It's been a while

With one semester of nursing school to go, I'm focusing on family and ending strong. This blog fuels a passion that can be a time hog and there's no 'extra' time to give these days. Signing off for... a while.

Don't be too trusting...

This is a great video clip breaking down why cesareans are so high in the US. It's to the point, concise and hopefully will empower one person to empower another...

OBGYN vs. Midwife

Thought this was worthy of sharing...Keep in mind Nurse Midwives care for low risk moms-to-be.

MORE Business of Being Born! Yahooo!!!

Are you a woman reading this or know a woman? Check out the link below to support a sure-to-be another empowering documentary for Moms-to-be. If you're not already aware I'm a HUGE fan of the documentary 'The Business of Being Born' by Ricki Lake and Abby Epstein. Simply put... these are women, many who are Moms, with a passion for educating women on current birthing trends (of which many, aren't necessarily for your benefit). Since this second film is funded by them, consider clicking on the link to learn more about the film and to show your support by donating as little as $5. Know you're contributing to empowering another future Mom-to-be...


http://www.kickstarter.com/projects/211982196/more-business-of-being-born-ricki-lake-and-abby-ep

Eating during labor

As one of my writing assignments, I researched the history of NPO (nothing by mouth) after midnight before heading into surgery. To give you a brief over view...It started in the 1940's when an obstetrician (Curtis Mendelson) took note of a couple deaths (out of 44,016 cases) related to aspiration during labor and delivery while under general anesthesia. These deaths were related to food and liquid intake, so he recommended fasting during labor for everyone (Crenshaw & Winslow, 2008, p.963).

Fast forward 60 years... Few laboring women under go general anesthesia for C-sections and of those who rarely do, they are at a greater risk of death associated with intubation difficulty rather then aspiration (Sharts-Hopko, 2010, p.198). Not to mention the quality of anesthesia has greatly improved along with the expertise in administration. Soooooo... based on research, eating popsicles and ice chips is no longer an acceptable practice. If your doctor says this is what you should follow, challenge it AND bring your own bag of snacks to the hospital to eat as you feel up to it.

There have been numerous studies on oral intake during labor and the conclusion is that "no adverse maternal or infant outcomes were associated with food ingestion" (Sharts-Hopko, p.202). In fact, numerous studies revealed that those who drank water up to two hours prior to surgery exhibited lower gastric volumes than those who followed a nothing by mouth diet (miller, 2009, p. 16). More stomach acid equals a greater risk for nausea/vomiting. Fluids taken two hours pre-operatively actually stimulated peristalsis (digestion) and emptying (Crenshaw & Winslow, p.967).

Here's a link to the benefits and suggestions of light foods to eat during labor:
http://www.suite101.com/content/eating-during-labor--a4982


References
Crenshaw, J. & Winslow, E. (2008). Preoperative fasting duration and medical instruction: Are we improving? AORN Journal, 88(6), 963-976.

Sharts-Hopko, N. (2010). Oral intake during labor: A review of the evidence. American Journal of Maternal Child Nursing, 35(4), 197-203.

Upright = shorter, less painful recovery...

An excerpt from The Birth Book by William and Martha Sears:

"Being upright for birth not only gives baby an easier angle for delivery, but it also widens the passage. When you're up and out of bed your pelvic joints, loosened by the hormones of pregnancy, are free to move and accommodate the little passenger with the large head and broad shoulders. While sitting or lying down, these bones aren't as free to move and your pelvic outlet narrows. In addition, vertical birthing allows more natural stretching of the birth canal tissues and is kinder to the perineum, making episiotomy unnecessary and tears less likely (p. 186)."

Five reasons NOT to birth on your back:
- It can hurt mother's back
- It can harm baby by reducing blood flow/oxygen
- Labor slows and becomes less efficient
- Episiotomy or tears are more likely
- You're working against gravity

Upright, moving and working WITH gravity...

Healthy Birth Practice #2:
Walk, Move Around, and Change Positions Throughout Labor

This is one of the Lamaze Healthy Birth Practices.


Teri Shilling, MS, CD(DONA), IBCLC, LCCE, FACCE

A pregnant woman in a Lamaze class asks about the mixed messages she has seen about birth, “In class, I see pictures of women walking, using tubs, or sitting on birth balls. But in the birth stories on TV, it seems like women spend most of their time in bed. Is being out of bed and moving around important?”

