I've got a friend who is pregnant with her second child and fighting her way towards a VBAC after an unnecessary c-section the first time around. She wrote a great post with some links to information about VBACs that I wanted to share, as I know I have a few readers who are wanting VBACs in the future.
See the post here on Operation Housewife.
Showing posts with label interventions. Show all posts
Showing posts with label interventions. Show all posts
Saturday, January 15, 2011
Saturday, December 18, 2010
What are you interested in?
So, part of my goal for this blog is to be a sort of "entry-level" blog into natural birth. Once you dive into researching birth, it is amazing the complexity that you'll find. But, I don't necessarily want to dive into complex areas of pregnancy and birth...after all, I'm not a birth professional (yet) so I technically don't have all of the scientific knowledge, etc. I mostly want to educate women on the choices they have. We have a choice in everything we do...everything!
Doctors and midwives have so much knowledge, thankfully, but ultimately, our care rests in our hands. It is so important to be educated and to work with your care provider so that you attain the best care possible. Many care providers are very busy and unfortunately, that may mean that you are not always in their best interest. That doesn't mean they don't care about you, or that you aren't important to them, but it may mean that often times, things are done simply as a routine. This is where choices come in. Research things and educate yourself so that you know when you have a choice about something and when you don't. For example, you might discuss IV placement (if birthing in a hospital) with your doctor or midwife. IV's are not medically necessary for birth, but they are routine. If you do not wish to have an IV, you do not have to have one (based on the discussion with your doctor). Obviously, if you are planning to have an epidural or other pain medication, you will need that IV. If you are desiring a natural, intervention free birth, you don't need that IV. Many doctors say you need at least a Hep Lock, in case of an emergency situation, but to that I say: if there is an emergency situation, I think you could put an IV in my arm fast enough that everything would be just fine (after all, if an EMT can place an IV in someone injured in a car wreck in the dark, one will most likely be able to be placed in me in a brightly lit room). That is one area where you do have a choice. Again, you research it, you weigh the pros and cons, and then you make a choice. If you feel more comfortable having an IV in your arm, by all means, have that IV. If you feel it would interfere with your ability to cope with the intensity of a natural birth, then decline the IV placement. Doctors and midwives vary on this practice. My second OB (before I switched to a home birth midwife) told me that I did not have to have an IV, but that she would prefer that I have a Hep Lock. When I told her I'd rather not have either, she was supportive of that. She is a great doctor who is understanding of how natural birth differs from medicalized births, so for me, she was a great choice as a care provider. The most important thing to remember is that you do have a choice in care providers, so if you are not happy with the way your doctor or midwife handles things or if you do not agree with the way they view birth, then you are free to make the choice to switch. You are the one paying them, so you are free to find someone who is a good fit for you. If you are not satisfied with their care, by all means, switch! It is your health, your birth, and you need to be with someone who will work with you, support you, and include you as part of your care. Informed consent...means you are educated, you work with your care provider to make decisions, and you make choices based on the information you have been given and learned.
So my question is, what things are you interested in learning about on this blog? What things would you like to know more about? Is there any particular aspect of pregnancy and/or birth that you would like to broaden your knowledge on?
Doctors and midwives have so much knowledge, thankfully, but ultimately, our care rests in our hands. It is so important to be educated and to work with your care provider so that you attain the best care possible. Many care providers are very busy and unfortunately, that may mean that you are not always in their best interest. That doesn't mean they don't care about you, or that you aren't important to them, but it may mean that often times, things are done simply as a routine. This is where choices come in. Research things and educate yourself so that you know when you have a choice about something and when you don't. For example, you might discuss IV placement (if birthing in a hospital) with your doctor or midwife. IV's are not medically necessary for birth, but they are routine. If you do not wish to have an IV, you do not have to have one (based on the discussion with your doctor). Obviously, if you are planning to have an epidural or other pain medication, you will need that IV. If you are desiring a natural, intervention free birth, you don't need that IV. Many doctors say you need at least a Hep Lock, in case of an emergency situation, but to that I say: if there is an emergency situation, I think you could put an IV in my arm fast enough that everything would be just fine (after all, if an EMT can place an IV in someone injured in a car wreck in the dark, one will most likely be able to be placed in me in a brightly lit room). That is one area where you do have a choice. Again, you research it, you weigh the pros and cons, and then you make a choice. If you feel more comfortable having an IV in your arm, by all means, have that IV. If you feel it would interfere with your ability to cope with the intensity of a natural birth, then decline the IV placement. Doctors and midwives vary on this practice. My second OB (before I switched to a home birth midwife) told me that I did not have to have an IV, but that she would prefer that I have a Hep Lock. When I told her I'd rather not have either, she was supportive of that. She is a great doctor who is understanding of how natural birth differs from medicalized births, so for me, she was a great choice as a care provider. The most important thing to remember is that you do have a choice in care providers, so if you are not happy with the way your doctor or midwife handles things or if you do not agree with the way they view birth, then you are free to make the choice to switch. You are the one paying them, so you are free to find someone who is a good fit for you. If you are not satisfied with their care, by all means, switch! It is your health, your birth, and you need to be with someone who will work with you, support you, and include you as part of your care. Informed consent...means you are educated, you work with your care provider to make decisions, and you make choices based on the information you have been given and learned.
