Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

Response to a Comment, Re: The Deal with Delayed Cord Cutting May 22, 2009

Filed under: Ramblings — NursingBirth @ 12:37 PM
Tags: ,

Posted May 21, 2009 @ 4:02pm  by pinky

Re: The Deal with Delayed Cord Cutting or “Hey! Doctor! Leave that Cord Alone!”

 

Dear NuringBirth

 

Curious? What is your education level? The reason I ask is that you have named every woomeister in the universe. I am surprised you have not mentioned Ghadi, Ina May and Santa Clause.

 

Tina Cassidy is a writer. She is not a authority on birth. I liked her book but I would get myself down to the medical library if you want to print up pros and cons of delayed cord clamping. You may start with the BMJ (British Medical Journal), they have done a few decent studies.

 

From,

Pinky

 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

 

Dear pinky,

 

I am being very honest when I say that I am a bit frustrated with your question “Curious? What is your education level?” because you have asked me this question before and I was happy to answer it then (see below).  I thought when you asked that question the first time you were merely being inquisitive but now I feel like there is more behind it and you are trying to discredit my post without presenting evidence to the contrary YOURSELF.

 

Here is the comment you wrote in April:

 

pinky Says: April 24, 2009 at 6:44 AM

Henci Goer? I have to wash my eyes out now! You lost me on that one. I did however, like Tina Cassidy’s book. I thought it was fair and accurate. Many books have an agenda, which pisses me off to no end. How long have you been in L&D?

 

Here is my response:

nursingbirth Says: April 24, 2009 at 10:06 AM

Pinky, I’ve been a nurse for three years, in L&D for 2 years. I am curious to why you would ask that question because I have never tried to pretend I am somebody I am not and I feel that whenever someone writes a dissenting comment on my blog, they often ask “how long I have been a nurse for” as if that should somehow discredit all of my experiences and opinions. The fact of the matter is that while experience is an incredibly invaluable resource to have as a nurse and educator, it is NOT all that is important. Education, open-mindedness, drive, passion, commitment, compassion, intelligence, and desire to always keep learning as well as MANY other things play a BIG role too. I value all those who have come before me especially those who have been in the business for many many years, including other nurses, doctors, midwives, doulas, childbirth educators, etc. I also value each mother I work with knowing that they have just as much to teach me as I have to teach them. I also value anyone in my life that has a different opinion than I do, in any area, because I believe we can learn just as much about the world and ourselves from our friends as well as our dissenters. But I have to be honest, valuing only experience over all the other qualities that make up a great nurse is part of the reason why we have a nursing shortage….Nurses eat their young!

You are not alone as an RN who does not like Henci Goer as I have seen many other people in healthcare scoff at her book. But in my opinion she backs up everything she writes about with research, gives pros & cons for each intervention, and from the very beginning of her book she is very honest about the fact that she has an opinion and is not afraid to say it. It’s HER book after all. You may feel her book is pushing her own agenda but there are many OBGYNs, nurses, and midwives who do the same to patients every day in this country, without the evidenced based research to support it!

On page 10 of “Thinking Woman’s Guide” she writes, “The things you are about to read may well worry or distress you or even make you angry. I have not tried to be needlessly alarming, but I haven’t pulled any punches either. This book was written on the same principle as sex education: namely, I would prefer you to be uncomfortable rather than ignorant. My goal is for you never to have cause to say “‘I didn’t know that was an option’ or ‘I never would have agreed if I had known that could happen.’ You can, of course, also leave all or most of your decisions up to your caregiver. That is a perfectly valid choice. The important thing is that it be a conscious choice, not one you felt constrained to make.”

All in all I appreciate everyone’s opinion who comments on my blog and I am humbled that anyone is even reading my words. I am grateful for all that I learn from all of my readers and I hope you will continue reading.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Pinky, I find it quite amusing that you thought Tina Cassidy’s book was, and I quote, “fair and accurate” in April but now she is just a “woomeister” (whatever that is supposed to mean…)  And for the record I personally admire both Gandhi and the wise Ina May Gaskin and I feel sorry that you do not!  (Maybe it is because I believed in Santa Claus as a small child, a flaw in your opinion!)

 

The fact of the matter is that I do not have nor have I ever had any problem telling people my credentials when they ask.  Perhaps my original response to you about my credentials was not complete enough.  Part of me does not feel like I should have to repeat myself or go into any more detail.  But apparently you insist I go more in depth.  If that is the case then here it goes….

 

I graduated Summa Cum Laude with departmental honors from a large research university in the United States with a Bachelor’s Degree in Nursing.  I spent 5 years in college because for the first year, I was a microbiology major on the pre-med track.  It was a hugely positive change in my life when I switched into the nursing major since I truly feel like nursing is a calling for me.  During nursing school I worked as a nursing assistant/nurse extern on an orthopedic/cardiac floor in a small community hospital for two years.  I was published as an undergraduate my senior year of college in the journal entitled Issues in mental health nursing.  For the honors program I wrote a 50+ page honors thesis and because of it I graduated with departmental honors. 

