Episode 44 (Epilogue): VBAC

Trailer, Trial of Labor: A Film About Birth

Tonight's jam-packed show was all about Vaginal Birth After Cesarean, or VBAC; a practice that has become more and more difficult to come by in the U.S. However, with recent ACOG policy revisions, we are beginning to see a paradigm shift. Joining us tonight to talk about the risks, the myths, and the realities of Vaginal Birth After Cesarean were Jennifer Kamel, author of www.VBACfacts.com; Dr. John Sullivan Jr. of Sarasota Memorial Health Care System; Erin Ernst of ICAN; and Tamara Taitt of the VBAC Summit, taking place in Miami August 17-19. First we spoke to Jennifer Kamel of the popular website VBACfacts.com.

Jennifer urged consumers to talk to their care providers first about their plans to pursue a VBAC. Posted on her website are these questions to ask a care provider when searching for a supporting VBAC practitioner.

Kamel says: "You might have to interview several providers until you find one who is truly supportive of VBAC. If you do find such a provider, refer all your friends, VBAC or not, to this provider so that they can reap the benefit of someone who supports non-interventive birth! I really think that true change won’t occur in the medical community in terms of supporting natural non-interventive birth and VBAC until the OBs and hospitals see their revenue decrease. For this reason, we all need to support OBs, midwives, and hospitals that support VBAC." Kamel also suggested listeners watch Dr. David Birnbach's presentation from the 2010 NIH's Consensus on VBAC. We mentioned that there are several hospitals that still have a ban against VBAC; these can be found on the ICAN website.

We then welcomed Dr. John Sullivan Jr., head of the OB Section at Sarasota Memorial Hospital. He and his partner Dr. Wayne Cohen have been welcoming VBAC clients into their practice for several years. He reminded listeners that Sarasota Memorial is the only facility south of St. Petersburg that allows VBAC, and shared the current SMH VBAC policy. We also talked with Dr. Sullivan about the new Hospitalist program at SMH and potential improvements the program will bring.

Then we introduced Erin Ernst, mother of two and local leader of the International Cesarean Awareness Network. Erin shared the birth stories of her daughters Kalina and Jasper, and shared with our listeners the mission of ICAN and how you can get involved. The group meets the second Wednesday of each month (the next meeting is Wednesday, August 8, 2012) at 6:30pm Firestation #1, Downtown Sarasota, 1445 4th St, Sarasota, FL 34239.

Finally, we heard from Tamara Taitt, co-planner of the 3rd Annual VBAC Summit, August 17-19 in Miami, Florida. She talked about speakers around the country coming to Miami, such as Jen Kamel and Gena Kirby, who will present at the summit. There are pre-conference workshops available at The Gathering Place throughout the week prior to the Summit, and a broad menu of offerings for attendees this year.

Our advice to those seeking a trial of labor after a cesarean section: Hire a doula. Know your rights. Do your research. And trust your body.

Episode 44: VBAC

Join the Conversation Tuesday, 7/31 at 6pm EST as Laura and Ryan take a look at Vaginal Birth After Cesarean (VBAC) in America. What are the trends? What are the facts? What are your rights? Is it safe? Tune in and find out as we listen to the experts. We will welcome Jen Kamel, author of the website VBACfacts.com, as well as Erin Ernst, the leader of the local International Cesarean Awareness Network and mother of two. We will also hear from Tamara Taitt, co-planner of the upcoming 2012 VBAC Summit in Miami, Florida.

Tune into WSLR 96.5 LPFM or online at www.wslr.org tonight, Tuesday, July 31st at 6:00pm.  The program will also available later in the evening via podcast at maternallyyoursradio.podomatic.com.

For more information, please contact the hostesses of Maternally Yours at MaternallyYoursRadio@gmail.com, or on our facebook page at facebook.com/maternallyyours.

Maternally Yours,
Cheryl, Carmela, Ryan and Laura

Episode 43: Green Your Baby

According to Mother Jones, one American child sends more than 3,500 disposable diapers to the landfill before their third birthday and generates as much CO2 as 106 Haitian children. Join the conversation Tuesday, July 24th from 6-7pm EST as Ryan and Carmela speak with local moms who want to help you buck this trend and Green Your Baby. We will discuss modern cloth diapering and Natural Infant Hygiene, highlight ways to make your home free of toxins and plastic waste, and share tips to get your whole family living green.

