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Keep Moving During Labor

June 17, 2013 By admin 2 Comments

When women give birth in the movies, they are generally portrayed one way: lying down, in bed. But research shows that moving freely in labor improves a woman’s sense of control, decreases her need for pain medication, and may reduce the length of her labor. Sometimes it is hard to move in labor due to routine procedures or lack of support and space. A recent US study found that 71 percent of laboring women did not walk at all during active labor. Instead, women often labor in bed propped up with pillows. Many women who have labored this way say next time they want to be more upright. This following list provides steps you can take to increase the chance that you will be able to maintain freedom of movement during labor.

  1. Choose a care provider and your birth place carefully to make sure you will be encouraged and supported to move and change positions. Find a care provider who will support you in choosing the positions that work best for you. When choosing a birth setting, look for birth balls, rocking chairs, squatting bars, and tubs.
  2. No matter where you give birth, stay home until you are in active labor, when contractions are five minutes apart and last about one minute. If your cervix is not dilated more than 4 centimeters when you arrive at your birth setting, consider going home or for a walk until your cervix dilates more. It’s often easier to move and respond to your labor at home. You can rock, slow
    dance, walk, or sit on your birth ball. Listen to your body and rest when needed.
  3. Once at the birth setting, request that your care provider not use any unnecessary intervention that may make it harder to move around. This will mean that continuous monitoring of the baby’s heart rate (“continuous EFM”) and intravenous lines (IVs), are only used when needed for medical reasons. If there is a medical reason for these, tell your care provider that you want to maintain as much freedom of movement as possible. There may be ways to minimize the effect of these interventions on your ability to move freely.
  4. Arrange to have continuous support in labor from a professional labor assistant (a doula) or a close friend or family member who makes you feel safe and confident. Ask them to remind you to try different positions or activities in labor.
  5. Consider the impact that pain medications will have on your ability to freely move during labor. All pain medications make it hard to stand or walk in labor. It is usually impossible when an epidural is used. You may hear about a “walking epidural” but this usually just allows you to move your legs in bed or walk short distances. Pain medications often lead to the need for other interventions, such as IVs and continuous electronic fetal monitoring, which restrict movement. Choose to birth at a place that provides easy access to a tub. Using water in labor decreases the need for pain medication. If you want an epidural in labor as a pain coping technique, wait until labor has progressed and you have already used lots of movement to help the baby rotate and move down in the pelvis. Encourage your support team to learn about ways to support a woman with an epidural and encourage movement compatible with epidural use.
  6. Attend a childbirth class that focuses on active labor, giving you and your partner plenty of movement and position options. Keep a list of the positions that you like best and bring it with you as a reminder in labor. Practice positions and movements before your labor begins, so you and your partner feel comfortable and confident using them.

Quick checklist for place of birth

  • Safe place to walk
  • iPod, smart phone, other MP3 player for dancing music
  • A tub
  • Birth ball
  • Rocking chair
  • Squatting bar
  • Telemetry (portable device used for continuous fetal monitoring)
  • Policy for intermittent auscultation (heart rate monitoring)
  • Policy for respecting women’s choices for labor support

For more information on the importance of maintaining movement during labor, check out the Lamaze Health Birth Practice video all about walking, moving, and changing positions during labor.

Filed Under Birth, Coping with pain, Featured Story, Healthy Birth Practice, Hospital Birth, Moving During Labor

Early Induction: What You Should Know

March 4, 2013 By Cara Terreri 3 Comments

In line with last week’s post about recommendations against elective induction before 39 weeks, let’s talk about what an early induction means. Below are some basic points with links to more in-depth information from evidence-based resources.

How early is an early induction?

An “early induction” is any induction that is performed before 39 weeks of pregnancy. Experts from several recognized organizations, including the American College of Obstetricians and Gynecologists (ACOG), Childbirth Connection and March of Dimes, state that a baby needs at least 39 completed weeks in order to fully develop their brain and other vital organs.

What are the risks of early induction?