 

I was inducted into the Sigma Theta Tau International Honor Society of Nursing my senior year.  I arranged my senior internship to be conducted at a large teaching hospital in an Labor, Delivery, Recovery, Postpartum (LDRP) ward where I worked full-time nights, 7pm-7am, three days a week on top of going to school full time, for three months.  After graduation from nursing school I got a job at a large teaching hospital in the medical-surgical float pool on evenings shift, 3pm-11pm.  I worked on the orthopedic/neurology, medical/dialysis, same-day surgery, inpatient surgery, oncology/gyn surgical, and cardiac floors rotating each night to the floor that was the busiest.  Occasionally I also floated to the emergency room, intensive care unit, and pediatric floor.  After a year in the float pool I got a job on the labor & delivery floor where I have been working for two years.  Our L&D ward is the high-risk hospital for cities and towns that span a 3 hour radius around hour city.  I am also a fully oriented peri-operative L&D nurse which means I can work as a circulating nurse, auxiliary nurse, and scrub nurse during cesarean sections. 

 

Through this blog I have been very open about still being a bit green behind the ears as a nurse.  I know that I have a lifetime left of learning as a nurse and learning something new about my job every single day is one of my favorite things about being a nurse!  I love being a nurse because it combines all of my career passions in life including advocacy, outreach, educating, supporting, and caring.  This blog is a hobby for as it is a personal blog.  I am not writing this blog on behalf of any organization or business, and I am not getting paid to write, however I do support a variety of organizations that promote natural childbirth, breastfeeding promotion, the mother-friendly childbirth initiative, and the baby-friendly hospital initiative including but not limited to:

 

The Association of Women’s Health and Neonatal Nursing

BirthNetwork National

Citizens for Midwifery

Coalition for Improving Maternity Services

International Cesarean Awareness Network

La Leche League International

World Health Organization

Childbirth Connection

 

My About NursingBirth page reads:

“This blog follows all HIPPA regulations.  Names, dates, events, and descriptions are altered for the privacy of all who may or may not be involved.  Unless otherwise quoted, all opinions expressed in this blog are my own.  Although this blog should not be used as a substitute for medical or midwifery advice, I try my best to support all facts with the appropriate research and encourage all who stumble upon this site to talk to their midwife or obstetrician about any questions that may arise while reading my posts.”

 

I try to support all of my posts with appropriate research and resources but unlike you, I value different types of sources as long as they are well researched themselves.  I value research published in medical journals and nursing journals however I also often quote various websites, blogs, and books about birth that may or may not (*GASP*) be written by obstetricians!!  I value research and writings from obstetricians, nurses, midwives, pediatricians, nurse practitioners, childbirth educators, doulas, birth advocates, mothers, fathers, and yes EVEN writers and journalists.  Now, I may not think it is appropriate for a journalist who wrote a book about the history of birth (like Tina Cassidy) to be an expert witness during a trial however I think that journalists and writers (again like Tina Cassidy and Henci Goer) have just as much of an ability to do a thorough and appropriate historical review or review of the literature as any other health care professional could.  

 

You also wrote in your comment, “I liked her book but I would get myself down to the medical library if you want to print up pros and cons of delayed cord clamping. You may start with the BMJ, they have done a few decent studies.”

 

However in that very post you are referring to (Super Comment! Re: The Deal with Delayed Cord Cutting)  I referenced two research articles from the Cochrane Collaboration (considered the gold standard of review of the literature and often used to create hospital policy or professional guidelines) which themselves INCLUDE references to the British Medical Journal (BMJ).  You are right however, I did not quote every single research article out there that supports delayed cord clamping.  If I was researching this topic in order to get published, well then yes, I would have referenced every one.  But jeeze, cut me some slack!  This blog, after all, is my HOBBY, not my full time job!

 

Also in that post I referenced the following health care providers that support and have written/spoke out about their support of delayed cord clamping:

 

George M. Morley, MD (retired OB):  http://www.cordclamp.com/

Stuart Fischbein, MD (OB, California)

Sarah J. Buckley, MD (Family Practice/OB):  http://www.sarahjbuckley.com/

Elizabeth Allemann, MD (birth center director): http://www.birthcolumbia.org/

Emmett Miller, MD (mind-body medicine physician): http://www.drmiller.com/

Barbara Herrera, LM, CPM (homebirth midwife): http://www.amamamamidwifery.com/

Gladys McGarey, MD (homebirth & holistic physician): http://www.mcgareyfoundation.com/

Allison Osborn, LM (homebirth midwife): http://www.alisonthemidwife.com/

 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

 

I welcome hearty debate as a part of this blog and I read and try to respond to every comment that is posted.  However I will not tolerate ad hominem (i.e. “replying to an argument or factual claim by attacking or appealing to a characteristic or belief of the source making the argument or claim, rather than by addressing the substance of the argument or producing evidence against the claim”) or defamatory attacks.  If you continue to post such comments I will have no choice but to delete them, something I do not want to have to do.

 

Of course there is always the obvious, you could just stop ready my blog, or better yet, post your problems or concerns on your own blog which I know you have. 

 

For more information on my personal philosophy please check out: My Philosophy: Birth, Breastfeeding, and Advocacy

 

 I have said my peace and I will no longer take up a post or any of my time to respond to any such comments.

Sincerely,

NursingBirth

Advertisements
 

42 Responses to “Response to a Comment, Re: The Deal with Delayed Cord Cutting”

  1. Candice Says:

    Personally, I happen to think you are an empowering advocate for all women of childbearing age. But then again, as a fellow Bachelor’s prepared nurse with over five years OB experience AND current second year graduate student (WHNP), what do I know? 😉 Thanks for sharing evidence- based practice with a dash of information that is more easily related to (I too appreciate Ina May’s own amazing statistics, but am more of a Penny Simkin kind of girl).

