May is Pregnancy Awareness Month — a month of events and media that celebrate this special time in a woman’s life. The activities this year are being kicked off with the 6th Annual Signature Pregnancy Awareness Month™ Event on Sunday May 5th from noon to 4 p.m. in Santa Monica. Dr. Greene is speaking at the kick-off event. In honor of this important month, we are re-publishing five posts by founder Anna Getty. Originally posted May 2009.

I recently learned that on average babies are being born with over 200 chemicals in their systems. This was learned by studying the cord blood of newborns. This is not meant to scare you, although it may. This bit of information is meant to get you to be proactive at any stage of parenthood, whether you are deciding to conceive, are recently pregnant, about to give birth, or have young children already. It is not too late to get proactive, to educate yourself and make different choices.

For example, I am often told that eating small amounts of tuna during ones pregnancy is safe. Well, The Environmental Working Group recommends that women of child bearing age and young children under 5 do not eat any albacore tuna at all. Most albacore has very high levels of mercury. My doctor often asks me, “if I were to hand you a class half-full of poison and a glass full of poison, which would you drink?” My response is always a resolute, “neither.” So why chance it with fish when you have a vulnerable developing baby growing inside you?

Another study recently revealed that some infant formula has the ingredient perchlorate found in rocket fuel.  Again, the point is not to terrify you but to remind us that we are indeed living in a toxic world and it is up to each and everyone of us to do our research and seek out reliable sources to help us decipher the toxic from the healthy.

Eat organic food whenever possible, get rid of beauty products and household cleaners filled with chemicals and begin to take care of the temple that your body is. We will pass our good health onto our children.

P.S. Pick up a copy of Sara Snow’s Fresh Living: The Essential Room-by-Room guide to a Greener, Healthier Family and Home.

P.P.S And of course the new paper back addition of Healthy Child Healthy World by Christopher Gavigan.

Becoming a birth doula was one of the best and most rewarding decisions I’ve ever made. I cannot express with words the sheer joy I have experienced at each and every one of the 50+ births I’ve attended throughout my career as a doula. Although most of my “work” as a doula at the present time is spent volunteering to help teen moms and military families, you can have a very successful and lucrative doula business if you choose.

The training and certification to become a doula is fairly inexpensive (typically $400-$600) and requires both theory and practical training. To begin with, you will typically be given a book list to read. Next you will likely attend a series of childbirth education classes prior to your actual doula training. These consist of watching videos, discussing the female anatomy, what to expect during labor, and how to work with pregnant and birthing mothers. Your doula training usually lasts from 3 full days to 2 weeks or longer, depending on what organization you certify with, or who trains you. Your training will be in depth and about all things birth related. You will learn comfort measures to use with laboring mothers, and how to advocate for them when you interact with hospital staff. You will also learn how to market your services to the public and likely create your very first network with your classmates.

To give you an idea of the income potential, the average doula charges anywhere from $500-$1,000+ per birth, depending on her experience, services offered, and additional areas of expertise (a doula who is also a massage therapist is obviously able to charge more). As a doula, you can attend about 2-4 births per month on your own, or up to 8 births per month if you’re working with a group of doulas that provide “back up” in the event that 2 or more clients go into labor at the same time.

I completed my doula training and certification through DONA International in 2002, and ALACE (now To Labor) in 2005. While DONA is probably the most well-known, widely respected doula training organization, there are many options available. Furthermore, while any reputable doula should receive quality training, certification is not required to practice as a doula.  Anyone can work as a doula regardless of whether or not they have been certified to do so. However, many clients will only work with certified doulas, and if you are serious about pursuing a career as a doula, it’s definitely worth getting certified with a reputable organization.

If you’re interested in becoming a doula, I recommend registering for a birth doula training with one of the following reputable organizations:

DONA International
To Labor (Formerly ALACE)
CAPPA
ICEA
Birthing From Within- Love them!

When it comes to dads and doulas couples can have a myriad of concerns, but the truth is both play a very important role.  As a doula and mother who knows firsthand how important dads and doulas can be, I’d like to address some of the most common concerns – because dads and doulas make a great team!

