Changing Hospitals/Clinics Late in Your Pregnancy

Many women get attached to their caregivers in the sense that they don't want anyone else delivering their baby. Some have even gone as far as submitting to a C-section because their doctor was going out of town and they'd rather have their doctor perform a C-section than give birth vaginally with another doctor.

I believe these three tips can help women get the birth they want.
1. Choose their caregiver wisely and find someone who agrees with them.
2. Get a doula. They're worth their weight in gold.
3. Labor at home as long as possible. The clock is your worst enemy.

Here in Korea, and even back home, doctors are superstar doctors! That means that while you're in labor (average time is 18 hours for first time moms) you're probably not going to see your doctor at all: most of the time you'll have nurses attending you. When the main event comes, ie, when you birth your baby, the doctor will come in, deliver the baby, check to make sure everything's all right, and leave. That's it. A couple minutes, maybe a half hour, and then the doctor leaves. You'll spend most of your time with the nurses.

Some women aren't 100% happy with their caregivers but would rather stick with them than change. It's up to you, but you should trust your gut. I read Mama Cairo's blog and found three reasons to switch doctors.

Reason 1: Your doctor brushes you off and doesn't answer their questions. This can be a cultural thing. Doctors in Korea are seen as all-knowing and shouldn't be questioned. As a foreigner, ask away!

Reason 2: You leave the hospital/clinic in tears. Your doctor should not be making you cry.

Reason 3: They flat out refuse to give you want you want even though there's evidence to back up your claims, ex. skin-to-skin, breastfeeding, episiotomies, shaving, enemas, no pitocin, eating and drinking while in labor, laboring in water, not being strapped to the bed to labor on your back, not being able to opt out of an IV, etc.

I will have to saw that you might want to do a little give and take here. While ideally it would be fantastic that you could get everything you want, it doesn't happen to everyone. Pick your battles. If you don't want an episiotomy or an IV, but your doctor wants you to have both, pick the one that you feel more strongly about. For example, you could agree to an IV if the doctor agrees not to give you an episiotomy (just be careful, they're fast!).

Also, remember that you'll need evidence to back up your request. As foreigners there's a lot we can get away with, but if you want to do something that's totally out in left field, such as have your pet dog there while you give birth, don't expect your doctor to allow you to do this.



-----------------------------------------------------------------------------------------------------------------------
Tender Embrace Birthing offers childbirth, breastfeeding, and newborn care classes and support.

How to Turn a Breech Baby or Forward Facing Baby

Updated 15 November 2016

As you get further on into your pregnancy, the majority of babies turn meaning that they're head down. About 3-4% of babies are breech at term (which is 37-39 weeks depending on what doctor you talk to). Ideally they should also be facing your spine since their faces are squishy. If they're facing forward this can cause back pain and back labor. Even if your baby is facing forward there's still a chance that the baby can turn while you are in labor. Here are some things that you can do to help your baby turn.

Things that help babies get in the right position 

• Both
• Breech
• Forward facing 

Some techniques, such as pelvis rocking, myofascial release, and acupressure are traditionally used for breech babies, but can also be used for forward facing babies. Talk to your caregiver or seek out an alternative medicine specialists to see what's right for you.

