Birth "tidbits"

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10 Childbirth Facts

posted Sep 17, 2011, 10:46 AM by Misty Curreli   [ updated Oct 11, 2011, 3:51 PM ]

10 Childbirth Facts

What women should know about giving birth

by Ceridwen Morris | November 16, 2010Birth is a normal physiological event

Fact 1: It’s not like the movies

In the movies, the water breaks, everyone panics, mom wobbles up, grabs her belly, and on cue has an enormous contraction, then yells for a taxi. In real life, the water usually breaks during labor and if it does break early, there’s no reason to run screaming to the hospital. Real-life labor is really hard, but it’s not one big screaming emergency. Every labor is unique, but perhaps none more “unique” than th

Fact 2: Your due date is more like a due month

A full-term pregnancy is anywhere between 37 and 42 weeks. The estimated due date (EDD) is an educated guess, not a firm deadline. The majority of babies are born before or after their due dates; most first-time babies are born an average of four days past the EDD. It can be hard to mentally plan for a whole due month, but a due date is too specific. So, how about a due fortnight? e mythical Hollywood birth.

Fact 3: Labor goes through very distinct phases with different challenges

Labor is not one continuous, unwavering sensation; it’s a dynamic, rhythmic process. Early labor tends to be long but usually easier to deal with than active labor, which generally requires much more focus and pain-coping techniques. Pushing the baby out at the end is another thing entirely and can actually be a welcome change (now you can finally do something!). Learning about the stages of labor helps you prepare for each one in different ways.

Fact 4: An epidural is just one of many ways to cope with labor

There’s a lot of debate about whether getting an epidural is a “good” idea or a “bad” idea. The only answer is: it depends. An early epidural can slow things down and therefore make more medical intervention necessary. But an epidural given after laboring for a very long time (and when mom is completely exhausted) can actually speed up labor and reduce the chances of more interventions. Try to forget “good” and “bad” when it comes to the epidural; instead, educate yourself about the risks and benefits of the drugs and learn other coping techniques, then see how your labor goes.

Fact 5: The philosophy of your care-provider matters. A lot.

Some doctors believe in actively managing the labor, introducing medical technology — from labor induction drugs to continuous fetal monitoring — even before they are necessary. Other care-providers believe labor should unfold on its own and medical intervention should only be brought in if something comes up. The way your labor will be handled has a lot to do with who is handling it; talk to your caregiver now about his or her philosophy of birth. And make sure it matches up to your own.

Fact 6: Your doctor or midwife will not be with you for most of your labor

This often comes as a big surprise to an expecting couple, but it’s common. Doctors and midwives will be on call, advising you when to go to the hospital and will check in on your progress periodically. But for the most part they just show up at the end to catch the baby — midwives tend to be present for longer, but it depends. This is one reason childbirth classes and doulas can be so valuable.

Fact 7: Induced labors are twice as likely to end in C-Section

Expectations to get births moving at an unrealistic pace have led to the overuse of pitocin, which doubles the odds of having a C-section. Pitocin requires monitoring, which means mom cannot move during labor. Yet, changing position can actually help labor progress and help with pain. Bottom line: Try to avoid induction unless it’s medically necessary.

Fact 8: Staying Home in Early Labor Can Reduce the Chances of a C-section

Barring any specific concerns, there’s no reason to rush to the hospital at the first, or even 50th contraction. You may be turned away if you go in too soon. A good guideline to follow for first pregnancies is 411: Go in when your contractions are four minutes apart, one minute long and have been that way for one hour. Talk about this with your midwife or doctor and call when you know labor has started, but allow your body time at home to really get labor going.

Fact 9: Birth is a normal physiological event

Yeah, contractions can be very intense and the process of birth can seem overwhelming or even impossible, but the fact is, our bodies were built to do it. Unlike other kinds of pain, labor does not indicate that something is wrong or broken. There are things you can do to get through the hard work: Take a childbirth education class, get some good labor support and learn how labor works.

Fact 10: A good birth experience is not about how you do it

Surveys of thousands of mothers have revealed that it’s actually not about whether you got the epidural or didn’t get the epidural that makes birth a positive experience. It’s more about whether you were treated with kindness and respect at a vulnerable time. Women with realistic expectations also tend to be happier with their births. This doesn’t mean low expectations, but rather an understanding of what you can control, and what you can’t. Remember that once we banish the idea of a “perfect” birth, the “imperfect” birth goes with it. A good birth experience is not about how you do it

http://www.babble.com/pregnancy/giving-birth/10-facts-childbirth-labor-delivery-signs-giving-birth/?page=1

Taking Charge of Giving Birth

posted Sep 8, 2011, 9:57 AM by Misty Curreli

by Cynthia Overgard

A commitment to natural delivery in a birth center, without doctors or pain relief of any kind on the premises, was the farthest notion from my mind the summer I learned I was pregnant. Like many other newly expecting women, I reluctantly envisioned my hospital birth to resemble every other actual and fictitious birth I had known. Agonized and disoriented, I would be rushed into a medical scene amid bright lights, confusing equipment and an assortment of intense, unfamiliar faces. I envisioned myself in the usual, dreaded position of lying on my back with knees bent, nobly trying to resist an epidural for as long as possible before finally acquiescing to the temptation, praying all the while that my baby and I would not be harmed by the anesthesia. This vision, unsettling as it was, was far too deeply ingrained by society and mainstream media for me to have realized I could choose otherwise.

At the same time, I was haunted to know that surgical births were fast becoming the norm in the United States, and in fact cesarean sections had skyrocketed from 1 in 20 births to 1 in 3 within my lifetime. What was a rarity thirty years ago had earned its rank as our country’s most common major surgery, and I dreaded the possibility that my obstetrician might deprive me of my birthing experience by performing the quick but drastic procedure without irrefutable evidence that doing so was truly a matter of life and death. That early in my pregnancy, I had yet to learn that cesareans statistically posed a far greater mortality threat to both mothers and babies over vaginal birth. I was guided instead by my intuition: If my body was capable of doing something so astounding as to create and deliver into the world another human being, then I wanted to experience that miracle for myself.

One evening, while conducting Internet research on childbirth, I happened across a website in which a mother shared the details of her natural home birth. To my amazement, she never described a single sensation as painful. I skeptically considered whether she withheld the negative details, or possibly even fabricated the whole tale.

But photos of husband and wife, newborn and siblings, removed all suspicion. Serenity, intimacy and laughter shaped each scene. My mind struggled to accept what I saw. Certainly I always knew natural childbirth was possible, but I never dreamed it could be so simple. My heart physically ached with longing, compelling me to admit a natural, drug-free birth was my dream. But I quickly dismissed the notion, rallying myself into society’s conventional way of thinking: Surely any educated, metropolitan woman like me would be out of her mind to birth outside of a hospital. I reminded myself that natural childbirth was nothing more than the unfortunate, inevitable fate of our ancestors. That’s why virtually no rational woman today, or so I believed, declined pain medication that was readily available and administered by experts. To think that we could numb the sensations of childbirth with an injection or an IV—surely I should consider myself among the luckiest women in history.