So my question is, what things are you interested in learning about on this blog? What things would you like to know more about? Is there any particular aspect of pregnancy and/or birth that you would like to broaden your knowledge on?
Thursday, December 16, 2010
Thoughts
I have to apologize for my lack of posts lately on this blog (if anyone's even reading!) but between a husband, two kids, a house, and life in general, i haven't found the time to share my thoughts about birth.
I've had lots of thoughts and ideas running through my head lately about birth but since I happen to be short on time, I'll share only one of those thoughts.
Each month, I attend a birth circle in Queen Creek, Arizona. It is a place where like-minded women meet to discuss pregnancy and birth. It is an awesome group! For one thing, it is nice to have conversations about birth where you can literally finish the other person's sentence. There is such a tangible feeling their of true concern and love for each other...it is just wonderful.
So, at our last meeting, two nurses came from a local hospital because they were feeling very frustrated with what they see every day at Labor and Delivery and were looking to find support for their ideas and feelings (they are the "black sheep" where they work because *gasp* they support natural birth!!!). It was quite shocking to hear what they had to say about the things they're seeing at work. Obviously no personal information was shared, so as to not break any laws, but they explained to us the kinds of things they're seeing; the kinds of things I've been reading and hearing about! It was sad to me to realize that all of the issues we're facing in birth right now aren't simply things I've read about on the internet...they are actually happening right in my back yard. That particular day at work, those ladies had 16 births. How many of those births do you think were cesarean sections? Seven. Seven out of sixteen births! Born by c-section. We asked what the reasons for the c-sections were and the majority would be considered unnecessary, meaning they were failure to progress/failed induction, etc. Hearing this made me so sad. That is almost a 50% c-section rate for that day. Astounding! That particular hospital's rate is between 33-34% overall...much, much too high. Unfortunately, extremely common.
What I came away with, however, was not overwhelming sadness and disgust for the way birth is at this point in time...I came away with a renewed desire to continue educating and inspiring women so that they do not have to go through traumatic births (vaginal or surgical). I want to help women see that birth can be something that doesn't have to be feared. I want to help women have the type of birth they want and know how to achieve that in any setting whether that is a hospital, a birth center, or at home. I want to make a difference...even if it is one woman at a time. Right now, my scope of influence is very small, but I hope someday to have more opportunities to educate and inspire by becoming a doula and a childbirth educator. I've pondered those things a lot lately and have come to realize that as badly as I want to do those things right now, it is not the right time. That makes me sad, but I also know that my most important job is to take care of my family first. I know someday I'll be able to work with women and help them achieve the births they desire. Until then, this blog will continue to be a wonderful outlet for me and my small way of making a difference.
More posts to come (soon, hopefully)!
What things have you been thinking about lately, in regards to pregnancy or birth?
I've had lots of thoughts and ideas running through my head lately about birth but since I happen to be short on time, I'll share only one of those thoughts.
Each month, I attend a birth circle in Queen Creek, Arizona. It is a place where like-minded women meet to discuss pregnancy and birth. It is an awesome group! For one thing, it is nice to have conversations about birth where you can literally finish the other person's sentence. There is such a tangible feeling their of true concern and love for each other...it is just wonderful.
So, at our last meeting, two nurses came from a local hospital because they were feeling very frustrated with what they see every day at Labor and Delivery and were looking to find support for their ideas and feelings (they are the "black sheep" where they work because *gasp* they support natural birth!!!). It was quite shocking to hear what they had to say about the things they're seeing at work. Obviously no personal information was shared, so as to not break any laws, but they explained to us the kinds of things they're seeing; the kinds of things I've been reading and hearing about! It was sad to me to realize that all of the issues we're facing in birth right now aren't simply things I've read about on the internet...they are actually happening right in my back yard. That particular day at work, those ladies had 16 births. How many of those births do you think were cesarean sections? Seven. Seven out of sixteen births! Born by c-section. We asked what the reasons for the c-sections were and the majority would be considered unnecessary, meaning they were failure to progress/failed induction, etc. Hearing this made me so sad. That is almost a 50% c-section rate for that day. Astounding! That particular hospital's rate is between 33-34% overall...much, much too high. Unfortunately, extremely common.
