Posts Tagged ‘Healthy Mother

In the past month we kicked off a monthly meeting / workshop titled “Transition to New Motherhood and Infant Care“. The workshop series is a collaboration between Healthy Mother and the global healthcare company Johnson & Johnson (India). The idea behind the workshop series is that many new mothers (dads), especially from nuclear families find it difficult to make a smooth transition from being just a couple to new parenthood. They have lots of questions on bathing their child, massage, sleep patterns, breastfeeding etc, and are hardpressed to find credible answers which are evidence-based.

The June workshop saw a team of pediatrician, gynaecologist, and yours truly talk about myths and good practices in infant care, how to care for yourself when you become a new mother, and had a interactive session on infant massage.

The workshop was a big hit among the parents and we feel encouraged that we are able to help many new parents in this crucial time of adjustment and transition. Watch out for the announcement for the July workshop.

Here is the link to some pictures from the event.

Dr. Vijaya


Some very good news….

Over the past many months I have had many queries from aspiring Lamaze Childbirth Educators from all over India asking if we conduct any training program for Lamaze teachers. In fact some of my new mothers who have graduated from our Lamaze classes have been quite fascinated by the Lamaze Philosophy and their birth experience that they now want to become Lamaze teachers and help other expectant mothers.

Good news for all of you!! We at Healthy Mother have partnered with Douglas College, one of the foremost institutions for Lamaze Educator Training and are bringing their program to India. We will be hosting a Lamaze Teaching Skills Workshop on May 14, 15, and 16, 2009 in Hyderabad for those who want to become Officially Certified Lamaze Childbirth Educators. The workshop will be conducted by Kathleen Lindstrom, CD, CDT (DONA), LCCE, FACCE (Lamaze International) and co-taught by me. Attending such a Workshop is one of the eligibility requirements for sitting for the official Lamaze Certification examination from Lamaze International.

Kathleen is the Perinatal Program Manager, in the Faculty of Health Sciences, Douglas College, Canada and has 25 years experience in teaching prenatal classes, developing Lamaze Training Curriculum and presenting workshops. She is currently on the Board of Directors of Lamaze International. In addition, Kathleen is a DONA certified Doula and Trainer and has 28 years experience in training nursing staff about breastfeeding techniques, and working with breastfeeding families.

We will also be offering a FREE Doula Training Workshop on May 19th and 20th. I encourage everyone who is interested to register for the workshop as soon as possible as slots are very limited.

You can contact me for details about costs, and other details.

Dr. Vijaya Krishnan

Recently, I was talking to one of our Healthy Mother Labor and Childbirth program participants who had gone to her parents’ house in Kerala to spend the rest of her pregnancy. During a routine check up at the local hospital four weeks before her due date, her baby’s heart rate was seen to be fluctuant, accompanied by significant decelerations. Her OB suspected that there may be cord entanglement, and immediately admitted her to the hospital. With severe decelerations of the baby’s heart rate continuing, her doctors  decided to immediately take her for an emergency C-Section. Soon after her delivery, the doctors found that her baby had significant difficulty with breathing, and the pediatrician counseled the parents to admit him to the Neonatal Intensive Care Unit (NICU).

However, neither the hospital in which the baby was born, nor any other hospital in the vicinity, had NICU facilities. Thus began a ten day emotional and physical rollercoaster ride for mom and dad. The baby was shifted to the nearest hospital with NICU facilities, which was about 6 hours away. Mom could not be discharged from where she was for the next 3-4 days, and baby was 6 hours away in NICU. Dad shuttled between the 2 places daily, until mom was finally discharged and was able to see her baby. In adition, the hospital practices where the NICU was located were not mother-friendly, so mom was not allowed to touch or hold her baby for several days. She could only see her baby from outside the glass walls of the intensive care unit.

Finally the baby was discharged from the NICU in good health, and as I write this mom and baby have been at their home for several days, and both are doing well. Since the mother had continued to pump breastmilk while her baby was in the NICU, she is now nursing her baby without much difficulty. Way to go, mom!