The Myth of My First Trimester: Doctors Operate in My Best Interest

I became determined to educate myself on the complexity of the obstetrics industry in our country. My education came at a cost: an ever-increasing fear of the very hospital birth I was planning. I was stunned to learn that doctors were held to revenue targets at hospitals; a cynicism grew within me. Natural birthing meant low revenue for medical providers. Far more disturbing were the risks and adverse outcomes associated with each money-generating intervention. Even seemingly innocuous and routine procedures were exposed as significant threats to the mother’s and baby’s safety. Moreover, each intervention increased the odds, often dramatically, that a subsequent, more radical procedure would be required, purely in response to the risks and side effects it introduced.

If patients had the right to informed consent, then I couldn’t understand why more women didn’t refuse some of these interventions. Pitocin and Cytotec, for example, have never been FDAapproved for the elective induction of labor, yet countless women followed their doctors’ recommendations to use it for that very purpose. Were women provided with a full disclosure of the risks and side effects? Were they aware they could refuse? Knowing that revenue targets were hanging over obstetricians’ heads, I realized that birthing mothers had fallen victim to a powerful conflict of interest in the medical community.

At my 12-week checkup, I asked my own obstetrician a straightforward question: her cesarean rate. Her response was a casual wave of the hand, claiming she hadn’t bothered to calculate those numbers in years. After pressing her relentlessly, she finally admitted it was at least 40 percent.

Incredulously, I asked whether she truly believed life and death situations were so frequently at hand. I added that the rate of C-sections was just 5 percent in 1970, and that the World Health Organization said no place on earth should exceed a rate of 10 to 15 percent.

“Some cesareans are elective,” she began. “Many women feel they would prefer to have their own doctor perform a cesarean rather than take the chance of delivering vaginally with a less familiar doctor from the same practice.”

And you actually give merit to that choice? I wanted to ask. Major surgery, unnecessarily performed as a matter of familiarity and convenience?

“As for emergency cesareans,” she sighed, “we don’t like if the mother is too old, too heavy or too thin, or if the baby is premature, too big or overdue. Other concerns are low amniotic fluid, multiples, placenta previa, breech positioning, gestational diabetes and failure to progress—that is, we’d like to see you dilate at least one centimeter per hour.”

I was bewildered at how she could recite such an exhaustive list with a straight face, and dejectedly realized all three of my mother’s vaginal births had exceeded 10 hours. In fact, I had read that birthing, on average, lasts 12 to 14 hours. Why are women today being subjected to an arbitrary and unnaturally short timeline when our ancestors were not? And whose idea was it to brand us a “failure” in the very diagnosis, with invasive surgery as its looming punishment?

“I’ll be honest with you,” she finally added. “Litigation plays a big role.”

I was unprepared for the ubiquitous “litigation argument” so frequently used by obstetricians. This defense allows doctors to give the impression that they aren’t willing to take any chances, thereby creating grounds to perform a surgical birth and reduce the likelihood of a malpractice suit. The irony is that this assertion manipulates couples into inferring that a cesarean is the safer method of childbirth, when in fact it is statistically far more likely to produce an adverse outcome over vaginal birth.

Ironically, my obstetrician figured she could comfort me by drawing an imaginary line along my lower abdomen to show me where she would make the incision, assuring me even the smallest bikini would hide the scar. That she misunderstood me so greatly was staggering. If we were discussing the potentiality of undergoing major abdominal surgery in order to save a life, then wasn’t the scar inconsequential? I couldn’t imagine surgeons of cancer and organ transplants reassuring their patients of the cosmetic outcome.

Soon thereafter, my husband and I learned that hiring a doula—a labor assistant—would improve my odds of a comfortable, vaginal birth. When I told my obstetrician a doula would attend the birth with us, she shrugged. “Fine with me, if you really think it’s worth all that money,” she said. “Just make sure your doula remembers who’s in charge.”

That evening I told our doula what the doctor had said. She stated plainly, “Of course I remember who’s in charge. You are.”

I am? I nearly cowered at the thought.

Her words took hold as I slept. In the morning I telephoned my obstetrician’s office and asked them to prepare a copy of my medical file: I was leaving the practice.

My bold move led me to a disheartening, circular thought process: Where would we deliver our baby? Fear held me paralyzed between two extremes: the doctors and medical intervention I was determined to avoid, and the agony I assumed would accompany natural birth.

My husband discovered we lived an hour from Connecticut’s only free-standing birth center, and we made plans to visit the following day. After a lengthy, enjoyable consultation with the midwife director, we were led upstairs to the beautiful birthing suites. I was struck by the setting: The plush double bed, hardwood floors and floral window dressings were reminiscent of a New England bed-and-breakfast. We walked through the bedroom and into the large, marble bathroom, complete with a free-standing shower-for-two and Jacuzzi bathtub.

As we walked, the midwife said, “You can deliver on the bed, in the birthing chair, on the floor, standing up, on your side, in the shower or in the Jacuzzi bathtub. We only ask that you not deliver lying on your back—it would be painful for you, risky for the baby, and makes birthing far more challenging because it compresses the pelvis.”

“Is it difficult for you when the mother chooses to birth in an unconventional position?”

“No,” she smiled. “This isn’t about my convenience and comfort; it’s about yours.”

That night, we came to our decision. At long last, I allowed my fear of natural birth to subside as my fear of medical intervention maintained its firm hold. From then on, I held every remaining prenatal appointment at the birth center, cheerfully driving an hour each way through the cold winter season.


The Myth of My Second Trimester: Childbirth Must Be Painful

To strengthen my resolve, I began telling everyone—social acquaintances, business colleagues and relatives—that I was planning a natural delivery with midwives. All the while, I quietly nursed the hope that I would come across another woman who had experienced her own unmedicated birth.

Initially, it was a discouraging process—not just because natural labor was rare, but because there was occasionally some confusion as to what “natural” meant in the first place. Some women told me they had natural labor because the epidural didn’t numb them thoroughly—as if natural meant painful, rather than the avoidance of drugs. Then a woman in my prenatal yoga class told me how glad she was to have had natural labor with her first baby, until she clarified: “Wait a second—I had an epidural, and all. I’m just saying I didn’t end up with a C-section.”

Aside from my own parents and brothers, who had unanimously applauded our decision, the general lack of encouragement I received—particularly from other women—was confounding. Good friends at work said I was out of my mind and showed no interest in discussing it further. A neighbor of ours enthusiastically told me she was in such agony during her own labor that she and her husband prayed, out loud, to spare her from death during the delivery. Her description horrified me until she went on to explain her labor had been initiated with a heavy dose of Pitocin at her own request, given that her parents were visiting and she wanted them to see the baby before leaving town.

Each night, I recounted the day’s negative comments over the phone to my mother, relying on her to help me regain my determination. What struck us most greatly was that so many people chose to perceive themselves as sufferers and victims rather than the persevering and capable women they were.

To overcome my anxiety, my husband and I took a Hypno- Birthing class, whose philosophy asserts that fear and tension are the actual cause of labor pain. Fearful thoughts release adrenaline, which causes the cervix to constrict rather than dilate—this, they say, is nature’s way of protecting the newborn from encountering danger. The resulting fight-or-flight response in the mother’s body prohibits blood supply to the uterus and leads to stronger contractions.

It occurred to me that all other mammals are relaxed during birth; there are no cries of pain, no fear in the eyes, no bodily tension. Therefore, my job was to develop a deep trust in myself and this process. Just as the brain is the most sexual organ, so too is it the primary birthing organ. I needed to keep my cool, first and foremost, and reconnect with the knowledge that all females carry at a cellular level: My body and my baby would instinctively know how to birth, even if my conscious mind had no idea how I would ever pull it off.


