baby close to the mother or the father, where both, the caregiver and the baby, are bare chested and usually a thin cloth is used to cover them. While this practice is often seen while caring for preterm babies in the initial phase of their life outside the womb, it is also very beneficial while caring for full term, healthy babies.This practice, though age old in many cultures, is becoming popular amongst caregivers in the recent years because of its many benefits to both, the baby and the parents, especially mothers.

Babies cannot control their body temperatures soon after birth. Holding them close to one’s body helps regulate their temperatures as well as their heartbeat. It is believed that the mother’s heartbeat and breathing patterns are familiar to the baby and this helps the baby transition from the atmosphere and security of the womb to the outside world with the least amount of stress and thereby reducing episodes of crying and discomfort.  A study shows that skin-to-skin for atleast 3 hours a day can reduce infant crying by almost 43%. This, in turn, reduces stress levels for the caregiver as well as the baby. Skin-to-skin practice is believed to calm the baby and help him/her fall asleep easier and also sleep for longer hours, thus helping the mental and physical development during the initial days of life outside the womb.

Soon after birth, a mother’s body goes through many changes. This is both, an exhilarating and at the same time exhausting period for the new mother. Many a times, establishing breastfeeding can be a challenge. Skin-to-skin helps the mother’s body regulate the milk supply as per the demands and needs of her baby, thus reducing lactation and latching on problems.

The hour following the birth of a baby is called the ‘golden hour’ where, if the mother and baby are allowed to follow skin-to-skin, the mother’s body secretes happy hormones which greatly helps in the initial bonding between the mother and baby. It is also believed that this bonding and hormone release helps reduce the chances of postpartum depression in mothers.

While the benefits of this practice are immense for the bonding between the baby and the mother, it is believed to be the same for the baby to bond with the father too. A baby, though born from the womb of the mother, can develop a strong bonding with the father in the initial days in the outside world and feel as secure and safe with the other parent too. This not only helps the family bond as one, but it can also give some much needed rest to the mother so that her body adjusts to the changes happening inside as well as around her. This leads to her feeling happier, healthier and stress free which in turn helps her produce more milk for the baby too. In the long run, it is believed that babies who experienced this special bonding with their parents grow up to be more emotionally secure and independent adults.

I have personally seen first hand the benefits of skin-to-skin bonding. I was not aware about it when my elder child was born and we had quite a few days of crying, colic and exhaustion. However, I did follow it during the initial period with my second born. What I noticed was, he was a lot calmer, had much lesser colic problems than his brother did and he also shares a deep bond with his father. So all you to be and new parents out there, go ahead and give it a try. Holding and breathing in the scents of a newborn baby held close to you is guaranteed to give you extreme happiness and all the benefits that come free along with it will just be the cherry on the top!

Thursday, 14 September 2017

Silver Lining of the Grey GDM Cloud - Aarti Mehta


My GDM (Gestational DiabetesMellitus) experience started when I was 16 weeks pregnant. Since I had some obvious characteristics for a GDM suspect - overweight, age 30+ and diabetes in the family, my doctor advised to get a GCT (Glucose Challenge Test) done anytime between 16 to 18 weeks. I had this lingering regret that I wanted to shed a few kilos and become healthier before I conceived but life always has plans for you rather than the other way around!

As anticipated the GCT result was disappointing. I was 3 points over the upper limit. GTT (Glucose Tolerance Test) was the next test to confirm GDM and here too, the result exceeded the upper limit.

I was asked to consult a General Physician who, within five minutes of our meeting, prescribed Insulin twice every day and casually told us how it was easy to administer, that we should buy it and the nurse can show how it has to be injected. There was no other precaution, no advice on checking blood sugar regularly or even room for us to question him. I was overwhelmed to say the least. The word “Diabetes” had checked into my life, Insulin was closely following and I felt I had no control of the situation. But the logical, practical, problem solving me, re-appeared! I spent that night reading loads and loads on GDM.

Next day, I met a renowned endocrinologist and came back feeling a hundred times better. I got a diet chart, instructions on how to check and monitor my blood glucose and advice on exercise. I was re-assured of my views about having a healthy pregnancy with GDM through controlled diet and exercise. I also found a dietician to help me with GDM diet who was an angel in disguise and provided the encouragement to conquer GDM with self-control and meal planning.

I immediately started morning and evening walks (something I had been procrastinating for a few weeks unnecessarily) and made changes to my diet.