Induction in and of itself carries risks to mom and baby. Because induction is an artificial process for starting labor, your body may not be ready to follow its cues. As a result, inductions can cause a cascade of additional medical processes (interventions) to keep labor going, which can ultimately lead to an increased risk for cesarean surgery. Unless there is clear medical indication (see below), letting labor begin on its own is the safest decision.

Induction before 39 weeks brings an additional risk of prematurity. Babies born even a little too early can experience complications like problems with breathing, feeding, maintaining body temperature and jaundice. In most cases, babies know best when it comes to being born.

What if I need to be induced?

There are solid medical reasons for induction before 39 weeks. Being done with being pregnant, isn’t one of them. ;)  There are also several reasons given for induction that are not true medical reasons. It’s important to know the difference. Click through and read up on the two links provided above on the new induction resource page on Childbirth Connection, a not-for-profit organization founded that works to improve the quality of maternity care.

If you’re pregnant and faced with the decision to induce — and even if you’re not — read up! Inform yourself. Learn all that you can, from sources in addition to your care provider and other than well-meaning family and friends. Start here:

Filed Under Birth, Featured Story, Healthy Birth Practice, Induction, Interventions Tagged With labor induction

What is a Safe and Healthy Birth?

December 26, 2012 By admin 1 Comment

Adapted from The Official Lamaze Guide: Giving Birth with Confidence.

We are just one generation away from the days when a girl grew up on a farm watching the sheep and pigs give birth. Anyone who saw that year after year knew that giving birth was a natural process, a process that could be trusted. —Ina May Gaskin

The mission of Lamaze International is to promote, support and protect natural, safe and healthy birth through education and advocacy through the dedicated efforts of childbirth educators, providers and parents. A normal birth is one that unfolds naturally, free of unnecessary interventions. A woman’s body is beautifully designed to grow, birth and nurture a baby. To work properly, this elegant design requires patience and trust.

An evolving body of research repeatedly shows the danger of interfering without a valid reason in the natural processes of pregnancy, birth, and breastfeeding. Any intervention, no matter how simple it seems, may disrupt the normal process and create problems that, in turn, must be managed with more interventions. All interventions have side effects that can be risky for both mothers and babies. In light of such evidence, the World Health Organization (WHO), a leader in the international public health effort to promote normal birth, says that maternity care should aim to achieve a healthy mother and child with the least intervention safely possible.

In the United States, reality falls far short of this goal. Most births in the U.S. today are interrupted by procedures designed to start, maintain, and finish labor according to an arbitrary schedule. Few women experience their pregnant bodies unfolding and opening in their own time, in their own way. Ironically, normal birth isn’t the norm for American women.

Practices That Support Normal Birth

Research reveals not only the dangers of interfering in the natural process of birth, but also maternity care practices that help keep birth normal. The WHO identifies four care practices, and Lamaze adds two more (marked with asterisks: *). These practices ensure the best care for birthing women around the world.

  1. Let Labor begin on its own.
  2. Walk, move around, and change position throughout labor.*
  3. Bring a loved one, friend, or doula for continuous support.
  4. Avoid interventions that are not medically indicated.*
  5. Avoid giving birth on your back, and follow your body’s urges to push.
  6. Keep mother and baby together – its best for mother, baby, and breastfeeding.

Additional important information:

Filed Under Birth, Featured Story, Healthy Birth Practice Tagged With Healthy Birth Practices

Lamaze Care Practices: What They Are & How They Can Help

October 17, 2012 By Cara Terreri 3 Comments

Common sense tells us and research confirms that the Six Lamaze Healthy Birth Practices featured in these video clips and print materials are tried-and-true ways to make birth as safe and healthy as possible. But don’t take our word for it — click through to watch each of the short clips to learn more about safe & healthy birth and how best to achieve it, no matter where you give birth.

Introduction: Safe and Healthy Birth Practice - Download PDF

#1: Let Labor Begin on Its Own - Download PDF

#2: Walk, Move & Change Positions - Download PDF

#3: Have Continuous Support - Download PDF

#4: Avoid Unnecessary Interventions - Download PDF

#5: Get Upright & Follow Urges to Push - Download PDF

#6: Keep Your Baby With You - Download PDF

Download the complete booklet here.

Lamaze International partnered with InJoy Productions and their new Mother’s Advocate program to provide you with this free, evidence-based educational material.

