What You Should Know About Common Birth Interventions

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

You may be planning a natural birth, but there are times when your health-care provider must intervene for health and safety reasons. Or you may find that standard hospital practices often include medical interventions. In either situation, it’s important that you be involved in the decisions related to your care. You can do that by asking questions and openly communicating your desires to everyone in attendance. When a medical intervention is suggested or presented as routine procedure, ask about the benefits, risks, alternatives and whether you can do the procedure later – or not at all. Most important, trust your intuition. Everyone, including you, should stop and think before an intervention is suggested. Research shows that many times interventions are done more for convenience sake than for medical reasons. Being well-informed about the common interventions that might arise will enhance your ability to make crucial decisions. Educate yourself, communicate your preferences well in advance and stay involved in all decisions related to labor and birth. Your choices will be critical to the health and safety of you and your baby.

Read more about medical interventions:

Appropriate Use of Interventions: Induction or Augmentation with Pitocin

Pitocin — the synthetic form of oxytocin, the body’s natural hormone that stimulates contractions — is one of the most frequently used medical interventions to induce or augment (speed up) birth. Below are some facts and tips to help you learn more about Pitocin, including how to avoid it, when it’s necessary, and how to keep labor as normal as possible if you are induced with Pitocin.

From The Official Lamaze Guide: Giving Birth with Confidence.

What to Know:

  • Pitocin increases stress on your baby and your uterus and makes contractions more difficult to manage.
  • Pitocin use necessitates an IV and continuous EFM, restricts your mobility, and raises your risk of epidural and cesarean.
  • The WHO believes that Pitocin induction and augmentation are often used inappropriately.
  • The ACOG notes the risks of Pitocin use and recommends cautious decision making.

You’ll Need Induction if:

  • Your labor is slow and doesn’t respond to movement, position change, and hydration.
  • You don’t go into labor spontaneously by forty-two weeks gestation.
  • You have a uterine infection.
  • You have severe pregnancy-induced hypertension.

How to Avoid Unnecessary Use:

  • Be patient waiting for labor to begin and to progress.
  • Remember that your body knows how to give birth.
  • Surround yourself with helpers who trust birth.
  • Stay confident.
  • Use all the comfort measures you’ve learned.
  • Don’t agree to be induced because your caregiver says your baby is getting too big.
  • If your water breaks before contractions start, or if you go past your due date, discuss with your caregiver natural ways to stimulate contractions, such as drinking a bit of castor oil in juice, stimulating your nipples, and being active.
  • Ask, “What if I wait?” if your caregiver is insistent about inducing labor.

How to Keep Labor as Normal as Possible if You are Induced:

  • Make sure your helpers give you continuous emotional and physical support.
  • Actively seek comfort in response to the pain of contractions.
  • Remember that your body knows how to give birth.
  • Visualize your baby rotating and descending through your birth canal.
  • Keep moving and changing positions as much as possible.

Did you have Pitocin during your birth? How did it affect your experience? What advice can you give to other moms who may have Pitocin?

What Does Lamaze Say About Epidurals?

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:

 

Common Medical Birth Interventions You Should Know

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

You may be planning a natural birth, but there are times when your health-care provider must intervene for health and safety reasons. Or you may find that standard hospital practices often include medical interventions. In either situation, it’s important that you be involved in the decisions related to your care. You can do that by asking questions and openly com-municating your desires to everyone in attendance. When a medical intervention is sug-gested or presented as routine pro-cedure, ask about the benefits, risks, alternatives and whether you can do the procedure later – or not at all. Most important, trust your intuition. Everyone, including you, should stop and think before an intervention is suggested. Research shows that many times interventions are done more for convenience sake than for medical reasons. Being well-informed about the common interventions that might arise will enhance your ability to make crucial decisions. Educate yourself, communicate your preferences well in advance and stay involved in all decisions related to labor and birth. Your choices will be critical to the health and safety of you and your baby.

ELECTRONIC FETAL MONITORING

What: Electronic Fetal Monitoring (EFM) is used to evaluate uterine contractions and the baby’s response to them. There are three types of monitors. External monitors have two belts that use ultrasound and a pressure transducer. Telemetry units allow the woman more movement, so she’s not  “tethered” close to the machine. If there is some reason that the above are not taking accurate measurements, internal monitors can also be used.  

Why: For a long time, listening to a baby’s heartbeat has been used to assess how the baby is tolerating labor. Low-risk women can be monitored intermittently, while high- risk women may be monitored nonstop. Continuous monitoring has not improved outcomes for healthy women having normal labors; instead, it has proven to increase the rate of cesarean. And it has affected women’s ability to move and change positions as needed. There are times when continuous monitoring is necessary in low-risk women, for example, if your labor is induced or augmented with Pitocin, or if you have an epidural. If your baby’s heart rate changes, or you or your baby have a health problem, you also may be monitored continuously.