    Keep up the good work- looking forward to your next post! 🙂

    • nursingbirth Says:

      Candice, I really appreciate your comment!! 🙂 I am pumped for you that you are going for your WHNP! LOVE Penny Simkin too! I just bought her book “The Birth Partner” for my sister in law who is planning a home birth and is pregnant with #2! I couldnt give her my copy…I reference it too much! So far she loves it! I hope to go to midwifery school some day 🙂

  2. Sara Says:

    You handled that beautifully!

    May I please point out the humor in seeing someone whose blog and comments are laden with spelling and grammatical errors criticize a cohort by inferring that they lack the education level to write about a certain topic? Sorry to take it *there*, but in light of the nastiness of Pinky’s comment, I’d say I get a pass to point that out.

    Maybe this is an attempt by PinkyRN to be funny? Sometimes snark is funny and poignant. It’s why I love The Daily Show and The Colbert Report. Tossing around epithets like “woomeister” does not a pundit or a comedian make. What the hell is a woomeister anyway?! Anyone?

    It was rather nice to see Ina May Gaskin placed in the same category as Gandhi.

    Great response and the original post was fantastic as are all of your posts, NB. Perhaps the good nurse feels a little bit jealous of you? Who knows? Who cares, really?

  3. Emily Jones Says:

    Thanks for this! Writing a blog that is specifically for reviewing the literature and collecting topical information, I get asked this all the time. “Are you a doctor? What do you know? What makes you an expert?”

    But you don’t have to be an expert to read. Doctors don’t hold the keys to an underground vault where all special medical knowledge and research is stored, inaccessible to the rest of the world. We all have the same access to the same literature, and with a modicum of intelligence (and maybe a bit of math skills), anyone can divine for themselves which course to take, and which risks are inherent in any decision.

    I don’t have to be a meteorologist to see the gathering clouds and say that it might rain. I don’t need to be a mechanic to learn how to change the oil on my car.

    Besides that, as I am sure you know, doctors are far from infallible. They are regular people holding a job, just like the rest of us. Some are better than others. Somebody had to graduate in the bottom of their class.

  4. Mama Kalila Says:

    I’m glad you responded to that because I was taken aback for you when I read it… Of course I had to laugh when one of the ones she referenced as a woomiester was recommended by our midwife to a friend! I can’t wait until she finishes reading it to discuss it…

  5. Rini Says:

    Here’s a random question: What is a teaching hospital like? I have this mental image of House’s team following each doctor into the room, of free clinics and low-cost “student” care – sort of like cheap haircuts at beauty school.

    So just how far off base am I anyway? 😉

    • nursingbirth Says:

      Rini, haha that is a great question. For me on OB a teaching hospital means a lot of red tape. Many decisions about the floor are made to make sure the “residents/med students get the best learning experiences” which is good on one hand (I mean, I want our future doctors of the world to get a well rounded education too) however because we generally do NOT take care of “sick” people, sometimes I get really put off by the residents feeling a bit, shall we say, entitled to such experiences without remembering that families are going through one of the most life changing, profoud, spiritual experiences of their lives…bring LIFE into the world! Your “cheap haircuts” idea is really funny, haha! I mean, its not that bad. We happen to have a great staff of attending physicians that run the residents program that are really confident, experienced, and qualified so they generally dont let the residents just go crazy on people without some type of guidance. But yes,….there is a LOT of following around. That gets annoying. Often i have to be like “Okay, only one medstudent can come in and interview the patient…not a whole troop!!”

  6. briome Says:

    Well I LOVE your blog (as do a number of my ICAN group) and welcome someone who is willing and able to look at ALL areas for information and not be another ‘blind leading the blind’ as it were. There is more going on then what DR. God or ‘Big Medical Conglomerate approved by God’ says. It is time to get away from factory behavior for human health.

  7. Your reply was just freaking awesome!

  8. Kim Says:

    I just think it’s inappropriate to come graffiti all over your turf like that. It’s not like you’re spouting ideas off the top of your head or from some romantic ideal. Everything you say is backed up with some sort of research. Granted not everything is a black and white issue, and when it falls in a gray area, there’s nothing wrong with having a preference leaning a certain way.

    On the other hand, I haven’t seen a fair rebuttal to the research presented, and until it’s offered, no one has much of a right to go spouting off on how unprofessional, naive, or ignorant your posts are.

    I feel like if people disagree they should do so with the attitude:
    “You bring your research, I’ll bring mine, and we’ll discuss the situation like colleagues.”

    That’s what science should be about. Not some willy-nilly ‘woomeisters’ throwing mud back and forth. Thanks for being mature and professional in your presentation.

  9. Arwen Says:

    What a great response, NB! (Is it okay if I call you that?)

    In more than four years of blogging here’s what I’ve learned: if a critical comment includes more than one typo and/or grammatical error (and I counted at least three in Pinky’s comment) then he or she is not paying attention and is not worth engaging. There are so many trolls out there!

    However, I’m so glad you responded to Pinky’s comment, because you were so thorough (as usual!) and really showed him, in my opinion. Great job!