Filed Under Birth, Coping with pain, Dads, Featured Story, Healthy Birth Practice, Hospital Birth, Labor, Parenting, Skin-to-Skin, Support Tagged With Healthy Birth Practices

Spot the Best Care

August 20, 2012 By Cara Terreri 1 Comment

Knowing how to spot good maternity care is the key to getting it.

There are countless places on the Internet with information about being pregnant – this is probably not the first website you’ve visited! With so much information about pregnancy and birth available, how do you separate fact from fiction?

Lamaze International has simplified the scientific facts into six healthy birth practices to make it easy for you to choose the safest care, understand your options, and steer clear of care practices or unnecessary interventions that may not be the best for you and your baby.

  • Let Labor Begin on Its Own: The research around induction of labor has become so convincing that many hospitals are clamping down on inductions that don’t have a strong, compelling medical reason. But not everyone has caught up with the research yet. Be wary of induction that’s suggested because your baby is “measuring big,” you’re a few days past your due date, or your mom wants to schedule her travel. For the best chance at a healthy baby and healthy mom, it’s best to let your baby and your body tell you when it’s time.
  • Walk, Move Around and Change Positions Throughout Labor: In childbirth, gravity is your friend. It helps to move your baby down and makes it easier for your baby to fit and rotate. Movement is also a natural and active way to manage labor pain.
  • Bring a Loved One, Friend or Doula for Continuous Support: Doctors, midwives and nurses work hard to meet the needs of their patients. But few women find a care provider who will stay by their side throughout labor. A continuous support person, such as your partner or a doula, can help you feel safer and more comfortable, and help your labor progress.

  • Avoid Unnecessary Interventions: Many interventions may seem like they would make childbirth easier, but they can have unintended consequences and can make birth more difficult and less safe. Knowing the difference between something that’s medically necessary and something that’s done purely out of “routine” can help you feel equipped to partner with your care provider in making important decisions.
  • Avoid Giving Birth on Your Back, and Follow Your Body’s Urges to Push: The last birth you saw was probably a Hollywood portrayal of labor, with a woman giving birth on her back in a hospital bed. But, did you know that you don’t have to be on your back when you give birth and wait for your care provider to tell you when to push? During pushing, ease your baby down and out when and how your body tells you to and choose the positions for birth that are the most comfortable for you. By responding to what you are feeling, you will make birth easier and safer for you and your baby.
  • Keep Mother and Baby Together – It’s Best for Mother, Baby and Breastfeeding: During pregnancy, you and your little one were inseparable. Continuing that important connection after birth is best for you and your healthy baby. Skin-to-skin contact helps your healthy baby stay warm, cry less, and be more likely to breastfeed. In fact, interrupting, delaying, or limiting the time that you spend together may have a harmful effect on your relationship and on successful breastfeeding.
Filed Under Birth, Choosing a care provider, Featured Story, Healthy Birth Practice, Pregnancy, Push for Your Baby Tagged With Healthy Birth Practices, Push for Your Baby

By Invitation Only: Who Will Attend Your Birth?

July 27, 2012 By Cara Terreri Leave a Comment

Some women envision their birth-day as a time to invite anyone who is close and dear to them into the birthing room—mother, sisters, partner/husband, children, in-laws, next-door neighbor—and yet other moms feel most comfortable with only their husband/partner in the room. Ultimately, there is no one right way, but rather, the way that is best for you.

Choosing who may attend your birth can be a challenging task for moms who receive pressure from friends and family. This is a time when you have permission to be selfish! While your mother may assume that she has a front row seat during your birth, you may not feel comfortable birthing in the same room with a woman who has a long history of nagging and criticizing.

When considering who to allow in your birthing room, explore your relationship with the person. Ask yourself some questions:

  • How do I feel about this person?
  • How does this person feel about my birth preferences?
  • How did this person respond the last time I needed their support?
  • Write down five words that describe this person. How do those words make you feel?

Continuous support (emotional and physical) during labor and birth has been shown to result in healthier birth outcomes and a more positive birth experience.

