Archive for the ‘OB’ Category

Technology and the Prenatal “Diet”

Wednesday, February 17th, 2010

In westernized countries, television and the internet have almost completely replaced the generational teaching and learning found in the “circles” of the past. Women would gather over sewing, quilting, canning, and life events including pregnancy and childbirth. They offered support, told their stories, spoke of family life, shared their everyday knowledge, wisdom and expertise while the children played at their feet.

At first glance it seems that through these technologies women are able to gain vast amounts of incredible knowledge regarding childbirth.  There are very popular websites, message boards and forums to meet and greet other women who are expecting the very same month.  Any topic is available to explore. Excellent places for a sense of community and belonging. The information is so prevalent that some women even eschew childbirth classes because they feel well enough prepared from all the exposure. Fantastic to be sure, at first glance.

Upon a deeper look  with a critical eye at the most popular shows and on-line communities, it becomes pretty obvious that overwhelmingly the messages and scenes actually have little to do with real encouragement and instilling confidence in a woman’s design and inherent ability to birth.

Let’s start with the satellite/cable television shows on the learning and health channels. Stop for a moment and think of what occurred during the last episode you viewed.  Did you see a spontaneous labor from entry to hospital to birth without augmentation, epidural, or any other intervention except for intermittent monitoring and perhaps a saline lock (IV port) placed? Was it an induction with an epidural? Was it a cesarean or a vaginal delivery? Did she have adequate support? Was her background given in any detail? Who made the decisions? What about informed consent? Was the laboring woman paid attention too or were the machines heeded more? What sort of comfort measures did she employ? Was she ever out of bed? Who delivered the baby?  What response to her baby did the mother have? Who saw her baby first? With that clear memory in mind, how did you feel after viewing it? What thoughts came to your mind? Now consider that essentially all of the births shown take place in a hospital. In fact any birth that does not, is often touted as extreme or some other like descriptive.

Let’s move on for a moment.

Now let’s take a look at the most popular pregnancy websites, message boards and forums where women connect with one another.  The “conversations” and threads are filled with all things related to the impending birth. Chatter about baby showers, maternity leave, body changes, vaccinations, previous experiences, breastfeeding, nursery preparations and so much more. Really anything under the prenatal sun. Inspecting further though, there seems to be an inordinate amount of discussion regarding the need for scheduled inductions and cesareans and very little conversation or even support for natural or spontaneous labor and birth.

With intervention appearing to be the ruling majority within the technological communities and filling the television, how is a pregnant woman feeding her eyes, heart, and mind on this type of diet supposed to feel confident, uplifted and excited about her upcoming birth? I am uncertain that she can with the seeds of inadequacy, fear, brokenness, helplessness, and lack of options being sewn into her being at such an alarming ratio.  Sometimes yes interventions are needed, however, in practice it isn’t a need for many women and babies.

These shows and internet locales are like junk food. Like all junk food they are not to be an integral part of a healthy prenatal “diet” that will be encouraging, expand useful knowledge, grow confidence, spark self-advocacy, promote self-awareness, ignite excitement, and offer joy to the expecting mother.

How can an expecting mother improve her “diet” regardless of the type of birth she is planning? What are the better places to “shop”?

  • Turning off the TV
  • Check out and attend local groups and support meetings. Educational sessions and workshops are often free of charge. For example: Doula Groups, ICAN, Midwifery Groups, Birth Network, Birth Circles, and similar.
  • Try some different message boards, forums and sites. See Blog Roll and Resources listed on this site.
  • Seek out positive free videos to watch on You Tube.  https://prepforbirth.com/2009/07/30/birth-videos/
  • Talk to women who have birthed in the hospital, birth center and at home. Get a variety of positive stories.
  • Try some different reading on for size. https://prepforbirth.com/books-videos-and-more/
  • Rent or borrow movies from Netflix, a doula or childbirth educator, such as, Business of Being Born, Pregnant in America, or Orgasmic Birth to name a few.
  • Take the challenge to learn about and be open to the variety of birthing techniques, locations, options and provider types that women are utilizing.

Bottom line, the most prevalent “food group” in a diet is going to positively or negatively affect the parts and the whole of the journey to having a babe in arms.  No matter what the mother and baby live with the outcomes from the birth. Enriching the prenatal “diet” is not a guarantee of outcome or path to the birth. It does however give much more possibility and opportunity for both mother and baby to have a better birth and start together.

