 In April I gave a presentation to a group of healthcare professionals on the topic of tongue-tie. It was important for me to see where moms were getting the initial idea there might be a tie -- the diagnosing and treating was not part of this poll. What impressed me about this is, moms are generally the ones who figure this out. There is wisdom in mothering! Before the first book was written or the first study published, there were mothers -- sharing stories, knowledge, and experience with the next generations. That has not changed simply because information is easier to access. Follow your instincts! 
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 As a young mother, I had a few friends with tiny kids. We formed a tight-knit group, and we met together frequently to let our kids explore nature and run (safely) amok. One of these parents experienced a miscarriage, and we all grieved this loss with her. A second friend brought her a gift: a picture showing many smiling baby statues, looking like something out of a Studio Ghibli movie. She said she and her partner encountered these while traveling in Japan, and they were called "Jizos." She gave this picture to our grieving friend, and we learned, despite the juxtaposition of cheery faces, toys, and bright red hats, Jizos hold a deeper purpose. In Japan, there is a way to honor and acknowledge the loss experienced through miscarriage and babies born still. "Mizuko Kuyo" literally means, "water" and "baby," and it represents the spirit of an infant who has passed, “beings who float in a watery world awaiting birth” (Jizo Bodhisattva: Modern Healing & Traditional Buddhist Practice, by Jan Chozen). Statues called "Jizos" represent children that never were. Initially the family writes the baby's name on the Jizo, as well as the date of the loss. They may also include a personal message to the baby. If there are ultrasound pictures, one might also be left with the Jizo. The ceremony is performed by a Buddhist Monk, who essentially reads a scripture-like prayer for the baby. Families may come and add caps or bibs of red, pinwheels or other small toys and food offerings. Mizuko Kuyo has no direct English translation. I would go even further to say, English-language cultures (and many other cultures) have no direct translation in ceremony, emotional comfort and release, and community acknowledgement of this loss.  As a doula, I have seen women and families experience miscarriage and babies born still. While every parent feels their experience differently, they often do feel it deeply. Sometimes these are family mournings, when the baby is closer to birth or gestational maturity -- society deems it more aceptable to share this news and mourn together. But with the majority of miscarriages occurring before 12 weeks of pregnancy, more often this loss is a private ordeal. Many parents or couples haven't shared the news of their pregnancy yet; the support which might be extended by their community is missing, and the pregnant parent, especially, floats through the loss feeling alone with their secret pain. I don't know why our culture is so bad at this type of loss (we aren't good with loss in general). The point of Mizuko Kuyo is to recognize the passing of a "baby before birth." One Buddhist Monk notes, it doesn't have to be an official religious ceremony, and anyone can have their own Mizuko Kuyo -- even years after their loss. One woman, searching for a way to peace after her miscarriage, asked her husband to participate in Mizuko Kuyo with her. She shares: "I gathered a few things. The pregnancy test – it symbolized the happiness my husband and I shared when we learned of our pregnancy. A family picture. I also wrote a note that simply said, This post has been inspired by a dear friend dealing with her own loss tonight. I am sorry to all who have experienced this pain. You don't have to be Buddhist to remember your little one with a Jizo or similar ritual -- consider marking your baby's time with you in a way that settles with your heart. Love and light <3.  "Cesarean delivery for active phase arrest in the first stage of labor should be reserved for women at or beyond 6 cm of dilation with ruptured membranes who fail to progress despite 4 hours of adequate uterine activity, or at least 6 hours of oxytocin administration with inadequate uterine activity and no cervical change."
I love this pic from a birth almost 5 years ago. This was the laboring mama and her own mother during an intense contraction. I appreciate there is specific criteria that we can look to in making the decision to move to a cesarean birth. Basically, if a woman whose water has broken has not had any cervical changes (measurable progress, right?) after 4 hours of effective contractions, OR after 6 hours of pitocin, cesarean may be warranted. One thing to keep in mind: there are more ways to progress in labor than just cervical dilation. Progress can be baby moving down in the pelvis, even if the cervix seems to be at the same dilation number (eg, first vaginal exam mom was 3 cm, baby was -4 station; next VE mom is still 3 cm, but baby is -1 station -- baby has come down regardless of where mom's cervix is, and that shows progress!).  Have you heard "6 is the new 4"? When looking at the stages of labor, it was taught that 0-4ish was latent or early labor, 4ish-7ish was active labor, and 7ish to complete (what we call "10") was transition. After seeing that we misjudged the amount of time in active phase, it is possible many women received cesarean births simply due to what was thought of as non-progressing labor, when in reality, with 4-6 more hours in that phase, birth would have happened on its own. Patience is not only a virtue, but it is also the safer way to birth for moms and babies.
 "Slow but progressive labor in the first stage of labor should not be an indication for cesarean delivery."
Slow and steady wins the race! As long as Mom and Baby are okay, slow progress is still progress! When we let labor unfold on its own and give Mom and Baby their time, we reduce cesarean births. Many of us are excited about these new evidence-based findings ACOG released in March. There are almost 20 statements that show how we can better support laboring moms to work in preventing a woman's first cesarean birth (knowing once she has had a cesarean birth, her chances of obtaining a vaginal birth after cesarean, or VBAC, are extremely low due to our climate). Basically what these statements boil down to are, women need more time in first and second stage, and we should not rush to cesarean delivery if mom and baby are doing well. Please share these. I love Lamaze's amazing infographic which states it can take up to 17 years for medical practices to change when new information becomes available -- and Lamaze goes on to emphasize, as pregnant women, we don't have 17 years for our providers to catch up. It is all of our responsibilities to inform ourselves and present these best-care practices to our providers and see that we are treated accordingly.  "A prolonged latent phase (eg, greater than 20 hours in nulliparous women and greater than 14 hours in multiparous women) should not be an indication for cesarean delivery."
We have learned women don't line up with Friedman's Curve like we thought they should. So basically this new data tells us: dilation from 4-6 cm can take 4-6 hours longer than we thought! Patience is what we need -- give moms and babies more time when everything is going okay with them both. |
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Stacie Bingham, LCCE, CD(DONA), CBS(LER)Calm, comfortable Lamaze education & experienced support for pregnancy, birth, & breastfeeding serving Bakersfield, Delano, Hanford, Porterville, Tehachapi, Tulare, Visalia + the World
661.446.4532 [email protected] |
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