    I’ve been meaning to leave a comment for a while because I am loving your blog; it’s my new favorite L&D blog and I am a total L&D/birth-story junkie, so that is saying something. You’re such a good writer and great at explaining things. I’m learning a lot from you! I also love and totally agree with your philosophy.

    Let the troll-ish comments roll off you, and keep up the wonderful blogging work!

  10. Johanna Silva Says:

    NursingBirth, personally, I am very impressed with your blog. I can tell that you take a lot of time to research what you are discussing and share your findings with us. Thank you for taking the time to do so. As far as hobbies go, thiso one is a time-consuming one! As a woman who is not in the medical field but who believes in self-educating, as a mother, and as someone who might give birth for the second time in the future, I am beyond ecstatic and greatful for your blog.

  11. Johanna Silva Says:

    Dear NursingBirth,

    I have recently been reflecting on my birth story. I have been happy with the decisions I made at the time, but now that I know more than I did 20 months ago, I do wonder every now and then if perhaps I could/should have done things differently. I have a happy and healthy little girl. So no regrets. But I would like to learn from my birth story so that I can use that knowledge in the future. I was wondering if you would share your opinion as an L&D nurse.

    I’ll start by saying that my OB was great. She answered my questions throughout the entire pregnancy. She believes that there is a place for both science and a mother’s gut feeling. She respected my wishes. She believes in letting the mother’s body do its thing until 41.5 weeks. She says that at that point she will intervene because of concerns about the placenta.

    That being said, here is my story.

    According to LMP, I was due on 9/12/07. According to an ultrasound at 8 weeks and to me (I tracked ovulation), I was due on 9/15.

    At 40 weeks plus, I started noticing that fetal movement was decreasing. I went in for the procedure where the baby’s heart rate is monitored for about 20 minutes (NST, is it?!). Baby passed with flying colors.

    A few days after that, I saw my OB. I told her of the decrease in movement. She gave me options: induce or wait a little longer to see if things would happen on their own. She pointed out that with an induction, there is a higher rate of c-section and she didn’t want to do a c-section. She said my cervix was doing the right thing; she was confident I could have a vaginal birth. That being said, she said “go with your gut. If movement is decreasing, we can induce.”

    Something that troubled me is the fact that when you go into labor on your own, you have no idea what OB will be at the hospital on that day. I really trust my OB and another OB at her practice, but what if it was one of the other nine OB’s when I went in? What if she/he was not… Someone I felt comfortable with? What if she/he was pushing procedures I did not want?

    Because of the reasons listed above, I decided to induce. I did not want to risk my baby’s wellbeing and it was beyond comforting that my OB would be delivering my daughter.

    I went in on the evening of 9/17. Pitocin was started at 9pm. For 1.5 hours, I had tiny contractions that I was not really feeling. After 1.5 hours, my OB came in and asked if I wanted her to break my water. She explained that different hormones would take over and so my body would behave differently. Don’t quote me on her words; this was 20 months ago. Whatever she said, all that matters is that she took the time to educate my husband and I and we felt like we had options all along.

    I told her to go ahead and break my water. That’s when things got interesting! I was suddenly in serious labor! Nothing gradual about it. Suddenly, I was having contractions that lasted 75-90 seconds every two minutes.

    I did a great job with the contractions for about 2.5 hours. I was on a birth ball most of the time. My husband was putting lots of pressure on my lower back when the contractions came. I had all the support in the world from my husband and my mother-in-law. (Yes, my mother-in-law; I invited her myself!)

    Pitocin was increased every 15 minutes. I was offered an epidural. I really was hoping not to get one, but I heard pitocin contractions are different than natural contractions, if you will. So I decided to keep an open mind and play it by ear.

    Suddenly, I had what felt like a never-ending contraction. It felt like a never-ending peak. It lasted 4 minutes, if I remember right. I felt so discouraged. I felt like I was no longer in control and I was not going to be able to do this med-free.

    I decided to get the epidural. Apparently, I said I was ok with a student doing it. (I don’t remember this, but my husband says I did say yes.) After 3 tries and horrible pain, the anesthesiologist took over and I felt much better instantly.

    From what I remember, it felt like getting me the epidural was a chaotic time. My heart rate was increasing. My blood pressure was low. Baby’s heart rate was decreasing with contractions.

    Fast-forward a few hours – I pushed for an hour and Arianna was born after 7 hours of real labor. Her chord was wrapped around her shoulder.

    I wonder – was her heart rate decreasing because the chord was wrapped around her shoulder? Was it because of the pitocin? I know it was not the epidural because it was happening before it was administered.

    In the end, I have a healthy baby and that is all that matters. But I wonder if I should have waited and maybe I would have gone into labor? Or, maybe I would have lost her because of a chord accident? Or, are babies born with the chord wrapped around them all the time and they are fine most of the time?

    I know you don’t have all the facts, but if you have any thoughts/opinions and would like to share them, I’d love to read what you have to say.

    One thing I will definitely do is if I become pregnant again, I will ask my OB to review my chart and tell me how “normal” or complicated was my labor and delivery really.

    • nursingbirth Says:

      To Johanna Silva,

      SO SORRY it took me so long to respond! I have worked 8 out of the last 9 days and I am pooped!! Haha! Okay lets chat….