Preparing For Birth – Labor Length and Progress

Monday, October 19th, 2009

There are always questions on what is the normal length for labor and what is not.  Women in labor are not static.  Though there may be averages, falling outside of those may not be reason to manage labor by augmentation or cesarean.   Patience and individualized care tend to be the biggest keys to better labor outcomes.   Of course, maternal emotions, fetal positioning, maternal movement in labor or lack thereof, use of epidural or other pain management, provider or staff attitudes, over use of vaginal exams, continuous monitoring without risk association, and other can influence the normal course of labor.  There is no one-size fits all time-line to put on a mom and baby.

Generally as long as a progressing labor doesn’t all of a sudden stall out, become unorganized, or stop without a reason (see above), dystocia may not be present at all.

Below is a compilation list of information relating to progression of labor and dystocia.

Dytocia Defined First time Mothers AAFP

diagnostics – reassessing the labor curve.pages

Varney’s Midwifery Book

http://emedicine.medscape.com/article/260036-overview

Spontaneous Vaginal Delivery – AAFP

Labor Progress Handbook excerpt.

http://www.guideline.gov/algorithm/5587/NGC-5587_6.html

Helpful hints for keeping labor progressing:

  • If at all possible (lacking medical necessity),  do not arrive at the hospital or birth center prior to well established labor (contractions as close as 3 minutes apart and a minute or more long).
  • Eschew labor induction for any reason other than medical.   https://prepforbirth.com/?s=labor+induction
  • Decline pain management if at all possible.
  • Labor in the water.
  • Continue to eat and drink in labor.
  • Hire a labor doula.
  • Attend evidence-based childbirth classes – not good patient classes.
  • Attend meetings in your community who promote natural, healthy birth practices: ICAN, Birth Network, local doula organization, etc.
  • Read variety of books – https://prepforbirth.com/products-page/books-videos-and-more/
  • Surround yourself with those who believe in you.
  • Be confident that you can birth!

Remember, a mother and baby are a unique pairing.  Some labors are short and some are long. Progress is defined by much more than cervical dilation. There is a huge spectrum of normal. No mother and baby will fit into a box.

Lastly, prior to labor also make sure you understand what your provider’s expectations are and how dystocia is defined.  That alone can determine whether or not you will have a successful vaginal birth.

Shocking quotes regarding maternal choice to VBAC birth

Friday, October 16th, 2009

Joy Szabo has been in the news lately for desiring a second VBAC for her fourth baby (vaginal birth, emergency cesarean, and vaginal birth).  She has been denied locally in her area of Page, AZ to have a vaginal birth. Due to this situation, the International Cesarean Awareness Network has been assisting her in fighting the VBAC ban along with seeking out additional options.

After reading the latest article regarding Ms. Szabo, I am completely dumbfounded by the remarks made by other readers of her story.  I am stunned by how it seems the general populous regards a woman’s autonomy and medical rights.  I am also including positive comments as counterpoint. Where do you fall?  What do you believe? Many of these comments point me in the direction of what is so wrong with the system.  That of physician and hospital trumping patient.

You decide is the comment pro or con?

“…..it seems like many people do not grasp malpractice and insurance companies. This is not about the hospital, but about medical professionals and hospitals not wanting litigation. Can you blame them? After spending tens of thousands of dollars on an education before making a dime, I would do what I needed to to avoid a lawsuit, too! … we go to doctors because they DO know what is best for our health! Like another poster said, in health care, the customer is NOT always right.”

“My son was born by c-section, then my daughter vaginally, with no adverse affects. While I agree it’s the doctor’s decision to take the risk or not, it seems over-the-top conservative. Does the doctor’s insurance premium go up if this procedure is performed? Then charge more and give the patient the option.”

“C-sections are done in the US more routinely than in any other developed country but our infant mortality rate is not lower but higher. Doctors do not want to deliver on weekends, at night, if the mother is one week over her electronically determined due date. Yes complications can happen, more so if you are made to stay in a bed hooked up to monitors, a monitor screwed in to the baby’s head, your water broke prematurely, inducement before the baby or mother are physically ready to give birth. All of this leads to more injuries and deaths than needed. Doctors look upon birth as an illness, not the process that it is – an inexact human birth. I am not suggesting giving birth in a field alone, but a c-section has a greater risk than the V-Bac especially if she has had one already. C-sections for true emergencies yes, otherwise no.”

