Prevent Complications Associated With Cesarean Delivery

A wonderful, concise, evidence-based article by Dr. Patrick Duff was published in the December edition of Obstetrics and Gynecology entitled, "A Simple Checklist for Preventing Major Complications Associated with Cesarean Delivery".

Dr. Duff proposed the following evidence-based eight steps to significantly reduce maternal morbidity and mortality associated with cesarean delivery:

1. Clip the hair at the surgical site just before making the incision

2. Cleanse the skin with chlorhexidine solution rather than povidone-iodine solution

3. Administer broad-spectrum systemic antibiotic prophylaxis before the surgical incision rather than after the neonate's umbilical cord is clamped

4. Remove the placenta by traction on the umbilical cord rather than by manual extraction

5. Close the uterine incision in two layers rather than one

6. In women whose subcutaneous tissue is greater than 2 cm in thickness, close the layer with a running suture

7. Patients at intermediate risk for deep vein thrombosis [BMI > 30, those with gross varicose veins, those immobilized for > 4 days before surgery, those who have concurrent medical illness that predisposes to thromboembolism (e.g. sickle cell disease, sickle cell C disease, cancer, antiphospholipid syndrome, hereditary thrombophilia with no history of DVT or PE)] should receive prophylaxis postoperatively with either sequential compression devices or subcutaneous heparin

8. Patients at high risk for postoperative deep vein thrombosis (those with more than two risk factors in the moderate-risk category, those with prior DVT or PE, those who have a cesarean hysterectomy) should receive prophylaxis with both sequential compression devices and subcutaneous heparin until the patient is fully ambulatory

Referenced article: Obstet Gynecol 2010;116:1393-6

Mindfulness and Parenting

A very helpful excerpt on the benefits of practicing mindfulness while undertaking the challenges of parenting - from Jon Kabat-Zinn's chapter "Parenting and Practice" in Wherever You Go There You Are: Mindfulness Meditation in Everday Life.

And it gets more challenging as the children grow older and develop their own ideas and strong wills. It's one thing to look after the needs of babies, which are very simple, after all, especially before they can talk and when they are at their absolute cutest and most adorable. It's quite another to see clearly and to respond effectively and with some modicum of wisdom and balance (after all, you are the adult) when there is a continual clash of wills with older children, who are not always so cute and cuddly, who can argue circles around you, tease each other mercilessly, fight, rebel, refuse to listen, get into social situations in which they need your guidance and clarity but may not be open to it; in short, whose needs require a constant energy output that leaves you little time for yourself...

These trials are not impediments to either parenting or mindfulness practice. They are the practice if you can remember to see it this way. Otherwise, your life as a parent can become one very long and unsatisfying burden, in which your lack of strength and clarity of purpose may lead to forgetting to honor or even see the inner goodness of your children and yourself.

Children can easily become wounded and diminished from a childhood which consistently fails to adequately honor their needs and their inner beauty. Wounding will just create more problems for them and for the family, problems with self-confidence, with communication and competencies, problems that don't disappear on their own as the children grow older but usually amplify...

It is obvious that, with all that energy going outward, there has to be some source of energy coming in which nurtures and revitalizes the parents...I can think of only two possible sources (of this energy): outside support from your partner, other family memebers, friends, baby-sitters and so on and from doing things you love, at least occasionally; and inner support, which you could get from a formal meditation practice...if you can make even a little time in your life for stillness, for just being, for just sitting, or for doing a little yoga, for nourishing yourself in ways that you need to be nourished...

Parenting and family life can be a perfect field for nindfulness practice, but it's not for the weak-hearted, the selfish or lazy, or the hopelessly romantic. Parenting is a mirror that forces you to look at yourself. If you can learn from what you observe, you just may have a chance to keep growing yourself.

Picture: My husband, Stuart and our three sons in 2003 (Mitch 19, Shayne 14, Alex 13)

I wish I knew then what I know now!