What I came away with, however, was not overwhelming sadness and disgust for the way birth is at this point in time...I came away with a renewed desire to continue educating and inspiring women so that they do not have to go through traumatic births (vaginal or surgical). I want to help women see that birth can be something that doesn't have to be feared. I want to help women have the type of birth they want and know how to achieve that in any setting whether that is a hospital, a birth center, or at home. I want to make a difference...even if it is one woman at a time. Right now, my scope of influence is very small, but I hope someday to have more opportunities to educate and inspire by becoming a doula and a childbirth educator. I've pondered those things a lot lately and have come to realize that as badly as I want to do those things right now, it is not the right time. That makes me sad, but I also know that my most important job is to take care of my family first. I know someday I'll be able to work with women and help them achieve the births they desire. Until then, this blog will continue to be a wonderful outlet for me and my small way of making a difference.
More posts to come (soon, hopefully)!
What things have you been thinking about lately, in regards to pregnancy or birth?
Monday, June 14, 2010
How to have a natural birth in a hospital
I asked my friend, Rachel, who blogs at The Beginning of Motherhood, to share some thoughts about how to achieve a natural birth in a hospital setting. Rachel has a lot of experience with this, as she has had five children naturally and works as a nurse in Labor and Delivery. Thank you so much for sharing your wonderful tips!
----------
I have seen all sorts of births and all sorts of birth plans. I have seen women do fabulous going natural on pitocin, laying in bed, and in all sorts of other situations. I have also seen some women who have been doing great soaking in a tub, but ask for an epidural. I have seen some who I would have thought regretted not getting an epidural, but when asked, said they appreciated the experience. Any way it happens, a natural birth(going without pain medication) is something that you need to have a reason for wanting. To me, that has been the key ingredient. Also, your desire may change further down the road through labor, and that's OK. So, I would say the first step in having a natural birth in the hospital, is to decide if you really want to and why. These are not questions that anyone can really give you an answer too, but yourself, but I'll attempt to start you on your path.
First off, you can do a natural birth. Women have been doing them forever. So the real question is do you want to. The main reason for getting an epidural is the obvious: pain relief. Labor is hard work, and can be very painful. But, pain tolerance is not really an indicator of whether or not you will want an epidural. What you need to decide is if your reason for wanting one is greater than your reason for not wanting one. A few case examples. Many women are afraid of the needle in an epidural, or the pain of the epidural itself. I have had one woman tell me that when her contractions are so intense that she no longer is afraid of the needle then she gets the epidural. She always gets them. Therefore, for her, the labor is worse than the epidural. On the other hand, another woman I took care of felt like her fear of the epidural was greater than her fear of labor. Therefore, she always went natural. Some other factors to think about when it comes to reasons for/against getting epidurals: 1)you ability to move is greatly reduced when you have an epidural. Once you have one you are in bed, with a tube to drain your urine, and the nurses have to help with movement of the legs. This may be OK with you, and may be worth it, but again, it's just something to think about. Many people are worried about drugs being introduced. From what I have researched, the drugs given in epidurals will not cross into your babies body, but it does effect immediate breastfeeding(though not long term). It does tend to slow down labor, and there is an increased use of forceps or vacuums with them. For those who are experiencing exhaustion or can not relax, though, it may be useful. These are just some of the factors involved, and I would suggest thoroughly researching them.
So onto how to work through a natural labor in the hospital.
Request a hep-lock(where the iv is in you, but not connected to any tubing), or no iv at all if you feel comfortable with that. If you are not receiving iv fluids, make sure you are eating and drinking. If your hospital only allows ice chips, eat as many ice chips as possible and add sugar:) I would even bring some Gatorade pre frozen just for you to suck on. As long as it's ice, it fits in the policy. Some research I have read suggests that a woman needs at least 125-250 ml of water and hour. That's 1L of fluids every 4-8 hours. If you have to have an iv, you are still capable of moving. Request that you have an iv pole for the fluids to hang on so that you can walk around with it. If you do have any fluids running in, keep in mind that you can also get too much. Especially if you are on pitocin as that tends to increase water retention. One bag of iv fluid equals a liter, so keep that in mind when gaging how much you are drinking. Make sure you are going to the bathroom often, at least every one or two hours. An empty bladder will facilitate labor. Sitting on the toilet is also a comfortable position:) An iv pole can actually be very useful to hold onto during contractions. When you are feeling weaker, but still want to stand, an iv pole makes a good brace to pull down on. It is also useful during pushing. If you are wanting to squat, the pole can be used to hold onto.