What does positive support look and sound like? First and foremost, the person(s) supporting you during labor and birth must be familiar with and comfortable with your birth preferences. A good support person will offer words of encouragement and compassion, and refrain from passing judgment. “Just get the epidural, honey—there’s no need to put yourself through this kind of pain,” or “I birthed all three of my kids naturally; there’s no reason you can’t too,” are not the kinds of feedback and support you need anytime, and especially not during your birth.

What if you just can’t say no?
Sometimes, even if we know better than to allow our aunt/grandma/mother-in-law in the birthing room, we do it anyway. If this is your situation, plan for additional support. Appoint at least one other trustworthy person to be your primary support during labor and birth. Ideally, this person is very familiar with your birth preferences and will be your advocate and spokesperson—including speaking up to your sister/mother/aunt who insists that you ask your doctor to break your water, because that’s what she did in her births.

You also may consider hiring a professional labor support person, called a doula. Doulas are trained professionals skilled in providing physical, emotional and psychological support to a woman during birth. A doula does not replace your partner/husband’s role during birth, but rather supplements their support. Doula fees average $600, but can be as low as $250 in some places. You also may be able to contract free or significantly reduced fee doula services from a doula in training. Often, doulas will accept payment in installments and certain company flex-spending accounts can be used to cover doula fees.

 Final Words
Having the right support person during your birth is a critical component of your birth experience, and in some cases, it can mean the difference between a good birth experience and a traumatic one. As with any life goal or achievement, putting measures in place for success provides room for success to happen.

 

Who was part of your support team on your birth day? Were you happy with your decision or do you wish you would have chosen differently?

Filed Under Birth, Featured Story, Healthy Birth Practice, Support

Push for Your Baby

May 22, 2012 By Cara Terreri 2 Comments

Have you ever felt scared or insecure when asking your doctor a question? Personally, there have been times when I felt like, “what if I ask a stupid question,” or “will she think I’m one of those know-it-all internet research junkies,” or “I don’t want to come across as too pushy.” As it turns out, women who feel this way aren’t alone. A recent study in Health Affairs highlights how patients, worried about being labeled “difficult,” can be reluctant to discuss or question a health care provider’s recommendation.[i] For pregnant women, the pressure to agree to certain practices from family and friends, as well as care providers, can be significant. In fact, a Childbirth Connection study showed that many mothers have felt pressured by a health care provider to have an induction (17 percent with induction) and C-section (24 percent with cesarean).[ii]

In recognition of this issue, Lamaze International has initiated the “Push for Your Baby” campaign, which  encourages women to advocate for better care for their babies and themselves. “With the right information and education, women have the opportunity to be active partners in their care during pregnancy and birth, not just recipients of that care,” said Lamaze President-elect Tara Owens Shuler, MEd, CD(DONA), LCCE, FACCE, Director of Continuing Education, Special Projects, and Lamaze Childbirth Educator Program for the Duke AHEC Program. “This campaign is designed to help women be ‘savvy shoppers’ and prepared to seek out the best care for their babies and themselves.”

Through the Push for Your Baby campaign, Lamaze is working to provide expecting parents with the tools and resources they need to partner with their care providers to get that care, including:

    • PushforYourBaby.com – A website dedicated to expecting moms and dads that houses up-to-date information about childbirth challenges, ways to identify the best care, tips for pushing for better care, details about Lamaze education, and questions to ask their care provider.
    • Parents Push – With this shareable video, moms – and dads – share their personal childbirth experience, both the highs and lows, and underscore the importance of childbirth education to having the safest, healthiest birth possible. The video offers those expecting a little one a chance to hear directly from someone who has been in their shoes.
    • Push Story Sharing – Lamaze knows that some of the best learning happens through story telling. The Push for Your Baby campaign gives parents the opportunity to share both written and video birth stories highlighting the things they were glad they knew – or wish they had known – before labor and delivery, as well as the role that childbirth education played in their experience. Submissions will be shared on the campaign website and the top three entries in each category (written and video) will receive prizes from Lamaze, Tomy and GC Brands Childrenswear, and their photos and blogs posted to the home pages of Lamaze.org and PushForYourBaby.com.

