Natural Childbirth — Labor Interventions

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Doulas on The Today Show 0

Doulas are a wonderful addition to the modern, medical birthing environment. They are proven to reduce a number of unnecessary interventions, including cesarean. They offer emotional support and in many instances, doulas will gently remind a woman who is being coerced into unnecessary procedures about her original intentions and birth plan. Doctors (and CNMs) hate this. The following clip is from the Today Show which aired on November 20, 2008 and in which mother and doula's opinions were downplayed while the obstetrician got the lion's share of the interview and the woman basically blamed doulas for less than favorable outcomes which is absolutely and utterly ridiculous. They (the cogs in the medical model) have no one to blame but themselves, their wallets and their watch for less than favorable outcomes.

How to Avoid Cesarean Delivery 5

Avoid CesareanAuthor: Kara Spencer, LMT, CD A Cesarean section is major abdominal surgery performed in order to deliver a baby from its mother, through an incision in her abdomen. Cesareans are a vital emergency surgery for mothers and babies who are at severe risk. However, C-sections are on the rise in US and around the world, and it is reaching epidemic proportions. In the 1960's, only 5% of babies were born by Cesarean, in the 1970's and 1980's the surgery increased to 25% of women delivered their babies through surgery. Now, in the US, one in three women deliver their babies via Cesarean. You are having a baby and you want to avoid a cesarean - what do you do? The best thing you can do to reduce the risk of Cesarean is to hire a midwife for your prenatal care, labor and delivery. Midwives have dramatically higher rates of successful healthy vaginal delivery than obstetricians. A new research study by Sutter Health, shows that the two factors in hospital birth that most lead to a Cesarean are active management of early labor and medical induction. You can avoid active management of early labor through hiring a doula to support you through labor. A doula can come to your home in early labor, and is familiar with signs and behaviors of the different stages of labor, and may help you to cope at home, so you don't show up at the hospital too early. Try to stay at home until you are in active labor to avoid unnecessary interventions which may lead to iatrogenic complications. Increase your awareness of the realities of medical induction. Along with Cesareans, there is an epidemic of inductions happening in the United States. The baby's due date is an estimated due date, yet there is increasingly a medical and cultural belief that babies should be born on or before the due date. In fact, only 4% of babies are born on their estimated due dates, and most first time moms go about a week over due. Also, due dates can be tricky to calculate due to variations in women's menstrual cycles and the timing of ovulation. The Lamaze Institute for Normal Birth has a position paper on inductions, which I feel is a must-read for pregnant women. At one of my local hospitals, 70% of women who are medically induced end up delivering via Cesarean section. Also, choose your place of birth carefully. Midwives have lower c-section rates than doctors. Non-profit hospitals have lower c-section rates than for-profit or teaching hospitals. In Seattle, the non-profit Group Health has a c-section rate of 16%, while the nearby profit and teaching hospitals have c-section rates of 36%! Cesarean surgery is a hugely profitable industry, and 80% of cesareans happen Monday through Friday between 8 am and 5 pm. While surgery may be more convenient for the doctor, the increased risks are not convenient for mom and baby. Education increases your chances of a healthy informed birth. Hire a midwife, a doula, make informed choices, and trust in your body and your baby! Research and practice techniques for optimal fetal positioning, to encourage your baby to be in the best position for labor and birth. For more resources on Cesarean awareness and prevention, check out the ICAN website of the International Cesarean Awareness Network. About the author: Kara Maia Spencer envisions the birth of a peaceful humanity through midwives, doulas, gentle birth, conscious parenting, and sustainable living. She is the founder of the Birth Ecology Project and the owner of Maia Healing Arts Image Source: http://flickr.com/photos/chimmy/911626776/