“Did anyone else notice that when they list the risks of a C-section, they failed to mention that the mother is 4-7 times more likely to DIE than with a vaginal birth.?!?!?! They also fail to mention all the potential complications to her health, the roughly 30% rate of problems following the surgery (some severe enough to require rehospitalization) and the challenges associated with caring for children while recovering from major abdominal surgery.  Good for this mom and I hope more mothers will take courage from her”

“This story is exaggeration. If the woman wants a vbac, she just has to show up at that hospital in labor and refuse a section. They can’t force her to have a c-section no matter what they would prefer she do. You can’t force a woman to have a c-section under any circumstances, so as long as the docs and nurses say she and the baby are tolerating labor, she has no reason to fear being forced into an operation.”

“I worked in the hospital for 5 years and then in a birth center for the last 4 years. I had to get out of the hospital because I started feeling guilty about my complicity in that system in which so much goes on behind closed doors of which the patient is never informed. I’ve had docs tell me in the lunch room that they are doing a c-section because they have an important golf game, fishing trip, or hot date. Then they go into the room, lie to the woman and say, ” oh your baby is too big, your progress is too slow, it’s never going to happen.” the woman believes them and thanks them so much for saving their babies lives. Over and over and over again. In Miami we have over 50% c-section rate, and it’s way more convenient for the docs. If VBACS are not allowed at more and more hospitals, the rest of the country will soon be like it is here…..”

“I find this decision by the hospital(s) to not do a VBAC as a little crazy. My older brother was born (in 1955) by C-section; both me (in 1958) and my younger brother (in 1962) were born vaginally. NO COMPLICATIONS. It could be done 50 years ago, but not now??”

“The risk of MAJOR complication from a second cesarean is TEN TIMES that of the risk of uterine rupture in a VBAC mother. Someone please explain to me how an “elective” repeat cesarean is safer than a VBAC? Especially since more than 75% of uterine ruptures occur PRIOR to the onset of labor. How is a scheduled cesarean at 39 weeks (which is the ACOG recommendation) going to save the mother who ruptures at the dinner table at 34 weeks? Using their logic, we should all go live at the hospital the moment we become pregnant after a previous cesarean, just in case our uterus blows up and we need an OB and an anesthesiologist “immediately available”.”

So what do you think?  It worries me that is seems the mother’s rights do not count for much. That in some of the comments the idea of  forcing a cesarean is no big deal if it makes the doctor’s position safer.

I think that most people are woefully under educated on childbirth and what safety really means.  A conservative physician errs on the side of evidence not defensive practice.  Do your own research. Be your own advocate.

Preparing For Birth – The Passage from She Births

Sunday, October 11th, 2009

The below writing in my opinion is one of the most eloquent and beautiful takes on labor and birth I have read.   I am using it by permission of the author, Marcie Macari from her book She Births.   I encourage you to go to her site and see her offerings.  Inspiring and fantastic. Thank you Marcie for allowing me to bless others.

I have and will continue to use this piece as a visualization with clients and class participants.  Enjoy!

“The Passage” from She Births by Marcie Macari

The earth shook. The women gathered.

The chanting of The Women Of a Thousand Generations began,  their hands intertwined.

I breathe low, moaning deep through my body to touch the depth of sound they generate.

And for a moment I am with them.

“We’re here-with you, you are one of us-you can do it!”

One of them

I breathe.

The coals glow-mocking my strength

Embers flick their tongues tormenting my courage.

I step onto the coals-

The Women Of a Thousand Generations push closer to the embers- their faces glowing from the coals.

I keep my eyes on them, focusing on THEIR ability to push through the pain, to keep walking in spite of their fear- remembering that they made it to the other side.

I find MY courage and step again.

I feel the embers, and wince.

The Women start beating a drum.

I find their rhythm in my abdomen, and slowly move forward:

One step- look at the face.

Second step- focus on the eyes.

Third step…

I see the African dancers, rehearsing their steps as I walk my last few.

