Larger Circle

01/02/2023

2022 by some numbers (not all of them, that would be tedious):

*I accompanied 12 births! 11 clients of my own, 1 as backup
*First time parents: 58%, Multips: 42%
*Age of birthing person: all in their 30s this year
*Race/ethnicity of parents: 83% white, 8% Asian/SE Asian, 8% Jewish/Middle Eastern
*All hospital births this year
*50% of labors started on their own, 25% used cervical ripeners, 33% used a balloon and/or Pitocin, 17% of birthing people experienced blood pressure issues and/or preeclampsia
*33% unmedicated, 58% epidural, 25% narcotic or nitrous
*42% of birthing people had intact perineums, 58% tore
*Average length of labor 36 hours (there were some long ones this year)
*Average time pushing 1 hour 15 min
*75% spontaneous vaginal births, 25% primary cesarean births (2 primips, 1 multip), 8% VBAC
*Average time I was present at a birth: 8 - 9 hours

08/12/2021

News you can use.

Pregnancy and vaccines: Latest and greatest

The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM)- the two leading organizations for OB clinicians- strongly recommend vaccines for pregnant people. Yesterday, the CDC strengthened its guidelines to align with the ever growing body of scientific evidence that mRNA vaccines are safe and needed for pregnancy.

***There is a great need***
Only 23.3% of pregnant people have received at least one vaccine dose in the United States. And, among them, there is overwhelming racial/ethnic disparities. Asians have by far the highest vaccination rate (like the general public) at 34.7% and Blacks have the lowest at 10.9%.

Pregnant people that don’t have an immunity wall in the wake of Delta is a huge problem. They (and their unborn babies) are at high risk for severe COVID-19 disease. By now this is well-established, as there have been 42+ studies on this topic thus far. Pregnant people with COVID-19 disease are…

…more likely to go to the ICU, need ventilation, and/or need oxygen compared to non-pregnant (here)
…more likely to have preeclampsia (here)
…more likely to die from COVID19 (here, here)
…more likely to have babies born preterm (here) or stillborn (here)
…more likely to have their babies admitted to the neonatal unit (here)

***What prompted the CDC to strengthen guidance?***
While there is no biological reason to expect that mRNA COVID-19 vaccines present a risk to pregnancy, pregnant people weren’t eligible for clinical trials (this is normal practice that is under high scrutiny) so real world data is important to track.

A new study came out this week in which scientists analyzed V-safe data- an active surveillance program initiated by the CDC to evaluate “real world” safety of vaccines. In the database, 2,020 pregnant people received an mRNA vaccine preconception or prior to 20 weeks’ gestation. They were then followed until birth and beyond (and, if willing, continue to be followed for data). What did they find?

A total of 165 participants reported a miscarriage (i.e. spontaneous abortion), of which 154 occurred prior to 14 weeks’ gestation.
After taking into account age of the mother, the risk of miscarriage was 12.8%. Which is the same risk of miscarriage in the general population.

***This evidence adds the numerous other studies on this topic***
In June, the New England Journal of Medicine also published results using V-safe. (See my previous post about it here). In short, among the 3,958 pregnant people, they found no unexpected pregnancy or infant outcomes related to COVID-19 vaccination during pregnancy, regardless of when they got vaccinated (1st, 2nd, and 3rd trimester). Specifically, they found that of the 827 people who completed pregnancy, pregnancy loss, preterm birth, babies size, congenital problems, and death was not different among those with the vaccine compared to the background rate.

***Vaccines protect the babies (once they’re born) too!***
If a pregnant person gets vaccinated, there is mounting scientific evidence showing that babies get protection too. Both through antibodies crossing the placenta (here, here, here, here, here, here, here) and breastmilk (here, here, here).

***Bottom Line:***
If you’re pregnant you need the vaccine. It not only protects you but also protects the baby. We have overwhelming evidence that the vaccines are safe. And, not only that, they are overwhelmingly better than getting a COVID19 infection, which is likely to happen in the Delta wave.