GDM without Mobility

I was all charged up, consumed by the world of meal planning & timing, calorie counting, glucose monitoring, staying hydrated, etc.  Then, the unthinkable happened. I twisted my ankle and fractured foot meant no exercise. Thankfully, we found a physiotherapist who consulted for pregnancy. She taught me a range of upper body exercises that I could do while sitting on the bed. Life seemed sorted out, atleast for the moment.

IUGR Scare
My 20 week scan was normal. I monitored my sugar levels regularly and maintained a food journal that kept me on track. With drastic change in diet and exercise, I lost weight which worried my husband a lot. He kept raising this concern with the gynaecologist at our appointments but she took note of it only at the 28 week appointment. She asked me to focus on gaining weight. Her advice - stop exercising to conserve calories and work with dietician to increase my daily calorie intake. Post this, I did put on about a kilogram in two weeks. 

However, the 32 week scan showed that the growth velocity had de-accelerated and the fetal weight was in the 5th percentile. The doctor anticipated a premature delivery and I was prescribed a steroid to help develop baby’s lungs. The doctor also explained that taking these shots can cause a spike in blood glucose and advised me to get admitted to take these shots so that the blood sugar could be monitored and insulin be given as per requirement.

Welcome Weight Gain

We weren’t convinced and decided to take a second opinion. We found a GDM friendly gynaecologist who patiently answered all our queries and provided logical answers to all our GDM and IUGR related queries. She advised against taking the steroid at that point much to our relief.

I continued to rest after each meal, kept exercise to the minimum and increased my lean protein intake. My weight increased gradually and much to our relief, the 34th week scan showed improvement in the fetal weight. I still had to watch my blood sugar levels closely.

Insulin Scare

Over the next two weeks, as much as I was trying to achieve a steady weight gain without an increase in the blood sugar level, my glucometer disappointed me increasingly. At the 36th week appointment, my gynaecologist showed concern towards my blood sugar readings. I visited the endocrinologist again who prescribed a slight difference in my diet, suggested doing a light stroll after each meal (by now my plaster cast had come off) and asked me to visit her in a week’s time. 

After a week, I was prescribed insulin. However, since there was only a few weeks left for my due date, I wanted to try making it work without insulin. Yet, as a precaution we bought the insulin, learnt how to administer it and went back. I promised my husband that if at any time my two consecutive readings were high, I would start insulin. Since my weight gain was now on a steady rise, I started exercising again - ate only the meals that had worked well in the past and watched my glucose levels like a hawk. I was living on the edge from one meal to another.

Finish Line
The 37th week scan showed fetal weight as normal. From there on, I could see the finish line of my GDM race. We never went back to the endocrinologist and the insulin remained unused.

Most private hospitals follow a protocol to induce GDM moms at 38-39 weeks. That was my final problem to tackle. I wished to complete full term (or go into labor naturally before 40 weeks). At 38 weeks we consulted at another hospital for a back-up, in case my doctor insists on an induction. But my doctor, true to her word, did let me complete full term and beyond. After trying all tricks in the book for inducing labor naturally, I settled for induction of labor after 41 weeks. Induction too didn’t work and finally, I delivered a healthy baby through emergency c- section.

The Silver Lining
Now, you must be wondering where the silver lining is.  Let me show it to you:
  • Eating healthy and exercising is important during pregnancy and I don’t know if without GDM I would have been able to do it so well.
  • I have never eaten so much salad in my life! With a healthy diet that included salads, lean protein, omega-3 fatty acid rich food – it did wonders for my skin and hair. And I kept stayed away from common pregnancy complaints like swelled feet, backache, etc.
  • Good health helped me recover much faster after the c-section.
  • Diabetes runs in both of our families and GDM helped us to eat healthier and we hope to continue the same and keep diabetes away from our lives for as long as we can.
  • Since I did not put on much weight most of my pregnancy, I continued wearing my regular clothes till the final few weeks. 
  •  And finally, the entire experience brought us closer to each other. Parenting is a lot about teamwork and this experience was a reassurance that we can sail through stressful situations by having each other’s trust and support.

Editor’s Note
 * BBN maintains a service directory that provides you with a list of professional health services in Bangalore, including pre & post natal fitness. You can access the directory here.  

*To read more about GDM and how to manage it, click here. 

* Induction before 41 weeks should not be suggested if gestational diabetes is the only medical issue. Click here to know more about gestational diabetes and induction of labour.