Walking, moving around, and changing positions throughout labor make the birth of your baby easier. It is the best way for you to use gravity to help your baby move down and to increase the size and shape of your pelvis to make it easier for your baby to fit and rotate as necessary. Movement helps you respond to pain in an active way and shortens the length of the first stage of labor (Lawrence, Lewis, Hofmeyr, Dowswell, & Styles, 2009).

In contrast to what you see on popular television shows in the United States, pictures throughout history and across cultures show women in many different positions for labor. Many hospitals today provide birth balls, rocking chairs, tubs/showers, and safe places to walk in order to encourage women to stay out of bed during labor. A pilot study was recently conducted at two Canadian hospitals where women in labor were randomly assigned to a regular labor room or to an “ambient room.” In the ambient room, the standard hospital labor bed was removed, and additional equipment was added to promote relaxation, mobility, and a calm atmosphere. The evaluations from women assigned to the ambient room were positive; they spent 50% or less time laboring in bed and reduced the need for artificial oxytocic infusions (Hodnett, Stremler, Weston, & McKeever, 2009).

Activity during labor may distract you from discomfort, gives you a sense of greater personal freedom, and provides a way to release muscle tension. In fact, women who use movement in labor report that it is an effective method of relieving pain (Storton, 2007). Restricting women’s movement may result in worse birth outcomes and may decrease women’s satisfaction with their birth experiences (Storton, 2007).

Why Movement Helps
When you walk or move around in labor, your uterus, a muscle, works more efficiently (Roberts, Mendez-Bauer, & Wodell (1983). Changing position frequently moves the bones of the pelvis to help the baby find the best fit, while upright positions use gravity to help bring the baby down the birth canal (Simkin & Ancheta, 2005). The diameter of the pelvic inlet and outlet can increase as a woman moves around in labor. When labor slows, a change in position often will help you “find your rhythm” again.

At times during labor, you may feel tired and need to rest in a comfortable position. However, according to a 2003 study published in Nursing Research, a laboring woman’s lower back pain is worse when she is lying down (Adachi, Shimada, & Usai, 2003). You can get the rest you need without having more pain if you have options for resting other than lying on your back.

What Research Tells Us
Researchers who examined all of the published studies on movement in labor found that, when compared with policies restricting movement, policies that encourage women to walk, move around, or change position in labor may result in the following outcomes:

* less severe pain,
* less need for pain medications such as epidurals and narcotics,
* shorter labors,
* less continuous monitoring, and
* fewer cesarean surgeries (Lawrence et al., 2009; Simkin & Bolding, 2004; Simkin & O’Hara, 2002).

In fact, no woman who participated in any of the research studies said that she was more comfortable on her back than in other positions (Simkin & Bolding, 2004). No study has ever shown that walking in labor is harmful in healthy women with normal labors (Storton, 2007).

The Role of Support and the Birth Setting
Without encouragement from caregivers, and due to cultural conditioning and the central location of the bed in most birth settings, many women unfortunately are not be able to walk or move around during labor (Simkin & Bolding, 2004). However, when laboring women are encouraged to move and do not have restrictions, they walk and change positions frequently (Simkin & Bolding, 2004). Although your hospital may not have a policy that requires you to labor in bed, the routine use of continuous electronic fetal monitoring (EFM), intravenous lines (IVs), drugs to induce or speed up labor, and epidurals limit your movement and often will confine you to bed. When women who took part in a national survey about their childbirth experiences were asked why they did not walk around during labor, the most common answer was ”being connected to things” (Declercq, Sakala, Corry, Applebaum, & Risher, 2002, p. 25).

To improve women’s comfort during labor and to support natural, safe, and healthy birth, interventions such as EFM and IVs should be used only when complications make them necessary. If it becomes medically necessary to use these interventions, including epidural anesthesia, you should be guided to continue to move in whatever way you can (Roberts, Algert, & Olive, 2004).

For example, your nurse or labor partner can help you change from a side-lying position to a position where you lean over the back of the bed or on the squat bar. If there is a medical reason that you need continuous EFM, movement and position changes can occur while you sit on a birth ball or in a rocking chair. Monitoring does not mean you must stay in bed. Women who birth in facilities that have access to showers or tubs are also more active and upright. Water immersion during the first stage of labor reduces maternal pain (Hofmeyr et al., 2008).

Practicing Helpful Positions and Movements
In childbirth education classes, you will practice various positions and movements, including how to rock your pelvis and use techniques such as the lunge, the stomp/squat, slow dancing, the knee/chest position, and stair climbing. If you practice with aids, such as a birth ball or a rebozo (a Mexican shawl), you will find it easier to use them in labor. When you have tried different positions and movements before labor, you will have more confidence to use them during labor.