The Myth of My Third Trimester: Birthing Requires Assistance

As it turned out, I did not ease gradually into labor like many women: My first contraction was intense enough to bring me to my hands and knees, and the second followed within four minutes. I was 6 centimeters dilated when we arrived at the birth center an hour later. It was just before dawn, and my midwives were cheerful upon seeing us. One of them wrapped an arm around me as we walked to the birthing suite and exclaimed, “Just imagine, Cynthia, you’re going to meet your baby today!”

I eased into the heavenly warmth and weightlessness of the Jacuzzi, where I found my place between control and surrender. Without a single tube, needle or machine in the room—not even an identification bracelet around my wrist—there was no sense of being an ailing patient rather than the healthy woman I was. Hardly a word was spoken, and I was able to turn inward as nature demanded. I envisioned my baby and reminded myself that the more I relaxed, the faster I would dilate.

The HypnoBirthing techniques apparently worked, because I was at 10 centimeters within the hour. I took long drinks of water and spoke in relaxed conversation during those brief, merciful moments of total reprieve between contractions. Soon I felt an unbelievable force of energy making its way through me. Our doula knelt as she held a cool washcloth to my forehead, and whispered her only words during the entire birth: “Look outside, Cynthia. The sun is rising.”

Her comment brought me from the internal present to the external. It was a clear morning in early March, with shades of red and orange across the horizon. What a beautiful day to be born, I thought. Then, precisely when I knew I was birthing the next soul into the world, I was overcome with gratitude for the serendipitous course of events that had occurred to allow our baby to emerge from a mother who was calm, safe and loved.

With the final surge, our baby was lifted from the water and placed on my chest. My eyes were squeezed shut in that instant, and everyone saw the gender except me. In those first sublime moments of contentedness and relief, I held our newborn to me tenderly and completely forgot to check.

My husband waited for the cord to stop pulsating before cutting, and the midwives helped me to the bed and layered warm towels over my body as we initiated breastfeeding. Despite my small frame and our baby’s hefty weight of 8 pounds 14 ounces, the labor had lasted just three and a half hours since its onset at home.

When the post-birth examination was complete, we were encouraged to take a few hours of private family time to rest in bed. Nestled snugly between mother and father, our son, Alexander, gazed contentedly into our eyes.

We walked into our home as a family within eight hours of Alexander’s birth. Whether it had been good planning or good fortune, I ended up with the beautiful, natural birth I longed to experience. I was proud of myself for pursuing the dream that had exposed my fears.

And yet, I was humbled. I had once believed newborns to be frail and helpless, dependent on the rest of us to push, pull or cut them free from the womb. As much as I had relied on my husband and our birthing team, I realized I could now look into the eyes of my true birth partner. Alexander had worked as intensely as I had, and he, too, needed nourishment and rest to regain his strength from his own achievement. I marveled to consider that, without the supportive and loving presence of all the others, Alexander and I still would have attained his beautiful birth. The respect I instantly felt for my newborn son was the most enduring of all my lessons learned.

How to give birth is a choice that women need not surrender to others. At times, our preparation was arduous: My husband and I had conducted countless hours of research on the host of decisions that come along with birthing and parenting. We challenged one another with complicated questions ranging from logistical to moral, and we consistently faced opposition from a misinformed but well-meaning society. We replaced fear with trust, and misconception with fact. Empowered as individuals and as a couple, we eventually quieted the outside noise and heard our own articulate voices.

And this is what we learned: We learned what it meant to take full responsibility for ourselves and our baby. We learned how to make informed decisions, consciously and carefully. We learned to stop explaining ourselves. And in the end, one truth spoke clearest: Whether she chooses to birth at home, a hospital or a birth center, it is the right—in fact, the responsibility—of every woman to plan her own baby’s birth with the information, honor and freedom to which she is entitled.


Cynthia OvergardAbout the Author:

Cynthia Overgard, MBA, HBCE, became a certified HypnoBirthing practitioner and a natural birthing advocate after the birth of her son, Alex. In June 2009, Cynthia experienced another water birth when she gave birth to her 9 lb. 7 oz. daughter, Vanessa, during a planned home birth. She and her family live in Westport, Connecticut, and enjoy a holistic, vegetarian lifestyle. Cynthia is a professor of finance at the University of Connecticut and a published writer. To contact Cynthia, visit hypnobirthingct.com.

View article references and author information here: pathwaystofamilywellness.org/references.html.

 
 
 

Placenta encapsulation

posted Aug 24, 2011, 9:02 PM by Misty Curreli

The Placenta Cookbook

For a growing number of new mothers, there’s no better nutritional snack after childbirth than the fruit of their own labor.

  • By Atossa Araxia Abrahamian
  • Published Aug 21, 2011

Jennifer Hughes’s placenta was delivered ten minutes after her first child, just before midnight on March 31. It was on the large side, with a liverish texture and a bluish tinge; it measured nine inches in diameter and weighed a pound and a half. Placentas are considered biohazardous waste by the medical Establishment and are usually disposed of accordingly. Some hospitals send the afterbirth in formaldehyde to a pathology lab for analysis before it is carted off by a tissue-disposal service; others toss it out with bloody miscellany in special containers.

But in the birth plan that Hughes brought with her to Beth Israel Medical Center, she specified that she wanted to keep her placenta, for cultural reasons. Complying with New York State health regulations, which says that hospitals “may, at the request of a patient or patient’s representative, return a healthy placenta for disposition by the patient,” the hospital allowed her to take it home, and even packed it up for her.

In some cultures, it is customary to bury the placenta and plant a tree over it.

Hughes had other plans. She was going to eat it.

Early the next morning, a 28-year-old woman named Jennifer Mayer is driving a Subaru from Manhattan over the Brooklyn Bridge with an opaque takeout container in the passenger seat. Inside the container is a gallon-size Ziploc bag, and inside the bag is Jennifer Hughes’s placenta.

Mayer—an upbeat, blue-eyed blonde from upstate New York—is a professional placenta-preparer. Her job is to transform placentas into supplements that are said to alleviate postpartum depression, aid in breastmilk production and lactation, act as a uterine tonic, and replenish nutrients lost during pregnancy. Her clients are mostly middle-class, like Hughes and her husband, Doug, who are college-educated, in their thirties, and live on a gentrifying street in Crown Heights. On this dreary April morning, Mayer is driving the afterbirth to their apartment to begin preparing it.

“It’s the freshest placenta I’ve ever worked with!” she says, glancing over at the container as the car lurches through traffic. Mayer speaks about the organ in tones most women reserve for newborns: ­“perfect,” “beautiful,” “precious.”

Her enthusiasm isn’t unfounded. The placenta feeds the baby until birth, filtering toxins while letting in vitamins, minerals, oxygen, and other nutrients from the mother’s bloodstream. It even helps reduce the risk of transmitting viruses, including HIV, from mother to child.

Mayer, who also works as a massage therapist and doula, first became interested in placentas as a student at the University of Colorado. After reading up on the purported benefits of consuming one’s afterbirth and learning that a client was planning to try it, Mayer decided that she wanted to offer her customers placenta capsules: dried, ground afterbirth packaged into a clear pill no bigger than a regular vitamin supplement.