Lower your risk: The American College of Obstetricians and Gynecologists (ACOG) supports periodic monitoring (once every 30 minutes in active labor) via EFM or auscultation, which is “listening” to what’s going on with the baby and the contractions using ultrasound. If that’s not an option in your hospital or birth center, talk with your nurse about being upright (such as in a rocking chair or on a birth ball) when being monitored, as opposed to laboring in bed. Or, ask for a mobile monitoring unit so that you may continue to walk, go to the bathroom, stretch or slow dance. Try not to labor in bed for long periods. Don’t be distracted by the monitor – turn it away and lower the sound. Remind your support team to focus on you, not on the machine. 

INDUCTION

What: An artificial way to start labor using one of the following induction methods:
1. Membrane stripping or sweeping via your health-care provider’s finger to separate your cervix from the tissue around your baby’s head.
2. Rupture of membranes using a sterile hooked instrument.
3. Cervical ripening with the insertion
of either a prostaglandin gel or a balloon-like catheter.
4. Pitocin, a synthetic hormone given through an IV drip in steadily increasing amounts to stimulate contractions.  

In addition, some non-medical induction methods may be suggested, including acupuncture, homeopathy and/or herbs, sexual intercourse and nipple stimulation. Discuss the pros and cons with your health-care provider. If you do try one of the above, keep him or her updated on your progress.

Why: ACOG recognizes various medical reasons for inducing labor (see “When Induction Is Necessary,” right). However, the number of inductions in the United States is on the rise, due to a recent trend of inducing for non-medical reasons. These include the mother’s desire to plan the baby’s birth date, to minimize end-of-pregnancy discomfort, or to have a favorite health-care provider attend the birth. In addition, many women are induced because their health-care provider suspects the baby is large. According to ACOG, this is not a medical reason for induction. Studies show that the birth of a big baby is not affected by inducing labor versus letting labor begin on its own.

Lower your risk: Unless there is a clear medical reason for induction (see right), it is far less complicated and far more healthy for you and your baby to let labor start on its own. Going into labor naturally is the best way to know that your baby is ready to be born and your body is ready for labor. (See “The Waiting Game,” page 23, for more information.) If a medical concern does arise, spend as much time as possible with your health-care provider weighing the benefits and risks of each labor-induction method.

DIRECTED PUSHING - BREATH HOLDING

What: Women are instructed to take a deep breath in and hold it for 10 counts, then push throughout the contraction – regardless of her natural urge to do so. Often, women are put in a semi-recumbent position, with legs up and chin tucked in a C-position.  

Why: Directed pushing during childbirth became the standard half a century ago when women were heavily medicated during labor and birth. It’s still a common practice in labor rooms, but evidence shows that this technique should be avoided. Instead, women should be encouraged to follow their bodies, pushing only when they feel an urge.

Lower your risk: Ask your labor support team to follow your lead when it comes to pushing. Change positions often during this stage. Remember, there is often a “rest and be thankful” stage between urges. Try moaning or exhaling while you push. Ninety percent of the work is done by your uterus. You can focus on relaxing your perineum and pushing with your body cues. Visualize your baby rotating and descending. 

If you have an epidural, remember that your pushing can be impeded by the numbness. Talk with your support team about the practice of “laboring down.” This means allowing the uterus to move the baby down without your active pushing, until the baby is low enough in the pelvis and triggers the receptors that will give you the urge to push. Patiently allowing time for the baby to descend naturally reduces the chance of requiring an instrument delivery (see “Instruments to Know,” right) or a cesarean.

EPISIOTOMY

What: A surgical cut to the perinium and the muscle beneath it, between the vagina and the anus, during the pushing stage.

Why: If there is fetal distress, an episiotomy may shorten the pushing stage by 5 to 15 minutes so the baby can be born faster. It is often required if the baby needs to be assisted, rotated with forceps or a vacuum extractor, or if her shoulders aren’t able to rotate and pass through the pelvis. Episiotomy should not be done routinely; it is largely unnecessary and carries risks to the mother, such as pain, infection and blood loss.

Lower your risk: Recent studies have shown that the routine use of episiotomy does not benefit the mother or newborn. Also, not only does it increase postpartum pain but it weakens the pelvic floor, contributing to long-term problems. Make it known before labor begins that you’d like to avoid having an episiotomy unless absolutely necessary.

During late pregnancy, continue Kegel exercises to strengthen and elasticize your pelvic floor. This will decrease your need for an episiotomy and lessen the chance of tearing naturally. Choose labor positions, like squatting, that help speed the process (see “Position Statement,” page 14). Try not to hold your breath for extended periods. And follow your body’s cues, pushing when you feel the urge. Warm compresses or oil on your perineum may help ease pain.

CESAREAN BIRTH

What: Major surgery that allows the baby to be removed via incisions into the abdomen and uterus.

Why: When there is an urgent threat to the life of the mother or the baby, a cesarean can be a life-saving intervention. Examples include a mother hemorrhaging or a baby not getting enough oxygen. But most cesareans are not emergencies. Some non-emergency reasons are prolonged labor (“failure to progress”), a baby in a breech or transverse position, and changes in the baby’s heart rate.

