BirthKuwait Inagural Gala

BirthKuwait Inagural Gala
celebrating 4 years of giving (note: it's by invite only)

Thursday, December 11, 2014

Be a Savvy Birth Consumer Part I

City Pages February 2014 Article
* see page 34

Do you want to get the most out of your birth experience? Be savvy. Understand the language used during birth and make informed decisions.
While birth is a normal process and research shows that many of the routines at hospitals today are not necessarily beneficial and may even be harmful[1], the fact remains that birth today has become intervention-intensive and the majority of moms in Kuwait will likely experience one or more intervention during their birth. Most of the statistics for these interventions are not publicly available in Kuwait, so I will use the most recent statistics for women in America. The most recent Listening to Mothers Survey[2] showed that the majority of women surveyed experienced one or more of the following interventions during labor:
   Continuous electronic fetal monitoring (EFM)(93 percent)
   Restrictions on eating (87 percent)
   IV fluids (86 percent)
   Restrictions on drinking (66 percent)
   Episiotomy (35 percent)
   Epidural anesthesia (63 percent)
   Artificially ruptured membranes (55 percent)
   Artificial oxytocin augmentation (53 percent)
   Cesarean surgery (24 percent)

What would those numbers look like in Kuwait? Perhaps some would be higher and some would be lower. The point is that you should be familiar with some technical medical terminology before you give birth. In the next two articles we will provide you with a brief explanation of the terms you should be familiar with before you give birth:

Continuous Electronic Fetal Monitoring (EFM):

You know the machine they hook you up to by wrapping stretchy cloth around the top and bottom of your belly to hold in place two little circles? Yep, that is the EFM machine. The EFM was designed to continuously monitor the baby’s heart rate in an effort to detect fetal distress and prevent injury. Sounds innocuous, yes? However, research shows that one of the unintended consequences of the routine use of continuous EFM is an increase in cesareans without any improved outcomes for babies.[3] (Translation: harmful for mom, no benefit to baby.)

The key words are: Routine and Continuous. The WHO and ACOG (American College of Obstetrics & Gynecologists) recommend intermittent monitoring with a Doppler or stethoscope during labor for low-risk healthy moms, every 30 minutes during active labor and every 15 minutes during pushing.[4] This also allows mom to be active and upright during labor which will help keep her comfortable and move things along.

Research shows that there are benefits to continuous EFM if you are using Syntocin/Pitocin, have an epidural, your baby is experiencing changes in heart rate, or if your or your baby are not in good health. But if you are a healthy low-risk mom, research shows that you would benefit more if your doctor monitored you and your baby intermittently with a Doppler or stethoscope.

Restrictions on Eating and IV Fluids:

OK, so doesn’t it sound a little crazy in the same sentence: Restricting normal eating and drinking, but then trying to keep mom nourished through an IV? The practice of restricting moms eating and drinking began when the majority of moms gave birth under anesthesia and the accompanying fear of aspiration. In addition, studies have confirmed that that are no medical benefits to routinely restricting eating and drinking during labor.[5] Instead it deprives a woman of energy when she needs it most. In addition, routinely hooking up mom to an IV during labor restricts movement, may adversely impact labor progression if mom becomes over-hydrated, and increases risk of low blood sugar in babies.[6] The WHO and ACOG recommend fluids be offered to mom by mouth, and the routine use of IV fluids be eliminated. If you are a healthy low-risk mom ask your doctor about a hep-lock, an IV started in your hand/arm that is capped off so that it is in place and available but does not interfere with mom’s movement and normal labor progression.


This is a controversial procedure with no easy explanation. Sometimes when moms are pushing their babies out, the doctor makes an incision to widen the birth canal (yeah- they cut down there!) This is a controversial procedure because research has provided no evidence that an episiotomy reduces the risk of perineal injury, improves perineal healing, prevents birth injury to babies, or reduces the risk of future incontinence (these are all reasons cited by doctors for the routine use of episiotomies).[7][8] Research does show that routine or liberal use of episiotomy is likely to be ineffective and harmful to mother[9] (the list of risks to mom are too long for this article). In addition, the WHO recommends eliminating routine or liberal episiotomy.

Of course there are times an episiotomy would be beneficial. For example, if a change of position or taking a break from pushing does not resolve signs of distress in your baby, or if your baby is very large or in an unusual position (again, first try changing your positions to see if it helps) an episiotomy might be necessary. If you want to avoid an episiotomy, discuss your concerns with your doctor before hand and choose your care provider carefully, push in an upright position that lets your birth canal stretch gently as your baby descends, change positions often while you’re pushing, push spontaneously when you feel urges rather than directed, and remember your body knows how to give birth and be patient!

[1] Lamaze Healthy Birth Practice 4: Avoid Interventions That Are Not Medically Necessary, The Official Lamaze Guide: Giving Birth With Confidence

[2] Declerq ER, Sakala C, Corry MP, Applebaum S, Herrlich A. Listening to MothersIII: Pregnancy and Birth. New York: Childbirth Connection, May 2013

[3] Goer, H., Leslie, M. S., & Romano, A. (2007). The Coalition for Improving Maternity Services: Evidence basis for the ten steps of mother-friendly care. Step 6: Does not routinely employ practices, procedures unsupported by scientific evidence. The Journal of Perinatal Education, 16(Suppl. 1), 32S– 64S.
[4] American College of Obstetricians and Gynecologists [ACOG]. (2005). ACOG practice bulletin #70: Intrapartum fetal heart rate monitoring. Obstetrics and Gynecology, 106(6), 1453–1460.

[5] Goer, et al, (2007)

[6] Enkin, M., Keirse, M., Neilson, J., Crowther, C., Duley, L., Hodnett, E., et al. (2000). A guide to effective care in pregnancy and childbirth. New York: Oxford University Press.