Recommendations from Lamaze International
Walking, moving around, and changing positions make labor easier and safer. Like many women throughout the world, you can use movement to make labor more comfortable and your contractions more effective. Your freedom to choose and respond in your own way allows your birth to unfold without artificial restrictions. Birth is an active process and, with support from your labor companions, you will respond to make birth easier and safer for yourself and your baby. Lamaze International encourages you to plan to be active throughout labor, to practice labor and birth positions during pregnancy, and to choose a care provider and birth setting that provide many different options for using movement.

To learn more about safe, healthy birth, read The Official Lamaze Guide: Giving Birth with Confidence (Lothian & DeVries, 2005), visit the Lamaze Web site (www.lamaze.org), and sign up to receive the Lamaze…Building Confidence Week by Week e-mails.

Most Recent Update: July 2009

References
Adachi, K., Shimada, M., & Usai, A. (2003). The relationship between the parturient’s positions and perceptions of labor pain intensity. Nursing Research, 52(1), 47–51.

Declercq, E. R., Sakala, C., Corry, M. P., Applebaum, S., & Risher, P. (2002). Listening to mothers: Report of the first national U.S. survey of women’s childbearing experiences. New York: Maternity Center Association (now, Childbirth Connection).

Hodnett, E. D., Stremler, R., Weston, J. A., & McKeever, P. (2009). Re-conceptualizing the hospital labor room: The PLACE (pregnant and laboring in an ambient clinical environment) pilot trial. Birth, 36(2), 159–166.

Hofmeyr, G., Neilson, J. P., Alfirevic, Z., Crowther, C. A., Duley, L., Gulmezoglu, M., et al. (2008). Pregnancy and childbirth – A Cochrane pocketbook. W. Sussex, England: Wiley.

Lawrence, A., Lewis, L., Hofmeyr, G., Dowswell, T., & Styles, C. (2009). Maternal positions and mobility during first stage labour. Cochrane Database of Systematic Reviews, Issue 2, Art. No.: CD003934.

Roberts, C. L., Algert, C. S., & Olive, E. (2004). Impact of first–stage ambulation on mode of delivery among women with epidural analgesia. Australian and New Zealand Journal of Obstetrics and Gynaecology, 44(6), 489–494.

Roberts, J. E., Mendez–Bauer, C., & Wodell, D. A. (1983). The effects of maternal position on uterine contractility and efficiency. Birth, 10(4), 243–249.

Simkin, P., & Ancheta, R. (2005). The labor progress handbook (2nd ed.). Malden, MA: Blackwell Science.

Simkin, P., & Bolding, A. (2004). Update on nonpharmacologic approaches to relieve labor pain and prevent suffering. Journal of Midwifery and Women’s Health, 49(6), 489–504.

Simkin, P., & O’Hara, M. (2002). Nonpharmacologic relief of pain during labor: Systematic reviews of five methods. American Journal of Obstetrics and Gynecology, 186(Suppl. 5), S127–S159.

Storton, S. (2007). The Coalition for Improving Maternity Services: Evidence basis for the ten steps of mother–friendly care. Step 4: Provides the birthing woman with freedom of movement to walk, move, assume positions of her choice. The Journal of Perinatal Education, 16(Suppl. 1), 25S–27S.

Acknowledgements
This healthy birth practice paper was revised and updated by Teri Shilling, MS, CD(DONA), IBCLC, LCCE, FACCE.

The six healthy birth practice papers were originally written in 2003 by Lamaze International as the 6 Care Practice Papers.
http://www.lamaze.org/ChildbirthEducators/ResourcesforEducators/CarePracticePapers/FreedomofMovement/tabid/484/Default.aspx

Training for a marathon...

It's finals week, so no updates till after the 9th (for my huge audience out there ; )... The video is of the ideal educated soon-to-be-laboring Mom! More hard facts to come after the 9th.

You have choices in childbirth...

I'm on a journey... I'm a former Art Teacher who hung up my 'smock' to stay home to raise two beautiful boys. Two boys who arrived so differently and by doing so, altered my future career path. As a big reader, I read a fair amount about pregnancy and childbirth before the arrival of our first son. A few weeks before delivery I arrived at my prenatal check-up with a birth plan in hand. My husband and I discussed what interventions we wanted to avoid and what our expectations were. Most wishes were hesitantly accepted. It was a 26 hour labor with no epidural, no pitocin and the feeling of winning the longest race I'd ever run and it was... EXHILARATING! The repercussions of having an OB assisted hospital birth were: I was limited to the lithotomy position in bed, which resulted in a minor perineum tear (the worst recovery pain EVER!), I lacked the support/encouragement/knowledge of another experienced labor coach/assistant, and lacked food needed for energy during the long hours of labor.

