Certificate, Business Cards & Insurance

Today has been full of good surprises. I've literally been stalking my mailbox for days waiting for these items to come. I know I was "official" before but now I feel SUPER official. :)

First of all, my doula certificate arrived. I've been waiting on it for about two weeks. Best of all, they backdated it to the date when I submitted my final assignment. I had assumed it would be dated when I received my final grade. So, technically, I've been a certified doula for more than a month. Sweet!

Along with my certificate, came my official name badge. I'm not sure if I will actually wear it to a hospital birth but I will certainly keep it clipped to the outside of my bag. It's small but I worry about it getting in the way. Doulas use our hands and arms quite a bit and we are usually in close quarters with mom or dad. I'm just thinking it would rub somebody the wrong way. Literally. Figuratively, I have to think that it could cause some tension among the hospital staff if I bust up in there looking all "official" but I'm not part of their staff. Really, I could care less what they think, but my ideal is to be an extension of the parents and blend into their surroundings. I'm probably putting too much thought into the perception of a name tag, but I know it happens. My job is to help create peace and community, not awkwardness and conflict. So, on my bag it will most likely stay.

Then, there was another package with my business cards. I love how they turned out. I used the same header concept I have on my website for the front and my info on the back. Speaking of, have you noticed that I now have a custom URL (www.nurturingYOUnaturally.com)? Cool, huh?! Anyway, I'm ready to start passing these cards around. If you need some, let me know.

Finally, I had applied for an NPI # and my approval showed up in my email today. This is really exciting because it means that my clients can submit my services to their insurance company for reimbursement. It totally depends on the insurance whether they will pay or not but I'm hearing that it is happening more and more. I believe that every woman should have access to a doula and this is certainly a step in the right direction. We can certainly help to hold down medical costs so I don't know whey they wouldn't pay. Ah, that's a debate for another day.

See?! Lots of good surprises today. I'm thrilled to be super official.

Getting Informed Consent

Source: NY Times

I'm extremely concerned with the lack of information given to parents before they are subjected to hospital protocols & procedures. In fact, this is one of the biggest reasons I became a doula. Informed consent is NOT just signing your name on a piece of paper. While that may be "consent," it isn't informed consent. The key? Patient education. As a doula, I do not make decisions for parents. I support their decisions. However, part of my job is to make sure that they feel confident in their choice because it will affect their overall birth experience.

Before consenting to any procedure or intervention, I encourage parents to ask the following questions.

1. What is the diagnosis?
2. Why is this a problem?
3. What are the risks to the proposed solution?
4. How will this change my care?
5. What are the alternatives?

The above questions help the parents to understand why a recommendation is being made as well as the risks and benefits of said procedure. However, I believe that question #3 is the most crucial. In childbirth, every intervention ultimately leads to something else. For example, even an epidural will lead to continuous monitoring, a catheter, and bed confinement. An epidural will also limit your position options for pushing. While these aren't necessarily risks, they do change how you have been cared for up until this point and would have been cared for if an epidural had not been chosen. (side note: I am not against epidurals. This is just one example of how a cascade of interventions can get started.)

Assuming there is no pending emergency, I would recommend the parents request some time to discuss this information. As a doula, I am available to answer questions or request clarification from the staff. If a decision is required right away, I would suggest the parents make a choice based on their first instinct. The options are always the same.

• Yes
• No
• Wait

It is extremely important that a mother knows she can say 'no.' She is delivering this baby. She is the parent. She gets to choose. Waiting is also a very acceptable answer. (side note: 'Wait' may quite possibly be my favorite answer. Sometimes things just need a tincture of time and they will resolve on their own. Not always. But sometimes.)

To further clarify what informed consent looks like from a medical perspective, the American Medical Association defines IC as follows

Informed consent is more than simply getting a patient to sign a written consent form. It is a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention.

In the communications process, you, as the physician providing or performing the treatment and/or procedure (not a delegated representative), should disclose and discuss with your patient:

• The patient's diagnosis, if known;
• The nature and purpose of a proposed treatment or procedure;
• The risks and benefits of a proposed treatment or procedure;
• Alternatives (regardless of their cost or the extent to which the treatment options are covered by health insurance);
• The risks and benefits of the alternative treatment or procedure; and
• The risks and benefits of not receiving or undergoing a treatment or procedure.