      First off, I just want to remind you that I am not a midwife, or a physician. So anything I say here can not be substituted for medical/midwifery advice. Also, I was not there and although you gave a great synopsis of your experience, I cannot be totally sure what was going on. So basically what I am saying is, can we pretend like we are two girlfriends at a coffee shop chatting about your experience?! Okay? Good. I’ll have the Twinnings Irish Breakfast..and for you? Haha 🙂

      Okay, sounds to me like you have one great relationship with one great OB. To me, it sounds like she laid out all the facts for you and your man, the pros and cons of induction (the fact that she told you it increased your chances of c/s is more truth than many of the OBs I work with give their patients. As one OB I work with said “I only tell my patients what I think they need to know.” Oh brother RED FLAG!!!), and let you and your husband make all the decisions. Kind of like “Here’s what we can do, You make the call”. You did make the call about induction, and it was your decision. You had concerns about your baby’s wellbeing, decreased fetal movement, and although the tests came back reassuring, you were 40+ weeks, and you make the decision. I don’t think there is anything wrong about that.

      As far as the pitocin, then water breaking (AROM) again, according to your story, I am left with the impression that you were given the options and chose the one that worked for you. Pitocin contractions are stronger and longer than natural contractions and I don’t dispute that a well timed epidural cannot be helpful in aiding a vaginal delivery. I am a huge advocate for unmedicated, natural births but I also know that induction is a whole different ball game. So you made the choice that is best for you. Some might argue against you but I advocate more for women being truly informed and making their own safe decisions more so than anything else. Also it sounds like to me you were as upright as you could be (on birthing ball etc) all the way up until the epidural. THAT IS AWESOME! I hope you know how important that was for you and your baby : )

      You write, “From what I remember, it felt like getting me the epidural was a chaotic time. My heart rate was increasing. My blood pressure was low. Baby’s heart rate was decreasing with contractions.”

      I can see how that would be your experience. Epidurals can cause a crash in the mom’s BP and then a crash in the baby’s heart rate. Think about it, lets say your BP is like 120/70s for your labor. Your baby is used to getting a certain amount of blood flow related to that BP via the placenta. With blood flow comes oxygen. Then you get the epidural and your BP crashes ….80s/30s, 90s/40s…..as what happened to a patient of mine just this weekend….the baby goes “Hey! What the hell!! Where did all my oxygen rich blood flow go!” Some babies tolerate this dip. Some babies crash their heart rate but then can recover with position change, oxygen via face mask to mom, IV fluid bolus, etc. Other babies don’t recover no matter what we do and yes, we end up in an emergency c/s. It happens. Luckily your baby recovered.

      A VERY QUICK little Fetal heart rate lesson:
      There are four types of fetal heart rate decelerations:

      Early: decrease in heart rate that coincides with the onset of a uterine contraction caused by fetal head compression as baby comes down birth canal. Often means delivery is close. These are benign.

      Late: decrease in heart rate occurring after the peak of a uterine contraction, which may indicate fetal hypoxia related to utero-placental insufficiency. These are a BIG deal if they keep happening. Often babies who have been compromised for a while get these.

      Variable: decelerations that vary in intensity, duration, and relation to uterine contraction, resulting from umbilical cord compression. If they are repetitive and deep they are more worrisome than if they are every now and then and don’t keep coming. They can happen after AROM, artificial rupture of membranes since the cushion of amniotic fluid is gone to cushion the cord. A prolonged variable decel can also happen after an epidural. Often if a baby does have a cord around the neck, shoulder, body, arm, etc, and the fluid is gone, the cord can start to become compressed.

      I am going to assume that your baby’s were variable just related to my experiences of taking care of women post epidural. They could have been related to the pitocin (hyperstimulation?), the epidural (drop in blood pressure), cord compression from the baby moving down the canal and having no fluid to protect the cord. It could have been a combination. I believe you when you say very chaotic time!!

      Now about cord accidents……there has been a lot of talk about them on my blog comments section lately. All I am going to say is that a simple cord around the neck or shoulder is very often no big deal. Many Many babies are born with them, they are easily reduced and cause no problems. A smaller minority of babies have true cord accidents or are really compromised by multiple cords around the neck etc….. It does happen but seeing a cord around the neck via sono, for example, is no reason to do a c/s or anything drastic like that. So that is all I will say about that for now because my husband is bugging me to help him out in the garden! Perhaps I will do a post on that some other time 

      So what is the moral of the story? The induction, AROM, and epidural could have caused some of your problems. They certainly have the potential too but I wasn’t there so I cant say anything definite. I applaud you for reviewing your experience and thinking/researching about it. However, if you were so anxious about losing the baby or not having your OB there that you were making yourself sick about it then it probably was a good decision for you to induce. And I am so happy you have a happy healthy baby. I also applaud you for reviewing your experience and thinking/researching about it. It can only help you for baby #2, research and reflection can never hurt!!!! Perhaps next time you will go into labor on your own and have a totally different experience. I wish you a positive and empowering birth experience and I hope as I wish it for every woman!

