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Planning for Baby

Can I still have a natural birth if I am over 35?

Women are often considered of an advanced maternal age if they are delivering their baby after their 35th birthday.  While there is some increased risk in pregnancy and birth over 35, most women can look forward to a wonderful and positive birth experience.  

Does being 35 make me high risk?

While some research concerning birthing of 35 does show increased problems, the truth is much less clear cut.  Actually, for older women there are many things that are not a higher risk for them.

In fact, one large study done in 2005 found:

“No statistically significant differences were noted among the groups [of various aged women] for threatened abortion, gestational hypertension, pre-eclampsia, preterm labor, preterm PROM, and assisted vaginal delivery.” ¹

According to this study, many of the things that women over 35 worry about, such as gestational hypertension and pre-eclampsia, are, actually, not statistically more likely for them.  This knowledge alone can make a woman feel much less fearful and more capable of achieving the birth she wants. 

The researchers go on to say that:

“In summary, the majority of women of advanced maternal age deliver at term without maternal or perinatal adverse outcomes.” ¹

One thing that does appear to be more likely as a birthing woman gets older is the risk of stillbirth.  Even this risk, though, when examined carefully is still incredibly low in developed countries.  This review of numerous studies found that:

“However, the absolute increase in risk was relatively small in studies from developed countries, with crude odds ratios varying from 1.20 to 2.23 on top of baseline stillbirth rates varying from 1.55 to 17.89 per 1000 total births” ³

Even though there is a small increase in stillbirth, it is still very low even for women considered to be of “advanced maternal age.” 

Chromosomal abnormalities also show some increase as a woman gets older, but this alone shouldn’t preclude a natural birth. 6, 7

Why are women 35 and older experiencing more cesarean sections?

Women, who happen to be 35 or older at the time of delivery, have higher rates of cesarean section birth.  In fact, women of this age or older are actually three times more likely to deliver by scheduled c-section.²

Researchers point out that women of this age may simply be birthing surgically more often due to their age alone (and not need), despite the relative safety of natural or vaginal birth.  

“Nonetheless, maternal age alone may be a factor influencing physician decision making.  It is uncertain whether the increased rates of cesarean delivery are due to a real increase in the prevalence of obstetric complications or whether there is a component of iatrogenic intervention secondary to both physician and patient attitudes toward pregnancy in this older patient population.” ¹

In essence, the researchers believe that it may be the attitudes of the physician and the patient regarding maternal age that increased these surgical births, not necessarily need.  (Iatrogenic refers to an intervention or illness caused by medical treatment.)  In fact, some studies found that the increased “surveillance” of these older mothers may even cause iatrogenic prematurity or babies born too early due to medical induction.² 

How can I increase my chances of natural birth if I am over 35?

Just because you are over 35 doesn’t mean you can’t have a great natural birth!  Research shows that this is true. 

“…most will achieve a successful pregnancy outcome. Best outcomes appear to be linked to pre-existing maternal health, and pregnancy care at tertiary centers may also contribute.”

Being healthy before you get pregnant, no matter your age, can improve outcome and possibly increase your chance of having the birth you want.  For example, one common risk for older women is gestational diabetes.  Gestational diabetes however has other risk factors independent of maternal age that contribute to it, including pre-pregnancy weight, health, and nutrition before and during pregnancy.  Another risk factor for women over 35 is chronic hypertension, but research shows that advanced age alone is not responsible for these complications.  Simply having a healthy blood pressure pre-pregnancy can be helpful. ¹

Leading medical groups point out that simple choices, such as eating well, exercising, and getting prenatal care, can be helpful in creating a healthy pregnancy over 35 or at any age.  If you desire a natural birth, a comprehensive natural birth class will prepare you best.  Look for one that includes instruction on both staying low risk and navigating common hospital procedures and testing.  These issues are especially relevant to women over 35 who are often encouraged to test excessively.