Psychological Pain of Childbirth 2

Psychological Pain of Childbirth Birth is an extraordinary event for families and for the whole community. We have come a long way, and it is now rare for women to die in childbirth. There are still, however, many unanswered questions. Why is birth still perceived as dangerous, when it is such a natural event and there has never been a safer time in history to give birth? The physical pain of childbirth is well known but the vast majority of women suffer from the rarely talked about psychological pain of childbirth. Were we truly cursed by God in Genesis? These are questions that can become important for a woman, particularly after undergoing a particularly traumatic or surgical childbirth. Birth is a rite of passage into womanhood and if unplanned major assistance is provided it is not uncommon for a woman to feel that she has perhaps failed. Unresolved relationship issues may also surface which can be detrimental to the birthing process while also being distressing. "What happened?" a woman may ask, or even "Am I fit to be a good mother?" My own beliefs regarding child birth have developed from a life long interest that began for me in rural England, as a small child, watching farm animals as well as my own pets give birth. I was likewise drawn to the local women who regularly shared stories, not meant for my young ears. This of course only whet my appetite further! Telling one's story has, in psychology, always been the beginning of understanding and of healing. In my practice, in my research and now on my website I encourage women to share their birth stories. By sharing our words we open new possibilities for the entire community. A growing body of research together with my years of experience, including working with post birth trauma, has led me to predict a swing back towards natural birth, and indeed a new psychological model for birth is now emerging. The emphasis for those wanting a natural birth has been to be physically and mentally prepared. Caregivers often lack a psychological viewpoint and because of this I am often invited and consistently welcomed training and supervising medical staff in understanding the deeper emotional needs of mother and child at this significant transition. Being psychologically prepared for the birth of a child is as important as the physical preparation! Your well-being in both areas requires planning and preparation. This will benefit both you and your child. Hypno birthing, calm birth and an experienced Doula are all beneficial tools to consider for yourself. I will share with you my five golden rules of natural child birth; 1. Birth is a inward experience, such as meditation or prayer. Don't have anyone present while you are birthing that you don't feel totally comfortable ignoring or who is going to distract you. Your partner may be better helping with preparing food for the next few days, answering and making phone calls cleaning house or keeping company with other friends and relatives. Can you meditate comfortably for an hour or more with your partner present without being distracted by their presence or them being hurt by you ignoring them? Even if you don't meditate, try doing something like this with your partner to see if it feels comfortable. This can be a useful guide. Hypnobirthing is becoming very popular now and is very good for preparing both partners for the kind of state that a woman will deliver the most positive outcome for all involved . This can and should be part of your childbirth education or childbirth classes. 2.Adrenaline slows and disrupts (and can even put a brake on) the sequence of natural body chemicals necessary for a smooth delivery and bonding between mother and child. Any issues of fear around the birth (experienced by either partner) needs to be addressed well before time. The doctor, midwife or support person that you choose should be trained to help keep you calm and focused "inward" if you should be-come agitated or afraid. 3. Practice positions for first and second stage labor that you feel comfortable meditating or relaxing in. In the bath, in Open Lotus position, sitting up in a chair etc. Follow your bodies signals about what is comfortable. Feeling totally relaxed and no pressure on you to perform or give attention to others is powerful pain relief. Accept totally that your body knows what is happening and knows what to do. Birth is a neurochemical process, trust your body and let the process unfold. 4. Have a good relationship with your doctor or midwife who will be present at the birth. Make sure that they are aware of your intended approach. Not all caregivers have had training in the positive psychology of birth, these ideas may be new to them and you may need to take some time choosing the right support. This is vital to you feeling safe and secure. 5. Resolve emotional issues with yourself and your partner before the birth. Do you long for more attention from your partner? The birth process is not a good time to look for this. Do you feel resentment or fear about your partner controlling or possibly abandoning you? These issues can arise during birth bringing unwanted adrenaline into the equation. If unresolved they can get worse after the baby is born rather than better. There is wonderful help available for these and other unresolved emotional issues and needs. Start preparing psychologically for the best birth experience for yourself as soon as you plan to become or become pregnant. For those who have suffered an invasive or traumatic birth in the past, understanding what happened and how it might have been different can be very healing. For Childbirth education and childbirth classes visit www.newbirthways.com for more information. For those with unresolved emotional issues from a past traumatic birth experience help is available and will make you a stronger and more confident woman and mother. Happy new beginnings. Susan

Sheryl's comment:

Susan's five golden rules of birth can all be addressed with an unassisted childbirth.