As I was speaking to this couple, I thought I would re-emphasize the importance of choosing the right hospital for your baby’s birth. Not only is it important to choose a hospital that provides you with the best possible support and care that can promote a natural childbirth, but it is also important to check whether they have good emergency backup and post-delivery care infrastructure such as NICU facilities, should your baby need it. If not, at least you should check to see whether there are hospitals in the vicinity which offer NICU facilities, so that mother-baby separation can be kept to a minimum. Over and above this, there are several questions that you need to ask of your doctor and/or hospital, so that you can ensure the best possible birthing experience for you and your baby.

The Coalition for Improving Maternity Services (CIMS) is doing a remarkable job of advocating mother-baby friendly practices in US hospitals and medical facilities . I have adapted some of their recommendations in a document after making them relevant to the current Indian conditions. You can download the document here (Points to consider about your hospital).

In my next post, I will write about how Lamaze is helping women and their families in rethinking the different aspects of labor and childbirth.

Dr. Vijaya Krishnan

Dec 18th, 2008:: This particular mom had attended my Prenatal Lamaze program in Hyderabad, but went to Bangalore for her delivery – Bangalore being where her mother lives. At the start of the antenatal program, she expressed to me that she was so afraid of labor pains, that she had instructed her sister (who is a doctor) to help her go ahead with an elective C-Section. By the end of the program, this same mom had become a staunch believer in the power of natural birth, but most importantly, in her own ability to handle pains and birth naturally. We worked on a customized birth plan to suit her particular needs, and when she went to Bangalore, she met with her OB and hospital staff several times, to ensure that everybody in the team respected and appreciated her desire to give birth as naturally as possible.

We kept in touch over the next several weeks, and as the due date neared, there was still no sign of labor. Dec 15th was her due date, and it came and went without any signs of labor. However, at the previous OB visit, she was found to be 4 cms dilated, so as per her plan, it was decided that everyone would wait and monitor over the next week for labor to begin on its own. Mom followed her exercise program eagerly, as well as tried some of the pressure points that she had learnt in our classes, to try and help labor to begin. Meanwhile, her husband had to go out of the country on a business trip on the 19th, so mom decided to go in for an induction on Jan 18th, so dad could be present for their baby’s birth. She was induced with oral prostaglandins at about 10 am in the morning, with a repeat dose being given at around 3 pm. Labor started soon afterwards, and by 7 pm, she was in intensely active labor. At some point during this phase, she asked for an epidural, but her husband, sister, OB and her support staff, all reminded of her birth plan, and amply supported her during this phase. Finally, she went onto the pushing phase at around 9 pm, and pushed with her urge and lots of support for around one and one-half hours. Even though her OB knew from her previous visit and scan that the baby’s birth weight would be high, all involved were committed to the cause of natural childbirth, and finally at 10:45 pm, mom gave birth to a healthy 4.2 kgs baby girl without any episiotomy. There were perineal tears that mom sustained during pushing, but in the end mom was able to give birth the way she wanted. Way to go mom!

Lessons learnt: This mother was in charge of her birthing experience, and that is always good. Her OB and labor support were very good and encouraged her every step of the way. Yes, the labor was induced – and yes, it would have been ideal to wait for labor to start on its own; however, given her personal circumstances and the fact that she was already past her due date made her decide to go in for induction. However, her induction probably had better chances of working, since she was already effaced and dilated to 4 cm. If this had not been the case, then the induction might have failed, and potential for a C-Section could have arisen if labor failed to progress adequately. In the end, mom’s knowledge of what to expect, her due diligence in choosing a good OB and hospital, and her preparation for labor through the antenatal sessions, as well as excellent labor support helped her to make her daughter’s birth experience exceptional for her.

I return to this blog, invigorated from having taken part in a number of incredible events, each marking a significant moment in the lives of seven members of our Healthy Mother family. Seven “Healthy Babies” joined our Healthy Mother family between the 9th and 21st of Dec. Five of our mothers gave birth in Hyderabad, one in Bangalore and one in the northeastern state of Assam.

I usually do not write about every labor and delivery, but in this group of mothers we had such a complete gamut of birth stories, that I felt, by revisiting these experiences and putting them down on paper, we would be able to learn about the myriad of outcomes and accompany childbirth. These experiences also highlight to me the full range of variability in the progress of labor, and the occasional necessity of Caesarean Sections when it becomes medically necessary for either the safety of mother or her baby.