• Abdominal stroking: for forward facing babies, get all on fours and have your partner stroke from one side of your belly to the other; only stroke in one direction!
• Acupuncture: traditional oriental medicine that is said to cure a lot of things.
• Acupressure: similar to acupuncture, but no needles! Bladder 67, located at the outside of the pinkie toe. Use with caution. Seek a licensed acupressurist.
• Aromatherapy: may help you relax and the baby turn. 
• Bagnell Technique: similar to Webster but also takes the cervical vertabrae into account.
• Belly dancing: can loosen muscles and help baby turn.
• Belly lifts: simply lift your belly up. This can give your baby space to move. 
• Bowen technique: gently uses the thumbs and fingers over muscles, tendons, fascia, and nerves. Frequent pauses are used in this technique.
• Breech tilt: lie on your back so your hips are higher than your heart. You can also use an ironing board. Find out more in the Spinning babies parent class and Daily Essentials. 
• Chiropractors: some chiropractors can help adjust your pelvis and spine to help the baby turn. Make sure your chiropractor has experience doing this. 
• Circuit: 3 simple exercises that you can do at home. 
• Cold at the top of your belly: this encourages breech babies to move away from the coldness. 
• Craniosacral therapy: addresses the body as a whole and believes fixing minor misalignment can have huge benefits. 
• Diet: eat more yang foods (fish, poultry, eggs, red meat, dairy, and miso). Decrease yin foods and products (fruit, ice cream, oil, coffee, sweets, drugs, chemicals, cigarettes, and stress). 
• Doulas: some doulas can help you use the techniques mentioned here. For example, Kate Beslame who is a doula and midwife has helped mothers turn their babies with moxa, Bowen technique, and hypnosis.
• Elephant walking: walk on hands and feet.  
• Emotional Freedom Technique (EFT): based on the connection between mind and body.
• External Cephalic Version (ECV): your doctor or midwife will manually try to turn your baby from the outside. It has about a 50-60% success rate but babies can flip back into a breech position. Using acoustic stimulation before an ECV is performed has been shown to dramatically increase the success rate. YouTube has some videos that show how it work. Some places will use medicine to relax your uterus and/or only do it up until 36 weeks, so be sure to ask around. Some hospitals and birthing centers in Seoul such as Cheil Hospital, Jungan Hospital, Medi Flower, Rosa, Soonchunhyun, and Yeon and Nature will do them. Here's the contact information for these places.
• Forward leaning inversion: find out more in the Spinning babies parent class and Daily Essentials. 
• Forward sitting: don't lean back while sitting. 
• Homeopathy: they often prescribe pulsatilla, ignatia amara, or natrum muriaticum.
• Hypnosis: mind over matter. Here's a sample script.
  
• Inverted shoulder stand: hold your waist so your feet are up in the air. Do twice a day for 5 minutes. 
• Light: towards the base of the belly can help breech babies turn. 
• Lunges: helps loosen muscles.
• Mayan massage: can help with alignment.
• Meditation: some believe that a mother's fears can inhibit a baby to turn. Releasing these fears can help the baby get in the correct position.
  
• Moxibustion 무연 미니 뜸: this herb is said to help turn babies between 34-36 weeks. You can buy it over the counter at Korean pharmacies.
• Music near the bottom of your belly: breech babies move towards the music.
• Myofascial release: they help release muscular shortness and tightness. 
• Pelvic rocking: Both birthing balls and peanut balls are great for this.
• Photos: get photos of babies in the optimal position and place them at work and at home so you see them all the time.
• Polar bear position (knee-chest; modified handstand): for breech babies, get on all fours, bend your elbows to the ground and stick your butt up in the air for 30-45 minutes.
• Rebozo sifting: helps loosen muscles and tension. 
• Relaxation: these techniques can help your baby turn. 
• Spinning babies: you'll learn how to what position your baby is in and how to get your baby into an ideal birthing position. Find out more in the Spinning babies parent class and Daily Essentials.
• Side-lying: helps babies turn.
  
• Side lying release: find out more in the Spinning babies parent class and Daily Essentials.
• Slow dancing: helps loosen muscles so a forward facing baby can turn.
• Squatting: helps a forward facing baby turn. 
• Standing sacral release: find out more in the Spinning babies parent class and Daily Essentials.
• Swimming: somersaults may help the baby turn. 
• Talking to the baby: telling the baby that you want it to turn.
• Visualisation: mind over matter, see your baby turning.  
• Water: you might be dehydrated and the baby doesn't have enough amniotic fluid to turn.
• Warmth near the bottom of your belly: breech babies move towards the warmth. 
• Webster Technique: is a chiropractic method. Here's how it works and the history behind it. 

