Red Light, Green Light – A Quiz on Getting the Best Care

Are you getting the best prenatal care from your provider (midwife, OB, or family doctor)? Take this “red light, green light” quiz to find out. Red light indicates care that is not evidence based or respectful of your choices. Yellow light indicates care that should make you question your provider further to see if she is the best fit. Green light indicates great care!

New Medical Guidelines Released to Prevent Cesareans

Earlier this week, the American Congress of Obstetricians and Gynecologists (ACOG) along with the Society for Maternal-Fetal Medicine (SMFM) released a joint Obstetric Care Consensus: Safe Prevention of the Primary Cesarean Delivery, in response to rapidly rising first-time cesarean birth rates that have shown no improvement in the death rates for moms or babies. (Complete details on the consensus can be found on ACOG’s website.) In the statement, the two groups put forth several new recommendations that propose to help prevent the first cesarean for women. If you are pregnant, you can use these new guidelines as a conversation starter during a prenatal appointment — find out how these new suggestions measure against your care provider’s routine practices. A sample summary of the recommendations is below.

A long first stage of labor — more than 20 hours in first-time moms — should not be cause for a cesarean. Many women are put on a time clock to dilate to 10cm, when in reality, a long labor alone should not be cause for a cesarean. If you hear statements like, “Your labor has stalled,” “You are not progressing,” or “Failure to progress,” followed by a recommendation for cesarean, ask: “Is my baby OK? Am I OK? What’s the risk in waiting or doing nothing right now? (or, what’s the alternative?)”

First-time moms should be permitted to push for at least 3 hours (2 hours for second-time moms) before recommending a cesarean. Unlike what Hollywood and The Baby Story show us, pushing can take a while. It’s important for moms to be given enough time to push out their baby, as long as mom and baby are both doing well.

Because induction raises the risk of cesarean, it should not be performed before 41 weeks unless medically indicated. Yes, 41 weeks! Allowing  baby enough time to continue developing and for your body to gear up for labor will give you the best chance of having a healthy mom and baby.

Ultrasounds performed late in pregnancy to determine your baby’s weight should be used only if there is clear indication, as these ultrasounds are linked to increased rate of cesarean for a “big baby,” which is rarely a good reason for cesarean. Ultrasounds have been shown, time and again, to be off by up to (or more than) a pound in either direction. If cesarean is suggested because your baby is estimated to be too big — get a second opinion from a care provider in another practice.

Continuous labor support — like that provided from a doula — is “one of the most effective tools” in improving birth outcomes. Good labor support is not just a “nice to have,” but a key component to improving your care during birth. Lamaze has known this for quite some time — check out our Healthy Care Practice number 3, “Bring a loved one, friend or doula for continuous support.

Being pregnant with twins does not automatically mean a cesarean, if twin A is in a head-down position for birth — even if the second twin is not head down. Vaginal birth for twin mamas — it IS possible!

Baby’s position in labor should be determined — especially if there are problems with baby moving down the birth canal — and if possible, an attempt should be made to manually re-position baby before suggesting a cesarean. A posterior baby (where baby faces toward your front instead of your back)  can cause problems in labor. Often, a baby will correct its position before birth, but not always, and this can cause issues. If you suspect an issue with your baby’s position during labor, mention it to your care provider. You can ask for ultrasound in labor to verify. Ask for help with trying to get baby in a better position for birth.

60 Tips for Healthy Birth: Part 6 – Keep Mother and Baby Together – It’s Best for Mother, Baby, and Breastfeeding

In this six-part series, we are sharing 10 tips for each of the Lamaze six Healthy Birth Practices that help guide women toward a safe and healthy birth. The Lamaze Healthy Birth Practices are supported by research studies that examine the benefits and risks of maternity care practices. Learn more about each practice, including short, informative videos at Lamaze.com. To read the rest of the 60 tips, check out the other posts in this series.

10 Ways to Keep Mother and Baby Together after Birth

1. Learn why keeping mother and baby together is healthy for you, your baby, and breastfeeding.

2. Ask your care provider about routine practices after birth. Does she encourage mom and baby to stay together?

3. During your hospital tour, ask the tour guide what nursing staff does to help mom and baby get off to the best start after birth. Do they promote skin-to-skin care? Do they delay routine newborn procedures until mom and baby have had a chance to feed?

4. Include on your birth plan that mom and baby should be kept together after birth. Share your birth plan with your care provider and the nursing staff at your place of birth.