The technique, called encapsulation, was not widely practiced in Colorado and, until quite recently, was practically unknown on the East Coast. But Mayer found a doula who conducted training sessions with donated placentas, and started her business, Brooklyn Placenta Services, shortly thereafter.

“They’re happy pills,” Mayer says. “They’re made by your body, for your body. Why wouldn’t you want to try?”

In 1930, the researchers Otto Tinklepaugh and Carl Hartman described a female macaque monkey eating her placenta. “After licking the afterbirth, she begins the grueling task … of consuming this tough fibrous mass,” they wrote. “Holding the organ in her hands, she bites and tears at it with her teeth.” Tinklepaugh and Hartman could not determine the precise reason why macaques—and virtually every other land mammal—eat their own placenta. To this day, the reasons remain unclear.

Mark Kristal, a behavioral neuroscientist at the University of Buffalo, is the country’s leading (and quite possibly only) authority on placentophagia, the practice of placenta consumption. He has been researching the phenomenon for twenty years, and concludes that it must offer “a fundamental biological advantage” to all mammals. What this advantage is, he writes in one of his papers, “is still a mystery … in fact, a double mystery. We are not sure either of the immediate causes … nor are we sure of the consequences of the behavior.” But placentas have carried a special spiritual significance in some cultures. In ancient Egypt, it had its own hieroglyph, and the Ibo tribe in Nigeria and Ghana treats the placenta like a child’s dead twin. In traditional Chinese medicine, small doses of human placenta are sometimes dried, mixed with herbs, and ingested to alleviate, among other things, impotence and lactation conditions. And in modern medicine, doctors often bank umbilical-cord blood to treat genetic diseases with harvested stem cells.

According to Kristal, the first recorded placentophagia movement in America began in the seventies, when people residing in communes would cook up a placenta stew and share it among themselves. “It’s a New Age phenomenon,” he explains. “Every ten or twenty years people say, ‘We should do this because it’s natural and animals do it.’ But it’s not based on science. It’s a fad.”

Most scientists agree that the existing research is tenuous. Placenta is known to contain high levels of iron, vitamin B-12, and certain hormones—a fact activists cite as proof of its nutritional value—but there is no conclusive study linking, for example, the iron in a placenta to increased strength in a new mother. Advocates also say placentophagia helps mothers produce milk, and reference a 1954 study that claimed 86 percent of mothers experiencing lactation problems showed improved milk supply after eating freeze-dried placenta. But the study has repeatedly been discredited as unrigorous. As for cooked placenta, Kristal says any potential nutritional value would be reduced to that of a “steer liver.”

For Alexa Beckham, a petite brunette who started an encapsulation service called Ruby Tree Birth late last year, the science, or lack thereof, has little impact on the magic she experienced.

“When I was pregnant, I just craved organs,” says Beckham, a onetime vegan and raw-foodist who now eats grass-fed and organic meat. “I’d go to Diner [the Williamsburg restaurant] and order beef hearts, marrow … so the placenta just made sense.

“After I gave birth, I threw a chunk of placenta in the Vitamix with coconut water and a banana,” she adds. “It gave me the wildest rush. You know the feeling of drinking green juice on an empty stomach? It’s like that, but much more intense. It was definitely physical.”

Former model and self-described “baby planner, doula, marriage counselor, and placenta lady” London King explains, “The body follows the mind. If I drink a green drink and I think it’s good for me, then that’s great. The same thing holds for the placenta. Even if it is 100 percent psychological, it has its purpose. I’ve seen people report fewer breast-feeding problems and higher energy, and that’s evidence enough for me.”

 

"I have to push!"

posted Aug 13, 2011, 9:46 PM by Misty Curreli

Pushing for First-Time Moms

by Gloria Lemay

© 2000 Midwifery Today, Inc. All rights reserved.

[Editor's note: This article first appeared in Midwifery Today Issue 55, Autumn 2000, and is also available online in French and Spanish and Russian.]

The expulsion of a first baby from a woman's body is a space in time for much mischief and mishap to occur. It is also a space in time where her obstetrical future often gets decided and where she can be well served by a patient, rested midwife. Why do I make the distinction between primip pushing and multip pushing? The multiparous uterus is faster and more efficient at pushing babies out and the multiparous woman can often bypass obstetrical mismanagement simply because she is too quick to get any.

It actually amazes me to see multips being shouted at to "push, push, push" on the televised births on A Baby Story. My experience is that midwives must do everything they can to slow down the pushing in multips because the body is so good at expelling those second, third and fourth babies. In most cases with multips, having the mother do the minimum pushing possible will result in a nice intact perineum. As far as direction from the midwife goes, first babies are a different matter. I am not saying they need to be pushed out forcefully or worked hard on. Rather, I say they require more time and patience on the part of the midwife, and a smooth birth requires a dance to a different tune.

Let's take a typical scenario with an unmedicated first birth at home. The mother has been in the birth process for about twelve hours. The attendants have spelled each other off through the night. Membranes ruptured spontaneously with clear fluid after eight hours in active phase and mother and baby have normal vitals. There is dark red show (about two tablespoons per sensation) and mother says, "I have to push!" This declaration on the part of the mother brings renewed life to the room. The attendants rally and think, Finally, we're going to see the baby. The long wait will be done. We'll be relieved to see baby breathe spontaneously. We can start the clean up and be home to our families. Typically, the midwife does a pelvic exam at this point to see if the woman is fully dilated and can get on with the pushing now. It is common to find the woman eight centimeters with this scenario. The mood of the room then turns to disappointment.

My recommendation with this scenario: Don't do that pelvic exam. A European-trained midwife that I know told me she was trained to manage birth without doing pelvic exams. For her first two years of clinic, she had to do everything by external observation of "signs." When a first-time mother says, "I have to push!" begin to observe her for external signs rather than do an internal exam. Reassure her that gentle, easy pushing is fine and she can "Listen to her body." No one ever swelled her own cervix by gently pushing as directed by her own body messages. The way swollen cervices happen is with directed pushing (that is, being instructed by a midwife or physician) that goes beyond the mother's own cues. It has become the paranoia of North American midwifery that someone will push on an undilated cervix. Relax, this is not a big deal, and an uncomfortable pelvic exam at this point can set the birth back several hours. The external signs you will be looking for are as follows:

  1. When she "pushes" spontaneously, does it begin at the very beginning of the sensation or is it just at the peak? If it is just at the peak, it is an indication that there is still some dilating to do. The woman will usually enter a deep trance state at this time (we call this "going to Mars"). She is accessing her most rudimentary brain stem where the ancient knowledge of giving birth is stored. She must have quiet and dark to get to this essential place in the brain. She usually will close her eyes and should not be told to open them.
  2. Does she "push" (that is, grunt and bear down) with each sensation or with every other one? If some sensations don't have a pushing urge, there is still some dilating to do. Keep the room dark and quiet as above.
  3. Are you continuing to see "show"? Red show is a sign that the cervix is still dilating. Once dilation is complete the "show of blood" usually ceases while the head molding takes place. Then you can get another gush of blood from vaginal wall tears at the point that the head distends the perineum.
  4. Watch her rectum. The rectum will tell you a good deal about where the baby's forehead is located and how the dilation is going. If there is no rectal flaring or distention with the grunting, there is still more dilating to do. A dark red line extends straight up from the rectum between the bum cheeks when full dilation happens. To observe all this, of course, the mother must be in hands and knees or sidelying position.