Fast forward 2 years being pregnant for the 2nd time. I knew I wanted more support and encouragement from my provider. I wanted to enter a hospital feeling like I wasn't 'at risk' for something to go wrong but rather that I was capable and was designed to do this birthing thing. I sought the care of the one and only certified nurse midwife in town. She was wonderful. She explained each test, procedure and possible interventions in labor. I was informed of the risks and benefits of each. She taught and demonstrated various techniques for managing labor pains (use of a birthing ball, side lying, back massage, etc.) During labor she spent more time helping me to recognize what stage of labor I was in. She also helped ward off other unnecessary, but commonly given interventions (constant fetal monitoring, intra-uterine pressure catheter and an epidural). I freely ate, which she encouraged and shared that their was no scientific evidence to prove it unsafe. She was not only my advocate, but she empowered me to trust what I wanted and what my body could do. With this birth, I changed positions often, used a birthing ball and ended up delivering our second son in a hands and knees position. The result: a healthy baby boy with no evidence of tearing. My postpartum recovery was a snap! I went shopping 3 days later.

We have choices in childbirth and we should be questioning protocol and giving ourselves permission to say "No", because present day practices truly aren't all evidence based (meaning it's not what's best for you or baby). Maternity decisions are driven by monetary and legal reasons. Obstetricians are paid more when you arrive and deliver during their shift. On top of that, obstetricians and medical residents want to get home to their families and this means... intervening to speed up your labor process. Have you ever heard of the phrase "intervention cascade"? One intervention leads to another that leads to another. If you're considered low risk, does it make sense that you need to be poked, prodded and limited to bed? Generally speaking, obstetricians want to be in control, they want us (as one nurse summed it up) 'numb and dumb'. It's the only area I've witnessed doctors, medical residents, and nurses enter a room and state what they're going to do often without explaining risks/benefits to a patient so that she can give informed consent. You should be asking what the risks and benefits are to each and every treatment/intervention and stating that you'd like a few minutes to process the information (given it's not an emergency). You have the right to say no and to call the shots. Here's a link to 'The Rights of Childbearing Women'. It matters how our babies arrive and we'll remember their arrival forever...

Upon arrival at the hospital...

Think you want an epidural? Here's a picture of what 'you'll' look like in a typical hospital labor and delivery unit after an epidural. What you may not know is that when an epidural is given before the active phase (2nd stage when you're dilated between 4-7 centimeters) of labor, your chances of having a cesarean section doubles. Epidurals commonly slow down labor, so you'll be put on a synthetic hormone called pitocin to speed up contractions. Since you can't feel your lower half, you'll be bed bound and need a urinary catheter put in. They'll routinely put in a intrauterine pressure catheter to "better" monitor how your uterus is contracting and this requires breaking your bag of water if it hasn't already. Now that you're all 'hooked up' you'll be left alone to be periodically checked on, otherwise nurses will be watching your progress on a screen at the nurses station.
Does this snapshot seem ideal? I recognize that for some women this common scenario is just fine and needed in high risk pregnancies, but for many others considered low risk this is invasive and induces powerlessness and fear. The best thing you can do for yourself and baby is to educate yourself on each of these interventions before arriving to the hospital and ask your OB about each one. We'll first take a look at epidurals. Since I'm no expert and there's no need to re-invent the wheel, here's a site that presents the risks and benefits along with questions to ask your provider in a nice chart...
http://www.kimjames.net/maternal%20risk%20chart.htm
I also liked this video:
http://www.youtube.com/watch?v=tXVhaVATcbQ

What drives OB decisions is not evidence based practice...

"OB is a business. It's a volume business," chimes another doctor, Stephen Crane, MD. "If you get paid $2400 to deliver a baby and you pay out $90,000 in malpractice insurance, you have to do a lot of deliveries to pay for that fee." ---excerpt from the book PUSHED by Jennifer Block. Does this help explain the high C-section rates and invasive interventions used during labor and delivery? YES!!! I'm returning to my blog with a new focus... posting information for the pregnant Mom-to-be on labor and delivery practices, links to informative sites, and questions to specifically ask your provider to empower your choices. Our bodies are NOT failing us, the birthing industry IS... let's PUSH back!

A new focus...