Lower your risk: Cesarean rates in the United States have reached an all-time high of almost 32 percent, and the World Health Organization is urging health-care providers to decrease that number. Lower your risk by choosing a health-care provider and place of birth with a low cesarean rate. Skilled, continuous labor support is also vital. Research has shown that the presence of a doula can lower the chance of having a cesarean. Finally, be actively involved in all decision making before and during labor, and ask if each medical intervention or pain-relief option increases the risk of cesarean birth.

Some hospitals or health-care providers will not allow a woman to have a vaginal birth after she has had a cesarean (VBAC). But the American Academy of Family Physicians has a policy to expand VBACs, so research your options.

Practices that Promote Healthy Birth: Avoid Common Interventions

Today, childbirth is viewed as and transpires as more of a medical procedure than a natural bodily function. Women who seek to have a natural birth often look for resources and information on how to achieve a more natural experience instead of one that is over-medicalized.

Truthfully, if you want to avoid all common hospital interventions, the best place to give birth (for low-risk women) is either at home or in a birth center. In my own experience, confronting hospital staff to avoid simple things like an IV line can bring added stress that just isn’t part of an enjoyable birth experience. That being said, birth should take place where you feel most comfortable, and if that is in a hospital, the best thing to do is educate yourself about the choices and risks and related to common medical interventions.

 

Common Medical Birth Interventions

  • IV for fluids
  • Epidural anesthesia
  • Continous electronic fetal monitoring
  • Pitocin
  • Artificially breaking the bag of water
  • Episiotomy

Most of these interventions are medically unnecessary, but are used in many hospitals today in the United States. An IV, for example, is used to administer fluids and medication, if necessary. However, when women are allowed to eat and drink during labor, an IV for fluids is not necessary. Recent studies show that there is no need to prevent a woman from eating and drinking while she is in labor

Continuous electronic fetal monitoring is also over-used in low-risk women. In recent years, The American Congress of Obstetricians and Gynecologists (ACOG) has shown that in the 40 years that electronic fetal monitoring has been the norm, there have been no improved outcomes in mothers or babies. Of course, like anything, there are some situations when it is necessary, but mostly in high-risk cases. 

Epidurals for those who choose to use them for labor can be the right fit, but they are not risk free. Epidurals can slow labor and pose other risks to mothers and babies. There are other, more natural and effective ways to help relieve the pain of labor

Pitocin can cause contractions, but it can also cause contractions that are too strong and result in fetal distress and bring on a cascade of interventions

Episiotomy has been shown in recent years to be medically unnecessary in the majority of cases. 

Skipping Common Interventions

There are several ways to avoid routine hospital interventions.

  • Hire a birth doula to help be your advocate and employ natural pain relieving strategies
  • Write a birth plan and provide copies to your provider and hospital staff on call during your stay
  • Talk to your provider about your expectations and practices and procedures you are concerned about
  • Take a tour of your hospital
  • Research your chosen hospital’s cesarean and intervention statistics prior to giving birth

These simple steps can help you avoid common medical interventions and increase your chance of having a safe and healthy birth experience.

Healthy Birth Blog Carnival #6: MotherBaby Edition

We’ve hosted Blog Carnivals for each of the Lamaze Healthy Birth Practices at our sister blog, Science & Sensibility.

This time, we’re bringing our 6th Blog Carnival to Giving Birth with Confidence.  As usual, the bloggers offered up such insightful, thoughtful contributions and I believe yet again that we have one of the best collections on the topic out there on the internet!

Why does keeping moms and babies together after birth matter? Because separating moms and babies is harmful.

Kimmelin Hull at Writing My Way Through Motherhood and Beyond writes:

The research on this issue is crystal clear: babies do better in the first minutes, hours and days, the more time they spend in skin-to-skin contact with their mothers. Their breathing and heart rates remain more stable. Their body temperatures fluctuate less. Ditto for their blood sugar levels. They cry less and they nurse and sleep better, too.”

Danielle at Momotics also reviews the harms of mother-infant separation and suggests that her baby’s 30 hour stay in the NICU for management of blood sugar instability may have been preventable if the hospital had allowed for skin-to-skin contact instead of routine separation. She also points out that skin-to-skin contact exposes newborns to normal bacteria on the mother, which can protect them from getting sick from hospital-acquired bacteria.

All of this just from putting our newborn’s baby against our own? Kristen at Birthing Beautiful Ideas says it simply (and beautifully): Women have superpowers!

Perhaps babies have superpowers, too. The power, that is, to protect their mothers from postpartum depression. Lauren at My Postpartum Voice discusses the amazing health benefits for preterm or low birthweight newborns who experience “Kangaroo Care” — skin-to-skin contact with their mothers in the neonatal intensive care unit. Research also suggests that Kangaroo Care offers protection or relief from postpartum depression. Lauren reports on a study in which no mother developed depression during their Kangaroo Care stay.