I see the circle being set-the fire at the center,  the food and festivities.

This will be the stage for my welcoming into this elite group- this Women Of a Thousand Generations.

My heart swells.

I am close to the end now, and my body starts to shake-

Spirit stronger than flesh.

I want to give up-to step on the cool grass

And off these coals.

I look for the faces, and my eyes meet theirs.

One of them smiles.

She who is With Woman, reaches out her hand

Her face is the clearest, eyes at my level.

“Listen to your body and do what it tells you” She says-no trace of concern.

The chanting changes: “Listen to your bo-dy”

In rhythm, hands are again joined, like an infinite chain.

I realize just how many have gone this way before me.

The one who smiled places her hand on the shoulder

of the One who is With Woman- with me, and I breathe,

stretching out my hand to grasp the outstretched.

I am about to cross over-

Silence comes over the Universe.

I near the end-

my body aches,

my mind is empty of everything but that last step.

Last step.

Hands grasped.

Cool grass. On my toes, cooling my feet-

my arms reach out to claim my prize-

“Reach down and take your baby.”

I hold him to me tightly, and proudly take my place in the chain.

I am now a Woman Of a Thousand Generations.

The celebration begins.

Excerpt from She Births: A Modern Woman’s Guidebook For an Ancient Rite of Passage, by Marcie Macari.

“There is more to Birth than the physical process of having a baby. Birth is a Spiritual Rite of Passage for women, offering an opportunity for profound transformation. She Births challenges each woman to consider how their Birth Choices profoundly affect not only their lives individually, but the world as a whole.”

How real is active phase arrest of labor?

Thursday, September 17th, 2009

Preparing For Birth: 35+ and Pregnant

Wednesday, September 16th, 2009

Hourglass

The disturbing trend in treating ALL  “advanced maternal age”  mothers (over 35 at the time of impending birth) high risk continues to grow despite lack of evidence to do so.

My original post from 3.5 years ago still rings true today.

They are being subject to weekly Biophysical profiles or Fetal Non-stress tests tests that are normally reserved only for high-risk mothers and babies from as early as 32 weeks in pregnancy.  On top of the scans, these mothers are often pressured to agree to an early delivery of their babies by means of labor induction or cesarean even without other risk associations.  This is growing more and more prevalent especially for women over 35 who are first time mothers.

I have heard even from women that at their first OB appointment they are being told they will be induced at 39 weeks as a standard of practice and expectation for signing on with said provider.  The seed of fear and worry is being planted that their growing baby will die if the pregnancy goes to 40 weeks or longer.  What a way to start out a provider/mother relationship.  I would call that a red flag of immense proportion.

So what really is the big deal with “old” mothers?  This study Advanced Maternal Age Morbidity and Mortality correlates various medical issues with “AMA” mothers though the biggest hot button is an elevated yet unknown cause of perinatal death.  This statement alone has caused a huge shift in the way these mothers are viewed regardless of  overall pregnancy health and absence of any known risk associations. ACOG’s February 2009  Managing Stillbirths maintains there is a risk to older mothers with no explanation as to why there is a risk, what the percentage of  risk increase is or any prevention protocols.  Seems dodgy since the other groups noted in the bulletin have all the data included.

There are some serious problems with any practitioner taking this study and applying it across the board to “AMA” women.  The study even says so much, “It is important to note that the findings of this study may not be generalized to every advanced-maternal-age obstetric patient in the United States. Although the FASTER trial patient population was unselected, meaning that patients were not excluded based on any confounding factors such as race, parity, BMI, education, marital status, smoking, pre-existing medical conditions, previous adverse pregnancy outcomes, and use of assisted reproductive care, there may have been significant patient or provider self-selection.” So the population could have been skewed from the get go by provider or patient selection, along with the fact that it seems the only point of homogeneity is present in that most of the women were Caucasian.  Throw all these women in a pot and see what happens?  Next step is to make protocols and change practice style upon weak findings?

The study also shows an increased risk for cesarean by “AMA” mothers.  “As with prior literature, this study demonstrated that women aged 40 years and older are at increased risk for cesarean delivery. Older women may be at increased risk for abnormalities of the course of labor, perhaps secondary to the physiology of aging. It is possible that decreased myometrial efficiency occurs with aging. 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.” Very interesting. So “old” women are perceived as being unable or problematic so they have less successful vaginal birth outcomes. Now that is a self-fulfilling practice style with a huge dose of ageism thrown in.  I also wonder what the cesarean rate in this age grouping is going to be due to these protocols.

