In Part One and Part Two of this segment, I discussed why I believe in the six care practices and the first three of the care practices which include: labor begins on its own , freedom of movement throughout labor and continuous labor support. The six care practices that support normal birth are based on research and evidence based maternity care. This is the healthiest and safest way to have a baby in most cases. In a normal healthy pregnancy most women can and should deliver their babies vaginally and with few interventions. All this medicalization of labor and delivery is not only not necessary, it’s also causes problems.
The fourth care practice is no routine interventions.
Routine interventions are anything that is done or not allowed at hospital that isn’t medically necessary. Evidence based maternity care through research has shown that these interventions are not only not necessary but can cause more harm than good when used routinely. Here is a list of the most common routine interventions.
Restriction on eating and drinking: Back in the day when women were knocked out with general anesthesia food and drink were not allowed in case the woman vomited and inhaled it. Rarely is general ever used any more but it’s still the policy at most hospitals. Women need food and drink to keep their bodies fueled and hydrated for the hard work of labor.
Use of IV fluids: Because of the restriction on drink, the IV fluids are given to keep the mom from getting dehydrated. IV fluids are just not properly balanced in a way that gives the mom the energy she needs to labor. The intervention spiral tends to begin with the IV and it’s easy access to the vein and it also keeps you tethered and restricts movement. The IV line does provide quick access to the vein in case of an emergency. One compromise is a heparin lock. It’s the little catheter that put in the vein and shut off without the IV line actually being connected.
Continuous electronic fetal monitoring: In a normal low risk labor continuous EFM isn’t recommended. Intermittent monitoring, or 20 minutes out of every hour is just as beneficial. With intermittent monitoring the mom is allowed the freedom of movement. Continuous EFM increases the number of inventions without improving outcomes.
Speeding up labor: Artificial rupture of membranes and augmentation of labor: Speeding up labor sounds pretty tempting but when the water is artifically ruptured (AROM) it increases the pain of the labor and removes the baby’s cusion to move around and get into a better position. Infection risks are increased and most hospitals have a time limit on how long the water can be broken before intervening. Augmenting labor with pitocin can make labor go faster but it also interupts the normal flow of hormones and makes labor much more painful while increasing the risk of fetal distress.
Epidurals: Epidurals do take the pain away (most times) but can also cause a cascade of other interventions and problems. They increase the risk of an OP baby (sunny side up) because the pelvis is over relaxed and baby finds it harder to rotate and turn without the gravity because mom is stuck in bed. The risk of c section increases and the drugs do reach the baby potentially causing breastfeeding problems. Please see my post To Epidural or Not to Epidural for more details on the risks of epidurals. There are many other ways to cope with labor. Preparing physically and mentally for labor, continuous labor support and avoiding routine interventions all help make labor an easier process.
Episiotomy: Routine episiotomy can be more harmful than tearing. Tears typically aren’t as bad as the cut would be and they heal faster. Episiotomy frequently causes more tearing and more pain. Avoiding epidurals and upright pushing positions reduce the risk of or need for episiotomy.
Medical need for interventions are occasionally necessary. Routine intervention should be avoided. Learning about the routine interventions and when they may become necessary and writing a birth plan can help reduce the chance of having routine interventions forced on a laboring woman. I think it is also very important for the partner to understand these procedures so that they can assist the mother as much as possible. Research is on the side of the mother when it comes to these routine interventions and discussing the written birth plan before the birth will help the labor go more smoothly. Hiring a doula can also help keep routine interventions from being carried out as she can remind the mom of what the risks and benefits of the interventions are and of what her wants are.Read Full Post | Make a Comment ( 5 so far )
As I said in Part One of this article, there are six care practices that support normal birth. Lamaze International says “The six care practices below are supported by research studies that examine the benefits and risks of maternity care practices. Therefore, they represent “evidence-based care,” which is the gold standard for maternity care worldwide. Evidence-based care means “using the best research about the effects of specific procedures, drugs, tests, and treatments, to help guide decision-making.”