Research aside, what about common sense? From the baby’s perspective, the “maternal environment” represents a familiar landscape in which to feel safe and avoid distress (which has well-documented physiological effects.)

Danielle at Informed Parenting describes the moments after birth from the perspective of the baby held skin-to-skin:

Then suddenly he is enveloped in warmth, laying wet and slippery on his mothers chest. He hears it- the beating of his mothers heart. He hears her voice, so clearly for the first time. He knows what he needs and he seeks out that attachment, the physical bond to tie them back together. Little toes flex and dig into his mother soft belly as he wiggles and squirms forward, his little mouth open and questing. The sound of her voice draws him forward. Her arms support him in his journey. In a feat of strength and coordination that is truly amazing he reaches his goal and re-establishes their physical bond. As he suckles her nipple, drops of liquid gold land on his tongue.

Mamapoekie at Authentic Parenting describes a similar scenario, and then contrasts it with the far more common scenario:

You are being pulled away from the one smell and feel you knew to again another entirely different setting. They prick you and it hurts and they rub you down and put stuff in your eyes, it stings even more than the light! You are starting to feel very desperate, very helpless.

From the mother’s perspective, we yearn for closeness with our babies, to take in every detail of their newborn bodies. After all, we’ve worked so hard to grow and give birth to them.

Molly at first the egg writes that while the yearning instinct is deeply primal, yearning is not part of birth when mother and baby are kept together. With gorgeous pictures from her own birth in 1981 and her son’s birth in 2006, Molly shares,

My mother had to yearn for closeness while she fell in love with me. I am so grateful that, twenty-five years later, my newborn and I got to have it.

Kori at Babble.com’s Band On the Diaper Run, who as one-half of the band Mates of State, just hit the road for their summer tour with kids in tow. She shares a powerful testament to the importance of a strong support network to keep her working family together. Her story begins with her yearning for closeness just after her first daughter’s birth:

I shouted across the room, with a strong, primal urge, “Give her to me..I want to hold her..I need to feed her!” Until finally, she was in my arms. I didn’t even recognize my own voice, the words just came out. I needed to have her with me. They really couldn’t ignore me.

And from the family’s perspective, keeping mother and baby together in the hours and days after birth helps them develop a rhythm together and begin to bond and grow as a family. Lauren at Hobo Mama wrote:

Sam, Mikko, and I stayed together from the time we entered our room, three hours prior to the birth, until we all exited as a new family two days later, and it was absolutely the best way I can think of handling it.

boheime at Living Peacefully with Children believes that both birth and bonding are easiest when the mother feels well cared for, and can simply be with her baby to find the right rhythm. She relies on her very willing husband as her primary support for both.

With the birth of each child, he has taken off 2-3 weeks from work in order to cook, clean, and help out however I need him. It’s because of his support that I have been able to focus on getting to know each of our children, establish breastfeeding with them, and not feel as though the entire house has fallen apart.

With so many documented harms from mother-infant separation, not to mention the primal urge for mothers to hold their babies, routine separation of mothers and babies is a mainstay of modern obstetrics, and may give rise to the epidemic of breastfeeding problems.

Sheridan at the Enjoy Birth Blog remarked that her students who have given birth before are among the most surprised that mothers are “allowed” to have their babies with them right after birth. She writes:

It is shocking to me how many moms who are taking my Hypnobabies class for the 3rd or 4th baby and they are amazed that they have the option of keeping the baby on them for an hour or two.

After participating in many hospital births, Carol van der Woude at Aliisa’s Letter also had an awakening about how unnecessary hospital routine are. She describes the first time she saw a home birth:

My wonder at the miracle of birth was renewed. I watched as the baby emerged and the umbilical cord was left intact. The pulsating cord delivered oxygen to the baby as he made the transition to life outside the womb. The baby was placed on the mother’s chest, skin to skin, for warmth. The infant was comforted and stimulated in his mother’s arms.

Lamaze educator Nicole VanWoudenberg who blogs at A Little Bit of This and a Little Bit of That was in fact one of those women who didn’t know about the importance of immediate and close contact after birth until after she had had several babies. She describes her first and last births. After her first birth:

They cleaned her up, weighed and measured her, gave her the vitamin K shot, the eye ointment and whatever else, I was stitched up and approximately 45 minutes later, I got my burrito-baby. Seriously, she was diapered and all wrapped up in towels!! I did not know better, and left her like that while “bonding” with her. Did I have breastfeeding issues? Absolutely. Are the two connected? Absolutely.

For her fourth baby, born at home, she recalls:

I didn’t wait 45 minutes to receive my son. I birthed him and brought him up to my chest, for skin to skin snuggling myself. And there he stayed while we marveled at the wonder of birth, and his appearance! I only let him go while I got out of the pool to birth my placenta. As soon as I was settled on the couch, he was back in my arms, skin to skin – starting to nurse. He breastfed the best, and the longest of all four of my children. Are these two things connected? Absolutely.