Let’s get to the perinatal and neonatal death risks.  The study says: “Studies regarding an increased risk for perinatal mortality in women of advanced maternal age have been controversial. In this study, the increased risk of perinatal mortality was not statistically significant for patients aged 35–39 years (adjOR 1.1). Age 40 years and older was associated with a statistically significant increased risk of perinatal loss (adjOR 2.2). There were only 119 stillbirths and 37 neonatal demises in total. As a result, we could not draw any meaningful conclusions about the etiology or timing of perinatal mortality in women of advancing maternal age. The reason that advanced-maternal-age patients may be at increased risk of perinatal mortality is unknown. The failure of uterine vasculature to adapt to the increased hemodynamic demands of pregnancy as women age is a proposed explanation. So in conclusion, we have no idea why this might occur and have no way of counseling “AMA” mothers to lower the risk especially those over 40. Another noteworthy thought is that this study had 79% under 34 year old women, 17% 35-39 year old women, and only 4% women over aged 40.  So with such a small grouping ALL women considered “AMA” are being put under very heavy handed protocols to delivery their babies in the 39th week of gestation.

In closing, I find it difficult to believe that anyone who reads this study would change practice style because of it and move pregnant patients who are otherwise maintaining a healthy pregnancy without risk associations to a high risk model of care. Amazingly the study itself says the same thing, “In summary, the majority of women of advanced maternal age deliver at term without maternal or perinatal adverse outcomes.” And, “The role of routine antenatal surveillance in women aged 40 years and older requires further investigation because these women seem to be at increased risk for perinatal mortality, including stillbirth. Although the likelihood of adverse outcomes increases along with maternal age, patients and obstetric care providers can be reassured that overall maternal and fetal outcomes are favorable in this patient population.”

Couldn’t have said it better myself.

Since the original posting – – – instead of women being told they must be induced in the 39th week they are now being “offered” non-medical, cesareans as a first course of action.  This sort of pressure is not evidence-based or even medically ethical in my opinion.

Preparing For Birth – Common Pregnancy and Childbirth Terms

Tuesday, August 25th, 2009

Below is a compilation of common terms and acronyms that women often will come across during pregnancy, labor, and delivery.  Check back as more will be added from time to time.