I use a plastic mirror and flashlight to make these observations. The mother should be touched or spoken to only if it is very helpful and she requests it. Involuntarily passing stool is another sign of descent and full dilation. Simply put, where there is maternal poop there is usually a little head not far behind.

Why avoid that eight-centimeter dilation check? First, because it is excruciating for the mother. Second, because it disturbs a delicate point in the birth where the body is doing many fine adjustments to prepare to expel the baby and the woman is accessing the very primitive part of her ancient brain. Third, because it eliminates the performance anxiety/disappointment atmosphere that can muddy the primip birth waters. Birth attendants must extend their patience beyond their known limits in order to be with this delicate time between dilating and pushing.

Often when the primiparous woman says, "I have to push," she is feeling a downward surge in her belly but no rectal pressure at all. The rectal pressure comes much later when she is fully dilated, but in some women there is a downward, pushy, abdominal feeling. I have seen so many hospital scenarios where this abdominal feeling has been treated like a premature pushing urge and the mother instructed to blow, puff, inhale gas and so forth to resist the abdominal pushing. Such instruction is not only ridiculous but also harmful. A feeling of the baby moving down in the abdomen should be encouraged and the woman gently directed to "go with your body."

When I first started coaching births in the hospital I would run and get the nurse when the mother said, "I have to push." I soon learned not to do this because of the exams, the frustration and the eventual scenario of having to witness a perfectly healthy mother and baby operated on to get the baby out with forceps, vacuum or c-section. I have learned to downplay this declaration from first-time moms as much as possible, both at home and in the hospital. Especially if you have had a long first stage, you will have plenty of time in second stage to get people into the room when the scalp is showing at the perineum.

Feeling stuck

I recommend that midwives change their notion of what is happening in the pushing phase with a primip from "descent of the head" to "shaping of the head." Each expulsive sensation shapes the head of the baby to conform to the contours of the mother's pelvis. This can take time and lots of patience especially if the baby is large. This shaping of the baby's skull must be done with the same gentleness and care as that taken by Michelangelo applying plaster and shaping a statue. This shaping work often takes place over time in the midpelvis and is erroneously interpreted as "lack of descent," "arrest" or "failure to progress" by those who do not appreciate art. I tell mothers at this time, "It's normal to feel like the baby is stuck. The baby's head is elongating and getting shaped a little more with each sensation. It will suddenly feel like it has come down." This is exactly what happens.

Given time to mold, the head of the baby suddenly appears. This progression is not linear and does not happen in stations of descent. All those textbook diagrams of a pelvis with little one-centimeter gradations up and down from the ischial spines could only have been put forth by someone who has never felt a baby's forehead passing over his/her rectum!

Often the mother can sleep deeply between sensations and this is most helpful to recharge her batteries and allow gentle shaping of the babe's head. Plain water with a bendable straw on the bedside table helps keep hydration up. The baby is an active participant and must not be pushed and forced out of the mother's body until he/she is prepared to make the exit. In her book Ocean Born (l989) midwife Chris Griscom describes her experience of allowing her son to push his own way out of her womb:

[I ask] . . . the cervix what color it needs to open easily, the color flashes before my eyes and I begin to visualize myself drinking that color directly into the cervix. I sense a subtle but immediate response.
There is a quickening now. The baby is moving down, as I've begun the dreaming. Spun off time's orbit, I sleep in the sea, until I feel it rise with the contraction. I surface like the dolphin, then dive again. Birth is coming. Gratitude for the ease of this passage floods me, and I feel salty, slow motion tears trace the outline of my face. Like a gigantic stone, the pressure of his head weighs down through my pelvic floor. With all my power I am pushing the stone . . . yes, I am also that stone myself. The motion catches me and I feel myself impelled faster and faster . . .
An explosion of light
I see the belly of a huge Buddha,
I am propelled into it
Rapture
Bliss
Ecstasy.

Do not disturb

For anyone who has taken workshops with Dr. Michel Odent, you will have heard him repeat over and over, "Zee most important thing is do not disturb zee birthing woman." We think we know what this means. The more births I attend, the more I realize how much I disturb the birthing woman. Disturbing often comes disguised in the form of "helping." Asking the mother questions, constant verbal coaching, side conversations in the room, clicking cameras—there are so many ways to draw the mother from her ancient brain trance (necessary for a smooth expulsion of the baby) into the present-time world (using the neocortex which interferes with smooth birth). This must be avoided. A recent article on the homebirth of model Cindy Crawford describes how the three birth attendants and Cindy's husband had a discussion about chewing gum while she was giving birth. Cindy describes her experience: "It was absolutely surreal. There I was, in active labor, and they're debating about gum! I wanted to tell them to shut up, but at that point, I couldn't even talk." (Redbook, March 2000). This was in her own home, and she couldn't control the disturbance that was happening in her first birth. Needless to say, she had a long, painful, exhausting second stage.

Human birth is mammal birth. A cat giving birth to her kittens is a good model to look to for what is the optimal human birth environment: a bowl of water, darkness, a pile of old sweaters, quiet, solitude, privacy and protection from predators. When given this environment, 99.7 percent of cats will give birth to kittens just fine. We spend so much money in North America on labor, delivery and recovery (LDR) rooms and now, adding postpartum, LDRP rooms. Yes, it is an advancement that women are not moved from room to room in the birth process, but there is so much more that can disturb the process: lighting, changing staff, monitoring, beeping alarms, exams, questions, bracelets, tidying, assessing, chattering, touching, checking, charting, changing positions and so on.

When midwives come back from the big maternity hospital in Jamaica, they bring an interesting observation about birth. The birthing women are ignored until they come to the door of the unit and say, "Nurse, I have to go poopy." They are then brought into the unit and within twenty-five minutes give birth to the baby. Cervical lips are unheard of. Most times, the head is visible when the woman gets onto the birth table. Her entire eight-centimeter-to-head-visible time is done in the company of the other birthing mothers, and she is cautioned not to go near the midwives until the expulsive feeling in her bum is overwhelming. Cesarean section and instrument delivery rates are very low.

Reversing the energy

Birth is better left alone and pushing should be at the mother's cues. Having said that, I want to address the exceptions to the rule. After hours of full dilation with dwindling sensations, what if the mother is languishing? The sense of anxiety and fatigue in the room builds, and nothing is served by allowing this to go on too long. Such situations often occur at first births, where the mother insists on having her whole family present. This dynamic is one reason why I forbid vaginal birth after cesarean (VBAC) moms to have spectators at their births. Birth is best done in privacy even if the woman desires on a conscious level to have visitors. In this type of situation the midwife can help by changing the direction of the flow. Normally we think of the baby coming "down and out." In this scenario, nothing is moving. It's a bit like having your finger stuck in one of those woven finger traps. The more the mother attempts to bring the baby down the more tired and tight the process becomes. At this point, it can be helpful to get the mother into knee/chest position and tell her to try to take the baby's bum up to her neck for a few pushes. This will sound like strange instruction but, if she has learned to trust you, she will give it a whirl. Reversing the energy and moving it the opposite direction can perform miracles. After five or six sensations in this position with minimal exertion of the mother, the fetal head often appears suddenly at the perineum. For those of you who know Eastern martial arts, you will understand this concept of reversing directions in order to gain momentum. This is midwife Tai Chi!