Concern: If I have my partner, why do I need a doula?

Truth: The dad-to-be is in an unfamiliar environment, and trying to become familiar with the process and language of birth, understand medical procedures, and advocate for his partner is often extremely stressful. A doula can eliminate this stress by explaining what to expect, providing the information needed to help parents make appropriate decisions, and facilitate communication between the couple and medical team.

Additionally, it’s hard for a father to understand a woman’s instinctive behavior during birth and he may react anxiously to what a doula knows to be the normal process of birth. Seeing his partner in pain may cause the father to become distressed. A doula can skillfully help the mother to cope with labor pain in her own unique way, offer reassurance to both the mother and father, and encourage the father to participate at his own comfort level.

Concern: What if the doula takes over, displacing the father-to-be and interfering with the intimate birthing experience?

Truth: The doula can actually bring the couple closer, making sure the partner’s needs are met (food, drink, and reassurance) so the woman and partner can work more closely together. When the dad-to-be chooses to be the main source of support, the doula can help him be more successful by using her expertise to make suggestions for comfort measures, keep him informed about what’s going on, and offer words of encouragement and reassurance. During a long tiring labor, the doula can also offer the father a break or brief rest, without him feeling guilty about leaving his partner alone.

For the father who is shy, uncertain, or unversed in his role, the doula can suggest simple but truly useful tasks such as timing contractions, holding the woman, supporting her in a particular position, or showing him how to apply counter pressure to her back.

While the doula probably knows more about birth, hospitals, and maternity care, the partner certainly knows more about the woman’s personality, likes and dislikes, and needs. Moreover, he loves the woman more than anyone else there. The combined contributions of the father and doula, along with a competent, and caring medical team give the mother everything she needs to have the best birthing experience possible!

Concern: The doula has her own belief about how the birth should go, and imposes it on the woman and couple.

Truth: The doula’s number one goal is to help ensure the woman’s or couples birth plan is acknowledged and followed as best as possible. If the doula is thoroughly familiar with the couple’s wishes and their birth plan, she may actually think more about it than the couple, especially when labor is intense and things are happening rapidly. The doula can remind the staff or the couple of some items on the birth plan that are forgotten, but which later might be important. Sometimes when the birth plan is not followed, the couple later looks back with regret or disappointment- especially if it was a result of the choices they made.

The doula never makes decisions for the couple, but instead asks questions that will ensure the right information is provided so the couple can make an informed decision of their own.  She may also suggest alternatives (like waiting a while) for the couple to consider their options.

In summary, the doula helps make the birth experience as rewarding and satisfying as possible. As one father said “I heaved a big sigh of relief when the doula walked in. I hadn’t realized how much pressure I’d been feeling. She not only calmed my wife, she calmed me down too.”

The father’s presence and loving support in birth is comforting and reassuring. The love he shares with the mother and his child and his need to nurture and protect his family are priceless gifts that only he can provide. With her partner and a doula at birth, a mother can have the best of both worlds – her partner’s loving care and attention and the doula’s expertise and guidance in birth.

Many women and couples are now choosing to hire a professional birth doula to support them during their birthing journey. If you’re considering hiring a doula, here are some tips on where to find one, and what you should ask her before you seal the deal.

If you are looking for a birth doula, I recommend using the Doula Locater at www.DONA.org. Other options include asking your midwife or childbirth educator for a referral, or doing a Google search for birth doulas or doula groups in your area. Many doulas and doula groups have their own individual websites. Here in San Diego, we have www.beautifulbeginnings.org as well as several others.