9th Dec, 2008: Our first mother was attempting a VBAC (Vaginal birth after C- Section). On the day of her delivery, she came in to the hospital with her bag of waters leaking. She had been having small leaks on and off for the past three weeks, and was being monitored periodically for both fluid levels and CTG (cardiotocography – this test measures the baby’s heart rate and indicates how reactive the rate is to both the baby’s own movements and to mother’s uterine contractions). Since baby seemed to be doing well, and since baby’s movements were good, we adopted a wait and watch strategy. However, on the day of admission, mom’s bag of waters burst around 3 pm. After this there was some continuous trickling, and mild cramps, which indicated the start of labor. I told mom to get to the hospital, and told her that I would meet her there. However, mom was reasonably confident that she wanted to monitor the progress of labor at home, and by the time she and her husband reached the hospital, it was around 8 pm. By this time mom’s contractions were about 7-10 minutes apart, lasting for about 30-40 seconds and very manageable with breathing. Mom was in the early stages of labor. However, she was still continuously leaking fluid. On internal examination, it was found that her cervix was posterior, long and completely closed. We felt that it would be prudent to assess her amniotic fluid levels since she had been leaking fluid on and off for several weeks, and it was found that the level was low, with one pocket measuring 5. CTG was still showing reasonable reactivity, and therefore mom decided to labor for a while longer. We tried everything – walking, pelvic tilts, side lunges, wall squats, butterfly, etc. We rested in between and tried again. By about 11 pm, there was no progress in the intensity or duration of contractions, and CTG results were also not definite. Although we normally avoid frequent internal exams, we decided to conduct one in this case to check if there was any progress. Cervix was still long, posterior and completely closed.

We now had to make a choice. Mom had history of a previous still birth and C-Section. In that pregnancy, she had been leaking fluid on and off from her 6th month. It was shown that her baby had IUGR (Intra-uterine growth retardation) and had suddenly stopped moving at around the 36th week. With this history, and the current low levels of fluid, CTG results, and the condition of the cervix, we felt that the risk to the baby would be greater if we continued with laboring. Due to her previous C-section, she was also not a good candidate for any other intervention. We discussed all the possibilities with mom and dad every step of the way, while mom continued to labor until 1 am. By this time it had been about 10 hours since her bag of waters broke, and the CTGs were not showing good responsiveness either – the only reasonable option was to go in for a C- section. Mom and dad also agreed that this was the safest option. Dad, who had been very supportive all through labor, was present during the surgery, to support mom and see the birth of his baby girl, who weighed in at 3.3 kg. He was with his daughter all the time while mom was in surgery. Within the first hour, we had mom and baby in skin-to-skin contact, and nursing commenced without any difficulty. Mom was up and about the next day and both she and baby were doing great when I visited them for a post-natal checkup the next day.

Lessons learnt: Not all births end up being normal, despite the fact that we do everything possible to facilitate normal childbirth. Every mother’s labor is unique and how we deal with mothers’ labor tends to be different in each case. In this instance, mother and dad were diligent about following the advice given to them in their childbirth classes, however, in the interest of her baby’s well being we all made an informed choice of going in for a c-section. While C-section was a required medical intervention, the 10-hour period of labor was good for mom and baby.

In my next blog I will write about yet another birth that I had the opportunity to assist – a completely different experience..

I invite you to share your experience as well

Dr. Vijaya Krishnan, DPT, PT, LCCE

Wishing All Mothers and their Families a Very Happy, Healthy and Prosperous 2009.

The year 2008 was exciting for Healthy Mother, as we started our Lamaze and fitness classes for would-be mothers and new moms. I am happy to inform you that two weeks ago I was awarded the Lamaze Certified Childbirth Educator (LCCE) certification by Lamaze International.