In turn, your patient should have an opportunity to ask questions to elicit a better understanding of the treatment or procedure, so that he or she can make an informed decision to proceed or to refuse a particular course of medical intervention.

This communications process, or a variation thereof, is both an ethical obligation and a legal requirement spelled out in statutes and case law in all 50 states.

Parents, please make sure you are asking these questions before consenting (verbally or in writing) to any hospital procedure. It is your right to know!

Reading Roundup 7/3 (Sleep, Fevers, Fertility, Hep B, Newborn Care, and so much MORE!)

I finally cleaned out Google Reader so this is a mass dump of really neat articles. Hope you find something you like.

Midwife Mania? More Babies than Ever Are Delivered by Midwives - "New Mexico has the county’s highest rate, at 24% for all births. Not surprisingly, they also have one of the lowest C-section rates in the country."

The Miles Circuit - Series of easy maneuvers to help regulate or speed up a stalled labor. It is also helpful to relieve back pain for mom and turn a malpositioned baby.

My Mama Cloth Adventures and Review of Four Sources - I love the idea of cloth diapers and this is just another spin on that but for us moms and the infamous Aunt Flo.

Maizy's Beautiful Hypobabies Birth - I came across this birth story today. I'm still in awe of how mother-baby friendly this hospital was. The have a birthing tub, were open to Hypnobabies, did intermittent monitoring in the water, allowed mom to push in a position of her choice, allowed her to to push even though an OB or midwife were not available, delayed the full newborn exam, and allowed baby to nurse right away. *jealous* Wish they could all be similar to this.

Antidepressant Use During Pregnancy Increases Risk of Hypertension - VERY interesting. "Antidepressant use during pregnancy was associated with a 53% increased risk for pregnancy-induced hypertension."

This post also goes on to show that depression can be caused by low vitamin D levels, which has also been linked to PIH.

Frank Talk About the Hep B Vaccine for Newborns - You know I love a good chart. This compares the decline of Hep B (has a vaccine) vs. Hep C (does not have a vaccine). Pay close attention to the orange line (age 0-19). I still cannot fathom why we inject babies within their first few hours of life. For this.

How Fever Can Cure Cancer - "Fever is not a symptom that we must eliminate with toxic pharmaceuticals as prescribed by mainstream medicine. Fever is nature's way of healing and eliminating pathogens. "

All About CoQ10 - I'm just learning about the awesome antioxidant properties of this vitamin. I love this part... "CoQ10 in natural medicine has been found to be beneficial for those suffering from Parkinson's disease and Alzheimer's.It plays an important role in fighting premature aging.

10 Decisions for Parents of Newborns (Part 1 & Part 2) - Very good information presented in a non-biased way with lots of options. Great read for all parents.

Informed Consent - Gives the key questions to ask your provider before making any decision. I am a firm believer that patients should always have informed consent. This post even links to the AMA definition.

Science You Can Use: Why do my baby's hands always get in the way? "Ever notice that, just when you're getting your baby latched on, his hands always seem to get in the way?... What if those hand movements had a purpose?"

Losing Sleep? All Natural Ways to Fall Asleep and Get More Sleep - There are some great tips at the end of this article but I found these 3 things important to note.

1. The Journal of Occupation and Environmental Medicine recently found that women working the night shift had 400% higher risk of cancer.
2. If you sleep less than 7/hrs per night your changes of getting sick triples.
3. Sleep is one of the most important factors in your health.

Natural Fertility and Zinc - Zinc is actually one of the most studied nutrients when it comes to fertility. Much of the reason behind that statement most likely stem from the fact that zinc is an essential component of genetic material. This means that a deficiency in zinc can cause chromosomal changes.

Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes (Review) - This is a study from 2009, which analyzes 11 trials. The author's noted that delayed cord clamping (2-3 minutes) showed no increased postpartum hemorrhage risks to mother and there were long-term improvement of baby's iron levels up to six months post birth.