1. Birth becomes an inward experience when you trust the process and allow your primal self to do what it already knows how to do. 2. Humiliating, painful and invasive procedures and interventions done by doctors and midwives is one of the primary causes of adrenaline surges during childbirth as a woman's fight or flight response is engaged. This can be avoided by avoiding the cause of the "attack" and only seeking medical attention if there is a problem. 3.Doctors and some midwives will force you into unnatural and damaging birthing positions particularly during the actual delivery. You need to allow your instincts and your body to naturally choose the best positions to labor and deliver in. The easiest way to ensure an optimal birthing position is to avoid birth attendants. 4. You will not have to try to educate or enlist the support of a doctor or midwife who are used to doing things in a way which benefits them and their schedule if you do not use a doctor or midwife. 5. An unassisted birth requires a greater amount of preparation and responsibility and this includes preparing mentally, physically, psychologically and naturally engaging the full support of your partner. By: Susan Dalby About the author: Birthing options/Birth classes/Parenting classes/Hypnobirthing/Post Natal Depression/Creating a Birth Plan/Positive psychology/Birth related PTSD (post-traumatic stress -disorder) and it's effect on relationships and sex/Individual, couples and group counselling. Image Source: http://flickr.com/photos/xymox/156973810/

Benefits of Using a Doula for Childbirth 0

During a prenatal visit with Ann and Roger, a first-time mom and dad, the pediatrician asked about their childbirth education experiences. Ann said the classes were like a lecture, and there was little time to get questions answered. "As we went through the meetings and learned about things that might happen, we began to feel really nervous. The educator said it was best for the baby if the mother received no medication, so she suggested natural childbirth. I'm willing to try going without pain medication, but Roger doesn't want to see me in pain. Could I ask your opinion about a doula for childbirth?" Dr Wagner followed the mother's question with her own: "That sounds like an interesting idea. Tell me what you know about doulas." Ann replied, "Not much. I've only heard the name. You know, we recently moved here." Dr Wagner responded, "Well, Roger, let me tell you something that I have found exciting. In the last year, four fathers have come for their baby's first visit and have told me how great it was to have a doula. It was the third baby for one of them. He couldn't wait to tell me what a rewarding experience it was for him and his wife compared with their earlier experiences. I thought that there must be one fabulous woman in our community working as a doula, but all the fathers had a different doula! The fathers said that the doula assured them that she would be with the couple through the whole labor and the first 2 hours after delivery and that the fathers could leave at any time if tired or hungry. The doulas showed the fathers what they could do to help the mother." Roger interrupted, "That sounds great, but Ann and I thought we could manage by ourselves. I'm not sure about having a stranger in the room with us." Dr Wagner replied, "These four men and their wives met with the birth doula in their homes 1 or 2 times in the month before labor began. As a result, they knew her and liked her and then were relieved to see her when they went to the hospital. Let me be frank with you. There is a lot that goes on in a modern maternity hospital that will be new to you. There are strange smells and sounds, nurses and physicians rushing about, a lot of unfamiliar hospital lingo. There is a nationwide nursing shortage, and due to managed care most hospitals have found it necessary to cut costs drastically. Therefore, each nurse has to care for more than 1 patient at the same time. Obstetric care in the United States has become more intensive. From what I have learned from my patients about their labor and delivery experiences, it seems to me that every laboring woman needs a doula. And I say that knowing that there are many more important reasons for having continuous doula support. I am going to do some research about the doula, and then I will get back to you with what I learn." Six weeks later when the parents brought their new daughter for her first office visit, Dr Wagner was surprised at the change in their confidence and enthusiasm. Ann said, "We can't thank you enough for finding a doula for us and telling us the good effect she would have. From the time of our first meeting with our doula, Maria, I stopped feeling so nervous. She told Roger and me she would meet us when we came to the hospital in labor and would be with us until 2 hours after delivery. Maria wanted to make sure that I had the baby skin to skin on my chest right after birth and let the baby self-attach to my breast. And she did stay the whole 9 hours of labor plus the 2 hours postpartum! Maria was so strong that I could really relax. I could never have gone through that labor without her. I mean it." Roger interrupted, "She was terrific! She stayed the whole time and showed me what to do to help Ann. I think she helped me even more than she did Ann." If you have decided against homebirth for some reason but still want to try to have a "natural" birth in a hospital then GET A DOULA. I just cant stress this enough. Just do it. They are proven to decrease dangerous and unnecessary interventions. You will find that a doula is much more supporting, like a friend, than your OB or midwife is and I have never heard of anyone regretting hiring a doula. (And plenty of women regret hiring their OB or midwife). Speaking from personal experience, my childbirth was a living nightmare but I believe it would have been nothing short of living hell if my doula had not been there for me. I am still very grateful for her presence. Obviously in the future I will only choose unassisted childbirth unless I have a medical reason to deliver in a hospital but for those of you that aren't sold on UC, then I repeat, GET A DOULA. Author: Martin T. Stein, MD About the author: For more information on a birth doula visit MotherMeDoulas.com Image Source: http://flickr.com/photos/thomashawk/11708783/