[7] Goer et al, (2007)

[8] Hartmann, K., Viswanathan, M., Palmieri, R., Gartlehner, G., Thorp, J., & Lohr, K. N. (2005). Outcomes of routine episiotomy: A systematic review. Journal of the American Medical Association, 293(17), 2141–2148.

[9] Klein, M., Gauthier, R., Robbins, J., Kaczorowski, J., Jorgensen, S., Franco, E., et al. (1994). Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation. American Journal of Obstetrics and Gynecology, 171(3), 591–598.

Sunday, November 30, 2014

Car Seat Safety For Infants

How many of you use car seats for their kids? Up to what age are you using them? Do you know when you are supposed to switch to the next category?

To know more, read our article in the November issue of City Pages magazine:
click next 23 times to reach the page

Saturday, August 2, 2014

Birthing With Confidence in the GCC


BirthKuwait is pleased to announce an upcoming Conference: Birthing With Confidence in the GCC, Promoting Maternal and Infant Health Through Training Workshops for Professionals, Community Health Care Workers and Maternal Health Care Advocates, which will take place in October from the 14th to the 18th include:

1. Lamaze Childbirth Education Workshop (5 days Oct 14th-18th)

2. Breastfeeding Counselor Training (4 days, Oct 14th-17th)

3. "Breastfeeding Your Baby" Lactation Educator Workshop (For Professionals Only, 1 day on Oct 18th)

4. DONA Doula Training Workshop (3 days, Oct 16-18).

For more information check below:
(This document opens in google drive document)
Course Description

Training Workshops are facilitated and approved by renowned international maternal and infant health advocates: Lamaze International, EPI,  DUKE AHEC, DONA, and our local partner FSRI.

Please fill in the Application Form and e-mail it back to us on the e-mail below.
Kindly note that you need to fill this application on your pc or laptop
Here are some simple steps to fill the form:
1. Download the application
2. Open the application
3. Fill the application  ( by using sign mode )
4. Save as : add your name to the saved file ( save as a file on your pc or laptop)
5. Email to : with the attachment
6. Send

For details and registration, please visit or e-mail:

Wednesday, July 30, 2014

Make the Most of Your Epidural

The majority of birthing mothers at private hospitals today decide to get an epidural. Sometimes this is a decision made before labor ever began or a change in plans after a long and drawn our labor. The great thing about an epidural is it allows women to be awake and aware yet free from pain during labor and birth. It allows an exhausted mother to rest or sleep. And while an epidural’s usual effect is to slow labor, the profound relaxation they offer can sometimes put a stalled labor back on track.

However, epidurals, like all medical interventions, come with inherent risks, including the increased risk of a vacuum or forceps assisted delivery, an increased risk of an episiotomy or tear, an increased risk in a drop in blood pressure, possible nausea and itching as side effects of the narcotics, and the possibility of problems with breastfeeding. A very small percentage of mothers may experience life-threatening complications. Some mothers may also feel more anxious or stressed by all of the cords and beeps and noises associated with the epidural, and the common side effects (drop in blood pressure, difficulty breathing or swallowing) may case temporary psychological distress.

But most women experience epidurals as they are meant to be: almost complete pain relief with minimal side effects. To make sure you get the most out of your epidural and lower your risk of complications, I would suggest the following:

First, choose a care provider with a cesarean surgery rate of 15% or less. Studies show that in the hands of care providers with low rates, epidurals do not increase cesarean odds. Practitioners who have vaginal birth as a goal will have more patience and manage labor and epidurals differently than others.

Second, delay an epidural until active, progressive labor (around 5-6 cm). This will help prevent two problems: running a fever, which becomes more likely the longer the epidural is in place, and the baby persisting in the occiput posterior position (head down, facing the mother’s belly). These complications increase the likelihood of cesarean or instrumental vaginal delivery. And because epidural-related fever cannot be distinguished from fevers caused by infection, babies are more likely to be kept in the nursery for observation, undergo blood tests and possibly a spinal tap, and be given precautionary I.V. antibiotics.

Third, move every 30-60 minutes by rotating from your left to right side. If you baby is in an anterior position, keeping a pillow between your legs will be sufficient. If your baby is in a posterior position, trying extending your top leg far over the bottom leg and lie with a pillow supporting your top shoulder and arm so that you are almost lying on your belly (but obviously not fully on your belly!!) This often helps the baby to navigate the pelvis during a posterior birth.

Fourth, many mothers begin to shake and their teeth chatter as the hormones of birth, including adrenaline, fill their body. A wise midwife once showed me a way to help keep a mother “centered” during these episodes and help the shaking to stop. Place the father’s (or other support person) hand over the mother’s heart, directly on her skin, providing firm pressure over her heart chakra. Encourage the mother to draw on the strength of her partner or other support person to become centered and grounded once again and to reestablish calm and steady breathing. Keep the firm pressure of the hand over the heart for as long as needed or every time the shaking returns.

Finally, whether an epidural is Plan A or B, take classes that prepare you for coping with labor without one and consider hiring a doula. You will want a variety of comfort measures and coping strategies at your fingertips. For one thing, you may need them if you are delaying an epidural until active labor. For another, the anesthesiologist may not be available when you want your epidural, or you may be among the 1 in 10 women for whom it does not work. It is also possible that labor will turn out to be easier than you thought and you decide you don’t need one after all.

Epidurals can be a great medical tool when used wisely and with caution by mothers who are informed and supported.

Previously published in CityPages July 2014
By Sarah Paksima, BirthKuwait President Emeritus, Doula, Lamaze Childbirth Educator, Prenatal Yoga Instructor