I also recommend interviewing several birth doulas before deciding on one that’s best for you. Here are some points you may want to consider, and questions you may want to ask when you interview a doula…

• What kind of training does she have? Is she certified? How experienced is she? Has she given birth herself? Has she worked with your OB or midwife, at your birthplace? Can she provide references? What is her fee? Does she accept monthly payments or require one lump sum?
• What services does she provide? Does she have training in any other areas such as aromatherapy or massage? Will she come to your home in early labor? Can she offer suggestions for comfort and facilitating labor?
• What is her availability around your due date? How will you get in touch with her? Does she offer 24 hour phone support? Does she have a backup doula in case she is not available? Can you meet her? How many clients does she accept each month? How often will you meet prenatally and postpartum?
• What are her philosophies on childbirth? Do they “feel right” to you?
• How do you get along with her? How about your partner? Beware- personality conflicts can bring negative energies to a birth. You should feel confident and positive with her.
• Discuss your partner’s role at birth. She should be enthusiastic about support for both of you- offering her skills while supporting and enhancing your partner’s role.
• What does she expect from you in terms of preparation for birth and assuming responsibility? Although doulas act as advocates, remember that you and your partner are the parents of this baby, it is your birth, and you are the ones who must ultimately assume responsibility for decisions that are made. The doula can provide information and point out alternatives, but she cannot make decisions for you!

If you would like to have a doula, but are worried you can’t afford one there are several options available! Many doulas love their work so much they are willing to offer it on a volunteer basis, I know, because I am one of those doulas. I am not sure of the best way to find a trained/certified volunteer doula, but you could try searching your local Craig’s List, posting a wanted ad on Craig’s List, doing a Google search for volunteer doulas in your area, or simply try asking around. There are some hospitals that offer volunteer doulas to all patients, such as UCSD Medical Center in San Diego- if your hospital offers these services by all means take advantage! If you are a military family, there is an organization called Operation Special Delivery with doulas that volunteer their services to active duty military families. Another way to find a low or no cost doula is by contacting the organizations that train/certify doulas such as www.DONA.org (others listed below) and ask for a list of doulas who have recently completed their training, but are still working towards certification (you may have to get the name of your local doula trainer and contact her for the list of doulas she recently trained). Most doulas have to attend a certain number of births before they can get certified, and these doulas are often eager to volunteer at births in exchange for the experience they will gain.

National Birth Doula Organizations:
www.CAPPA.net
www.DONA.org
www.ChildbirthInternational.com
www.BirthingFromWithin.com
www.ICEA.org
www.ACBE.com
www.ALACE.org

I’ve had a birth doula present at 3 of my four births, and at the birth where a doula was not present I had a 50+ hour labor, an epidural, a vacuum delivery, an episiotomy, and many regrets.  Sure, in the end a healthy mom and baby is what counts, but having a doula at your birth can make the experience a whole lot better!

Since 1980, research has been done to determine the benefits of doula assisted births. These studies showed that there were significant decreases in birth interventions including:

• 50 % decrease in cesarean births
• 60 % decrease in epidurals
• 40 % decrease in the use of Pitocin
• 30% decrease in the use of narcotics
• 30% decrease in the use of forceps
• Overall, a 25% decrease in the length of labor

In addition, research also shows parents who receive good support during labor:

• Feel more secure and cared for
• Are more successful in adapting to new family dynamics
• Have greater success with breastfeeding
• Have greater self-confidence
• Have less postpartum depression
• Have lower incidence of abuse

A doula “mothers the mother”, and offers continuous support that most doctors, midwives, and labor nurses simply don’t have time to give. During most hospital births, the doctor checks in once or twice before being called in to deliver the baby, and labor nurses are busy juggling multiple patients at once. Aside from the woman’s partner and any family members attending the birth, a doula is the one constant source of support present throughout the birthing journey. She comforts, listens, informs, and helps protect the birthing experience as an advocate, helping communicate the birthing mother’s wishes to the medical staff.

In addition to supporting the birthing mother, a doula can also help the partner and other family members feel more at ease, resulting in a less stressful environment for all. Often times the father or partner wants to help the laboring mother, but doesn’t know how- a doula can show him what to do. When a nurse says the mother is 2 centimeters dilated, 50% effaced, and a -2 station, a doula can explain what that means. When a birth doesn’t go according to plan, the doula can help the mother and partner look at all possible options and make an informed decision they both feel good about.