Tune into WSLR 96.5 LPFM or online at www.wslr.org tonight, Tuesday, July 24th at 6:00pm.  The program will also available later in the evening via podcast at maternallyyoursradio.podomatic.com.

For more information, please contact the hostesses of Maternally Yours at MaternallyYoursRadio@gmail.com, or on our facebook page at facebook.com/maternallyyours.

Maternally Yours,
Cheryl, Carmela, Ryan and Laura

Episode 42 (Epilogue): Music for Kids and Parents

We had a great time on tonight's show talking about the amazing connection between children and music. Carmela mentioned this study from the American Association for the Advancement of Science, supporting the theory that music instruction can help build intellectual and emotional skills, facilitate children's learning and strengthen academic areas such as reading and math.

Our first guest was one of Carmela's favorite singer-songwriters, Nerissa Nields of the Nields Family. Nerissa and her sister Katryna have four children between them, ages 3 to 11, and have recorded 16 CD's and written three books and seven songbooks. One of these books is All Together Singing in the Kitchen, with over thirty songs (with lyrics, chords, and audio recordings) to get your family singing, musical games to get you dancing, and tips on playing instruments to get you grooving. This book will help you make music a larger part of your family's life, from playtime to bedtime.

The Nields sisters have recently developed a program for kids and parents called Hootenanny, which Nerissa compared to the Music Together program found nationwide. HooteNanny is an early music program for children aged 0-5 and their grown ups. There are nine discrete seasonal curricula, and each one endeavors to contain a mix of uptempos, ballads, familiar and new, songs with different time signatures, languages other than English, major and minor, silly and sublime. Says Nields, "HooteNanny families have been instrumental in helping us to create our curricula. We firmly believe in the folk process. Some of our favorite songs have come from parents in our classes, songs they learned from their grandparents. HooteNanny is all about drawing all of these communities together–– generational, geographical, cultural."

We then welcomed Sandi Grecco from The Drum Studio on the air all the way from Chicago where she was celebrating her birthday. The Drum Studio provides private music lessons for Drums, Guitar, Bass Guitar, Piano, Music Theory, Percussion and Rock/Funk/Metal Band Labs. The Drum Studio All-Stars are students from the Drum Studio and surrounding communities who have performed for many charities and benefits. Alumni from this program are pursuing careers in music via Berklee College of Music in Boston, Full  Recording Arts in Orlando, University of Miami, with nationally and internationally touring bands and various television and theater positions, including Syesha Mercado, American Idol finalist.

Then we shared some of the opportunities for musical education in our own community.

• Suzuki Institute of Music School in Sarasota
• Sarasota Youth Orchestra
• Let’s Rock Sarasota
• The Rhythm Inlet
• Alli Songs for Tots
• All-star Music Academy, Inc 

And finally, we shared some websites (and sounds) for the music lover in all of us.

• PBS Kids Music
• Farmer Jason
• Zoo Globble
• Trout Fishing in America

Episode 42: Music for Kids and Parents

Join the Conversation tonight, July 17th from 6-7pm EST as Carmela and Laura talk about music for kids and parents. We will talk to musicians Nerissa and Katryna Nields who stoke the musical fire in kids. Also joining us by phone will be  Sandi Grecco of The Drum Studio to tell us about getting kids involved locally. We will spin the sounds of some local young talent as well as music from bands that cater to all ages.

Tune into WSLR 96.5 LPFM or online at www.wslr.org tonight, Tuesday, July 17th at 6:00pm.  The program will also available later in the evening via podcast right here on our website, or at maternallyyoursradio.podomatic.com.

For more information, please contact the hostesses of Maternally Yours at MaternallyYoursRadio@gmail.com, or on our facebook page at facebook.com/maternallyyours.