Love, YLE

For the graphs and data sources, as always, go to my newsletter here: https://yourlocalepidemiologist.substack.com/p/pregnancy-and-vaccines-latest-and

01/18/2021

First dose!

11/11/2020

These are the doulas I work with in the Philly Doula Coop!

10/20/2020

All-virtual support isn't the ideal; but sometimes it can really, really fill a need.

"COVID hit when I was pregnant. Worse, my waters wound up breaking early and I was stuck in the hospital on bed rest for three weeks without visitors -- not even my husband. So we didn't get any prenatal visits, and the hospital didn't let us have a doula at the birth. Dawn worked with us to find a way to help us. We did Zoom prenatal visits. I went into labor on my own at the hospital. My husband got me through but once transition hit, I needed Dawn. She coached me over the phone. She is so experienced that she could tell I was in transition by the sound of my voice. Her coaching over the phone got me through it. I don't think I could have done it without her. She stayed on the phone with me for hours. Although not ideal, I am so grateful she was there with me through my birth, which was a successful unmedicated birth, despite the PPROM -- and despite a brow presentation! Dawn is motherly, kind, and down to earth. I highly, highly recommend her services." - A., April 2020

10/13/2020

Doulas are good to have around when things don't go the way you were expecting!

"Dawn was my doula for a very difficult birth. I had severe preeclampsia, and things got very medical very quickly. Despite all of this, having her presence in the room with me was such an important part of my birth experience. She was knowledgeable and caring, and helped me advocate for myself with doctors, as well as helped bolster my partner so he could be there for me too. Her encouragement and support were very much a part of how I was able to deliver my daughter. I am forever grateful and glad to have had her there with me." - S., April 2017

10/06/2020

What's it like to work with a doula during Covid-19? This birthing person shares her experience working with me during a planned birth center birth with an unexpected transfer to the hospital:

"I had my second child in June at a birth center with a hospital transfer. My labor was long and hard and had the added bonus of happening during covid. I don't think we would have survived without Dawn. She was the calm within the storm. She has a wealth of knowledge from her own birthing experiences and the births she has attended. She kept me focused and was always advocating for me. She offered suggestions and comfort which were definitely needed. When I think back on my experience; her words, patience and strength consistently come back to me. Even though we are close in age, her presence was definitely akin to having a mother present. A very competent and compassionate mother. Any birthing mother would be lucky to have Dawn's assistance at their labor." - M., June 2020

09/29/2020

Review from a client with a scheduled c-section:

""A friend recommended Dawn-Star so we arranged to meet up to see if it would work out. I found Dawn-Star very easy to chat to and felt very comfortable in her presence. After my second appt with her I discovered I was likely to need a c-section as my son was breach. She worked with me on some practices to try and turn him around but unfortunately no success. Although ended up with a scheduled c-section it was still great to have Dawn-Star there prior and for a short while after. She was a great calming presence and familiar with hospital processes. She took some great photos of my husband and son while I was still being cared for. Her visit a couple of days back at home was very reassuring to ask some questions. If I was to have another pregnancy I would look to have Dawn-Star help again." - H., July 2019

09/22/2020

A repeat client shares her experience: "Dawn Star has been my savior with a small "s" two times over now. After experiencing having her as my Doula, I hope I never have to give birth without her in my presence. She is very kind, caring, and a very good listener. I think she has a lot of empathy because she has been pregnant herself and given natural childbirth four times over to her beautiful children. I recall the last weeks of my pregnancy, I either called or texted Dawn with a question almost every day and she always got back to me promptly. For one of my boys, she arrived at the hospital before I did! She is a strong woman. I recall her allowing me to put all my weight on her for about two hours as she helped me during a very difficult part of my labor. If I was given the gift of another baby, I would choose Dawn in a heartbeat to walk alongside me during my pregnancy and be present at the birth of my child." - E., September 2017 and June 2015