If the birthing mother wishes to avoid pain medications, a doula can greatly increase her chances of success. Partners and family members often have a hard time seeing their loved one in pain, while a doula can reassure the mother what she’s feeling is normal, offer coping techniques, and empower the birthing mama to make it through drug free.

A doula can also be helpful to women who plan to use pain medication and/or epidural anesthesia. Giving birth is much more than a medical procedure. It is an emotional as well as a physical journey, and having a doula can help smooth the transition from pregnancy into parenthood. Epidurals do not hold your hand, rub your shoulders, or explain what is happening. Epidurals cannot suggest position changes to help your labor progress. Epidurals will never advocate for you, or help you get what you need from the hospital staff. Simply put, an epidural does not replace a doula.

When a doula is present before, during and after childbirth, women report greater satisfaction with their birth experience, make more positive assessments of their babies, have fewer cesareans and requests for medical intervention, and less postpartum depression. No matter what kind of birth you desire, a doula truly can help you have a better birth!

When I tell someone I’m a birth doula, the number one question that follows is…what’s that? Thankfully, I’m delighted to answer this question!  I believe the more people who are informed about doulas, the better birth outcomes will be. Numerous studies have found that a doulas presence tends to result in shorter labors with fewer complications, more positive feelings about one’s birthing experience, and a significant reduction in the number of interventions used during labor and childbirth. So what is a birth doula anyways? I’m glad you asked!

The word “doula” comes from the ancient Greek meaning “a woman who serves” and is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during, and just after birth.

Although doulas are just starting to gain popularity in the United States, the concept certainly isn’t a new one. In almost every culture throughout history, women have been supporting and caring for women during childbirth. Artistic representations of birth throughout the world usually include at least two other women surrounding and supporting the birthing mother. One of these women is the midwife, who is responsible for the safe passage of the mother and baby; the other woman or women are behind or beside the mother, holding and comforting her. The modern day birth doula is a manifestation of the woman beside the mother.

When it comes to the birthing team, each person involved in the care of the laboring woman contributes to her emotional wellbeing. However, doctors, nurses and midwives are primarily responsible for the health and wellbeing of the mother and baby. Medical care providers must assess the condition of the mother and baby, diagnose and treat complications as they arise, and focus on a safe delivery of the baby. These priorities rightly take precedence over the nonmedical emotional needs of laboring women. A doula helps ensure that these nonmedical needs are met while enhancing communication and understanding between the woman or couple and the staff.

Doulas also offer help and advice on a variety of comfort measures such as breathing, relaxation, movement, position, massage, and more.  They keep the woman and her partner informed about the course of their labor and the various options available, allowing them to make well informed decisions about the birth of their baby.  Another crucial role of the doula is providing continuous emotional reassurance and comfort for the duration of the labor, and moments immediately following the birth. Some doulas are also trained in lactation, and are able to help initiate breastfeeding as soon as the baby is born.

Doulas do not interfere with or replace the woman’s partner or support person, but instead work with him or her to create a strong and supportive team. Doulas also do not replace nurses or other medical staff, nor do they perform medical tasks such as taking blood pressure or temperature, monitoring fetal heart rate, doing vaginal exams, or providing postpartum clinical care. Most importantly, doulas do not make decisions for their clients, and never project their own values and goals onto the laboring woman.

In short, women have been supporting women during childbirth since the beginning of time, and today we call those women doulas. Research now supports what women have known for centuries- a doula’s continuous, knowledgeable, and reassuring presence can make a dramatic difference on how confident and comfortable a woman feels before, during, and after the birth of her baby.

Last week I was honored to be one of the speakers at TEDxBrussels along with Steve Wozniak, Mitch Altman, Xavier Damman, Eri Gentry, Tito Jankowski, Peter Jansen, Jeroen Raes, Aaron Rowe, Monte Stettin, and many other personal heroes.

When I was asked to speak last spring, I knew this would be the ideal opportunity to introduce Ticc Tocc — Transitioning Immediate Cord Clamping to Optimal Cord Clamping to a global audience.