Request intermittent monitoring. Keep in mind that this may only be possible if the nurses aren't busy, and your babies heart rate is looking OK. Intermittent monitoring has been shown to be safe and effective in monitoring the heart beat of the baby. ACOG guidelines suggest listening to the babies heart beat every 15-30 m while in active labor. This also needs to be done during a contraction and immediately after. This allows the nurse to check the heart rate while you are in different positions or different places. If you have to be connected to the monitors, you can still sit up and move around. You can stand, squat and walk. The difficulty in this comes from making sure that the heart rate stays on the monitor. It is helpful to have someone hold it on tighter during contractions, while sitting up, or squatting. Anyone can do this, it doesn't have to be a nurse. If you notice that the babies heart rate isn't picking up at different times during your labor, try having someone hand hold it. While I normally, don't like internal monitors, for someone who is going natural and having to be on the monitor, they can be useful. With internal monitors, the babies heart rate is picked up much easier and movement is not restricted as much. This would be something that I personally would like at on a case by case basis, and only if the mothers bag of water is already broken.
Which leads me to the bag of water. I would suggest not getting it broken as a matter of policy. Research shows that it does tend to decrease labor time, but only by about 20m. Once your water is broken, contractions tend to be stronger and harder. If you want to shave off time in labor, I would suggest having your water broken during transition or after(around8-10cm). At this point, your labor is already pretty intense, and shaving off time at this point is usually very welcomed. This really is just my opinion. Also, once the water is broken, it allows for germs to be introduced. So often the water is just broken, without a thought as to the individuals preference. Just make sure you at least think about it.
The bed in the hospital can actually be very useful. There are a lot of different positions that it can help you obtain. If you want to kneel, you can kneel over the top, bring the bottom down and kneel on that, or just be on your hands and knees on something soft. During pushing, you can bring the head all the way up and the feet all the way down to simulate a squat or birthing chair. I would play around with it and see how you might find it the most useful. It is also useful to use to kneel on, or put a birthing ball on and lean on.
Water....this has been shown to be one of the most effective pain relief measures for those who are going natural. If you find yourself getting tired, afraid you can't go on, or just needing to try something different, try a hot bath. Some hospitals do not allow this. If this is the case, bring a heating pad that you can use to sit on on the birthing ball, use with counter pressure, or just relax muscles and tension.
If you need to have pitocin, don't sell your selves short and feel like it's impossible to have a natural birht. I have seen many women do fantastic with pitocin. Some key things to remember...you can do it. You have to have a reason for wanting to do it, but it's OK if you don't want to. Ask your provider if you can do low dose pitocin. This will add the pitocin more gradually. You can also request that your pitocin be turned off once you have reached active labor. At this point, your body will sometimes take over and you will no longer need pitocin.
For some it is useful to try not to think about the contractions in terms of pain, but just intensity. If you prefer this, make sure you ask your nurse not to ask you your what level your pain is at. But let her know whether or not it is getting more intense. This is an important indicator of how your labor is progressing and how well a woman is coping.
One last point, when you first arrive at the hospital there is a whole admittance procedure. If you are not in too much pain, it's not that big of a deal. But if you are having to work hard through contractions, appoint someone else to answer the questions that are needed.
----------
I have seen all sorts of births and all sorts of birth plans. I have seen women do fabulous going natural on pitocin, laying in bed, and in all sorts of other situations. I have also seen some women who have been doing great soaking in a tub, but ask for an epidural. I have seen some who I would have thought regretted not getting an epidural, but when asked, said they appreciated the experience. Any way it happens, a natural birth(going without pain medication) is something that you need to have a reason for wanting. To me, that has been the key ingredient. Also, your desire may change further down the road through labor, and that's OK. So, I would say the first step in having a natural birth in the hospital, is to decide if you really want to and why. These are not questions that anyone can really give you an answer too, but yourself, but I'll attempt to start you on your path.