Molly at Talk Birth discusses the Birth-Breastfeeding Continuum in her post. She writes:

New mothers, and those who help them, are often left wondering, “Where did breastfeeding go wrong?” All too often the answer is, “during labor and birth.” Interventions during the birthing process are an often overlooked answer to the mystery of how breastfeeding becomes derailed.

Kmom at The Well Rounded Mama reviewed the research surrounding “Baby-Friendly” practices, points to a study that reported only 8% of babies actually experience the six Baby-Friendly practices, and then examines breastfeeding issues in women of size. She writes:

The role of aggressive birth interventions in the lower rate of breastfeeding among obese women typically goes conveniently unexamined in the research. Breastfeeding failure is blamed solely on fatness, when in fact, the high level of interventions in obese pregnancies and births may also play a significant role.

Laura Keegan, author of Breastfeeding with Comfort and Joy writes about the birth stories of women she works with in her practice. “A common theme in all of these stories has been the shock from the denial of contact with their babies or the importance of having that yearned-for close contact at birth,” and asks, “How many breastfeeding problems could be prevented if we facilitated this close contact at birth?”

 

Hobo Mama and her babe.

 

So, why are women and babies separated? Usually for routine care. But it doesn’t have to be that way.

Sheridan at the Enjoy Birth Blog is one of several bloggers who remind us that nurses can do everything they need to do for a healthy baby with the baby in the mother’s arms. She writes, “I understand that nurses have jobs they need to get done, checklists to mark off, but this time is so precious and these routines can wait!”

Fortunately, a new video has just become available to train hospital staff to incorporate skin-to-skin contact after both vaginal and cesarean births. Jeannette Crenshaw reviewed it on Science & Sensibility.

Both sections begin with health professionals teaching pregnant women about immediate skin to skin care prenatally, and on admission to the hospital—which “sets the stage” for immediate skin to skin contact as a normal part of the birth process. After the vaginal birth, the clinician immediately places the baby on mom’s abdomen. After the cesarean birth, the nurse immediately places the baby on mom’s chest, above the sterile field and drapes, as the doctor continues the surgery and the anesthesiologist monitors the mother. The baby’s father is at mom’s side in both segments…Both sections show competent nurses assessing the newborn, providing care, and supporting the mother and baby as the baby moves through the 9 stages of skin to skin.

Also on Science & Sensibility, I discuss a new vital sign for nurses to document after birth, the duration of skin-to-skin contact. I argue that this data may help hospitals comply with new Joint Commission perinatal quality standards.

If hospitals are serious about improving their exclusive breastfeeding rates, they should get serious about measuring the duration of skin-to-skin care. A new study in the Journal of Human Lactation demonstrates a strong dose-response relationship between skin-to-skin care and exclusive breastfeeding at hospital discharge.

The Nurse Blogger at At Your Cervix looks at how weighing babies can be done more humanely, when the time comes (after skin-to-skin contact and breastfeeding). She vows to start weighing newborns in the prone position on soft layers of blankets and states the expected outcome of her new approach:

newborns in the prone position while being weighed, lying on soft blankets, will be more content, with decreased startle reflex, as evidenced by reduced or absent crying.

Let us know how it goes, At Your Cervix!  Or better yet, publish your results!

Dionna at Code Name Mama points out that circumcision is another common reason mother and babies can be separated, and is not medically necessary.

The reason that American medical associations (and the vast majority of medical associations worldwide) do not recommend routine infant circumcision is because it is not medically necessary. And as the Lamaze Healthy Birth Practice Paper #6 details, “experts agree that unless a medical reason exists, healthy mothers and babies shouldn’t be separated after birth or during the early days following birth.” Consequently, unless there is a medical reason to circumcise your newborn son, it is inadvisable to agree to this unnecessary medical procedure.

Cesarean surgery is another major contributor to mother-infant separation after birth. But if this Blog Carnival has achieved anything, it has been to get the blogosphere talking about the fact that skin-to-skin contact is possible immediately after cesarean surgery. A powerful video emerged and was passed around in several of the bloggers’ contributions and on Facebook and Twitter:

Kathy at Woman to Woman Childbirth Education asks, “If you had a C-section, were you able to have your baby put skin-to-skin in the operating room? Did you even know that was a possibility?”

CPN at Cesarean Parent’s Blog got skin-to-skin contact with her baby after her cesarean without even asking for it, and didn’t know what a gift it was until after learning that this is not standard practice. She compares her experience to the typical experience in “reality” TV shows about birth, noting that OR staff do not just separate babies from their mothers for assessments, but for “silly things…, such as having foot prints taken, diapering, and tight swaddling, all before baby gets to meet their mom.”

Birthing Goddess also wrote about the care of mothers and babies after cesarean birth, including the importance of a “Baby Moon” and plenty of support during the longer recovery.