Maternally Yours,
Cheryl, Carmela, Ryan and Laura

Episode 41 (Epilogue): Gentle Cesarean Sections

Tonight we discussed the innovative and quickly growing technique of Gentle Cesarean Sections. Our guests were Dr. George Kovacevic and Nurse Manager Nancy Travis of Lee Memorial Health System, as well as mothers who delivered by Gentle Cesarean, Melissa Murray and Angie Ahmed. Both Dr. George and Nancy referred to Memorial Hospital in Rhode Island as their inspiration for innovating the program here in Florida. 

The practice has been in place in the United Kingdom for several years. The following video is sort of the gold standard for explaining this kind of delivery.

As we spoke to Dr. Kovacevic, we asked the tough question: is the idea of "Gentle Cesarean" in fact a wolf in sheep's clothing? Will this promote elective surgery? He said absolutely not. This is still a major abdominal surgery. And overwhelmingly the contact and feedback from our listeners has reinforced this belief. Every mother we spoke with that has experienced this method of delivery was planning a vaginal birth, had to change course for medically necessary reasons, and was extremely grateful for the opportunity to hold their baby immediately after the surgery. Dr. George said that in EVERY elective or scheduled cesarean delivery, gentle cesarean practices are possible. When asked how we can overall lower our cesarean section rates, Dr. George advised eliminating unnecessary labor inductions.

Next we spoke with Nurse Manager Nancy Travis, who facilitated the program for Lee Memorial Health System. She described the major differences between a routine cesarean and a gentle cesarean--the crux of which is the focus on immediate bonding between mother and baby. It was very refreshing to hear that the staff at Cape Coral Hospital was willing and excited by this concept and moved forward without insurmountable obstacles of paperwork. "We don't really have a policy for a mother to hold their babies. It just makes sense," said Travis.

We then spoke with mothers Melissa Murray and Angie Ahmed, who each found themselves at the right place at the right time when faced with changing their birth plans from natural delivery to cesarean birth. Dr. George delivered both women's babies and neither of them knew that the option existed for them to hold their babies immediately after delivery. Each mother felt surprised, empowered and grateful for the ability to bond and nurse their babies. Their pain levels were lower and their recovery times shorter than they had expected. Both mothers are successfully breastfeeding and neither is suffering from postpartum depression.

If you are a pregnant mother who is on the road toward a cesarean delivery (or should you find yourself changing course during your labor), you have rights as a pregnant patient to completely informed consent. You can create a birth plan, just as you would when planning a vaginal delivery. Here are some things you might consider including in your birth plan:

• I would like my arms unrestrained so that I may touch my baby
• I would like the screen lowered once my baby’s head is out so that I can see his/her birth
• I would like the baby to be placed immediately on my chest
• I would like to nurse the baby immediately
• I would like dad to hold baby
• I would like baby to stay with my partner and I (no nursery unless medically necessary)
• I would like my doula and my partner with me during the surgery

Finally, here are some ideas for the "Best Cesarean Possible" by Penny Simkin, a physical therapist who has specialized in childbirth education and labor support since 1968.

If you have learned that you must have a cesarean (a “planned cesarean”) for your safety or the baby’s, you may feel disappointed that you cannot have the birth you had hoped and planned for. Here are some ideas for tailoring the cesarean birth of your baby to make it very special and personally satisfying for you, your partner, and your baby.  

Before the Surgery: 

• Be sure you understand and agree with the reasons for the cesarean (i.e., malposition of the baby, a medical problem for you or the baby). Learn about the procedure. Read about it in Pregnancy, Childbirth and the Newborn or the Birth Partner and discuss it with your caregiver.
• Learn about your anesthesia choices and how each is administered. General information is available in the books mentioned above. If possible, however, meet and discuss medications with an anesthesiologist along with any concerns you have. A spinal or epidural block is the most common type of anesthesia when a cesarean is planned in advance, but there are other possibilities.
• Learn the layout of the operating room, particularly where the baby will be taken for initial care. Will she be in the same room or an adjacent room? Will you be able to see her? Can your partner move back and forth between your side and your baby’s?
• Discuss the possibility of waiting until you go into labor and then going to the hospital to have the cesarean. The advantage is that the timing for birth is more likely to be optimal for the baby. The disadvantages are that you might not know the doctor on call who will do the surgery, and that you cannot plan ahead (which is the same as with most vaginal births).  
• If you do not decide to await the onset of labor, make your appointment for the surgery. If there is a choice of times, you may want to consider having the first appointment of the day for two reasons: there is less likely to be a delay (from earlier surgeries taking longer than expected); and you will not be as hungry if you do not have to wait all day. You will probably have to avoid eating from the night before.