Can a woman over 35 achieve a natural birth?  The answer to this question is a resounding yes.  Being healthy, educated and aware can help you get what you want from the birth process.  Are there some risks to birthing over 35?  Yes.  But many of them can be minimized with a healthy lifestyle or do not prevent a natural birth. 

 

 

References

1. Cleary-Goldman J, et al. Impact of maternal age on obstetric outcome. Obstetrics & Gynecology. 2005;105:983.  (If you would like to view this entire study, copy and paste the entire title into your search bar.)

2. Advanced maternal age and pregnancy outcome (British)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3577849/

3.  Maternal age and risk of stillbirth: a systematic review

Ling Huang, MD MSc, Reg Sauve, MD MPH, [...], and Carl van Walraven, MD MSc

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2175002/

4. Very advanced maternal age

 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3637179/#!po=1.42857V

 5.  Midwifery. 2011 Dec;27(6):793-801. doi: 10.1016/j.midw.2010.07.006. Epub 2010 Oct 2.

Obstet Gynecol. 1981 Sep;58(3):282-5.

http://www.ncbi.nlm.nih.gov/pubmed/20888095

6.  Rates of chromosome abnormalities at different maternal ages.

http://www.ncbi.nlm.nih.gov/pubmed/6455611

7.  Table, Down Syndrome rates by maternal age

http://www.mothers35plus.co.uk/down.htm

8.  Very advanced maternal age

 http://www.ncbi.nlm.nih.gov/pubmed/23159159

9.  Mayo Clinic

http://www.mayoclinic.com/health/pregnancy/PR00115/NSECTIONGROUP=2

Announcing Your Pregnancy

The coming of a new baby is a wonderful thing.  Now with the benefits of social media, there are as many ways to announce the beginning of your newest adventure as there are types of personalities.  Here are a few cute (or fun or creative or just plain silly!) ways to share your joy with the ones you love. 

We would love to hear your ideas too.  Leave them in the comments!

~A darling way to announce a new baby- the tiny coffee cup with the expected due month on it! 

 

~If you have older children, have them each hold a chalkboard with their birth order marked on it.  For example, the oldest would hold a chalkboard with “#1” on it and the so on and at the end of a the picture would be a chalkboard sitting by itself, with the appropriate number for the newest family member.  This also works beautifully for a first baby, as shown below.  This couple used their simple initials in a heart for this tender announcement.

~Print a puzzle with a picture on it announcing the new baby for family to put together.  (This one works great as a Christmas or birthday present.)

 

~Address a card to each family member with an enclosed “letter from the baby” announcing their coming birth. 

 

~Take pictures of the entire families shoes lined up.  Mom, Dad, older siblings if applicable, and lastly some tiny baby shoes!  This one is great to share with social media.  Add in each member of the families birth year using photoshop for some extra fun.

~For family members give a gift with the announcement inside.  This one is especially wonderful for a long awaited baby.

 

~Make a family “movie” ending with mom and dad holding a positive pregnancy test.

~For a pregnancy announced around the time of a holiday, incorporate seasonal themes.  This family had an older sister hold eggs marked “big sis” and shared the photos with family members for Easter.

~If you have older children, a simple shirt with the words, “Big Brother” or “Big Sister” are a cute way to both announce a baby and involve the older children.  Or, if you are more creative, you can make your own shirts like the one above!

~“Bump Ahead” signs are always fun.  Have parents stand next to a “Bump Ahead” sign.  Dad points at the mommy belly, and mom points to the sign. 

 

~Give the grandparents a brag book or photo album with only the first sleeve filled- with your ultrasound picture!  Not only is this a cute way to announce a pregnancy, but it gives excited grandparents a place to document the growing of their loved one.

 

~T-shirts for extended family members, especially grandparents are a cute idea.  Just have shirts made (or find some you can buy) that say, “Grandma” or “Grandpa” on them. 

 

~A baby picture frame presented as a gift, only instead of a picture it it, have a note with the expected due date in it.