5. Let your partner and birth support team know that you would like to keep your baby with you after birth. With the chaos that generally happens after birth, they can help facilitate your wishes.

6. Take a good childbirth class to learn how interventions can affect birth and your baby, and how they can be avoided. Many interventions can lead to separation of you and your baby.

7. When you are moved to a postpartum room after birth, keep your baby in the room with you instead of sending her to the nursery. Babies sleep best when mom is near, and you will get the best start with breastfeeding when you are close enough to see and hear their early hunger cues.

8. Take a good breastfeeding class, which will provide information on how to get breastfeeding off to a good start, including skin-to-skin care and tips for the first latch/feed with your baby.

9. If you must be separated from your baby after birth, spend time skin to skin with your baby once she is back in your arms.

10. If you have a cesarean, ask your care provider about bringing your baby skin to skin immediately after he is out. Some hospitals perform “family centered cesareans,” where mom and baby are kept skin to skin and breastfeeding is initiated in the OR. If your hospital does not permit you to hold your baby skin to skin in the OR, ask that your partner or birth support person hold baby skin to skin while you finish out your surgery and get moved to the recovery room.

60 Tips for Healthy Birth: Part 5 – Avoid Giving Birth on Your Back and Follow Your Body’s Urges to Push

In this six-part series, we are sharing 10 tips for each of the Lamaze six Healthy Birth Practices that help guide women toward a safe and healthy birth. The Lamaze Healthy Birth Practices are supported by research studies that examine the benefits and risks of maternity care practices. Learn more about each practice, including short, informative videos at Lamaze.com. To read the rest of the 60 tips, check out the other posts in this series.

10 Ways to Avoid Giving Birth on Your Back and Follow Your Body’s Urges to Push

1. Learn why avoiding giving birth on your back and following your body’s urges to push is healthy for you and your baby.

2. Discuss early on with your care provider that you would like to do what comes naturally when it comes to positions and pushing during birth. If your care provider reacts negatively, this could be a red flag that she does not support evidence-based practices.

3. Take a good childbirth class to learn the many ways in which you can push out a baby, and in particular, the many positions you can push in/on/around a hospital bed that does not involve lying flat on your back.

4. Avoid interventions that restrict your mobility so you can easily move in any way you feel comfortable, including positions for pushing, like on all fours, standing, squatting, and side lying.

5. If interventions become necessary, involve your labor support team to help you remain as mobile as possible and get into upright positions for birthing.

6. Learn the difference between directed pushing and pushing with your body’s natural urges.

7. Include details in your birth plan about your preferences to push in a position that is most comfortable to you and to follow your body’s natural urges to push (ie, please don’t count or coach for pushing). Share your birth plan with your care provider during your pregnancy, and bring a copy of your birth plan to your place of birth to share with your nurses/attendants.

8. Consider “laboring down” to shorten the amount of time spent actively pushing and to provide you with more energy to push in upright positions.

9. If you are birthing at a hospital, ask your nurses in advance of pushing about using the squat bar. Nearly all maternity beds come with a squat bar attachment, but staff may need some time to locate it and bring it to your room. The squat bar  is an excellent tool that can help support your squatting position in labor and birth. It can even be used for women who have an epidural.

10. You may find that pushing on your back and/or pushing with the encouragement or coaching of your labor support team is actually helpful — and that’s ok, too! Labor and birth is about what works best for you and your baby to have the most healthy and positive experience.

60 Tips for Healthy Birth: Part 4 – Avoid Interventions that Are Not Medically Necessary

In this six-part series, we are sharing 10 tips for each of the Lamaze six Healthy Birth Practices that help guide women toward a safe and healthy birth. The Lamaze Healthy Birth Practices are supported by research studies that examine the benefits and risks of maternity care practices. Learn more about each practice, including short, informative videos at Lamaze.com. To read the rest of the 60 tips, check out the other posts in this series.

10 Ways to Avoid Interventions that Are Not Medically Necessary

1. Learn why avoiding interventions that are not medically necessary is important for you and your baby.

2. Ask your care provider (the earlier, the better) about the kinds of interventions they use and when they use them. You can ask about their rates of interventions, but you’ll  most likely get more accurate and telling answers with more open-ended questions, like, “For what reasons would you recommend an induction?” and “Why would I need a cesarean?”

3. Take a quality childbirth education class to really get to know different interventions and how they interplay with one another. For example, you cannot be induced without having continuous external fetal monitoring and IV fluids.