  • AROM – Artificial Rupture of Membranes – using a finger or tool to open the amniotic sac to to allow the fluid to release.
  • PROM – Premature Rupture of Membranes – when the amniotic fluids releases before labor starts.
  • SROM – Spontaneous Rupture of Membranes during labor.
  • ROM – Rupture of Membranes
  • Miso – Misoprostol is the pharmacological name for Cytotec a drug used for cervical ripening and induction though a controversial, off and against label used ulcer Medication
  • VBAC – Vaginal Birth After Cesarean
  • HBAC – Home Birth After Cesarean
  • WBAC – Water Birth After Cesarean
  • UBAC – Unattended Birth After Cesarean
  • CBAC – Cesarean Birth After Cesarean – This is a repeat cesarean after a woman desires and tries to have a vaginal birth after cesarean.
  • ERCS – Elective Repeat Cesarean
  • RCS – Repeat Cesarean
  • Natural Birth – Labor and vaginal delivery free from intervention except for intermittent fetal monitoring. In the hospital only a saline lock and intermittent monitoring.
  • Vaginal Birth – Baby born vaginally with or without medication and intervention.
  • First Stage – Early, Active, and Transition. This encompasses the effacement to 100%, dilation to 10 centimeters/complete, position movement of cervix from posterior to forward as contractions begin while staying longer, strong and closer together prior to pushing and delivery.
  • Second Stage – Pushing phase after cervix is completely dilated to delivery of baby.
  • Third Stage – Delivery of baby to delivery of placenta.
  • Fourth Stage – First hours after placenta is delivered.
  • Oxytocin – A hormone made in the brain that plays a role in childbirth and lactation by causing muscles to contract in the uterus (womb) and the mammary glands in the breast. It also plays a role in bonding with mate, child, and socially.
  • Pitocin (oxytocin injection, USP) is a sterile, clear, colorless aqueous solution of synthetic oxytocin, for intravenous infusion or intramuscular injection.
  • Prostaglandin – Any of a group of hormone like fatty acids found throughout the body, esp. in semen, that affect blood pressure, metabolism, body temperature, and other important body processes such as cervical ripening.
  • Uterus -The muscular organ in which a fertilized egg implants and matures through pregnancy. During menstruation, the uterus sheds the inner lining.
  • Cervix -The lower portion of the uterus that provides an opening between the uterus and the vagina. Also known as the neck of the uterus that softens, effaces, dilates and changes position during labor.
  • Vagina – A muscular canal between the uterus and the outside of the body. Also known as the birth canal.
  • Perineum – The area between the anus and the vulva (the labial opening to the vagina).
  • Pelvis -The basin like cavity formed by the ring of bones of the pelvic girdle in the posterior part of the trunk in many vertebrates: in humans, it is formed by the ilium, ischium, pubis, coccyx, and sacrum, supporting the spinal column and resting upon the legs.
  • Pelvic Floor Muscles -The sphincter mechanism of the lower urinary tract, the upper and lower vaginal supports, and the internal and external anal sphincters. It is a network of muscles, ligaments, and other tissues that hold up the pelvic organs.  Includes bladder, rectum, vagina and uterus.
  • Fundus –  Top of the uterus. During labor contractions the fundus thickens and gets more firm as the strength of contractions increase and dilation increases.
  • Placenta -The organ that develops during pregnancy that transports nutrients to the fetus and waste away from the fetus. The placenta is attached to the uterus and is connected to the fetus by the umbilical cord.
  • Umbilical cord – The cord that transports blood, oxygen and nutrients to the baby from the placenta.
  • Bloody Show – Mucous and blood mixed together as dilation and effacement occurs.  Starts off as blood tinged mucous and becomes heavier as labor progresses.
  • Stripping membranes –  Pressing the amniotic sac away from the inside of the cervix.
  • Mucous plug – The mucous that blocks off the non-dilated and non-ripened cervix for protection.
  • Lochia – Post birth bleeding that though a wound site from the placenta detaching from the uterine wall, it mimics a heavy and long menstrual period.
  • Cesarean – Baby born via a surgical incision made through the abdomen into the uterus.
  • Obstetrician – Is the surgical specialty dealing with the care of women and their children during pregnancy, childbirth and the immediate post birth time.
  • Midwife – Is a person usually a woman who is trained to assist women during pregnancy,  during childbirth, and postpartum as well as the newborn post birth.  There are many types of midwives – some work in the home, at birth centers or in the hospital.
  • Doula – Is an assistant who provides various forms of non-medical and non-midwifery support (physical and emotional) in the childbirth process. Based on a particular doula’s training and background, the doula may offer support during prenatal care, during childbirth and/or during the postpartum period. A birth doula provides support during labor. A labor doula may attend a home birth or might attend the laboring at home and continue while in transport and then complete supporting the birth at a hospital or a birth center. A postpartum doula typically begins providing care in the home after the birth. Such care might include cooking for the mother, breastfeeding support, newborn care assistance, errands, light housekeeping, etc. Such care is provided from the day after the birth, providing services through the first six weeks postpartum. In some cases, doula care can last several months or even to a year postpartum – especially in cases when mothers are suffering from postpartum depression, children with special needs require longer care, or there are multiple infants.
  • Birth Center – Free standing location usually run by one or more certified nurse midwife. True birth centers are almost always independently run. They are not overseen by a hospital or in a hospital. May be near a hospital. Often set-up like a home birth space and epidurals or other pain medications are not available.   Hospital “birth centers” are labor and delivery floors not birth centers in the true sense of the term.
  • Intervention – Anything that does not exist in a naturally occuring labor and delivery that is done.
  • Saline Lock/Buffalo Cap/ Hep Lock – Is the apparatus that the IV line hooks into.  It is silicone tubing that is lightweight with a plastic needle that stays under the skin to allow easy vein access.
  • Foley – A foley catheter is used to release the bladder if a woman unable to urinate due to an epidural, post surgery, or with a swollen urethra post birth.  It can also be used for successful cervical ripening in lieu of cytotec.
  • Induction – To attempt to artificially start labor usually by pitocin, artificial rupture of membranes with or without cervical ripening (Cytotec or Foley Catheter).
  • Epidural – A medical method of giving pain relief during labor. A catheter is inserted through the lower back into a space near the spinal cord. Anesthesia is given through this catheter, and results in decreased sensation from the abdomen to the feet.
  • Contraction – Tightening and loosening of your uterus. Productive contractions are often felt at the bottom of the uterus, start out like period cramps and progressively grow stronger, longer in length, and closer together.
  • Braxton-Hicks – Practice contractions that do not dilate or efface the cervix often felt at the top of the uterus versus the bottom.
  • Episiotomy – A surgical procedure to widen the outlet of the birth canal to facilitate delivery of the baby and avoid a jagged rip of the perineum. (Natural abrading or tearing is preferred and episiotomies are not evidence-based to be used except under specific circumstances).
  • Ina May’s Sphincter Law -Tapping into the concept that if one sphincter is open and relaxed, the others will also open, relax and be able to handle, quite adequately, the task at hand. This also includes the aspect of birth requiring privacy, sacredness, and honor as well so a woman feels safe, unwatched and supported.
  • Kegel Exercises – Named after Dr. Arnold Kegel, consists of contracting and relaxing the muscles that form part of the pelvic floor (sometimes called the “Kegel muscles”).