During the surgery and repair:

• For your personal comfort, consider these ideas: Have your partner put some pleasant-scented (lavender and bergamot are popular) lotion, massage oil, or cologne on your cheeks. He can also put it on his wrist for you to sniff. This is soothing and may counteract the “hospital smells.” Because some staff members may be allergic to some scents, you’d better ask if this is okay. 
• Ask if at least one arm can be left unrestrained. 
• Bring your own CD or tape of music to be played during the surgery. Music that is familiar and that you love improves the ambience. Many operating rooms have CD players.
• Plan to use relaxation techniques and slow breathing (like sighing) during the surgery. Hold your partner’s hand.
• Ask that they lower the screen when the baby is lifted from your body so that you can see the birth.
• During the repair procedure, there is one technique that some doctors do, while others believe it is unnecessary and possibly problematic. This is to lift the uterus out of the abdomen to inspect it and then replace it. This procedure may cause considerable nausea while it is being done, and later gas pains. You might wish to discuss this with your doctor beforehand. If he customarily does it, ask for the advantages.
• Ask about picture taking during the surgery or afterwards. There sometimes are policies restricting picture taking.  A digital camera has the advantage of allowing pictures of the baby to be shown to you within seconds. If your baby is out of your sight, it may be possible for your partner (or a nurse) to take a picture and show it to you.
• Once your baby is born, your partner might go to the baby and talk or sing to him. A familiar voice often calms the baby at this time, and seeing the baby’s response is a poignant moment for the partner. Some couples have sung a special song (i.e., “You Are My Sunshine”) aloud to the baby frequently before birth. The baby seems to be soothed when hearing that song.  
• The partner may be able to bring the wrapped baby back to you for your first contact. You can nuzzle, kiss and talk to your baby, but it is unlikely you will be able to hold her or breastfeed until you leave the operating room, because the operating table is narrow and you may feel quite weak.
• Spinal or epidural anesthesia and other medication issues: The spinal block has many advantages for a planned cesarean, which make it the usual choice. It is quick to administer and to take effect. It usually involves only a single injection, and does not require a catheter in your back. It causes numbness that lasts a few hours. You remain awake and aware. It hardly affects your baby. The injection may also contain some long-acting narcotic such as morphine that provides good postpartum pain relief without grogginess for up to 24 hours after the surgery. 
• An epidural is very similar and has these advantages, but is more complex to administer and takes longer to provide adequate pain relief. There are, however, some concerns about spinal and epidural blocks that might be frightening: It is not uncommon to have a period during which you feel breathless or as if you cannot breathe. It can be scary. It happens because the anesthetic may numb the nerves that let you feel your breathing, while the nerves to the muscles that make you breathe are not blocked. In other words, you are breathing, but cannot feel it. What to do: Say that you cannot breathe. The anesthesiologist, who is at your head, will check and reassure you. Your partner should coach you with every breath, watching closely and saying, “Take a long breath in -- yes you are doing it, and now breathe out. Good.” He might hold your hand in front of your mouth so you can feel your breath, and reassure you, “You are breathing, even though you can’t feel it.” This feeling does not last for the entire surgery.
• On very rare occasions, the level of anesthesia rises high enough to involve the muscles of breathing, so that you really are not breathing.You cannot talk either. The anesthesiologist, who is watching the monitors closely, discovers this and takes measures to assist your breathing. You and your partner should also have a signal. If you can’t breathe and can’t talk, blink your eyes many times. That means, “I can’t breathe!” Your partner should be watching you, and if you blink in that way, says, “I think she can’t breathe!” This may alert the anesthesiologist a few seconds before he would pick up the problem.
• On other, even more rare occasions, the anesthesia is not adequate, and you feel the surgery. This is very scary. The doctors will probably want to make sure your reaction is not an anxiety reaction to the surgery, and may seem not to believe you at first. If you are feeling the surgery, tell them to stop. Your partner must help you with this. Make them give you better anesthesia before proceeding. This might mean repeating your block or giving you a general anesthetic. 
• During the repair, you may feel nauseated and shaky for a period of time. These are normal reactions to major surgery and vary from feelings of queasiness to vomiting and from trembling to shaking and teeth chattering. There are medications to ease these symptoms. They are often put into your IV without you knowing, which may be okay with you. They may, however, cause amnesia (e.g., Versed), or make you very sleepy. They can keep you from being able to nurse your baby (or to remember that you did), and to remember the first hours of your baby’s life. If you want to stay awake for this time, discuss this with your anesthesiologist ahead of time. You might ask the anesthesiologist not to give you anything for nausea or trembling unless you ask. You may very well be able to tolerate the symptoms, but if you find you cannot, then you can ask for the medication.
• Post-operative pain medications are available to help you during the days and weeks after the birth. Some women try to avoid using them due to worries about possible effects on the baby. However, since very small amounts reach the baby, the effects to be minimal. The baby nurses and remains awake and alert for periods of time. The downside of avoiding pain medications is extreme pain, which greatly reduces your ability to move about and to care for, nurse, and enjoy your baby. With adequate pain relief, you can have more normal interactions with your baby.