~Simple, but sends the message!  Just sharing the picture of that positive test is a great way to tell your friends about your exciting news!

 

 

 

We express gratitude to all our readers who helped with the ideas for this post.  In particular we would love to recognize some of our amazing instructors who submitted ideas and pictures.  You can find more childbirth educators online.

Dani Long – www.YourBirthAdventure.com in Washington state

Cori Gentry – www.BirthMakesSense.com in California

Joni Yankus – jyankus@birthbootcamp.com in Texas

Kendra Parry – www.BirthAsIntended.com in Utah

Rachel Johnson – www.DFWBirthClass.com in Texas



 

Rules for Talking to a Laboring Woman

Preparing for birth is a unique time in a woman’s life. Many women spend their lives looking outward, seeking to serve others. But in labor and birth a woman has the opportunity to be at the center for a brief moment, and to have those around her serve her, listen to her, and help her in any way they can.

Occasionally, however, those close to a birthing woman use it as an opportunity to fill their own needs or express their own fears to the mother or those closest to her. While it may seem obvious to most, dumping our own emotional baggage on a pregnant or birthing woman is actually inappropriate. Sadly, there are many who have missed the boat on this particular subject.

How many birthing women are surrounded by people (including family) at their birth that they didn’t even want present? How many pregnant women must listen to the horror stories of others simply because they have a round belly and are, obviously, expecting? Birth, however, is not about making those that surround a woman happy and comfortable. A great birth team seeks to make the mother and her closest loved ones happy and supported so that they and the baby can have the best experience possible both physically and emotionally.

The Goldman and Silk “Ring Theory,” as discussed in this LA Times article, explains the idea that during times of extreme stress (such as turmoil or illness) the person most affected or at the “center” has the privilege of receiving emotional support, and the ability to “dump” outward. That is, the person at the center can ask for help, and the people outside can offer.

The idea that “support goes in, needs expressed go out” doesn’t just apply to illness; it works beautifully in labor, too.

When a woman is in labor she should be at the center of the circle, the center of attention, and the person who is focused on. She can request anything from those around her. Support should always flow towards the center from the outer circles, and requests should flow outward. For example, random strangers should not act as though the birth is theirs or that their needs are more important than those of the laboring mother. The mother should not have to support her partner, doula, or family. When the focus
of support stays on the mother, the entire labor goes better and she feels safe and secure.

Remember this simple rule of birth etiquette when attending a birth. Remember, also, that very soon that laboring woman will be a mother and all of her attention will be focused outward on her precious child. We can focus our love and support on her for a few hours to help ensure that both mom and baby receive the best start possible.

Cloth Diapers – Not What Your Mama Used

I am going to tell you a story about how I decided to cloth diaper. In 2002, I had a friend that was pregnant with her first. At the time she was also recently single and broke. She had said that she was going to cloth diaper to save money. When she went to Babies R Us the only thing that was available were prefolds and cruddy plastic pants. Ask any grandma, plastic pants suck. They always have, they always will. They are reminiscent of a shower cap with leg holes. Except this shower cap was designed to keep the moisture in. HA! Slightly disappointed in what was available at big box retailers, I turned to the internet. I quickly found Fuzzibunz. At the time I thought they were the coolest thing ever, but alas was not inspired enough to run out and have a baby.

Fast forward to 2010, I am pregnant and reminded of my find 8 years prior. Yes, Fuzzibunz have been around that long. So I jumped online and found that there was much more than just Fuzzibunz, there were Fuzzibunz, GroVia, AppleCheeks, bumGenius, and more. I was quickly overwhelmed with the options available. I was completely aware of prefolds (ref afore mention friend) but fitteds, pockets, and all in ones were a completely new ballgame.           

When I told my husband that I wanted to cloth diaper, he quickly told me that I was a complete lunatic. My husband is the second out of five boys. He remembered cloth diapering with those sucky plastic pants, prefolds, and pins. The conversation went a little like this:

“I am not washing diapers out in the toilet,” he told me.           