First off, you can do a natural birth. Women have been doing them forever. So the real question is do you want to. The main reason for getting an epidural is the obvious: pain relief. Labor is hard work, and can be very painful. But, pain tolerance is not really an indicator of whether or not you will want an epidural. What you need to decide is if your reason for wanting one is greater than your reason for not wanting one. A few case examples. Many women are afraid of the needle in an epidural, or the pain of the epidural itself. I have had one woman tell me that when her contractions are so intense that she no longer is afraid of the needle then she gets the epidural. She always gets them. Therefore, for her, the labor is worse than the epidural. On the other hand, another woman I took care of felt like her fear of the epidural was greater than her fear of labor. Therefore, she always went natural. Some other factors to think about when it comes to reasons for/against getting epidurals: 1)you ability to move is greatly reduced when you have an epidural. Once you have one you are in bed, with a tube to drain your urine, and the nurses have to help with movement of the legs. This may be OK with you, and may be worth it, but again, it's just something to think about. Many people are worried about drugs being introduced. From what I have researched, the drugs given in epidurals will not cross into your babies body, but it does effect immediate breastfeeding(though not long term). It does tend to slow down labor, and there is an increased use of forceps or vacuums with them. For those who are experiencing exhaustion or can not relax, though, it may be useful. These are just some of the factors involved, and I would suggest thoroughly researching them.
So onto how to work through a natural labor in the hospital.
Request a hep-lock(where the iv is in you, but not connected to any tubing), or no iv at all if you feel comfortable with that. If you are not receiving iv fluids, make sure you are eating and drinking. If your hospital only allows ice chips, eat as many ice chips as possible and add sugar:) I would even bring some Gatorade pre frozen just for you to suck on. As long as it's ice, it fits in the policy. Some research I have read suggests that a woman needs at least 125-250 ml of water and hour. That's 1L of fluids every 4-8 hours. If you have to have an iv, you are still capable of moving. Request that you have an iv pole for the fluids to hang on so that you can walk around with it. If you do have any fluids running in, keep in mind that you can also get too much. Especially if you are on pitocin as that tends to increase water retention. One bag of iv fluid equals a liter, so keep that in mind when gaging how much you are drinking. Make sure you are going to the bathroom often, at least every one or two hours. An empty bladder will facilitate labor. Sitting on the toilet is also a comfortable position:) An iv pole can actually be very useful to hold onto during contractions. When you are feeling weaker, but still want to stand, an iv pole makes a good brace to pull down on. It is also useful during pushing. If you are wanting to squat, the pole can be used to hold onto.
Request intermittent monitoring. Keep in mind that this may only be possible if the nurses aren't busy, and your babies heart rate is looking OK. Intermittent monitoring has been shown to be safe and effective in monitoring the heart beat of the baby. ACOG guidelines suggest listening to the babies heart beat every 15-30 m while in active labor. This also needs to be done during a contraction and immediately after. This allows the nurse to check the heart rate while you are in different positions or different places. If you have to be connected to the monitors, you can still sit up and move around. You can stand, squat and walk. The difficulty in this comes from making sure that the heart rate stays on the monitor. It is helpful to have someone hold it on tighter during contractions, while sitting up, or squatting. Anyone can do this, it doesn't have to be a nurse. If you notice that the babies heart rate isn't picking up at different times during your labor, try having someone hand hold it. While I normally, don't like internal monitors, for someone who is going natural and having to be on the monitor, they can be useful. With internal monitors, the babies heart rate is picked up much easier and movement is not restricted as much. This would be something that I personally would like at on a case by case basis, and only if the mothers bag of water is already broken.
Which leads me to the bag of water. I would suggest not getting it broken as a matter of policy. Research shows that it does tend to decrease labor time, but only by about 20m. Once your water is broken, contractions tend to be stronger and harder. If you want to shave off time in labor, I would suggest having your water broken during transition or after(around8-10cm). At this point, your labor is already pretty intense, and shaving off time at this point is usually very welcomed. This really is just my opinion. Also, once the water is broken, it allows for germs to be introduced. So often the water is just broken, without a thought as to the individuals preference. Just make sure you at least think about it.
The bed in the hospital can actually be very useful. There are a lot of different positions that it can help you obtain. If you want to kneel, you can kneel over the top, bring the bottom down and kneel on that, or just be on your hands and knees on something soft. During pushing, you can bring the head all the way up and the feet all the way down to simulate a squat or birthing chair. I would play around with it and see how you might find it the most useful. It is also useful to use to kneel on, or put a birthing ball on and lean on.
Water....this has been shown to be one of the most effective pain relief measures for those who are going natural. If you find yourself getting tired, afraid you can't go on, or just needing to try something different, try a hot bath. Some hospitals do not allow this. If this is the case, bring a heating pad that you can use to sit on on the birthing ball, use with counter pressure, or just relax muscles and tension.