I am so impressed with the amazing job Samia Lounis and the TEDxBrussles team did putting this event together and hope you enjoy the video they produced of my talk.

Tick tock. Tick tock. TICC TOCC.

At the moment of birth, only about 2/3 of the baby’s blood is in the baby. The remaining third is still in the umbilical cord and placenta. During the third stage of labor, which lasts from the delivery of the baby to the delivery of the placenta, the cord actively pumps iron-rich, oxygen-rich, stem-cell-rich blood into the baby.

Unless the cord is clamped too quickly.

Immediately clamping the umbilical cord was popularized in 1913 as one of three pillars of active management of the third stage of labor. While this intervention began in the West, we exported this technique to developing nations around the world. Today, in some low-income countries as many as 95 percent of delivery clinicians surveyed practice immediate cord clamping.

Immediate cord clamping results in up to 10x the risk of developing iron deficiency anemia.

Anemia hinders a quarter of the global population, and is disproportionately concentrated in low-income groups. Iron deficiency is the leading cause of anemia – but with iron deficiency, anemia is just the tip of the iceberg. Even when iron deficiency is not severe enough to cause anemia, it has been linked to lasting damage to the developing brain. Infancy is thus both one of the most important as well as most common life cycle windows for iron deficiency.

What can we do? It’s simple – improve the health of billions by spreading an idea.

Wait 90 seconds – until the cord stops actively pumping fetal blood into the baby, unless there is a strong reason otherwise. This has been studied all over the world and has been shown to be both safe and effective at significantly reducing the risk of iron deficiency. Other benefits may include reducing birth asphyxia (inadequate oxygen to the brain) and cerebral palsy. The health benefits from receiving the cord’s pluripotent stem cells may be the most significant impact, but has yet to be understood.

It’s time for TICC TOCC (Transitioning Immediate Cord Clamping to Optimal Cord Clamping).

Spreading an idea that makes intuitive sense, is cost effective and a simple first step to addressing a major global health problem.

Not only have people around the world traditionally waited for the cord to stop pulsing until the 20th century innovation, every other mammal studied instinctively waits for the cord to stop pulsing as well. More than a quarter million babies will be born today.

The clock is ticking.

Autism diagnoses have increased rapidly over the last two decades; so has the number of women taking antidepressants during pregnancy – from somewhere between 1% and 6% in the early 1990s to 7-13% more recently. The most common antidepressants alter serotonin levels; children with autism tend to have atypical serotonin levels in their blood. Antidepressants are known to affect our brains and to cross the placenta at a time when a baby’s brain is developing. We know that serotonin is critical in brain development, especially in the first trimester.

Researchers at Kaiser Permanente in Northern California decided to take a close look whether prenatal serotonin-affecting antidepressants might increase the risk of autism, and might be a force behind the rise of autism over the last decades. Their answer was yes and no. And even if you took these antidepressants throughout pregnancy and you had a child diagnosed with autism, it’s likely that the antidepressants were not the cause in your particular case.

Kaiser accounts for about 25% of all babies born in 14 northern California counties – and they keep a good electronic database of those they care for. The researchers scanned the records of all babies born at a Kaiser from January 1995 to June 1999 to find all those subsequently diagnosed with any type of autism and compare them to a control group.

The Link

Mothers who took these antidepressants during the year before pregnancy were about twice as likely to have a child with autism; those who took them during the first trimester were about three times as likely. Associations during the second and third trimester were less strong. The effect held up compared to similarly depressed mothers who had not taken this group of antidepressants.

Half Full or Half Empty?

Autism of some kind is now diagnosed in about 1% of kids (or perhaps between 1% and 2%). Doubling 1% would take this to 2%, tripling to 3%. Looking at these same numbers the other way, in general there is about a 99% chance of having a child never diagnosed with any type of autism. For those taking antidepressants, if this link proves true the odds may slip slightly to 98% or 97% — important, but not a cause to make rash decisions.

While the data suggests that prenatal antidepressant use and having a child with autism happen together a bit more frequently, it doesn’t prove the medicines are the cause.