Along the way, in 2008, we were incredibly fortunate to have met with a number of people who have enriched our lives and those of our program participants. These include doctors who are willing to give natural birth a chance, nurses and hospital staff who show incredible empathy for mothers who want to give birth normally, often against unwritten hospital policies, NGOs working tirelessly for the welfare of pregnant women and newborns, journalists who are not afraid to highlight the worrying trend of increasing, unnecessary c-sections and the medicalization of childbirth, and last but not the least, those hundreds of would-be mothers, their spouses, and families who were determined to follow nature’s simple plan for birth.

We dedicate 2009 to all the above, and also to those thousands of childbirth educators worldwide, who like us, are working hard to effect this movement of change, literally one mother at a time.

So here’s wishing all of you a very Happy, Healthy, Safe and Prosperous 2009.

Dr. Vijaya Krishnan

Two weeks ago, we welcomed one more baby into our Healthy Mother family. This story is a bit unique since mom had to go through quite a few trials and tribulations during the course of her pregnancy, but ultimately overcame all of it, and was able to have the natural childbirth that she had always wanted!

I came to know mom and dad over a course of several months, as they had come to attend the Healthy Mother Labor and Childbirth Workshop when mom was in her 5th month. A bit early, but since mom was intending to go to Chennai for her delivery, we thought it would be better if she could attend the program then. From having severe swelling in her feet (and sometimes on her hands), to having dizziness during her 5th and 6th months, we tackled quite a few of her pregnancy related concerns. In addition, she was diagnosed with placenta previa (low-lying placenta, covering the opening of the cervix) around the time that she finished her sessions with me. So, she had to prepone her trip to Chennai, so that she could be on complete bed-rest at her parents’ home.

Through all this, mom kept up a very positive attitude. She had been practicing yoga before she started on our program, and she took to our exercise programs and breathing/relaxation techniques wonderfully. When she was put on bed-rest, we kept in touch over the phone regarding how best she should deal with her concerns. Over the next several weeks the placenta gradually pulled itself up (as often happens), and mom was able to re-start her birth fitness exercises. She would practice them diligently, and wrote to me in her 37th week: “I am practicing all my exercises/ breathing everyday. I am also doing meditation daily to keep myself calm and am prepared for labor to start”! I was amazed with her inner wisdom and attitude as she prepared herself for the birth of her baby.

Three days before her due date, her bag of waters broke. It was around 7:30 p.m. when she called me, and asked if it was okay for her to practice her labor positions at home. Since the bag of waters had broken, I advised her to proceed to the hospital so that she could be evaluated, and medical care would be available if required. From that time on, she kept me abreast of developments. From time to time, I was able to reinforce the breathing/relaxation exercises and positions that she had learnt during her sessions.

By 6 a.m. the next morning, her labor pains had still not started. At this point, her obstetrician determined that it would be appropriate to induce her with Pitocin. She called me around 9 a.m. and told me that she was experiencing mild contractions, manageable through breathing, was 4 cm dilated, and was feeling pressure. I advised to keep changing her positions (mainly in bed since her hospital staff did not want her to walk), and to empty her bladder frequently. However, soon after this conversation, her Pitocin-induced contractions kicked in. She told me later, that in an hour’s time she went from 4 cm dilation to 9 cm dilation. Apparently, even her nurses had not anticipated how quickly she would progress, and at one point had to ask her to wait so that they could get in the obstetrician before she could push! All through this, mom managed her intense transition contractions with her breathing alone. She was able to manage her pain, and told me that she actually counted 15 transition contractions! Pretty incredible, if you consider the pain that she was going through. And, 15 minutes and a few pushes later, at 11:45 a.m., she had a healthy baby boy, weighing 3.56 kgs. CONGRATULATIONS MOM, DAD & FAMILY! Mom was able to nurse within half an hour of baby’s birth. As I write this, mother and baby are doing great.

This week, we also welcome two more babies to our Healthy Mother family. Both couples had attended the Healthy Mother Early Pregnancy workshop few months ago. First, a baby girl born on 23rd July and then, a baby boy born on 28th July. Moms, babies and dads are all doing well. Congratulations to all!

I anticipate a busy next couple of weeks, as quite a few of my moms and dads have their due dates coming up! Each one of you, do keep up practicing your birth fitness exercises and breathing …. And do call, write or e-mail me with any questions/concerns.