“Its all about women getting the care that matches their unique needs, and not just having things happen to them. Sometimes that may mean saying, ‘I’d like to consider another option,’” said Shuler. “Women should know it’s OK to push for better. And knowing how to spot good maternity care is the key to getting it.”

“With clear challenges to getting high-quality maternity care, the value in being prepared and educated is more important than ever,” said Shuler. “Childbirth education may seem like a hassle to busy parents and Google might feel like a decent way to answer questions, but a good childbirth education class can help pregnant women sort through conflicting or inaccurate information, and give them the tools they need to get the care they want. Lamaze certified childbirth educators (LCCE) have a stake in the expecting parents we teach, and it’s our priority to help them achieve the safest, healthiest outcomes.”

In addition to Push for Your Baby, Lamaze recently launched a newly revamped website (www.lamaze.org) with a focus on expecting parents, and a separate site dedicated to supporting Lamaze educators (www.lamazeinternational.org). The new parents’ site features the Push for Your Baby campaign resources, a social media updates, a video library, tips for expecting parents and evidence-backed information about maternity care from pregnancy through birth.

 

[i] Frosch, D., et. al. Authoritarian Physicians And Patients’ Fear Of Being Labeled ‘Difficult’ Among Key Obstacles To Shared Decision Making. Health Affairs. May 2012. Available online: http://content.healthaffairs.org/content/31/5/1030.abstract.

[ii] “Listening to Mothers II Report.” Childbirth Connection. 2006. Available online: http://www.childbirthconnection.org/article.asp?ck=10396. Accessed 4/16/2012.

Filed Under Birth, Childbirth education, Featured Story, Health and well-being, Healthy Birth Practice, Pregnancy, Push for Your Baby Tagged With Push for Your Baby

The Wonder of Mothers: Spontaneous Pushing During Birth

May 9, 2012 By Cara Terreri 5 Comments

May 13 is Mother’s Day and to celebrate, Giving Birth with Confidence will post throughout the month of May on “The Wonder of Mothers,” a series dedicated to sharing some of the many ways mothers’ bodies are beautifully designed to grow, birth, and nourish her baby. We’re also giving away a Lamaze stroller and infant car seat, so be sure to enter to win!

 

The Wonder of Mothers: Spontaneous Pushing During Birth

As a writer for Lamaze for nearly eight years now, I’ve read time and again about the point in birth when a woman’s body “just takes over” and she feels the uncontrollable urge to push out her baby. But it wasn’t until last year, during my third birth, that I truly experienced the phenomenon known as “spontaneous pushing.” After birthing two children, this was my first birth without any medicinal pain relief. When it came time for me to push (a mere 10 minutes after being admitted to my room), there was no denying the intense urge. My brain was no longer in control — my body “just took over.” At the time, I remember feeling overwhelmed by the intensity and seeming lack of control. And when you think about it, it can feel scary to lose control. What I realized after the fact, however, is that I did have control, my body was controlling and leading the way to birthing my baby. The wonder — and power — of a mother’s body is awesome.

The following is excerpted from the Lamaze Healthy Birth Practice #5 and talks about the benefits of spontaneous pushing.

Types of Pushing 
When you push in response to the natural urge to push, it is called “spontaneous pushing,” meaning you are doing what your body tells you to do. This natural urge comes and goes several times during each contraction. Each of these bearing-down efforts or urges usually lasts from five to seven seconds. However, when you are directed by your caregiver and those around you to hold your breath and push to a count of 10 seconds, repeating this two to three times during a contraction, you are using directed pushing.

Responding to the urge to push with short periods of holding your breath in a calm, unrushed environment has many advantages. Your baby will get more oxygen through the placenta, you will be less likely to become physically exhausted, and there is less chance of damage to the perineum and the muscles of the pelvic floor in the vagina (Albers, Sedler, Bedrick, Teaf, & Peralta, 2006; Roberts & Hanson, 2007). If you are having a very difficult time pushing the baby out, directed pushing might help. However, pushing spontaneously will usually be easiest and safest for both you and your baby.