Not the Culprit

Either way, antidepressant use is not the driving force behind the rise of autism. Only 6.7% of all the autistic children in the study had mothers who had taken antidepressants. This means that, at most, antidepressant use in the first trimester could account for 2.3% of autism.

Take Home

When possible, it’s wise to avoid exposure to unnecessary medications and other new chemicals while pregnant and during the months before conceiving. Look for other, time-tested ways to get the job done, whatever it may be. For depression this might include cognitive behavioral therapy, psychotherapy, support groups, exercise or time outdoors. For cleaning it might include vinegar and baking soda.

But for some women, the risks of not taking antidepressant medications may be greater than the risk of taking them. I’m grateful for this study, because having the numbers helps to weigh the options.

Croen LA, Grether JK, Yoshida CK, Odouli R, Hendrick V. “Antidepressant use during pregnancy and childhood autism spectrum disorders.” Archives of General Psychiatry.  Published online July 4, 2011. doi:10.1001/archgenpsychiatry.2011.73

A new technique could revolutionize the diagnosis of Down syndrome in a way that mothers will love. All it takes is 1/2 tsp of the mother’s blood for stunningly accurate results.

Then Not long ago the plan was for every pregnant woman over the age of 35 to be offered amniocentesis or chorionic villus sampling (CVS) for the diagnosis of Down syndrome.  These tests are quite accurate because they directly count the chromosomes of the fetus to detect three copies of chromosome 21, the defining characteristic of trisomy 21 (Down syndrome). But there were two problems:

1. About 5% of pregnant women in the US received these invasive tests. Amnio requires a needle to be passed through a mother’s abdominal wall and through the wall of her uterus into the fetal environment to collect a sample of amniotic fluid. The miscarriage rate is somewhere between 0.03% and 0.5%. And parents often don’t get an answer until 18 weeks pregnant. With CVS the needle can be passed either through the mother’s abdominal wall or through her cervix to get a sample of the placenta. Results are available as quickly as two months earlier than with amnio, but the miscarriage risk is 1%. When you consider the millions of women who have had amnio or CVS, the miscarriages are not trivial.

2. Only about 30% of Down cases were picked up with this plan; 70% were missed! Even though older women are a higher risk group, more babies are born to younger women.

Today’s Status Quo Experts began to use clues from prenatal ultrasounds and from combinations of markers found in blood tests of mothers to more precisely target who would benefit from amnio and CVS. As the blood tests progressed from double to triple to quadruple combinations the accuracy increased — but the items tested were still circumstantial evidence that often go along with trisomy 21, not the chromosomes themselves. This led to the current status quo:

1. Amnio or CVS is still recommended for 3 to 5% of pregnant women in the US, or about 120,000 to 200,000 women per year.

2. About 90% of cases of Down syndrome are picked up by this screening program; about 10% are not picked up until birth because their mothers never received amnio or CVS.

The Breakthrough A simple, non-invasive new test reported January 2011 in the BMJ directly counts the trace levels of fetal chromsomes that make their way into the mother’s blood. The test is simple from the mother’s perspective, but uses sophisticated massively parallel gene sequencing to get the job done. More than two million tests are performed on each 1/2 tsp sample. The new test, which can be performed in the first trimester, appears remarkable:

1. In this study, the test was able to detect 100% of cases of Down syndrome. A negative test appears to virtually rule out the presence of Down syndrome.

2. Because there is a small false positive rate, confirmatory amnio or CVS would be recommended for those with a positive test. Nevertheless, this new test would eliminate the need for about 98% of all amniocentesis and CVS.

A New Era This gene-sequencing blood test is not yet routinely available. But it is a clear glimpse of the near future, when non-invasive sequencing tests will be able to precisely and directly diagnose many conditions better than ever before.

Chiu, RWK et al. “Non-invasive prenatal assessment of trisomy 21 by multiplexed maternal plasma DNA sequencing: large scale validity study.” BMJ 2011;342:c7401 doi:10.1136/bmj.c7401