Unfortunately, in the U.S., the trend is not towards normal birth and adhering to the six care practices that support normal birth. Maternity care in the U.S. has a “prominent position, large expenditures and troubling performance” according to the Milbank report Evidence-Based Maternity Care: What It Is and What It Can Achieve released in October of 2008. This report discusses the issues with the U.S. maternity systems, the overuse of routine interventions and the harm they cause and closing the gap between them and the normal birth practices for healthier moms and babies. I will talk about this report in depth in another post as it has some great information that every pregnant woman should know.
This seems so obvious but women are being induced more and more and for more and more reasons that really are not means for induction. In my Truth About Pitocin post, I discussed the difference between medical inductions and elective inductions. The medical reasons for induction are:
* your water has broken and labor has not begun.
* your pregnancy is postterm (more than 42 weeks).
* you have high blood pressure caused by your pregnancy.
* you have health problems such as diabetes that could affect your baby.
* you have an infection in the uterus.
* your baby is growing too slowly.
Suspected big baby is not reason for induction and ACOG doesn’t recommend it either but it is commonly a reason for induction. Also common to that is the birth of an 8lb baby after the induction failed and a cesarean had to be performed when if given time, the mother would have spontaneously began labor on her own when both she and the baby were ready.
Also important to note is that a pregnancy is not considered post term until AFTER 42 weeks. Only after 42 weeks should the pregnancy be induced if all else is normal.
Labor induction is not without risk. Research has shown there is a significant increase in
* vacuum or forceps-assisted vaginal birth;
* vacuum or forceps-assisted vaginal birth;
* cesarean surgery;
* problems during labor such as fever, fetal heart rate changes, and shoulder dystocia
* babies born with low birth weight;
* admission to the NICU;
* jaundice (yellow skin caused by the breaking down of red blood cells) that required treatment; and
* increased length of hospital stay.
In addition, the chance of cesarean is nearly doubled when induced and there is a higher risk of prematurity as due dates are only estimates. There are also psychological effects as it makes us think that there is something wrong with us for not going into labor on our on. I have had clients ask me if I thought a friend was capable of going into labor or if someones water can break on it’s on. These are pretty valid questions, especially for a first time mom who has seen most of her friends get induced for one reason or another and every one of them had artificial rupture of membranes (water broken for them). The thing is, our bodies will not stay pregnant forever. We are meant to birth the babies that we grow. We are just forgetting that in this day in age where most women are given pitocin and think that they just HAD to have it or they couldn’t have birthed their baby. It’s really sad that we have come to this. We do not HAVE to have pitocin to give birth.
This one is pretty simple but too often women are told to get in the bed and stay there. Usually this happens because they are on some medication (pitocin, cytotec, anesthesia) that requires continual fetal monitoring and IV lines. All of this is counterproductive to what the body and the baby are trying to do. The uterus works better when a woman moves around. It’s a muscle and movement increases circulation. The pelvis not stationary. It moves and flexes and bends and as it does the baby is able to moved and wiggle down into it with the help of gravity. Being on the back in bed prohibits this movement and closes the pelvis up making a smaller exit for the baby to move in to.
The research has shown that movement causes:
more efficient contractions
less need for pain medicine in labor
Even if there is a medical reason to have continual electronic fetal monitoring, there is enough slack in the line to get out of bed and sit in a chair or a birth ball or to sway with your partner.
I am a doula, I think every woman should have a doula. It’s not because I am trying to justify the profession or the cost or to promote myself, but I really believe that no woman should have to birth without someone who is trained to support a laboring woman. There is a big difference between a doula and a loving partner, a doula and a best friend who has had five kids and a doula and the grandma. While a doula does form a relationship with her clients, she doesn’t have that intimate relationship these other people do and can help the laboring woman without the emotions that are often involved with these family members. Doulas are also trained professionals who study birth and labor and ways to make labor easier and more comfortable with different positions and massage and other techniques that even someone who has had a few kids of their own may not know. Doctors, midwives and nurses often times have several patients at once and cannot stay with the laboring woman.