“But honey we can cloth diaper at home and disposable while we are out. We will save a ton of money.” I replied

“You are crazy. I don’t care how much money we save. I am not swirling anything in the toilet.”           

“Ok fine, we can cloth diaper at home and disposable while we are out, and *I* will take care of the laundry. You just change the diaper.”

“Whatever, but I still think you are crazy”

So that is what we did. We started out in pockets, but I wasn’t thrilled with fit or absorbency. Still confused by the difference between a fitted and an all in one, I decided to attend a Cloth Diaper 101 at my Chiropractor’s office. We picked up a couple All in Ones, a GroVia and a Bottombumpers . 

Within a few weeks, my husband was helping me stuff our stash of pocket diapers.  He exclaimed, “Just be done with this and go with the All in Ones!” HE was hooked. From that point on, my son was in cloth 100% of the time.

Now when my husband hears somebody is having a new baby, the first thing he asks is if they will be cloth or conventional diapering. The average answer is similar to what his was in the beginning. Now his response to their objections is simple…”Cloth is awesome!”

 

Credit: Valerie Cannon Photography

 

Tiffany, owns and operates the Fort Worth Cloth Diaper store, Simple Baby. She is an advocate for natural birth, breastfeeding, and real diapers. She is a chapter leader for Tarrant County Birth Network, the largest chapter of Birth Network National in the nation. For more information about cloth diapers be sure to visit the Simple Baby Cloth Diaper Encyclopedia.

4 Simple Ways to Prepare for Natural Birth

Congratulations on your pregnancy!  Many women desire a natural birth but preparing for one can seem overwhelming.  Here are some wonderful tips for preparing yourself for the best natural birth possible.  There is so much you can do to ready yourself and your family for birth.  With these four simple things: education, nutrition, birth place, and birth team, you will be more able to make your goal a reality.  

#1-Education-  Probably the most important step in preparing for natural birth is to educate yourself as much as possible.  Just as with breastfeeding, the more you know about the benefits of natural birth for you and your baby, the more motivated you will be to follow through and prepare accordingly.

Of course there is a plethora of information out there on birth.  How do you trudge through it and find the diamonds among the coal?  First, a comprehensive childbirth education program is a must.  Look for one that is longer rather than shorter.  A weekend “crash course” cannot possibly give you all the information that you need to navigate policies, stay low risk and prepare properly for the birth you want. 

Look for natural childbirth classes that cover staying low risk, nutrition and exercise, relaxation techniques, choosing a care provider and birth place, the stages of labor, preparing your partner, common policies and procedures, breastfeeding and newborn care, and possible complications and how to avoid them. 

Not only will a good birth class help prepare you, it should prepare your partner as well.  In all honesty, your partner’s preparation is tantamount.  If they are frightened or simply unaware of normality, it will inevitably impact the birth negatively. 

In addition to preparing your partner, your natural birth instructor will be able to guide you to find the best books, websites, even care providers and doulas in your area.  Think of a childbirth instructor as somebody on the “inside.”  They have been there and done that and now they can help you accomplish the same thing.  (Our instructors are well trained women who have had natural births, themselves.  You can see a list of their requirements here.)

#2-Nutrition-  As you will quickly learn, preparing your body for a natural birth is just as important as preparing your mind.  Your body will go through some drastic changes as it grows first a placenta, then a baby, adds fluid, almost doubles its blood volume and prepares for future breastfeeding. 

Eating properly means not just avoiding refined foods such as sugars, white flours, packaged foods and chemical sweeteners, it also means adding the right foods into your diet.  Daily nutrition should include several servings of greens (broccoli, spinach, kale, asparagus, etc), citrus foods (oranges, tomatoes, kiwis, bell peppers), vegetables and fruits (celery, cucumbers, bananas and apples), whole grains (spelt, quinoa, oatmeal), eggs, complete protein sources (meats or other combined proteins such as beans and rice) and dairy (milk, Greek yogurt, keifer). 