Preparing for a medically necessary labor induction

Wednesday, August 12th, 2009

Labor induction is increasingly on the rise, however, even ACOG has a limited statement on what is a defines medically necessitated labor induction.  This is generally defined as gestation or chronic hypertension, preeclampsia, eclampsia, diabetes, premature rupture of membranes, severe fetal growth restriction, and postterm pregnancy (postterm dates are defined generally after 42 weeks gestation though protocols and practice style is often after 41 weeks).  There are varying opinions in the birth world of what is truly medically necessary so always research your options and need.

Induction is not a panacea, it only sometimes works, is more challenging than naturally occurring labor and is often long.  I hope my suggestions and information can help you be more well equipped when it is the best solution for you and your baby.

So you do need to be medically induced, how can you prepare?  Do you need cervical ripening prior to the induction as well ?

Start with the type of induction you need.

Ripening is for a cervix that is not ready for using pitocin for induction purposes (see Bishop’s score below). Ask your care provider what your score is.  If he or she does not use the Bishop scoring ask for the particulars of each of the five categories then you can use the table yourself.  The position category denotes the position of your cervix.

Are you a good candidate for induction? Do you need ripening too?

Are you a good candidate for induction? Do you need ripening too?

If you need a ripener prior to the induction, you have two common options (Cytotec or Foley Catheter) though there are more available (Cervidil or Prepadil), they are not widely used any longer.

Foley Catheter ripening is a mechanical ripening method that requires no medicine therefore has very little negative consequence related to the usage. The catheter is inserted in the cervix, then filled with saline to fill the end of the bulb and mechanically opens the cervix up to approximately 4 cm’s while the foley is in place. The mother will go home until the catheter falls out or will remain in the hospital overnight.  The pressure from the foley catheter promotes continual prostaglandin release that encourages the effacement and works in conjunction with the mechanical dilation to open the cervix.  When the catheter falls out, unless it prematurely dislodges the cervix is ripe and ready for induction (pitocin usage). Sometimes the mother is already in early labor and may not require pitocin or require less.   For more information and studies regarding foley cather ripening view my blog page https://prepforbirth.com/2009/07/20/foley-catheter-ripening-versus-medication-studies.html.

The most common yet riskier method of cervial ripening is the use of Cytotec (Misoprostol).  Cytotec is used in an off label manner for ripening the cervix. ACOG has this to say in the revised new guidelines that include seven recommendations based on “good and consistent scientific evidence” — considered the highest evidence level — including one that sanctions 25 mcg of misoprostol as “the initial dose for cervical ripening and labor induction.” The recommended frequency is “not more than every 3-6 hours.”  Though this drug has been shown to be successful for ripening it is not without concern, consequence, risk or controversy.  Please do your research ahead of time prior to allowing this drug to be used on you and your baby.