      So I hope that helps! I’ve got to go garden now! Take care : )

  12. Jessica Says:

    Yikes! Not the most open-minded person in the world, that pinky person. And what’s the deal with the education questions? One thing that I’ve learned in my almost-7-year career as a nurse is that just because a person has extensive education, that doesn’t make them smarter, and just because someone has a lesser education, that doesn’t make them dumber. In my time as a nurse, I have learned from the BSN’s and MSN’s as much as the ADN’s and LPN’s. It’s not just about the school that you went to or the amount of education that you have, it’s the passion behind your practice and your desire to learn more and more, rather than just sit on your degree. And when it comes to birth culture in America, a person can find a study to support just about anything they want it to, it just depends on who writes them and their motive and mindset about it. You know, my grandfather, a retired orthopedic surgeon, is all about me becoming a midwife because, as he put it, he doesn’t “understand why M.D’s had to get their hands in normal healthy birth, where no hands need be.” It’s not so much the education as it is the outlook. Having said all of that, you have great credentials! 😀

  13. Joy Says:

    BRAVO!

    Seriously, when people get self-righteous (especially when they don’t know what they’re talking about) I just have to laugh.

    While I don’t feel you needed to defend yourself I really appreciated reading more about your background history!

  14. Kathy Says:

    Let me just pop in and defend Pinky here — not that I agree with her, because I am having some discussions with her on this point on both my blog and hers. I understand where she’s coming from — she works in L&D and the NICU doctors seem to think there is a problem with delayed cord clamping, and she says that she has some problems with some of the studies and the conclusions that the researchers reached. She says on her blog that she’s “undecided.” That’s fine.

    But don’t judge her too harshly based on one comment — particularly on spelling errors. I used to be pretty judgmental about spelling and grammatical errors, but I have learned to look past all that, and see what is being said, not necessarily at just what is being said perfectly. I am a bit of a perfectionist in this area, myself, but having made friends with people who seem to be particularly challenged in this area — perhaps it may be due to being distracted, not being able to see the screen very well, being a poor typist, or perhaps some form of dyslexia or something — I know that not every spelling or grammatical error is due to thoughtlessness, carelessness, or ignorance. Some people struggle very much with this, and hate it, but can’t help it. It has little or nothing to do with intelligence.

    So, yeah, Pinky and I have our share of disagreements, but I don’t think she deserves some of the comments that have been made.

  15. Diana J. Says:

    Dear Nursing Birth,

    Just wanted to add my support that you have one of the most awesome birth blogs out there – please keep up the amazing work you’re doing! Your blog is a priceless addition to the birth community and I have learned a ton in the few months I’ve been reading it. Thank you for all of your wonderful writing! Don’t let negative comments get you down!

    Diana

  16. Mama Kalila Says:

    Wow.. I just proved how tired I am… after reading this last comment I went searching back to see where you referenced spelling/grammatical errors (because I never saw that mentioned). Read over it 3 times before realizing it was a comment by someone else!

    Which leads me to… I can’t figure out why some comments pass to my email and some don’t. Random!

  17. Emily Jones Says:

    Johanna Silva – I’m sure NB will come back with more answers for you, but I have also addressed those topics on my blog, complete with references, if you would like to learn more.

    The short answer is: cord wrapped around a body part, even the neck, is not life-threatening. “Old placenta” is a myth. You’re not overdue til 43 weeks. And yes, pitocin can adversely affect baby’s heart rate, as the contractions are unnaturally hard and do not allow baby to work with them.

  18. Candice Says:

    Ooh- you’ve got some cord questions! I need to dig into my CINAHL bag of tricks (in PDF format of course) to see what I’ve got on hand, but I know your responses will be more eloquent and well rounded than I.

    Along that line… one of these days we’ll have to have a positive outcome OB oddities face off. 😉 Here’s a few of my personal experiences… complete knot X 2 with Apgars 9/9? Check! Tight nuchal X 4 (yes, 4!!! two neck, two shoulder) with Apgars of 8/9? You bet! Battledore placenta? Sure!

  19. “Nurses eat their young.” So true. I will take a newbie any day. They are interested and passionate, and they listen! NB, it is fantastic that you have med/surg, ICU background. This is invaluable experience to L&D. Pregnancy is normal, but sometimes it is not, and having your background helps to see the woman holistically, and not just as a pregnant person.
    As far as the Pinky comment, I also love her blog. If we are being judged on typos, Yikes! I need a fire proof suit then. Peace out.

  20. Jessica Says:

    My problem with pinky’s reply wasn’t her grammar/spelling, it was the tone in which she typed…”The reason I ask is that you have named every woomeister in the universe. I am surprised you have not mentioned Ghadi, Ina May and Santa Clause.” That’s making a mockery of NB’s posts, and that’s rude. If you want to debate, debate away. But don’t be rude. It’s just not nice.

  21. Jessica Says:

    Oh, and for those of you not familiar with “woo”, “woomeister”, or other “woo” variations, here’s a little definition for you: Woo-woo (or just plain woo) refers to ideas considered irrational or based on extremely flimsy evidence or that appeal to mysterious occult forces or powers.

    “Here’s a dictionary definition of woo-woo:

    adj. concerned with emotions, mysticism, or spiritualism; other than rational or scientific; mysterious; new agey. Also n., a person who has mystical or new age beliefs.

    When used by skeptics, woo-woo is a derogatory and dismissive term used to refer to beliefs one considers nonsense or to a person who holds such beliefs.

    Sometimes woo-woo is used by skeptics as a synonym for pseudoscience, true-believer, or quackery. But mostly the term is used for its emotive content and is an emotive synonym for such terms as nonsense, irrational, nutter, nut, or crazy.”