Women are amazed at how much better they feel when eating properly during pregnancy. Many common pregnancy ailments disappear. Great nutrition and adequate protein can even help eliminate morning sickness.  Your childbirth instructor can provide you with a complete system to chart your nutritional intake and make corrections, if needed.  You can also find many phone apps with which you can keep track of your daily nutrition throughout pregnancy. 

Great nutrition will help your body and your baby be ready for a natural birth.  Many care providers believe that common ailments that surface at the end of pregnancy and often lead to induction or C-section can actually be avoided with optimal nutrition.

#3-Choose Your Birth Place Carefully-   One of the most important choices, as you prepare for a natural birth, is your choice of birth place.  Many factors play into this decision from insurance coverage to proximity.  Women often have three main choices available to them when it comes to birth place:  hospital, birth center or home.  The birth place that works best for you and your family will be influenced by many things, from cost to your own health to where you feel most emotionally comfortable. 

Wherever you choose to birth, be sure that the policies are not so prohibitive that they make natural birth nearly impossible.  Some important policies to look for are:

  • Women are encouraged to eat and drink in early labor.
  • Vaginal exams are kept to a minimum.
  • Women are encouraged to move about in labor.
  • IV’s are only given when necessary.
  • Breastfeeding is supported.
  • They have a low C-section rate. 

In a birth center, you may want a hospital nearby in case of transfer and an environment in which you feel comfortable and supported.  If choosing a home birth (as with any other birth place), you will want to carefully choose your midwife. Look specifically for someone with experience, skills or certification that you feel comfortable with. 

While it may be tempting to choose a birth place simply because it is close, doing things because they seem “easy” is an often regretted decision for birthing women.  A nearby hospital with a sky high induction and C-section rate will greatly increase your chances for the same.  In the case of an unwanted and/or unneeded cesarean section, a shorter drive for a birth place can yield a much longer recovery.  Choose your birth place carefully. 

#4-Choose Your Team Well-  You won’t win the Super Bowl with a football team made up of expert karaoke singers and you won’t get a natural birth with a team of care providers who specialize in surgical birth.  Choosing your birth team carefully is one of the best ways to ensure you get a natural birth.  Sometimes, even when a mother is knowledgeable and physically prepared, things can fall apart for her in labor if her team doesn’t support her decisions. 

So how do you find this pro-natural birth team of supporters?  Asking your childbirth instructor is a great way to start.  As a woman experienced in birth and engaged in the local birth community, she should have a list of resources to provide you with. 

There are many people who will make up your birth team. All of these people will influence your birth experience.

A great doula (a woman trained to support a birthing mother) can be a fabulous resource for both the laboring woman and her partner.  She can provide emotional and physical support, an experts view on supportive care providers, and may act as a sounding board for advice. 

Another good person to have on your team is a Webster Certified chiropractor.  Chiropractic care during pregnancy (and even birth) can help ensure the pelvis is well aligned so that it can move for a faster and more comfortable birthing experience with a better positioned baby.  This alone can help avoid many problems that prevent natural birth. 

Probably most important of all is your choice of care provider.  Your doctor or midwife will make decisions when you can’t and will be there for the final moments of birth.  It is vitally important that this person be both trustworthy and skilled.  If you are a low risk woman, you may want to consider midwifery care.  Midwives often work in hospitals (thought many can be found working in a home birth or birth center environment) and their approach to birth tends to be more supportive of  natural choices. 

You CAN Have an Amazing Birth!  Choosing a natural birth is a wonderful decision. With the right choices and preparation, we believe that most women can achieve this goal.  (Check out our stats from our students!)  Proper education, excellent nutrition, and careful choice of your birth team and your birth place are all things that can make your choice of a natural birth more attainable.  When all is said and done, sometimes things don’t go exactly as planned.  But, when we have done our best and chosen a care provider that we trust, we can rest assured that we did everything possible to accomplish our goal.

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