The first few days:

• Most hospitals have a bed available for the partner so he or she can remain in the hospital with you. This is lovely for many reasons. You are together as a family. Your partner can share in baby care. If your partner is there, your baby can probably room in with you the entire time. If he or she is not there, you will need help from the nurse to change the baby’s diapers, move him from one breast to the other, and carrying him, even for short distances. In some hospitals, the baby spends more time in the nursery if the partner is not there.
• Breastfeeding is definitely possible, but presents some challengs after a cesarean. Nursing positions such as sidelying, and the “football” or clutch hold avoid painful pressure on your incision. Using a pillow over the incision also reduces pain while holding your baby on your lap. Ask for help from the hospital’s lactation consultant in getting started with nursing.
• Rolling over in bed can be very painful, if you don’t know how to do it. The least painful way uses “bridging.” To roll from back to side, first draw up your legs, one at a time so that your feet are flat on the bed. Then “bridge,” that is, lift your hips off the bed, by pressing your feet into the bed. While your hips are raised, turn hips, legs, and shoulders over to one side. This avoids strain on your incision.
• Help at home is essential to a rapid recovery. If possible, someone in addition to your partner should help keep the household running smoothly. If that person knows about newborn care and feeding, all the better. All three (or more) of you need nurturing and help during the first days and weeks to ease and speed your recovery and help you establish yourselves as a happy family.

Episode 41: Gentle Cesarean Sections

Join the conversation tonight, July 10th from 6-7pm EST as Laura and Ryan explore the Gentle Cesarean Section. They will be joined by Dr. George Kovacevic who performs the procedure for Lee Memorial Health System, as well as Nancy Travis, the nurse manager who facilitated the protocol there to make it possible. Also calling in will be mothers who have had gentle cesarean deliveries, and we will hear from the team at a Rhode Island hospital who pioneered the surgery in the U.S.

Tune into WSLR 96.5 LPFM or online at www.wslr.org tonight, Tuesday, July 10th at 6:00pm.  The program will also available later in the evening via podcast at maternallyyoursradio.podomatic.com.

For more information, please contact the hostesses of Maternally Yours at MaternallyYoursRadio@gmail.com, or on our facebook page at facebook.com/maternallyyours.

Maternally Yours,
Cheryl, Carmela, Ryan and Laura

Episode 40 (Epilogue): Summer Reading

Before moving into our show topic tonight, we celebrated reaching our "due date"! From a Collective Conception to a fully grown baby, you have supported us through the birth of this radio show, and we could not be more grateful. Now we are DUE for bigger and better things to come! We have grown our family to welcome Cheryl's newest son Jonah, and we are thrilled to be joined by Lauren the Wonder Intern from New College of Florida! We have exciting guests, topics and events to share with you in the weeks and months to come...so keep listening, keep sharing, and THANK YOU for Joining the Conversation!