What Research Tells Us 
According to the Cochrane Pregnancy and Childbirth Group, a respected international organization that defines best practices based on research, the use of any upright or side-lying position compared with lying on your back with your legs in stirrups is associated with the following results:

  • shorter second (pushing) stage of labor;
  • a small decrease in the use of vacuum or forceps;
  • fewer episiotomies;
  • less chance of experiencing severe pain;
  • fewer abnormal fetal heart tracings;
  • a small increase in second-degree tears (in the upright group only); and
  • an increase in estimated blood loss, although there was no evidence of serious or long-term problems from the extra blood loss (Gupta, Hofmeyr, & Smyth, 2004).

Were you able to spontaneously push during your labor? Share in the comments about your experience!

Filed Under Birth, Featured Story, Healthy Birth Practice, Hospital Birth Tagged With pushing, spontaneous pushing

All About Pushing During Labor

February 22, 2012 By Cara Terreri 1 Comment

Despite what the media likes to depict, pushing while lying flat on your back during labor may not the most comfortable, helpful or efficient way to birth a baby. According to the Lamaze Healthy Birth Practices, “Upright positions—such as standing, kneeling, or squatting—take advantage of gravity to help your baby move down into the pelvis. Squatting increases the size of the pelvis, providing more room for the baby to move down (N. Johnson, V. Johnson, & Gupta, 1991; Simkin & Ancheta, 2005).”

Additionally, the outdated holding-your-breath-and-count-to-10-and-PUSH! method of pushing is not ideal. Also known as “purple pushing” (because your face turns purple when you hold you breath!), this style of pushing is often used in many hospital labor rooms, but it can deprive your body of oxygen, add undue stress to you and your baby, and increase your risk for perineal tears and further weaken your pelvic floor muscles after birth. A healthier way to push is to follow your body’s instincts and cues to push, taking breaks when needed and bearing down when you feel the urge.

Want to learn more by seeing examples? Watch this helpful video, created by Lamaze, which shows women birthing in hospitals– with and without epidurals — using different positions for pushing.

 

Filed Under Birth, Featured Story, Healthy Birth Practice, Labor Tagged With pushing

What Does Lamaze Say About Epidurals?

January 30, 2012 By Cara Terreri 5 Comments

With all the talk recently about epidurals, we would like to share with you where Lamaze childbirth educators stand — and what they teach — when it comes to epidural usage in labor.

 

What is Lamaze’s position on epidural use?

  • Expectant mothers need balanced and accurate information about the risks and benefits of epidurals to determine the best choice for her and her baby.
  • Mothers don’t need judgment – they need information.  Women are not always told all of the risks associated with an epidural.
  • Lamaze Certified Childbirth Educators provide the information moms need to make an educated decision.

 

What risks do epidurals pose to mothers and babies?

  • Epidurals are associated with a number of risks, including:
    • Prolonging labor
    • Higher risk of fever and postpartum separation to rule out infection
    • Increased risk of instrument delivery
    • Increased perineal trauma
    • Maternal hypotension, which can lead to worrying fetal heart rate changes
    • Increased difficulty with breastfeeding
    • If the mother opts to have an epidural, the timing is important.  The early use of an epidural is associated with increased cesarean rates.
    • Having an epidural inhibits the mother’s ability to move freely during labor – an important part of keeping labor moving smoothly.

 

When is an epidural medically necessary?

  • Expectant mothers may need an epidural in certain situations:
    • Labor is prolonged and difficult.
    • The mother undergoes a cesarean.
    • The mother has very high blood pressure.

 

What alternatives are there for coping with pain?

  • Lamaze teaches coping techniques to help women cope with labor pain, including bathing and changing position.
  • Continuous support from a partner, relative, friend or doula also can help women through contractions.
  • It is important to remember labor pain is not a pathological pain, like the pain of a broken arm or illness.  It is a natural part of the labor process and signals that the mother’s body is working as it should.
    • Pain can actually help keep the birth process moving, triggering a cascade of hormones needed to keep labor active.  It can also signal important things to the mother, such as the need to move and change positions to allow the baby to descend.

 

For additional information on epidural usage, check out the following links:

 

Filed Under Birth, Featured Story, Healthy Birth Practice, Hospital Birth Tagged With epidural, interventions
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