Facing Fear

Psychological factors in birth are a never-ending source of fascination to some birth attendants. I try to keep it simple. My job is to facilitate birth not practice psychology. When I start to be afraid at births, the last thing I want to hear is someone else's fears in addition to mine. This is a natural inclination but not helpful for moving energy and getting babies into the world. I have learned to notice when I'm fearful and respond to my fears by saying out loud to the mother, "Linda, what's your biggest fear right now?"

Linda may take some time but eventually she'll say something that I never imagined she's holding as a fear. Usually it is enough for her to simply express it. Sometimes she needs some reassuring input. I find always that when fear is expressed it begins to disappear or at least lose its grip on the birth. Be bold about addressing fear and uncommunicated worry. One first-time Mom responded to my question "What's your biggest fear right now?" with "I'm afraid I won't be able to open up and let my baby out." As soon as the words were out, her baby gave a big push and the head was visible at the introitus.

Linguistics and concepts

Midwives have lots of research support encouraging them to be patient with the second stage and wait for physiological expulsion of the baby. Recognizing ways in which we can support the mother to enter that deep trance brain wave state that leads to smooth birth is imperative. I find it very helpful to have new language and concepts for explaining the process to practitioners. Dr. Odent has taught me to wait for the "fetus ejection reflex." This is a reflex like a sneeze. Once it is there you can't stop it, but if you don't have it, you can't force it. While waiting for the "fetus ejection reflex," I imagine the mother dilating to "eleven centimeters." This concept reminds me there may be dilation out of the reach of gloved fingers that we don't know about, but that some women have to do in order to begin the ejection of the baby. I also find it valuable to view birth as an "elimination process" like other elimination processes-coughing, pooping, peeing, crying and sweating. All are valuable (like giving birth is) for maintaining the health of the body. They all require removing the thinking mind and changing one's "state." My friend Leilah is fond of saying, "Birth is a no brainer." After all "elimination processes" are finished, we feel a lot better until the next time. Each individual is competent to handle her bodily elimination functions without a lot of input from others. Birth complications, especially in the first-time mother, are often the result of helpful tampering with something that simply needs time and privacy to unfold as intended.

Gloria Lemay is a Private Birth Attendant in Vancouver, British Columbia, Canada and a frequent contributor to Midwifery Today and The Birthkit.

 

Too many internal exams?

posted Aug 12, 2011, 7:20 PM by Misty Curreli

The Myth of a Vaginal Exam

By Robin Elise Weiss, LCCE, About.com Guide

 
Effacement of the Cervix

LifeART (and/or) MediClip image copyright 2008

Wolters Kluwer Health, Inc.- Lippincott Williams & Wilkins. All rights reserved.
 

Vaginal exams. I don't know a single woman who likes them.

However, there is a myth perpetuated in our society that vaginal exams at the end of pregnancy are beneficial. The common belief is that by doing a vaginal exam one can tell that labor will begin soon. This is not the case.

Most practitioners will do an initial vaginal exam at the beginning of pregnancy to do a pap smear, and other testing. Then they don't do any until about the 36 week mark, unless complications arise that call for further testing or to assess the cervix. If your practitioner wants to do a vaginal exam at every visit, you should probably question them as to why.

Vaginal exams can measure certain things:

             Dilation: How far your cervix has opened. 10 centimeters being the widest.

  • Ripeness: The consistency of your cervix. It starts out being firm like the tip of your nose, softening to what your ear lobe feels like and eventually feeling like the inside of your cheek.

  • Effacement: This is how thin your cervix is. If you think of your cervix as funnel-like, and measuring about 2 inches, you will see that 50% effaced means that your cervix is now about 1 inch in length. As the cervix softens and dilates the length decreases as well.

    Station: This is the position of the baby in relation to your pelvis, measured in pluses and minuses. A baby who is at 0 station is said to be engaged, while a baby in the negative numbers is said to be floating. The positive numbers are the way out!

    Position of the baby: By feeling the suture lines on the skull of the baby, where the four plates of bone haven't fused yet, one can tell you which direction the baby is facing because the anterior and posterior fontanels (soft spots) are shaped differently.

    Position of the cervix: The cervix will move from being more posterior to anterior. Many women can tell when the cervix begins to move around because when a vaginal exam is performed it no longer feels like the cervix is located near her tonsils.

     

    What this equation leaves to be desired is something that is not always tangible. Many people try to use the information that is gathered from a vaginal exam to predict things like when labor will begin or if the baby will fit through the pelvis. A vaginal exam simply cannot measure these things.

Labor is not simply about a cervix that has dilated, softened or anything else. A woman can be very dilated and not have her baby before her due date or even near her due date. I've personally had women who were 6 centimeters dilated for weeks. Then there is the sad woman who calls me to say that her cervix is high and tight, she's been told that this baby isn't coming for awhile, only to be at her side as she gives birth within 24 hours. Vaginal exams are just not good predictors of when labor will start.

Using a vaginal exam to predict advisability for a vaginal birth is usually not very accurate, for several reasons. First of all it leaves out the factor of labor and positioning. During labor it's natural for the baby's head to mold and the mother's pelvis to move. If done in early pregnancy it also removes the knowledge of what hormones like Relaxin will do to help make the pelvis, a moveable structure, be flexible. The only real exception to this is in the case of a very oddly structured pelvis. For example, a mother who was in a car accident and suffered a shattered pelvis or someone who might have a specific bone problem, which is more commonly seen where there is improper nutrition during the growing years.

During labor vaginal exams can't tell you exactly how close you are either, so keeping them to a minimum then is also a good idea, particularly if your membranes have ruptured.

Okay, so there's not really a great reason to have a vaginal in exam done routinely for most women. So are there any reasons not to have vaginal exams? There sure are.

Vaginal exams can increase the risks of infection, even when done carefully and with sterile gloves, etc. It pushes the normal bacteria found in the vagina upwards towards the cervix. There is also increased risk of rupturing the membranes. Some practitioners routinely do what is called stripping the membranes, which simply separates the bag of waters from the cervix. The thought behind this is that it will stimulate the production of prostaglandins to help labor begin and irritate the cervix causing it to contract. This has not been shown to be effective for everyone and does have the aforementioned risks.

In the end only you and your practitioner can decide what is right for your care in pregnancy. Some women refuse vaginal exams altogether, so request to have them done only after 40 weeks, or every other week or whatever she feels comfortable with.

 
Resource:

When is induction a necessity?

posted Sep 15, 2009, 3:22 PM by Misty Curreli   [ updated Aug 12, 2011, 2:55 PM ]

What is the bottom line about induction of labor?

Unfortunately, research provides very few simple answers about induction of labor. For many of the reasons women undergo induced labor, we simply lack the research to say for sure whether the benefits outweigh the harms. For other common reasons for induction, research actually suggests that waiting for labor is safer.

The safety and effectiveness of labor induction depends on the health of the woman and her baby, whether the woman has given birth before, the timing of the induction, the method used, the characteristics of the birth facility, and many other factors. When studies combine many women with different circumstances - as most studies and all systematic reviews do - it becomes impossible to say for sure what the risks and benefits of induction for an individual woman might be.