  22. Hmm. When you ask someone what their background is twice, it implies that you don’t believe that they are qualified to speak on the topic. It’s condescending, no?

    I can see the irony in the spelling thing. I guess if I were going to try to call someone out on their education and credentials, I’d be prepared with spellcheck and some proofreading. It also makes me think of all of the times I typed up a comment, hit send and exclaimed “aww, crap!” because I spelled stuff wrong.

    By the way, “NB”, you’re durn smart!

  23. Jessica, thanks for the definition. I was thinking it had to do with wombs! I didn’t put it together with “woo woo.”

  24. Katie Says:

    Great blog response! I’ve been following your blog for a few weeks, and find the information you provide insightful and refreshing. This blog entry in particular was so eloquent and really fair-I might have not been so kind if I were in your shoes!
    I’m just an average 25 year old teacher and military spouse, hoping to have my first child in the next two years. All health care involves being your own advocate, but with the military we have few options as to where we can receive care (or else pay out of pocket in my case) so I’m trying to learn as MUCH as possible about the labor and delivery process so I can speak up for myself if I’m at a hospital and feel I’m receiving care I’m not comfortable with. Thank you for writing your blog, it has been so informative for me!

  25. Kathy Says:

    A nuchal cord is usually not a problem, but my husband’s best friend and his wife lost their baby three years ago on her due date due to cord strangulation. Again, it usually doesn’t happen, but everyone should be aware of baby’s movements in those weeks leading up to birth — look up “kick counts” on the internet for more information. Many mothers end up with stillborn babies because they don’t take notice of decreased fetal movement, until there is no fetal movement at all. A friend of a friend lost her baby due to a placenta problem — she noticed less movement, but did not take action until it was too late. This is not to scare anyone, but to empower you to be able to avoid this for yourselves.

  26. Emily Jones Says:

    Kathy – babies don’t die from “strangulation,” as they are not using their necks to breathe in utero. I wrote a post about nuchal cords here:

    http://jeremyscorner-grifter.blogspot.com/2009/02/cord-around-neck-is-not-emergency.html

    Cord around the neck is coincidental, and does not cause death (although it can be indicative of some other life-threatening problem, i.e. if there was unusual twisting at the placenta, or some other cord or placenta malfunction.)

  27. Kathy Says:

    Emily,

    They are not using their necks to breathe, but blood must get to their brains somehow. If the cord is tight enough to cut off blood supply, it can kill them.

  28. Emily Jones Says:

    Kathy – I would encourage you to read my blog on the subject, as I address all those concerns. Nuchal cords are not deadly.

  29. Kathy Says:

    All,

    Let me clarify that in defending Pinky from attacks, I wasn’t referring to this post, which I think was a very good response; I was referring to some of the comments of the post. Again, it seems like the medical literature supports what NB has said, and I haven’t seen such research being cited by Pinky… but it sounds like some people have made a snap judgment from one small comment, which I don’t think really holds up from knowing more about her.

  30. Kathy Says:

    Emily,

    I did read your blog post, and was quite taken aback — appalled, actually — by your tone, particularly dealing with grieving parents who lost their babies due to cord entanglement, nuchal cord, intra-uterine strangulation, etc. I also did some research myself, and noted that although not every study noted a statistical difference with perinatal outcome in nuchal cords, many did. And to the parents who lost their child in such a manner, to have you blithely say “it can’t happen” is a slap in the face and a punch in the gut. The case is simply not as strong as you say it is. Besides, it is just incorrect to say that cord entanglement cannot prevent a vaginal birth. You may have read hundreds of stories in which this didn’t happen, but if it happens only once in a thousand times, you just haven’t read enough! Besides, on my childbirth educators’ email list, a few months ago several of the women mentioned stories that they knew of (their former clients, usually, but perhaps friends or family), who had babies so wrapped up in their cords that they could not be born. In many instances, this was in home births that were transferred to the hospital, so you can’t blame doctors and interventions for causing the problem, the way you seem to do on your blog post and ensuing comments. The majority of these cases were completely natural labors, but fetal heartrate abnormalities, or the baby’s failure to descend (sometimes the cervix did not dilate, as well, due to no fetal head applying pressure) led to intervention — in many cases, it was to transfer from home to hospital, so you know there was no Pitocin or other drug interference causing the baby’s heartrate to drop or otherwise go funky, nor was the mother’s freedom of movement restricted, nor any other intervention you might wish to blame as the “real” cause; and in most if not all of the rest, the mothers were having an unmedicated labor in the hospital, when the same problems were noted, which led to intervention which saved the baby from death or disability.

    One big thing to consider would be tight vs loose nuchal cords. My older son had a nuchal cord at birth, and it was no big deal — in fact, I didn’t realize he had even had one until I looked at my birth records a few years later and saw that one had been noted. Of course, like most nuchal cords, it was loose enough that it didn’t cause any problems. Obviously, nuchal cords don’t always cause problems — they occur in up to 37% of births — but they can cause problems. Is it statistically significant? Perhaps not, but to the parents who lost a baby to that one-in-a-million (or higher) statistically insignificant death, it is VERY significant. If it is as rare as 1/10,000, then with 4 million babies born every year in the US, that’s still 400 dead babies and grieving parents. If it’s 1/100,000, that’s 40. Perhaps the studies haven’t been large enough or taken enough factors into account to find statistical significance of an event as rare as that.