Causes and Risk Factors for Birth Injury 9

By Michael Monheit, Esq. - Philadelphia Lawyer Any injury that is caused to the fetus in the course of childbirth, regardless of whether the injury is during or after delivery, is known as a birth injury. Some causes and risk factors for birth injury can result in cerebral palsy, Erb's palsy, etc. Although most birth injuries cannot be predicted, there are many factors that may increase the chances of the baby being injured during childbirth. This article elaborates on all those factors that make a birth high risk. Factors That Increase Risk To Baby 1. Maternal Age: The risk to baby increases if the mother is too young (in her teens for example), or is above the age of 35. Very young mothers may not know how to care for the fetus or themselves during pregnancy, which may increase the chances of a pre-term birth that can be harmful for the fetus. As for women over 35, they are more at risk for gestational diabetes and other medical conditions that can endanger the life of the unborn baby. 2. Maternal Obesity: The weight of the mother is an important criterion in the assessment of risk for birth injury. If maternal Body Mass Index (BMI) is more than 29.0 kg/m2 before pregnancy, then the woman is considered to be obese. Being obese puts her at risk for the following conditions:
  • Maternal hypertension (high blood pressure)
  • Diabetes
  • Post-term gestation
  • Fetal macrosomia
Due to the above risks of obesity, chances of birth injury increase tremendously. Obese women are thus advised to lose some weight before becoming pregnant and should also try and ensure that they do not put on more than 6-7 kilos during their pregnancy. In fact, not just obese women but underweight women are also predisposed to having babies with birth injuries. Being underweight may also result in low birth weight of the baby. Thus, it is important to ensure that maternal weight is at, or as close to as possible, to the desired weight before pregnancy. 3. Maternal Diabetes: Insulin is a substance in the human body that helps to break down glucose so that the sugars can then be used as body fuel by the numerous cells in the body. If the breaking down of glucose does not happen efficiently, body cells cannot function properly, thereby causing ill health. Sometimes, a person's body does not produce as much insulin as is required for optimum functioning of the body, or does produce the insulin but cannot use it effectively. Such a person is said to be suffering from diabetes. If a mother-to-be suffers from diabetes, her fetus is at an increased risk of birth injury. During pregnancy, a woman can suffer from two main types of diabetes that can predispose her fetus to birth injury. These two types of maternal diabetes are:
  • Existing Diabetes: This is when the woman has diabetes from before she conceived.
  • Gestational Diabetes: After becoming pregnant, a woman's body may sometimes become resistant to insulin due to the various hormonal changes occurring in her body because of the pregnancy. Such diabetes that comes on during pregnancy is known as gestational diabetes.
Pre existing maternal diabetes can put the fetus at risk for birth defects as the mother's blood glucose levels can become very high during the vital first three months of pregnancy. Since gestational diabetes generally develops after the first trimester, it generally does not contribute significantly towards birth defects. However, any type of maternal diabetes does increase the fetus's chances of injury during birth due to the following reasons:
  • Fetal Macrosomia: Fetal Macrosomia is the medical term that is used to describe babies that are significantly larger than normal. If fetal weight is already at or more than 4500 grams, or is estimated to go up to more than that, then the fetus is said to be macrosomic.
  • Although fetal macrosomia may affect any fetus, babies of mothers with diabetes are at a higher risk for macrosomia. The source of all the vital nutrients a fetus receives is its mother's blood. A woman with maternal diabetes has high levels of glucose in her blood; because of which the baby's pancreas secrete extra insulin in order to break down this added glucose. All the extra glucose gets stored as fat, thus increasing the size of the fetus.