Despite these limitations, studies provide some consistent findings. These findings come from studies of elective induction of labor - that is, induction without a medical reason (King and colleagues 2010, a systematic review). Looking at the outcomes of elective induction lets us evaluate the outcomes of induction itself, rather than the outcomes of complications that led to the induction.

  • Elective induction before 41 weeks increases the chance of having a c-section if the cervix is "unripe," especially in first-time mothers.
  • Using medications or procedures to "ripen" the cervix does not decrease the chance of a c-section.
  • Women in induced labor are more likely to request an epidural for pain relief than women in spontaneous labor. Epidurals introduce their own set of risks, including increased chance of instrumental vaginal delivery and fever in labor, which is often treated with antibiotics and may result in unnecessary tests and treatments for the baby and separation of the mother and baby after birth. (These and other risks are discussed in greater detail in our Labor Pain section.)

Induction methods also have a predictable effect on the type of care and monitoring you will need in labor. Induction of labor nearly always involves having at least one intravenous (IV) line, continuous electronic fetal monitoring, and medications after birth to reduce the risk of hemorrhage (excessive bleeding). The IV and fetal monitoring lines make it harder to move around in labor, which can increase pain. Many hospitals have policies that restrict what women can eat and drink when undergoing induction of labor.

In recent years, evidence has been mounting that elective delivery before 39 completed weeks clearly increases risks for babies. For optimal outcomes, women may also wish to avoid elective delivery at 40 or 41 weeks and to make informed decisions about this practice after 41 weeks.

In what circumstances does induction of labor improve health outcomes for the mother, baby, or both?

Although decisions about whether and when to induce labor must be individualized, a 2009 systematic review of the research on induction of labor (Mozurkewich and colleagues 2009) found only two conditions for which induction of labor seems to reliably improve health outcomes, and a later study identified a third (Koopmans and colleagues 2009). In all three cases, differences in important health outcomes were small and the studies left some important questions unanswered.
  • Pregnancy lasting beyond 41 weeks: Various studies have compared induction of labor at or after 41 weeks with expectant management, which involved repeated tests of fetal well-being between 41 and 42 weeks. Taken together, the studies suggest that for every 369 women induced during the week between 41 and 42 weeks, one stillbirth or neonatal death may be prevented. The risk of meconium aspiration syndrome (a serious illness that causes respiratory distress) may also be reduced, although studies have come to different conclusions on this outcome. The risk of c-section does not seem to be increased with induction between 41 and 42 weeks, and some studies have shown a decrease.
  • Prelabor rupture of membranes (PROM) at term (37-42 weeks): A large randomized controlled trial compared immediate induction with waiting up to three days for labor and only inducing before then if a complication developed. The study found that inducing right away was associated with a lower chance that the mother would develop an infection or the baby would go to the neonatal intensive care unit. Immediate induction did not affect the likelihood of c-section, newborn infection, or other important outcomes. These results suggest that early induction is the best approach. Several systematic reviews that relied on data from this large RCT came to the same conclusion. However, most women in the trial had vaginal exams before labor began, and those who carried Group B Strep (GBS, a bacteria that may be present in a woman's vagina and raises the risk of infection for the baby) were not given antibiotics to prevent infection. Many caregivers and researchers believe that many infections reported in the trial might have been prevented by awaiting labor before performing a vaginal exam and providing antibiotics to women with GBS. These are standard practice in U.S. maternity care settings today.
  • Increased blood pressure near the end of pregnancy: High blood pressure that develops in pregnancy may occur without other symptoms or signs (known as gestational hypertension) or with protein in the urine (a more dangerous condition known as preeclampsia). High blood pressure can affect the flow of oxygen to the baby, increase the chance of complications during labor, and is a risk factor for rare but very serious outcomes like stroke and seizures.

    Researchers studied outcomes of women at or beyond 36 weeks of pregnancy who developed gestational hypertension (diastolic blood pressure - generally, the second number in a blood pressure reading - between 95 and 110) or mild preeclampsia (diastolic blood pressure between 90 and 110 and protein in the urine). The study found that inducing labor right away improved maternal outcomes. However, they defined "poor maternal outcome" to include any cases where women developed severe high blood pressure. Very few of these women experienced serious health problems as a result of the blood pressure increase. There were no significant differences in the number of serious problems like seizure, need for intensive care, or postpartum hemorrhage, although the study was too small to show whether there were differences in these uncommon outcomes. There were also no significant differences in newborn outcomes, although a later study showed that neonatal intensive care admission, need for artificial ventilation (a machine to help the baby breathe), low birth-weight, and jaundice were more common the earlier a woman with mild gestational hypertension was induced, with best outcomes in the group induced after 38 weeks (Koopmans and colleagues 2009; Barton and colleagues 2011).

    In the randomized controlled trial, women with mild preeclampsia (versus gestational hypertension), women having their first baby, and those with the least amount of cervical dilation were the most likely to benefit from a policy of early induction. This is most likely because preeclampsia is a more serious condition than gestational hypertension and first-time mothers and those who haven't begun dilating would have remained pregnant longer, providing more opportunity for their condition to worsen.

What common "reasons" for induction are not supported by rigorous research?

For a surprising number of conditions, the effectiveness of induction has not been proven (Mozurkewich and colleagues 2009, a systematic review). Yet many women have induced labor with the understanding that they or their babies will benefit. More or larger studies are needed to confirm the benefits and harms of induction in these situations. These include:
  • Preterm prelabor rupture of the membranes (PPROM): A systematic review of 4 randomized controlled trials involving a total of 389 women with ruptured membranes between 30 and 36 weeks found no difference in important health outcomes between those who were induced right away and those who awaited labor. A new, larger study is currently underway.
  • Twin pregnancy: A single, small randomized controlled trial compared routine induction at 37 weeks with expectant management and found no differences in important health outcomes. More research is needed.
  • Gestational diabetes requiring insulin: One randomized controlled trial looked at the outcomes of 200 women randomized to be induced at 38 weeks or await labor. Those who awaited labor were more likely to have large babies. There were no differences in health outcomes for the mothers or babies, however. The trial may have been too small to detect these differences.
  • Intrauterine growth restriction (IUGR) at term: Two trials involving a combined 683 women found no benefit or harm to induction of labor for suspected IUGR at term. More and larger trials are needed.
  • Oligohydramnios (too little amniotic fluid): A single, small randomized controlled trial compared induction of labor with expectant management (watching fetal wellbeing closely until 42 weeks) for women with oligohydramnios at 41 weeks. The women were healthy and did not have other risk factors or complications. The study found no difference in maternal or newborn outcomes, but was too small to detect some important differences that may exist. No trials of induction for isolated oligohydramnios at other gestational ages were found.

For other conditions, the available evidence suggests induction is ineffective, harmful, or both (Mozurkewich and colleagues 2009, a systematic review). Despite the research, many caregivers continue to recommend induction of labor for these reasons. These reasons include:
  • Suspected macrosomia (too big baby): According to a systematic review of several studies involving over 3700 women, inducing labor when the caregiver believes the baby is large does not improve neonatal outcomes and appears to increase the chance that the woman will have a c-section.
  • Intrauterine growth restriction before term: A large, multi-center randomized controlled trial of over 1000 women with growth-restricted fetuses between 24 and 36 weeks and abnormal Doppler artery blood flow studies showed that induction increased the likelihood of c-section. In addition, babies born before 31 weeks in the induction group were more likely to have severe disabilities at 2 years of age than babies born before 31 weeks in the await labor group.
 