We also discussed the Supreme Court’s ruling last Thursday to uphold the Affordable Care Act, aka health care reform, aka Obamacare, and its potential for having wide reaching implications for women, children and families insured and uninsured. We asked several local officials and candidates for statements on the Court’s ruling.

Florida State Senator Arthenia Joyner said, “This decision is a major win for the people of Florida. For the first time, working families will no longer find themselves at the mercy of the whims of the powerful insurance industry as to who to cover, who to drop, and who to deny. For the first time, no Floridian will ever be denied coverage for a pre-existing condition like diabetes or asthma, and young children can remain on their parents’ policies until they are 26. Pregnancies will also be among the services insurance companies will be required to cover for women - a change long overdue.”

Keith Fitzgerald, Candidate for Florida’s 16th Congressional District, echoed Senator Joyner’s statement, “Today's Supreme Court ruling ensures that millions of Americans with preexisting conditions are now covered, insurance caps on coverage are outlawed, the practice of forcing women to pay more for insurance than men is prohibited, and students and recent college graduates are able to remain on their parent's health care plans until the age of 26.” However, he said, “There is still much hard work to be done to bring down the costs of health care for small businesses and middle class families.” Fitzgerald’s opponent Vern Buchanan did not respond to our request for a statement.

And finally, Adam Tebrugge, Candidate for Florida House of Representatives District 71 reminded us of the battles we’ve been seeing at the state level surrounding this legislation, “Since passage of the Affordable Health Care Act, the Florida Legislature has spent considerable legal fees fighting the law, while at the same time turning down Federal grants designed to help implement the act. Florida has so far declined to create a health exchange that complies with the law and has rejected or refused to pursue tens of millions of dollars in funding the federal government offered to help implement the exchanges and other provisions in the law.” Tebrugge said, “When I am elected I will ensure that Florida implements the Affordable Health Care Act for the benefit of all of our citizens.” We reached out to Tebrugge’s opponent, Jim Boyd, for a statement and did not receive a response.

Then we moved on to the night's topic - Summer Reading. It's estimated that school children will loose up to 3 months worth of learning over their summer vacations. Parents can help combat this phenomenon, known as "summer reading loss", by encouraging their children to participate in summer literacy programs. Here are a few we mentioned:

• Sarasota County Libraries
• WEDU Summer Reading Challenge 
• Just Read Florida

All of the initiatives mentioned have accompanying reading lists. In addition, book suggestions can be found via the New York Times Best Seller lists. And once again, Heidi Dahlborg came through with a great suggestion for audio books - BooksShouldBeFree.com.

During tonight's episode we also got into the reading mood by listening to Storyland, a monthly half hour show for children ages 5-11 from KPOV in Bend, Oregon. Every show features a story read with sound effects and music, a puzzle, and a youth segment where one or more kids read their own stories.

Lastly, we discussed books relating to pregnancy, postpartum and parenting. We asked our Facebook Fans to vote for their all-time favorite pregnancy or postpartum book and Ina May's Guide to Childbirth was the clear winner. Runners up were The Womanly Art of Breastfeeding by La Leche League International and Spiritual Midwifery by Ina May Gaskin. Our Facebook fans also listed The Continuum Concept, Sacred Pregnancy and Birthing from Within as favorites.

What will your family be reading this summer?

Episode 40: Summer Reading

Join the Conversation tonight, July 3rd from 6-7pm EST as Ryan and Carmela talk Summer Reading. We all want to keep our kids actively engaged in learning while on summer break. To help you with that goal we will review local and national summer reading initiatives, discuss our favorite books for kids and adults and take a listen to Storyland, a nationally podcast children's radio program from KPOV in Bend, Oregon.

Tune into WSLR 96.5 LPFM or online at www.wslr.org tonight, Tuesday, July 3rd at 6:00pm.  The program will also available later in the evening via podcast at maternallyyoursradio.podomatic.com.

For more information, please contact the hostesses of Maternally Yours at MaternallyYoursRadio@gmail.com, or on our facebook page at facebook.com/maternallyyours.

Maternally Yours,
Cheryl, Carmela, Ryan and Laura