If you need to have pitocin, don't sell your selves short and feel like it's impossible to have a natural birht. I have seen many women do fantastic with pitocin. Some key things to remember...you can do it. You have to have a reason for wanting to do it, but it's OK if you don't want to. Ask your provider if you can do low dose pitocin. This will add the pitocin more gradually. You can also request that your pitocin be turned off once you have reached active labor. At this point, your body will sometimes take over and you will no longer need pitocin.
For some it is useful to try not to think about the contractions in terms of pain, but just intensity. If you prefer this, make sure you ask your nurse not to ask you your what level your pain is at. But let her know whether or not it is getting more intense. This is an important indicator of how your labor is progressing and how well a woman is coping.
One last point, when you first arrive at the hospital there is a whole admittance procedure. If you are not in too much pain, it's not that big of a deal. But if you are having to work hard through contractions, appoint someone else to answer the questions that are needed.
Thursday, May 20, 2010
two great posts
i love stephanie's birth blog. she is a midwife here in Arizona and she has a nice writing style. two of her most recent posts were great and i can just say "amen" to everything she wrote!
check them out:
big babies
here's a quote i liked from "big babies"
“Big babies cause tears.” – I just don’t believe this! Big babies don’t cause tears as much as impatient care providers, rough perineal massage, epidurals, lithotomy position, coached pushing, poor diet in pregnancy, dehydration…! The two largest babies I’ve ever seen born were 11 lbs 8 ounces (this weekend), and 13 pounds 5 ounces (many years ago). Neither mom tore at all. (see #2 analogy of smoke detectors)
i second that!! my second baby was a pound bigger than my first - with my first i tore very badly (had an epidural and rough perineal massage by the doctor, which i thought was supposed to help not tear...but have found out that increases the chances of tearing...great!) - with my second...slight tear...like a papercut that didn't even need stitches. it healed on its own...i felt normal the second i gave birth (i am not kidding). there was no recovery. sooooo. i agree with the fact that big babies do not necessarily mean "big tearing."
what bugs me...
here's a quote i liked from "what bugs me..." it's something to think about...really! (emphasis added)
When I am talking to someone who finds out that I’m a midwife and their response is, “Oh, I LOVE my epidurals!!” (wait – I’m not to what bugs me yet! That’s fine and dandy with me, I totally get that and I’m glad that they had positive experiences with an epidural!) But as we continue the conversation and they start telling me about how they have horrible heartburn and their doctor gave them some prescription but they don’t want to take it because they don’t want the drugs to get to the baby….that they won’t even take Tylenol because they are pregnant….they are M-O-R-T-I-F-I-E-D if they see someone pregnant take a sip of wine!! But on the day in which their baby will go through the largest physical transformation they will ever have, the ONE day in which drugs will have the biggest possible impact on that baby….on that day they almost proudly declare, “Load me up!” (i've totally heard that before)
It’s socially unacceptable to take a sip of wine when you are 28 weeks pregnant…but totally okay to do Stadol and get an epidural with Fentanyl in it (Fentanyl is 100 times more potent than Morphine) – in fact, it’s weird if you don’t do that. I don’t get it.
check them out:
big babies
here's a quote i liked from "big babies"
“Big babies cause tears.” – I just don’t believe this! Big babies don’t cause tears as much as impatient care providers, rough perineal massage, epidurals, lithotomy position, coached pushing, poor diet in pregnancy, dehydration…! The two largest babies I’ve ever seen born were 11 lbs 8 ounces (this weekend), and 13 pounds 5 ounces (many years ago). Neither mom tore at all. (see #2 analogy of smoke detectors)
i second that!! my second baby was a pound bigger than my first - with my first i tore very badly (had an epidural and rough perineal massage by the doctor, which i thought was supposed to help not tear...but have found out that increases the chances of tearing...great!) - with my second...slight tear...like a papercut that didn't even need stitches. it healed on its own...i felt normal the second i gave birth (i am not kidding). there was no recovery. sooooo. i agree with the fact that big babies do not necessarily mean "big tearing."
what bugs me...
here's a quote i liked from "what bugs me..." it's something to think about...really! (emphasis added)
When I am talking to someone who finds out that I’m a midwife and their response is, “Oh, I LOVE my epidurals!!” (wait – I’m not to what bugs me yet! That’s fine and dandy with me, I totally get that and I’m glad that they had positive experiences with an epidural!) But as we continue the conversation and they start telling me about how they have horrible heartburn and their doctor gave them some prescription but they don’t want to take it because they don’t want the drugs to get to the baby….that they won’t even take Tylenol because they are pregnant….they are M-O-R-T-I-F-I-E-D if they see someone pregnant take a sip of wine!! But on the day in which their baby will go through the largest physical transformation they will ever have, the ONE day in which drugs will have the biggest possible impact on that baby….on that day they almost proudly declare, “Load me up!” (i've totally heard that before)
Let me make this clear….no, it is not just that your baby’s lungs start breathing, it’s so much more than that. Let’s look at just your baby’s heart! What happens IMMEDIATELY at birth…
… As soon as the baby is born, the foramen ovale, ductus arteriosus ductus venosus and umbilical vessels are no longer needed.