    Another factor to consider is how many times the cord is wrapped around the neck, because that also may play a role (some research points to this).

    There were some case studies I saw that identified nuchal cord as the only identifiable reason for fetal demise.

    Finally, there must also be a consideration of the type of nuchal cord — Type A or Type B. You never mentioned this in your post, so I hope you will go and do some research into this, but basically, in a Type A nuchal cord, the umbilical cord is merely wrapped around the baby’s neck, while in Type B, the cord is “hitched” or “locked” around the baby’s neck, tightening when the baby moves — I envision it as a noose, which can only get tighter and tighter, never looser, but I may be wrong. Even in this, a C-section is not necessarily required, although Type B nuchal cords are associated with much higher problems than Type A nuchal cords or no nuchal cord at all. In this scenario, then, a baby can actually cut off blood supply to the brain using its own umbilical cord.

    Women should be told to keep track of fetal movements, because far too often women notice that their babies aren’t moving as much as used to, but don’t go to the doctor until the baby isn’t moving at all. Then, it’s too late. Most women whose babies die in utero — for whatever reason — note a decrease in movement in the days or perhaps hours leading up to noticing no movement at all. Kick counts save lives.

  31. Emily Jones Says:

    Kathy – I will respond to your points here, but I don’t want to take up any more of NB’s space, so if you would like to continue this discussion, let’s take it over to my blog.

    “Besides, it is just incorrect to say that cord entanglement cannot prevent a vaginal birth. ”

    I don’t recall saying that. My point was that nuchal cord is not an absolute indication for c-section.

    “Besides, on my childbirth educators’ email list, a few months ago several of the women mentioned stories that they knew of (their former clients, usually, but perhaps friends or family), who had babies so wrapped up in their cords that they could not be born.”

    (This is an aside, but why is it that when defending home birth, HCPs like to scoff at anecdotal evidence as “not reliable,” but it’s perfectly acceptable for HCPs to use anecdotal evidence to support that one time this super rare horror story birth accident happened and intervention was justified?)

    “In many instances, this was in home births that were transferred to the hospital, so you can’t blame doctors and interventions for causing the problem, the way you seem to do on your blog post and ensuing comments.”

    I don’t believe I ever blamed doctors for causing nuchal cords? And just because they had fetal distress and a nuchal cord does not mean one caused the other. Correlation does not equal causation. Considering 99% of the research out there shows that pitocin and epidurals can cause fetal distress, and that there is no relationship between the incidence of nuchal cords and negative outcomes, I think it is a fair assumption to say that in a medicalized birth in which there was fetal distress, the distress was most likely due to the medicalization. In the case of these home birth transfers, who knows what the cause of fetal distress was? Of course it is possible it could have had something to do with the nuchal cord – anything’s possible – just not very likely.

    “Obviously, nuchal cords don’t always cause problems — they occur in up to 37% of births — but they can cause problems.”

    I would like to see some research that shows that?

    “There were some case studies I saw that identified nuchal cord as the only identifiable reason for fetal demise.”

    This is a misleading statement. Nuchal cord was not proven to be the cause of fetal demise in those cases, but was the only clinically significant (i.e. “not textbook”) thing about the birth. Again, correlation does not equal causation.

    “Finally, there must also be a consideration of the type of nuchal cord — Type A or Type B…in Type B, the cord is “hitched” or “locked” around the baby’s neck, tightening when the baby moves”

    I did not mention it by type, but Type B is a type involving knots, which I did indicate was problematic. Any type of cord compromise, be it knots, compression, or insertion issues, can result in negative outcomes. But a simple nuchal cord is not a “compromise,” and therefore no cause for concern.

    “Kick counts save lives.”

    I agree with you completely.

  32. Kathy Says:

    Your problem in your blog post, which is carried more over into your comments, is that you treat all nuchal cords as if they were simple, and then you say that since simple nuchal cords don’t cause a problem, then no nuchal cord should ever cause a problem. That’s just over-simplification.

    I will be taking this up with you on your blog, because I do agree that this blog is not the place for it.

  33. Sara Says:

    Kathy, thank you for reminding me to be compassionate. I did not even consider the possibility of dyslexia or something like it. Eck. I feel bad.

  34. MM Says:

    Bravo, NB. Very nicely handled.

  35. Kathy Says:

    If anybody is interested in reading my response, it was too long to fit in a comment on Emily’s blog, so I put it on my Blogger blog here, and put the link as a comment in her blog. I’m too wordy. 🙂 But it also made it easier to read, because I can do block-quotes and stuff.

  36. nursingbirth Says:

    Dear Sara, Emily Jones, Mama Kalila, briome, River Eden Doula, Kim, Jessica, Joy, Diana J., Candice, realityrounds, Jill-Unnecesarean, Katie & MM: THANK YOU so much for your encouragement and support 🙂 I really appreciate it!! I am happy to have been able to share more about myself with all of you and I am so happy that you all read and enjoy my blog 🙂

    P.S. Jessica…thanks for the lesson on what “woo” means!! I never knew!!!

  37. Renee Says:

    Encore, encore!

  38. Jill Says:

    HEY!!! What’s wrong with Ina May, anyway? 😉 Or Gandhi for that matter!


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s