As much as I wish every woman to experience a truly undisturbed and gentle birth, I also know that as of today, close to one out of three women in North America gives birth in the OR. It is up to us to demand things to change for the sake of our children, up to us to bring back a more humane and healthy perspective on birth. Hospital policies can be changed, but the consequences of risky practices for our children can’t. As a community, we can also support our fellow moms who have gone through a difficult birth, help them adjust to motherhood and their new babies, without judging, with compassion and care.

All of these bloggers agreed that, until our system changes, women who want skin-to-skin contact with their babies after cesarean birth need to speak up and ask for it. At Stork Stories…Birth & Breastfeeding, the OB nurse/change agent author writes about how she made immediate skin-to-skin contact happen in the operating room after a mother gave birth by cesarean:

“Give him to me, give him to me! He has to be ON me! You just took him OUT of me, now he HAS TO BE ON ME!” She was literally trying to sit up. Anesthesia was drawing up meds for her (that was his answer). I said “OK here he comes!” So I didn’t ask anyone’s permission this time….. just held that naked baby in one hand, snapped open her gown with the other and helped him move in. I asked for a warm blanket and looked up to see the other nurse and doctor staring at me. I said “Seriously… she’s exactly right, he does belong ON her!”

A system that pits babies’ needs against those of mothers give poor care to both.

Molly at the Citizens for Midwifery Blog muses about the phrase Maternal-Fetal Conflict and discusses the need for terminology that accepts mothers and babies as interdependent:

I think it is fitting to remember that mother and baby dyads are NOT independent of each other. I have written before about the concept of mamatoto–or, motherbaby–the idea that mother and baby are a single psychobiological organism whose needs are in harmony (what’s good for one is good for the other).

The blogger at Thoughtful Birth discusses bonding as an act that involves both the primitive brain and the rational brain, and happens easiest when the birth and postpartum settings facilitate the woman’s integration of the two.

Certainly the ability to override the physical is an amazing skill that allows a woman to overcome a traumatic birth to bond with her baby, or even to bond with an adopted baby. But when we take it for granted that a mother will use her powers of reason to bond with her baby no matter how much we abuse their relationship, we ignore the way the emotional, physical, and spiritual sides of ourselves participate in the birth and bonding process. Pregnancy and labor involve neurochemical and physical changes that make it easier for us to be mothers, and that emotional and hormonal dance does not end with labor.

Michelle at The Parenting Vortex suggests that what happens in the moments right after birth remains a mystery to many pregnant women, but these moments represent a major life transformation for both the woman and the baby, who now become separate but interdependent beings. She writes:

Reforming birth practices in countries where birth has become a highly medicalized event means recognizing birth as a multi-dimensional, life changing event for all members of the family. When birth is recognized and honoured as an emotional, spiritual, transformational AND biological process, then the importance of keeping a new baby and mother together will become more apparent.

Natural Birth at a Hospital: Making it Work for You

Last weekend, when discussing childbirth among women at my husband’s firehouse, mostly girlfriends and wives, I was shocked when most of the women discussed wanting a natural birth. It was a pleasant change—one that I have been working so hard toward!

I started doing some research after my discussion and came across a quote on natural childbirth in The Official Lamaze Guide that really struck a chord:

“In spite of evidence, U.S. maternity care continues to sabotage normal birth rather than support it. In 2002, the Listening to Mothers survey learned that among nearly 1,600 new mothers across the U.S., 44% had labor induced, 71% did not move freely during labor, 93% had electronic fetal monitoring, 86% had intravenous lines, 74% gave birth on their backs, and almost 50% of their babies spent the first hours after birth with hospital staff. Only 1% of the women experienced all six care practices that promote normal birth, and none of these women gave birth in a hospital.”

Lots of alarming statistics in there. This first-ever national survey of U.S. women’s childbearing experiences gives us a look into the way women are giving birth today in spite of evidence showing that these practices are outdated, unfounded, or harmful rather than helpful. Let’s take a closer look into each of the statistics listed and learn ways you can try to avoid becoming “one of the statistics” when birthing in a hospital:

44% of women had their labor induced. (!!)
That is a huge number for labor induction, especially since labor should only be induced for necessary medical reasons. Letting labor begin on its own is key for a healthy birth experience for women. It is also the way our bodies are meant to work in the natural stages of pregnancy. Labor induction is not a procedure that is risk free—it can increase the risk of premature birth, cesarean section, abnormal fetal heart rate, fetal distress, shoulder dystocia, and increase the risk of your baby needing to be admitted to the NICU. 

To reduce the incidence of unnecessary induction, find a provider with a low labor induction rate, and research the policies of the facility where you plan to give birth. This may be tricky, as many hospitals do not publicly advertise their rate of induction, cesarean surgery or other interventions. You might be lucky enough to find it on your hospital’s Web site. Or perhaps your hospital’s rating and feedback is listed on The Birth Survey. If not, take a hospital tour and be sure to ask LOTS of questions. Knowing information ahead of time gives you the opportunity to change your place of birth if you’re uncomfortable with their practices.