… The sphincter in the ductus venosus constricts, so that all blood entering the liver passes through the hepatic sinusoids.
… Occlusion of the placental circulation causes an immediate fall of blood pressure in the IVC and right atrium.
- Increasing uptake of oxygen by lungs (first and subsequent breaths) induces a vasoconstriction of ductus venosus and ductus arteriosis
… As soon as the baby is born, the foramen ovale, ductus arteriosus ductus venosus and umbilical vessels are no longer needed.
… The sphincter in the ductus venosus constricts, so that all blood entering the liver passes through the hepatic sinusoids.
… Occlusion of the placental circulation causes an immediate fall of blood pressure in the IVC and right atrium.
- Increasing uptake of oxygen by lungs (first and subsequent breaths) induces a vasoconstriction of ductus venosus and ductus arteriosis
It’s socially unacceptable to take a sip of wine when you are 28 weeks pregnant…but totally okay to do Stadol and get an epidural with Fentanyl in it (Fentanyl is 100 times more potent than Morphine) – in fact, it’s weird if you don’t do that. I don’t get it.
Monday, April 26, 2010
questioning the efficacy of continuous electronic fetal monitoring
this is an article that just came out, written by an OB, who is questioning the efficacy of continuous electronic fetal monitoring and proposing that it's failures lead to unnecessary cesarean surgeries.
it's worth a read, especially since you are most likely to be required to have continuous fetal monitoring in most any hospital. i am not sure what birth centers do, but i assume, like home birth, that the monitoring is intermittent (every 10-15 minutes, until pushing, which is then about every 5 minutes, give or take - correct me if i'm wrong).
"Test leads to needless C-sections"
coming up: all about homebirth - what is it and is it right for you?
it's worth a read, especially since you are most likely to be required to have continuous fetal monitoring in most any hospital. i am not sure what birth centers do, but i assume, like home birth, that the monitoring is intermittent (every 10-15 minutes, until pushing, which is then about every 5 minutes, give or take - correct me if i'm wrong).
"Test leads to needless C-sections"
coming up: all about homebirth - what is it and is it right for you?
Thursday, April 1, 2010
the cascade of interventions
here's a clip from the documentary, "The Business of Being Born."
it does a great job showing how one intervention can lead to another, which may lead to an undesirable outcome - most importantly, the undesirable outcome of having your baby in distress.
another great place to learn about interventions in childbirth is on the blog "pushed birth." go here to start reading.
Thursday, March 25, 2010
all about episiotomies
great title, huh!
an episiotomy is a surgical cut to a woman's perineum, performed during vaginal childbirth.
this practice used to be quite routine, as many deliveries were assisted by forceps.
according to a Centers for Disease Control’s 2001 study, forcep deliveries have decreased from a rate of 17.6 percent of all deliveries in 1980 to only four percent of all deliveries in the year 2000. episiotomy rates, however, have not followed this same trend. episiotomies have dropped to 32.7 percent of all deliveries versus 64 percent in 1988.
so if forcep deliveries are now less common, why would doctors still routinely give episiotomies? many doctors believe that episiotomies prevent damage to the perineum. however, studies show no evidence that the pelvic floor muscles would be "protected" by an episiotomy.
there are risks involved with episiotomies, such as infection, increased bleeding, hematoma, postpartum pain, damage to the anal sphincter, incontinence, increased scar tissue, loss of sexual sensation, and painful intercourse, among others. studies have shown that women who tear naturally return sooner to sexual intercourse after giving birth than women who receive episiotomies.
an episiotomy can be beneficial in a vaginal delivery because it speeds up birth. this is helpful when a baby is truly in distress. however, if the baby or the mother's life is not in danger, there are more risks to receiving an episiotomy than to letting the body take its natural course, even if some tearing occurs.
think of the vagina as a ribbon. when you cut a ribbon and then tear, what happens? lots and lots of fraying. it can be the same way when you receive an episiotomy. having an episiotomy does not mean you will not tear - in fact, if you do tear after an episiotomy, the results are usually much worse (like the ribbon example). when you try to tear a ribbon without making a cut, there is not as much fraying. it is like that when you tear without an episiotomy - a cleaner, often smaller tear occurs which is better for healing and longterm perineal health.