4. Learn about the interventions used regularly at your chosen place of birth. Sometimes, those rates are available publicly and sometimes (more often), they are not. You can also ask during your hospital tour or at a prenatal visit with your care provider. But your best bet is to ask local doulas and childbirth educators, who will most certainly have insider knowledge.

5. Research and practice a variety of coping and comfort measures, as well as position changes, to use during your labor and birth.

6. Consider hiring a doula, who is trained on the use of interventions and can offer additional resources for you to make the best informed decision about your care. A doula will not advocate on your behalf, but can help you be a better advocate for yourself.

7. When you hit 40 weeks and there is no sign of labor, remind yourself that 40 weeks is not a deadline but a vague estimate and that a healthy pregnancy can go to 42 weeks and beyond. Also remind yourself that you will not, in fact, be pregnant forever. As uncomfortable as you may be at 40 weeks of pregnancy, the healthy choice in most cases is to let labor begin on its own.

8. If faced with the decision to induce your labor, first find out why, and second, find out your Bishop’s Score. And, learn why an induction might be necessary and when it is not.

9. Make sure your partner or birth support person (spouse, partner, friend, family member) knows about your birth preferences and understands how best to support you during birth. Your birth partner will be an invaluable asset to your birth experience.

10. Interventions can be medically necessary and life-saving. If interventions become necessary, find out how you can keep your labor as healthy as possible.

 

photo credit: Rick Bolin via photopin cc

60 Tips for Healthy Birth: Part 3 – Bring a Loved One, Friend or Doula for Continuous Support

In this six-part series, we are sharing 10 tips for each of the Lamaze six Healthy Birth Practices that help guide women toward a safe and healthy birth. The Lamaze Healthy Birth Practices are supported by research studies that examine the benefits and risks of maternity care practices. Learn more about each practice, including short, informative videos at Lamaze.com. To read the rest of the 60 tips, check out the other posts in this series.

 

10 Ways to Have the Best Continuous Support During Labor and Birth

1. Learn why bringing a loved one, friend, or doula for continuous support is important for you and your baby.

2. Encourage your designated labor support person(s) to read The Birth Partner by Penny Simkin.

3. Curious about professional labor support? Find out why a doula can be a wonderful asset to your support team.

4. Learn about the many ways you can find comfort in labor by taking a good childbirth class.

5. Choose a care provider and place of birth that encourages bringing a doula to your birth.

6. Create a birth plan/preferences sheet and share it with your birth support person to make sure that she knows your wishes.

7. Spend time connecting with your birth support person prior to going into labor — get to know each other (if you don’t already), share your feelings about the upcoming birth, and talk about what you envision as the best labor support.

8. Pack a hospital or birth center bag with items you imagine will be useful to the person who supports you during labor — nourishment, scents, favorite lotion, focal point, etc.

9. Be sure that your support team — all of the members present with you during labor and those actively supporting you — are people you actually want by your side. You only get to birth this baby once!

10. If your spouse, family member, or friend is the one who will be your labor support person, be sure they know it is not their job to “save” you from the hard work of labor, but rather to support and comfort throughout your labor, as best as they possibly can.

 

60 Tips for Healthy Birth: Part 2 – Walk, Move Around and Change Positions Throughout Labor

In this six-part series, we are sharing 10 tips for each of the Lamaze six Healthy Birth Practices that help guide women toward a safe and healthy birth. The Lamaze Healthy Birth Practices are supported by research studies that examine the benefits and risks of maternity care practices. Learn more about each practice, including short, informative videos at Lamaze.com. To read the rest of the 60 tips, check out the other posts in this series.

10 Ways to Walk, Move Around and Change Positions Throughout Labor

1. Learn why walking, moving around, and changing positions throughout labor is important for you and your baby during labor.

2. Limit interventions, like epidural and routine IV fluids, both of which can restrict your ability to move during labor.

3. Bring a trusted friend, family member, your partner, or doula to serve as your birth support person who will be in charge of reminding you to change positions and offer suggestions for movement that keeps labor progressing, facilitates baby’s positioning, or allows you to rest in between contractions.

4. Find a care provider who supports evidence-based practices for a healthy birth, including remaining mobile during labor.

5. Make sure your place of birth is one that encourages women to move around and change positions during labor.

6. Request intermittent fetal monitoring (usually 20 minutes out of every hour) instead of continuous fetal monitoring, which is more restrictive for movement and has been shown to increase the risk of more interventions.