71% of women did not move freely during labor.
Being confined to a bed while laboring is not ideal by any means. Not only does it decrease the size of your pelvis, but it also can cause lowered blood pressure and fetal distress.  Better positions to give birth in and labor in include:

  • Standing
  • Hands and Knees
  • Side Lying
  • Knees to Chest
  • Squatting
  • The Sitting Position

93% had continuous electronic fetal monitoring.
This is a high number despite the fact that several studies have shown no improved outcome to mothers and babies with continuous electronic fetal monitoring. Also, recently, there has been a number of controversial articles about fetal monitoring and how medical professionals are reading the fetal heart tones.  Many think that the over-analyzing of small decelerations in fetal heart tones is leading to a higher rate of unnecessary cesarean births.  There are situations where monitoring may be a beneficial procedure, but in most birth situations, intermittent monitoring is safe. 

86% had IV Lines.
 Having an IV line in place in a laboring mother means that hospital staff has easier access to administering fluid and medications if needed. However, being attached to an IV line also restricts a laboring mother’s movement, interfering with her ability to change positions. Something that may help is requesting a “hep lock” in place of an IV line. A hep lock is a device that is inserted into a mother’s hand or arm so it is ready in case an IV line needs to be hooked up. Also, drinking and eating during labor will help to eliminate the risk of needing any kind of IV fluids during labor.

74% gave birth on their backs.
Laboring and giving birth on your back is pretty much the worst position. I recently wrote about this in two posts, Positions You Should Be Giving Birth In Part 1 and Part 2. Decreased pelvis size, blood pressure complications, lack of gravity to help with the birth itself are all huge factors in the supine (back-lying) position.

50% of babies spent the first hours of life with hospital staff. (!!)
Many mothers are not familiar with the benefits of skin-to-skin contact with your baby after they are born.  The first few hours are critical for mother-infant bonding. Unless your baby is experiencing complications or needs NICU care, babies should be kept with their mother in the first few hours — baths, weighing and measuring, etc. can all wait. Babies who have skin-to-skin contact after birth:

  • Cry less
  • Have more stable temperatures
  • Have more stable blood sugars (with the lack of skin-to-skin contact with my second son, because of my cesarean, made a change in his blood sugar which resulted in a 30-hour NICU stay)
  • Breastfeed sooner, longer, and more easily
  • Are exposed to normal bacteria on the mother, which can protect them from getting sick from unhealthy, or other types of bacteria, especially if birthing in a hospital
  • Have lower levels of stress hormones

Only 1% of these women experiences all 6 Lamaze Healthy Birth Practices.
Having a birth plan, and being an advocate for yourself and what you want for your birth experience in a hospital is key here. Communicate with your care provider and create a written birth plan to share with your care provider as well as the hospital staff when you arrive for baby’s birth. Make sure your partner knows about your birth preferences so he/she is comfortable talking with and reiterating to your provider and hospital staff on the big day.

When it comes to birthing in a hospital, being an empowered patient is critical to having a healthy and happy birth experience. Read, do research, take a Lamaze class, interview care providers and hospital settings — learn all that you can to be informed and make the best choices for you and your baby.

Photo from Inexplicable Ways

Your Questions Answered: What Is a Doula?

Q

I’ve heard a lot about doulas, but I don’t really know what they do and how they can help me during birth — can you provide more information?

A

A doula is a care provider who understands and trusts the normal process of birth. She provides care from the prenatal period through to postpartum. She provides emotional support, such as encouragement, reassurance, and continuous presence for a mom and her partner. She also offers physical support during labor and birth, such as comfort and relaxation measures, and suggesting different positions to facilitate labor. A doula is also a great resource for helping mom and her partner to understand medical tasks, so mom and her partner can make informed decisions.

A doula can be very helpful for you and your partner during your birth experience. The power of labor may surprise you and your partner, so it is helpful to have a knowledgeable person like a doula to reassure you that what is happening is normal. A doula’s presence can relieve anxiety for you and your partner so you can stay home longer and transition easier to your birth place. A doula also can sense when a laboring you need to change positions or when you need a comforting touch. She may also sense when it is beneficial for you to take a walk or a relaxing shower. When you are comfortable and feels well supported by your birth team, your labor may progress more quickly and feel easier.

Doulas stay with you through the whole process of labor and birth and through early postpartum. She also helps guide you through your first breastfeeding. Doulas do not perform any medical tasks, but she will help you understand and be able to explain any medical interventions that may arise. Doulas are there for your continuous emotional and physical support.

Studies have found that with continuous support, like that offered by a doula, laboring women are less likely to have:

  • Cesarean surgery
  • Assisted delivery with vacuum or forceps
  • Epidural or need for other pain medication
  • Dissatisfaction or negative feelings about their childbirth experience

For more information or how to find a Doula for your birth, visit www.dona.org or www.childbirth.org.