The research has shown that the presence of one-on-one support such as that of a doula a less likely to have:
have a cesarean section;
give birth with vacuum or forceps;
have regional analgesia (e.g., an epidural)
have any analgesia (pain medication)
report negative feelings about their childbirth experience
Doulas can also help incorporate the partner into the labor experience. Often times partners are very inexperienced in childbirth and they are nervous and worried and are scared of labor pains. They are often scared and unsure of how to help their partner even though they very much want to. I have found that they are relieved to have the help of a doula, especially once labor kicks in to high gear and they do feel more of a part of the labor process when they are shown ways to help the mother. It gives them a greater sense of importance and usefulness that they very much appreciate. I love working with the partners as much as the moms because they are so willing and grateful by the end. Even the strongest, most loving and supportive dads benefit from having a doula around.
There are three more care practices supporting normal birth. I will discuss them in Part Three.Read Full Post | Make a Comment ( 5 so far )
Many of you know that I will training to become a Lamaze certified childbirth educator. I am hosting a Passion for Birth (PfB) seminar in Seoul in October. PfB is a program accredited by Lamaze that focuses on how to ‘stomp out boring childbirth classes.’
I chose PfB and Lamaze for many reasons.I chose PfB because I liked the way the material is being presented. Stomping out boring childbirth classes, that’s GREAT! How many of you have been to a hospital childbirth class that was a full day of listening to someone tell you about when to show up to get your epidural, what the hospitals policies are and how everyone is required to have this or that done to them once they are admitted? How much did you learn about birth? About natural birth? Normal birth? Did you leave more nervous the when you got there? Were you worried about your birth plan being respected? The idea that PfB has of teaching CBE’s how to teach evidence based care and to be fun and interactive at the same time really inspired me. The other reason for chosing PfB is Ann Tumblin. My husband ran across her when I was pregnant with my son. We were searching for doulas in Korea and her name came up as she has been here to train Korean doula instructors for DONA. She was really nice to my husband and he remembered her (and she remembered him) over a year later when I decided to train as a doula myself and looked her up. I was trying to find other doulas in Korea to learn from. She was just amazing with her advice and with how willing she was to talk to me about being a doula and a childbirth educator. When I found out she was coming to Korea again in October, I just HAD to see if we could have a PfB seminar while she was here. I can’t wait!
So with the PfB portion of the childbirth educator training in place, I really had to spend some time learning about Lamaze International, since that’s who my certifying agency would be and whose care practices I would be teaching. I was one of those people who heard ‘lamaze’ and thought of the old school hoo-hoo, hee-hee breathing that I saw laboring women do in the movies. I was apprehensive because I took the Bradley Method when I was pregnant and while I loved the classes, the amount of childbirth education I received and the relaxation techniques, I had gathered that Lamaze was considered second rate to the Bradley Method. Just to set all this straight now so there is no confusion, I really do love and respect the Bradley Method and even considered becoming Bradley certified but I didn’t go with it because it is more of a method. I wanted flexibility so that I can teach normal birth but not necessarily methodically. I wanted a birth philosophy that was in line with my own way of thinking. All that said, I remember my classes making me think that Lamaze was in fact some kind of patterned breathing technique. It was but in the 80’s they changed from a method to a philosophy and that philosophy spoke to me when I started digging in.
I have a very strong idea about what kind of childbirth educator I want to be, about how I want to teach and the way I want my classes to be. For instance, I want to keep my classes to ten couples or less. I would like for them to be in someones home, mine or one of the students. I want to develop relationships with the students and answer their questions honestly and factually with evidence based answers. I want to instill trust of the birth process and of a woman’s ability to birth into my students. I want them to leave my classes with the knowledge and the confidence to have whatever kind of normal birth they want be it hospital, home or even unassisted. I want them to know that they have choices and a voice in the birth of their child. I believe that with PfB and Lamaze that I can accomplish these things and I am looking forward to my seminar very much. I just hope we have enough participation!
The title of this post is “The Six Care Practices that Support Normal Birth”. These are the care practices that Lamaze teaches. They are:
1. Labor begins on its own
2. Freedom of movement throughout labor
3. Continuous labor support
4. No routine interventions
5. Spontaneous pushing in upright or gravity-neutral positions
6. No separation of mother and baby after birth with unlimited opportunities for breastfeeding
I labeled this post Part One because I knew it would get long. In Part Two, I will discuss the six care practices. Stay Tuned!Read Full Post | Make a Comment ( 22 so far )