7. Labor as long as possible at home, where you are free to move around as much as you like.

8. If you need to have an epidural, ask your care provider and anesthesiologist about having a lower dose epidural to be able to move and change positions easily, and possibly get up and walk short distances (though many hospitals do not permit this).

9. If you must be monitored continuously or hooked up to an IV (like you would during an induction), you can still get out of the bed! Enlist the help of your support person(s) to help you move around with wires in tow.

10. Familiarize yourself with the many different labor positions you can use to help promote comfort and facilitate labor and birth.

60 Tips for Healthy Birth: Part 1 – Let Labor Begin on Its Own

In this six-part series, we will share 10 tips for each of the Lamaze six Healthy Birth Practices that help guide women toward a safe and healthy birth. The Lamaze Healthy Birth Practices are supported by research studies that examine the benefits and risks of maternity care practices. Learn more about each practice, including short, informative videos at Lamaze.com. To read the rest of the 60 tips, check out the other posts in this series.

 

10 Ways to Let Labor Begin on Its Own

1. Learn why letting labor begin on its own is important for you and your baby.

2. Choose a doctor or midwife who has a low rate of induction and who is comfortable with a pregnancy that lasts 42 weeks.

3. Know that your “due” date is not an expiration date. Only about 5 percent of moms give birth on their due date. Instead of a day, think of it as your due “month.”

4.  Learn about induction — when it’s needed for medical reasons and when it’s used for reasons of convenience. A good childbirth class will cover this topic in detail, as well as give you the tools you need to ask the best questions and make an informed decision.

5. If your care provider suggests an induction, ask questions. Is it an emergency? What’s the risk in waiting? What are the alternatives?

6. Unsure of your care provider’s recommendations? Consider seeking a second opinion.

7. Want to avoid the barrage of calls, texts, and emails around your due date? Keep your due date a secret. Tell friends and family you’re due “sometime in April,” or whatever month your predicted due date is in.

8. Prepare yourself for the mental mind game that occurs with nearly every mom who reaches 39-40 weeks. Schedule mini celebrations for each passing day or days — lunch with a friend, pedicure, ice cream, movie, bliss out to your favorite tunes. Do whatever it takes to relax and take your mind off of having a baby!

9. Remind yourself that every day your baby is still on the inside is one more day she needs to grow and develop. Healthy babies are worth the wait.

10. If you end up needing an induction, learn how you can keep your labor as normal and healthy as possible. If you are induced through the use of Pitocin, consider asking if your care provider can turn down or turn off the Pitocin once your body has established a good contraction pattern.

Healthy Birth Practice 1: Let Labor Begin on Its Own

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

Letting your body go into labor spontaneously is almost always the best way to know that your baby is ready to be born and that your body is ready for labor. In the vast majority of pregnancies, labor will start only when all the players—your baby, your uterus, your hormones, and your placenta—are ready. Naturally, labor usually goes better and mother and baby usually end up healthier when all systems are go for birth. Every day of the last weeks of pregnancy is vital to your baby’s and body’s preparation for birth.

If your labor is induced (started artificially), it becomes a medical event and proceeds quite differently from spontaneous labor.  Unless you or your baby has a health problem that necessitates induction, it makes sense to wait patiently for your labor to start on its own. Even if your due date has passed and you’re longing to hold your baby, remember that nature has good reasons for the wait.

  • Download the Lamaze Healthy Birth Practice Paper, available in eight languages, to learn more about induction of labor.
  • Learn some tips for avoiding labor induction.
  • Find out how to keep labor as natural as possible if you have a medical reason to be induced.
  •  Watch a video on why to let labor begin on it’s own.

 

For additional resources on induction, check out the following links:

 

Stop Birth Information Overload by Getting Back to Basics

With the wonderful world wide web available to us 24/7, the deluge of information we encounter (and seek out) during pregnancy can feel a lot like drowning. So many choices, so much to learn, so much to digest. There are times when everything seems to come into question — from what you eat during pregnancy to whether you should create a birth plan (the answer to that last one is yes, you should write a birth plan!). When you cut out the background noise and get back to the basic foundation of a healthy birth, you can better focus your energy on working to achieve the goals that will have the most impact on your birth experience and outcome.

The Lamaze Healthy Birth Practices are easy-to-follow measures that, when used together, add up to good outcomes for birth. Click through to each one for a more complete description along with an informative, short video. To give yourself the best chance of achieving these goals, find out if your care provider supports the practices. 

 

Did your birth follow some or all of the Lamaze Healthy Birth Practices? Which ones made the most impact? Which ones were the most difficult to achieve?