as with all interventions, there are risks and benefits. the time to research these interventions is while you are pregnant - find out why they are done, what the risks are, and talk to your doctor or midwife about it. most importantly, make sure you are well informed so that you can avoid any interventions that are unnecessary.
tips on avoiding an unnecessary episiotomy or excessive tearing:
1. become educated on the topic - know the pros and cons
2. push slowly and controlled (as much as you can control that overwhelming urge!), allowing your skin time to stretch (the "ring of fire" happens for a reason...it burns which is your body telling you to slow down and allow it time to stretch...listen to your body!)
3. know your caregiver's opinion on episiotomies - if your caregiver has a high episiotomy rate, consider finding someone else who uses them infrequently
4. do kegel exercises to strengthen your pelvic floor
5. in the last few weeks of pregnancy, do perineal massage to help stretch the opening
6. during pushing, ask that your doctor/midwife/nurse places support on your perineum to redirect pressure and ease the possibility of tearing (hot compresses and oil do wonders for this)
7. birth in a position other than on your back with your legs in stirrups - this position places a lot of unnecessary pressure on your perineum, thus increasing the possibility of tearing/use of episiotomy
8. birth naturally - when you birth naturally, you are in control of your body - chances of receiving an episiotomy go up with the administration of epidural anesthesia because pushing can be more difficult when numb
an episiotomy is a surgical cut to a woman's perineum, performed during vaginal childbirth.
this practice used to be quite routine, as many deliveries were assisted by forceps.
according to a Centers for Disease Control’s 2001 study, forcep deliveries have decreased from a rate of 17.6 percent of all deliveries in 1980 to only four percent of all deliveries in the year 2000. episiotomy rates, however, have not followed this same trend. episiotomies have dropped to 32.7 percent of all deliveries versus 64 percent in 1988.
so if forcep deliveries are now less common, why would doctors still routinely give episiotomies? many doctors believe that episiotomies prevent damage to the perineum. however, studies show no evidence that the pelvic floor muscles would be "protected" by an episiotomy.
there are risks involved with episiotomies, such as infection, increased bleeding, hematoma, postpartum pain, damage to the anal sphincter, incontinence, increased scar tissue, loss of sexual sensation, and painful intercourse, among others. studies have shown that women who tear naturally return sooner to sexual intercourse after giving birth than women who receive episiotomies.
an episiotomy can be beneficial in a vaginal delivery because it speeds up birth. this is helpful when a baby is truly in distress. however, if the baby or the mother's life is not in danger, there are more risks to receiving an episiotomy than to letting the body take its natural course, even if some tearing occurs.
think of the vagina as a ribbon. when you cut a ribbon and then tear, what happens? lots and lots of fraying. it can be the same way when you receive an episiotomy. having an episiotomy does not mean you will not tear - in fact, if you do tear after an episiotomy, the results are usually much worse (like the ribbon example). when you try to tear a ribbon without making a cut, there is not as much fraying. it is like that when you tear without an episiotomy - a cleaner, often smaller tear occurs which is better for healing and longterm perineal health.
as with all interventions, there are risks and benefits. the time to research these interventions is while you are pregnant - find out why they are done, what the risks are, and talk to your doctor or midwife about it. most importantly, make sure you are well informed so that you can avoid any interventions that are unnecessary.
tips on avoiding an unnecessary episiotomy or excessive tearing:
1. become educated on the topic - know the pros and cons
2. push slowly and controlled (as much as you can control that overwhelming urge!), allowing your skin time to stretch (the "ring of fire" happens for a reason...it burns which is your body telling you to slow down and allow it time to stretch...listen to your body!)
3. know your caregiver's opinion on episiotomies - if your caregiver has a high episiotomy rate, consider finding someone else who uses them infrequently
4. do kegel exercises to strengthen your pelvic floor
5. in the last few weeks of pregnancy, do perineal massage to help stretch the opening
6. during pushing, ask that your doctor/midwife/nurse places support on your perineum to redirect pressure and ease the possibility of tearing (hot compresses and oil do wonders for this)
7. birth in a position other than on your back with your legs in stirrups - this position places a lot of unnecessary pressure on your perineum, thus increasing the possibility of tearing/use of episiotomy
8. birth naturally - when you birth naturally, you are in control of your body - chances of receiving an episiotomy go up with the administration of epidural anesthesia because pushing can be more difficult when numb
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