Breech Babies and C-sections

Many doctors do not like to deliver breech babies vaginally and will schedule a C-section. When a baby is at full-term, their head and butt are about the same circumference. If you want to deliver vaginally, ask your doctor if they have experience delivering breech babies and are comfortable doing so or change hospitals. Some hospitals and birthing centers in Seoul such as Cheil Hospital, Jungan Hospital, Medi Flower, Rosa, Soonchunhyun, and Yeon and Nature will do them. Here's the contact information for these places.

If you are willing to have a C-section, ask your doctor if you can labor on your own first due to the hormones that your body produces. You can achieve this by going into labor naturally or being induced (pitocin is commonly used). There are many benefits for both you and your baby if you go into labor. It helps your baby get a higher Apgar score, breath better, and transition to life outside the womb more easily. It will help you bond easier to your baby, help create a transition from being pregnant to being a mom, and help your milk production.

-----------------------------------------------------------------------------------------------------------------------
Tender Embrace Birthing offers childbirth, breastfeeding, and newborn care classes and support.

Questions to Ask When You Interview a Doula

Updated 29 February 2016

There are a lot of birth doulas here in Korea now. Meeting with a couple doulas first and deciding which one you (and your partner) feel most comfortable with is best than just hiring them first doula you come across. Many doulas draw up contracts, which help both parties out. Here are some questions that you might want to ask. Gentle Birth Balance  and The Doula Book also have some very thought provoking questions to ask a birth doula.

History

• Where did you get your training? Are you certified?
• How long have you been a doula for?
• How many births have you attended?
• Have you attending a birth at my hospital? with my doctor? midwife?
• Could you tell me about some of the births you attended?
• Do you have children? Did you have a doula for your birth(s)?
• What's your view on childbirth?
• Have you attended a C-section birth? Home birth? Water birth? (Pick what's applicable)

Philosophy

• Why did you become a doula?
• How would you describe your style?
• How do you support labouring moms?
• Are there any books or websites that you'd recommend? 
• How do you involve the birth partner?
• How do you feel about pain medication? What other comfort techniques could I use?

The Fine Print

• Do you have a contract we can sign?
• What does your fee cover? What's your refund policy?
• How many births do you schedule a month?
• Is there a time limit for the birth?
• Who's your back-up doula? Can I meet them ahead of time?
• How do I get in touch with you? When should I get in touch with you?
• Will you travel?
• How many pre-natal visits do you do? For how long?
• How can you help my partner during my birth?
• Can you help me write a birth plan?
• What happens if you don't make it to the birth because it was a fast labor?

 
After the Birth

• How long do you stay after the birth?
• Do you come check-up on us after giving birth? How many times and for how long?
• Can you help with breastfeeding? 

-----------------------------------------------------------------------------------------------------------------------
Tender Embrace Birthing offers childbirth, breastfeeding, and newborn care classes and support.

VBACs (Vaginal Birth After Cesarean) in Korea

VBACs are relatively new since at one time there was the belief that "once a C-section, always a C-section". Thankfully this has changed in recent years. However, not everyone is a good candidate for a VBAC. Here are some things you can do to increase your chances of trying for a VBAC. If you already know you need to have a C-section, make sure that your doctor allows you to do these things so that you can try for a VBAC for your next birth.

• Double stitching, not single stitching
• A low, transverse incision (bikini line cut) 
• Being allowed to labor prior to getting your previous C-section can greatly help
• Time between births should be at least 18-24 months
• Many doctors will not allow you to try for a VBAC if you've already had two C-sections.
• A healthy pregnancy, not being over or underweight, eating properly, and exercising. No diabetes,  pre-eclampsia, or high blood pressure
• Being under 35
• No issues with the placenta or danger of uterine rupture
• Do your research and find out about natural childbirth vs. the cascade of interventions

C-sections in Korea
I recently blogged about signs that your doctor might perform an unnecessary C section. Unfortunately, C-sections are very common here in Korea. The rate is around 30%. Korean culture has something to do with it. Husbands rarely get days off (even though legally they're allowed 5 days paternity leave), auspicious days are chosen for the baby's birth, and the lack of education makes women believe that C-sections are easier: they're not. Most Korean hospitals will keep you for 3 days after a vaginal birth and 5 days after a C-section. Some women believe that you'll be wheeled in, cut open, sewn shut and ta-da it'll be over. It's not. Recovery takes weeks, sometimes months, sometimes women are left with permanent nerve damage and are numb.