 
Resource:

What if your baby is breech?

posted Sep 15, 2009, 3:18 PM by Misty Curreli   [ updated Aug 12, 2011, 3:10 PM ]

Breech Babies Are Another Variation of Normal

by Birth Without Fear on October 29, 2010

breech baby, frank breech, footling breech, complete breech

With my first child, I knew I wanted a natural birth. I chose the local birth center and hired the team of midwives. I attended my regular appointments and the birth classes they offered. Starting around 30 weeks I questioned the position of my baby. I asked three of the midwives at three different appointments if they could tell if my baby was head down. I was overweight at the time and did not think palpation was enough to determine her position. On midwife #3, I requested that we check it out and she agreed.

At my ultrasound appointment and 36 weeks pregnant, I was not shocked when the ultrasound technician said, “Yep, she is breech.” I was not surprised, but I was devastated. This was not something I was educated about or prepared for. Looking back, I was just along for the ride. Big mistake. My doula told me there was still time for her to turn, but not being educated about this, I wasn’t sure.

I started asking my midwives, chiropractors and friends about breech vaginal birth. All I received were mixed answers and usually, “Yes, it can be done, but if something goes wrong it will happen fast. Why take the risk?!” I did a few things, like hanging upside down frequently and handstands in the pool. My chiropractor did the Webster technique, as it has a high success rate in giving babies more room to turn head down. At 39 weeks I had an inversion done. Let me tell you that is painful and unnatural. Wouldn’t do it again.

Finally at 39 weeks I met with a good OB. My husband and I decided to have a c-section because we knew the OB was there to do it (he was in a practice with 16 docs). It was a very emotional ride.

OK, I know that if you are a birth advocate like me, you are completely cringing by now. Tell me about it. If you are trying to educate yourself more or are finding yourself in this situation, you might be asking, “What can I do differently? I need more information!” I am here to provide just that for you. Educate yourself, pray about it (or meditate) and make the best choice for you and your baby. Be strong and get the right support.

So, you find out that your baby is breech. What now?

Don’t panic! It’s going to be OK. Your baby is breech for a reason. (S)he may or may not turn and can do so even right before birth. So, be patient.

breech baby, frank breech, footling breech, complete breechWhich breech presentation is your baby favoring? There are three common types.

  • Frank Breech, which tends to be the most favorable. This is when baby’s bottom presents first and feet are by the head.
  • Footling Breech is when baby has one or both feet presenting first.
  • Complete Breech is when your baby is comfy sitting cross legged.

There are things you can do to help baby turn if that is what baby wants. Remember, your baby knows best what position to be in for his/her birth. Look into the following options:

Even when you decide to have faith in your body and your baby, you still want to be prepared and know how to help him/her gently enter this world. Here are some things to consider and research.

  • Know and be firm in your knowledge that a breech baby does not automatically mean c-section.
  • Make sure your OB or midwife is 100% on board and does not fear breech birth.
  • Always listen to YOUR intuition. If you have a fear, process it. If someone else does, don’t waiver in your faith. Trust your gut!
  • When birthing, get in a favorable position like standing, squatting, or even hand and knees (unless your body is telling you different).
  • Read a lot of great breech birth stories! Here is one with awesome pictures.
  • Do NOT let anyone (your midwife, spouse, doula, OB, etc.) pull on baby!
  • Something to educate yourself on further is making sure baby’s head is birthed before they start breathing. The book Emergency Childbirth by Gregory J. White was helpful for me.
  • Have a back up plan. There is nothing wrong with having one. Don’t focus on it, but know it’s there. Continue to have faith that your vaginal birth will be wonderful and successful.
  • If you get nothing else from this post, remember this: even if you have a c-section, WAIT. Wait for baby to start labor. I say this for two reasons. First, you will know for sure that your baby is ready to be earthside. Second, is that you have given your baby every chance to turn head down. In hindsight, my first baby was born at least 3 weeks early as all my other babies have been born between 42-44 weeks!

A baby that is breech is not abnormal or dangerous. Things can arise in any birth. Breech is another variation of normal!!!

Resource:

L.I. Hospital Stats - How does your hospital measure up?

posted Sep 15, 2009, 3:17 PM by Misty Curreli   [ updated Aug 12, 2011, 3:48 PM ]

Follow the link and select your hospital.  Go to Services and choose "Maternity care"  to see the statistics on many interventions, such as c-sections, forceps delivery,
 
 
Here's Stony Brook:
 

Maternity Information - University Hospital (Stony Brook)

New York State's Maternity Information Law requires each hospital to provide the following information about its childbirth practices and procedures. This information can help you to better understand what you can expect, learn more about your childbirth choices, and plan for your baby's birth. Data shown are for 2009. For more information please see the Maternity Information Brochure.

All births

Intervention This Facility Statewide
# % %
Total births 3,920 100.0% n/a
Forceps delivery 10 0.3% 0.6%
Low/outlet forceps delivery 9 0.2% 0.3%
Mid forceps delivery 1 0.0% 0.0%
Internal fetal monitoring 359 9.2% 9.4%
External fetal monitoring 2,799 71.4% 83.3%
Induction by artificial rupture of membranes 256 6.5% 10.9%
Induction by medicine 422 10.8% 16.0%
Augmented labor 784 20.0% 20.4%
Analgesia 415 16.0% 35.9%
Attended by midwife 622 15.9% 9.6%
  • % based on totals excluding cases with missing information.

Vaginal births

Intervention This Facility Statewide
# % %
Vaginal births 2,353 61.6% 65.2%
Vaginal birth after prior cesarean 65 8.8% 10.0%
Breech births delivered vaginally 4 0.1% 0.2%
Episiotomy 124 5.3% 19.1%
General anesthesia 34 1.4% 0.6%
Spinal anesthesia 25 1.1% 3.7%
Epidural anesthesia 1,670 71.0% 56.2%
Local/other anesthesia 145 6.2% 14.2%
Paracervical anesthesia 0 0.0% 0.0%
Pudendal anesthesia 0 0.0% 0.1%
  • % based on total vaginal births excluding cases with missing information.
  • % is percentage of total births
  • % is percentage of prior cesareans

Cesarean births

Intervention This Facility Statewide
# % %
Cesarean births 1,468 38.4% 34.8%
Primary cesarean 792 20.7% 23.6%
Repeat cesarean 676 17.7% 11.2%
General anesthesia 46 3.2% 4.4%
Spinal anesthesia 902 61.9% 67.4%
Epidural/local anesthesia 491 33.7% 27.2%
  • % based on total cesarean births excluding cases with missing information.
  • % is percentage of total births

Breastfeeding

Infant Feeding Method1 This Facility Statewide
# % %
Fed any breast milk 2,138 65.6% 76.4%
Fed exclusively breast milk 761 23.4% 42.0%
Breastfed Infants Supplemented with Formula2 1,377 64.4% 45.1%
  • 1Based on live born infants, excluding infants who were admitted to the Neonatal Intensive Care Unit or transferred to or from another hospital.
  • 2Percentage is based only on infants who were fed any breast milk.

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