Preparing for Natural Childbirth — First or Second Time

I looked at my second pregnancy as a “do over for the surgical birth of my first. I truly wanted an unmedicated, natural Vaginal Birth after Cesarean, also known as VBAC. I didn’t realized how much research I would put into my second pregnancy. Looking back on all the information I put together, learned, and came across, it would be foolish not to share with others. I think a lot of the efforts and education I put into my second child’s pregnancy and birth has been very helpful in my journey to becoming a childbirth educator.


I worked my own experience into small steps all pregnant women, or women considering trying to conceive, should read before birth.

  1. Interview Providers – Most women I have come across usually choose the OB their sister used, or even a simple referral from their insurance provider. With my first pregnancy, that is exactly what I did. By the end of my pregnancy, and after my birth, I knew the provider choice was a mistake. Providers can make or break your experience. Choose wisely.
  2. Find a Chiropractor – Most women think, “What the heck do I need a Chiropractor for?” without knowing the ins and outs of how your pelvis works!  Not only can Chiropractic Care help with pain, and discomfort, but it can help prepare your pelvis for a successful vaginal birth!
  3. Take a Childbirth Education Class - New studies show women who take a childbirth education course not only are better prepared for class, but they are less likely to be subjected to routine or unnecessary interventions in the hospital. Skip the classes hospitals offer in one day, most teach you how to be a good patient in their facility, rather than anything about childbirth. Lamaze is a great course that is not too long, and provides great education, and positive thinking surrounding birth.
  4. Hire a Doula! – Several North American studies have shown many benefits to having a birth doula. From lowering your chance from a cesarean, to shorter labor times.  There was an amazing difference in my two birth experiences, one including a doula, and one without.
  5. Check Out Your Local Hospital Statistics – Some states such as New York and Massachusetts publish the maternity care statistics by hospital, which is also required by law in these states. Unfortunately for women in other areas of the country, these numbers may not be as easily accessible, but local health departments and The Birth Survey can help you with this.
  6. Do Your Reading! – There are so many great childbirth books that can help you to focus on your journey to a natural childbirth experience.  Some of my favorites, and the most popular books include :        
    • The Thinking Woman’s Guide to a Better Birth – Henci Goer
    • Birthing From Within – Pam England
    • Gentle Birth Choices – Barbara Harper
    • Creating Your Birth Plan – Marsden Wagner
    • Ina May’s Guide to Childbirth – Ina May Gaskin
    • The Official Lamaze Guide – Judith Lothian & Charlotte DeVries
    • The Birth Partner – Penny Simkin
    • Birth The Surprising History of How We are Born – Tina Cassidy
    • Check out the ICAN Recommended Reading List also!

    What are your favorite pregnancy and birth books? Leave a comment to let other moms know about your favorite reading resources.

  7. Go internet shopping!  I get that term from the lovely Feminist Breeder, the term was something her provider hit her with when she discussed her own research she had done regarding VBAC.  Go online, and do your reading, there is so much amazing information on the internet that can help you in the right direction for starting a journey to natural childbirth. Some of my favorite online resources include :

    What are your favorite websites for natural childbirth, or preparing for birth?

These are simple steps that can’t all be done overnight, but they are basic steps in the right direction, many of which you can even start before getting pregnant.  The biggest key in having a successful and positive birth experience starts with education!

Your Questions Answered: Care Providers

Q:

I think I want to have a more natural labor and birth — or at the very least, I want the options available to me in my birth setting. What questions should I ask my care provider to make sure that they’re the right fit for my birth plan?

A:

Choosing the right care provider plays a big role in the health, happiness and safety of your birth experience. It’s a good idea to interview care providers before settling in on the one you want. If you’ve already chosen your care provider, make sure to talk to him/her about your intended birth plan. If they aren’t supportive of what you would like during birth, look into changing your care provider, even if you’re in the middle or late stages of your pregnancy. Here are a few questions to consider when talking to your care provider about their birth practices:

  • What can I expect at routine visits throughout my pregnancy?
  • Do you support natural labor and birth?
  • Can I expect you to attend my birth?
  • Who can be with me during labor and birth?
  • Do you support women who want to labor out of bed?
  • Will I be able to use comfort measures during labor and birth? (example: shower, birth ball, walking)
  • What positions do you recommend for labor and birth?
  • Will I be able to eat and drink when I am in labor?
  • What happens during a normal labor and birth in your care?
  • What do you normally do to help women in labor? Delivery?
  • What do you consider routine interventions for labor? (example: IV fluids, continuous fetal heart monitor, episiotomy, breaking my membranes)
  • Instead of drugs, what would you recommend for pain relief during labor?
  • How would you support me to breastfeed?

Learn more about the recommended Lamaze Healthy Birth Practices for a safe and healthy birth, as well as this tip sheet for considering a care provider.

Lamaze Certified Childbirth Educator Rachel Bohn has been a doula for 9 years and has been teaching Lamaze classes for 3 years. She currently teaches private Lamaze classes in the comfort of clients’ homes. You can learn more about her services by e-mailing her at 1rbohn@optonline.net.