A C-section is major abdominal surgery. Many C-sections can be avoided, especially the "emergency" C-sections. The number one, top, best ever way to avoid an unnecessary C-section (or unnecesarean) is to choose a hospital or clinic that supports VBACs (Vaginal Birth After Cesarean). It's hard enough to recover from major surgery let alone have to care for a newborn on top of it.

Where to get a VBAC in Korea
Here's a list of hospitals and clinics in Korea. Not all of them may support VBACs. Birthing centers and hospitals focused on natural birth should. Always ask a place what their view on VBACs are and what their success rate is. I can't stress it enough for you to get information. Even at the same hospital you may find some doctors who support them and some who don't. Get your doctor to sign your birth plan so that if your doctor isn't on call your wishes will still be respected. These are some VBAC friendly places in Gyeonggi-do and Seoul.

• Agitanseun Natural Birth Center (김옥진조산원) Kim Ok Jin (Rosa)
• GM Cheil Women's Clinic
• Lee Myung Hwa (행복한이명화조산원) they used to be Happy Birth  
• Mamas' Birth Center
• Medi Flower
• Soonchunhyang Hospital (SCH)
• Yeon and Nature

Getting the Birth You Want
There are many things you can do to get the birth you want. The number one thing you can do is to choose a caregiver wisely. You should also ask questions and see how likely it is that you will be able to try for a VBAC. Here are some things to consider asking:

• How far past your due date will they allow you to go? (Remember that there are different ways to calculate due dates. Add to that gestation age can vary up to 5 weeks and due dates can be up to 5 weeks off means that your due date isn't that accurate at all so doctors can get your due date wrong. Don't forget that first time moms are 8 days late on average.) The ACOG (American College of Obstetricians recommends not inteferring with a health pregnancy before 42 weeks.
• What's their C-section rate?
• What's their VBAC rate?
• Do they try to convince you to have a C section?
• Will they try to induce you if you go past your due date or automatically schedule a C-section? (Even if you need a C-section, being allowed to go into labor is beneficial for both the mom and the baby. Among other things, it allows the natural flow of hormones as well as squeezes the liquid out of the baby's lung so that it's easier to breath.)

Resources
If you're interested about learning more about VBAcs and C-sections, check out the links below. 

• American Pregnancy's info on VBACs
• C-Section: How to Avoid, Prepare for, and Recover From Your Cesarean 
• The Essential C-Section Guide
• How to Plan your VBAC
• ICAN (The International Cesarean Awareness Network). They have a section on VBACs.
• The Thinking Woman's Guide to a Better Birth by Henri Goer
• The Unnecesarean
• The VBAC Companion
• The VBAC Forum on Mothering.com 
• VBAC Facts. Check out their 13 Myths about VBACs.
• VBAC.com

-----------------------------------------------------------------------------------------------------------------------
Tender Embrace Birthing offers childbirth, breastfeeding, and newborn care classes and support.

The Bradley Method: Husband-Coached Childbirth

I found a great post about the Bradley Method. This method teaches that birth is normal, but you need to be trained for birthing because we have lost touch with our instincts. It also states that the baby's father is the best person to train the woman. Furthermore it says that he must take an active role in the birth. Dr. Bradley also strongly believes that most women should be able to give birth without any pain medication or interference.

The method can come off as my-way-or-the-highway and that the Bradley Method is superior to all other methods. However, many methods have similar beliefs. Go to Mama Seoul's blog and read more about her opinion of the Bradley Method.



-----------------------------------------------------------------------------------------------------------------------
Tender Embrace Birthing offers childbirth, breastfeeding, and newborn care classes and support.