Here are some helpful links:

http://www.aafp.org/afp/20060201/fpin.html

http://www.petitiononline.com/cytotec/petition.html

http://www.medscape.com/viewarticle/458959

http://www.thefreelibrary.com/Making+an+informed+choice:+Cytotec%5BR%5D+for+induction-a0128063329

Your cervix is ripe for induction

The most common next step is the use of Pitocin to induce labor contractions. What to expect: an IV with fluids running, continuous monitoring, and limited mobility. The increased pain and stronger than usual contractions over a longer period of time associated with Pitocin use often leads women to ask for epidural anesthesia. There are varying protocols, but the low-dose protocol is most often used today.  Induction is not fail safe, you may or may not respond to “tricking” your body into labor.  Your baby also may not respond favorably.  In the event the induction fails or causes maternal or fetal distress or host of other complications, a cesarean delivery is the next step.

Here are some helpful links regarding Pitocin.

http://www.rxlist.com/pitocin-drug.htm

http://www.corninghospital.com/Educate/Pit.htm

http://pregnancy.about.com/od/induction/a/pitocindiffers.htm

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=4975#section-4

Rethink how you pack your birth bag

Considering the length of time that you will be at the hospital  considering adding the following items to your birth bag.

  • Movies (make sure your hospital provides DVD players or you will want to bring one of your own)
  • Puzzles of all types
  • Cards
  • Games
  • Books
  • Laptop Computer
  • Extra changes of clothing
  • Extra food for husband, partner or labor support
  • Extra cash
  • Ear plugs and eye covering to make sleeping easier
  • More comforts from home to be soothing

Points to think about

  • You are having a baby and need to do the work of labor completely at the hospital. ONLY allow those who can help you keep the chaos and interruption to a minimum.  This is not a party.
  • Turn of cell phones.
  • Keep room comfortable, peaceful,  and stress-free.
  • Having your water broken artificially does not mimic it naturally breaking.
  • Use the space provided and get on the birth ball, stand near the bed and sway, use rocking chair, have equipment moved closer to bathroom so you may sit on the toilet, use as many positions as possible to help baby negotiate and to help dissuade a mal-position.
  • Induction increases the risk of a cesarean delivery becoming necessary whether from the induction failing (fooling a body into labor isn’t as easy as it sounds), maternal/fetal distress or another complication may arise.  Here is a sample cesarean delivery plan in the event it becomes necessary.  sample-cesarean-plan

My closing thought to you is take a deep breath and know when medically necessary an induction is a reasonable step.

My hope is for you to be well informed, be confident to ask questions, be strong to make your own decisions, and thrive to a successful birth even when Plan A isn’t an option anymore.

Choosing your birth location – A tip sheet

Monday, August 10th, 2009

Choosing the place of birth for your baby – It is incredibly important that you understand where you fit best prior to choosing where to birth your baby. Take hospital and/or birth center tour, call and talk to L&D floor, get facts on home birth by talking to home birth midwives, other moms who have had home births, online and in books. Being intellectually safe is not the same as being safe. Know the facts before you choose.

· Does the location offer what is most important to you (tubs, birth balls, wearing own clothing, intermittent monitoring, fetascope monitoring, etc.)?

· What are standard protocols and practices that are followed? Is individualized care a norm there or is cookie cutter style?

· Is water birth available?

· Are birthing stools or non-reclined pushing and delivery positions encouraged?

· What are the no/low intervention rates? These numbers are tracked monthly.

· What is the induction, epidural, cesarean rate? Are VBAC’s supported and encouraged?

· Are mom and baby friendly practices used? (no routine interventions, no separation of mom and baby, breastfeeding is the norm, movement in labor is utilized, doula accompaniment is accepted, labor induction rates are low, etc.)

· What if I choose to decline an intervention, medication or procedure? Will my decisions be respected? Are patient’s rights taken seriously?

Points to Ponder afterward

· Will I be able to have the type of birth I truly desire?

· What location will I ultimately feel most comfortable in physically, emotionally and spiritually?

· What location is ultimately safest for my specific needs (I am currently a low-risk or high risk)?

· Is insurance or lack of it the reason I am choosing the location?

· Do I have realistic expectations for the location?

· Am I willing to take responsibility for my birth in the location?

· Is staff open to working with a doula or natural birth?

· Are there any compelling reasons to choose one location over another?