It is more difficult for a woman to deliver an excessively large fetus as compared to a smaller one. Since the size of the baby is huge, there are added chances that the shoulder (or shoulders) of the fetus gets stuck behind the mother's pelvis after the head is delivered. If such shoulder dystocia does occur, the baby may suffer a birth injury known as brachial palsy or Erb's palsy.
  • Hypoglycemia: The fetus of a woman with maternal diabetes has high levels of insulin in its blood due to the increased glucose in the mother's blood.
Once the baby is born, it stops receiving the added glucose from its mother but its insulin levels are still high. These high levels of fetal insulin result in very low sugar levels in the baby's blood after it is born. This condition is known as hypoglycemia and can be dangerous for the baby. In addition to the above, maternal diabetes also puts a fetus at increased risk of breathing problems because increased glucose levels can hamper the lung formation of the fetus. 4. Post Term Gestation: Yet another factor that increase a baby's chances of birth injuries is post term gestation. Post term gestation refers to a baby being born after its estimated due date. If a pregnancy has lasted for over 42 weeks, the baby is said to be born post maturity. The main risks of a prolonged pregnancy are:
  • Excessively large baby: A baby born past its due date is more likely to be excessively large than babies born before 42 weeks. Such babies are at higher risk for shoulder dystocia and Erb's palsy as explained earlier.
  • Assisted deliveries: If a baby is past its due date, labor may have to be induced and it is more likely that the delivery will be assisted with forceps and vacuum suction devices. And in such assisted deliveries, the risk of birth injury to the fetus increases significantly.
  • Meconium aspiration: When a baby is born later than 42 weeks, there is a danger of the baby breathing in fluid that contains its meconium (first stool). This is known as meconium aspiration and can be dangerous to the baby.
  • Aging placenta: A pregnant woman supplies its fetus with oxygen and important nutrients through her placenta. In a post term pregnancy, the placenta may start to age and can stop working optimally. This interferes with the oxygen and nutrient supply to the baby because of which it can stop growing. Decreased oxygen supply also puts the baby in grave danger during labor.
Due to all these risks to baby in a post term gestation, doctors nowadays do not wait for much longer after a woman's delivery date has passed and opt for cesarean section instead. Due to this the mother and fetus lose out on all the advantages of a normal vaginal delivery. 5. Hypertension: Chronic high level of blood pressure is known as hypertension. A pregnant woman may have existing hypertension, or can develop the condition as a result of pregnancy. This is known as preeclampsia or Pregnancy Induced Hypertension (PIH). Babies of women with hypertension are at an increased risk of birth defects. If the condition becomes very severe, it can lead to maternal seizures and birth injuries. In extreme cases, it can also result in the death of the mother and her baby. With proper prenatal care, many of these risks to baby can be lowered. A failure to take these steps can constitute medical malpractice. If a woman has any of these risk factors that can increase her baby's chances of birth injury, she should consult a doctor for preventive measures. About the author: Michael Monheit, Esquire is the managing attorney for Monheit Law, located in Philadelphia, Pennsylvania. He is also a member of Anapol Schwartz. Monheit Law, P.C. concentrates its practice in the field of plaintiff personal injury cases on a contingency fee basis. They can be found at http://www.monheit.com and http://www.anapolschwartz.com Image Source: http://flickr.com/photos/alvarez-tostado/363243449/