Sunday, March 24, 2013

Just say "No"

ACOG has released an initiative of "Five Things Physicians and Patients Should Question" and guess what?!? The first two warn against non-medical inductions! 

Don’t schedule elective, non-medically indicated inductions of labor or Cesarean deliveries before 39 weeks 0 days gestational age.

Delivery prior to 39 weeks 0 days has been shown to be associated with an increased risk of learning disabilities and a potential increase in morbidity and mortality. There are clear medical indications for delivery prior to 39 weeks 0 days based on maternal and/or fetal conditions. A mature fetal lung test, in the absence of appropriate clinical criteria, is not an indication for delivery.

Don’t schedule elective, non-medically indicated inductions of labor between 39 weeks 0 days and 41 weeks 0 days unless the cervix is deemed favorable.

Ideally, labor should start on its own initiative whenever possible. Higher Cesarean delivery rates result from inductions of labor when the cervix is unfavorable. Health care practitioners should discuss the risks and benefits with their patients before considering inductions of labor without medical indications.

That is all, thank you! 

Wednesday, March 20, 2013

Why the wait? {Delayed Cord Clamping}

Delayed cord clamping is all the rage - but why?

Skin to Skin

Along with immediate skin to skin contact, the blood baby receives from the cord aids in stabilizing her temperature.  Furthermore, if baby is still attached to you, the chance of a nurse whisking her away to a warmer for typical newborn procedures is minimized.  Besides her blood, you may also want to let baby keep her vernix; avoid/delay the baby bath.  Like blood, vernix also can help regulate body temperature and has antibacterial properties, as well as being natures best moisturizer so it is best to rub this slimy cheese-like substance into the skin rather than wash it away.

Blood Flow

At 1 minute after birth approximately 80mL of blood is transferred from the placenta into baby.
At 3  minutes after birth that becomes approximately 100mL of blood according to the WHO.

Delayed cord clamping is defined by waiting about 3-5 minutes after birth or until the cord stops pulsating.

 Cord just after birth- still pulsating with blood.

Limp cord- blood fully delivered to baby.
Photo courtesy of Perfect Chance Photography

So why is this important?

Baby gets much needed iron supply.  According to Michelle Roberts, a BBC Health Reporter, iron deficient anemia is "a significant health problem because it can harm a child's brain development."  Allowing a child to receive the full potential of blood and iron stores meant for him ensures a good start; "babies with delayed cord clamping had better iron levels at four months of age." (Roberts, 2011)  This iron supply is especially important in premies who may have not had those last 8 weeks in utero to store up iron.

The brain is afforded some extra protection with this blood flow.  In babies with complicated births, especially a lack of oxygen, this layer of protection is crucial to the brain.  Oxygenated blood travels through the cord to the baby helping to prevent hypoxic injury and associated long term problems due to lack of oxygen.  
Elizabeth Perry describes a birth in which 
the baby was resuscitated physiologically through the intact, unclamped cord.
Perry, E. (2012). Redefining Normal. In N. Halseide (Ed.), Second Stage: The Pushing Phase of Labor, Midwifery Today, Inc. 
 -A highly recommended read from this Collection of  Articles from Midwifery Today Magazine.

The Count

A full-term newborn has an average of 120 ml of blood per kilogram of body weight, or an average of a total fetal-placental blood volume of about 480 ml (16.9 oz.) At any given time about 70 % of his blood is in his body and 30 % is in the placental/cord unit.
- Frye, A. (2004). Holistic midwifery. (Vol. 2). Portland: Labrys Press.

In premature babies and babies born to mothers with gestational diabetes these are very significant numbers. By receiving his full quota of blood, your baby is less likely to have low blood sugar and an increased count of white blood cells means better ability to fight off infection.

Q- Even in uncomplicated births and healthy babies, why not allow the baby the blood belonging to them? 
Jaundice is a commonly heard response, however studies show "no evidence of adverse affects from this."  Studies have shown that jaundice and polycythemia are not curbed by immediate cord clamping as there are other factors involved in their derivation.
A- Cord banking may be the only accurate answer to that question. More on this here.  The chances of a low-risk baby needing his stored stem cells is 1 in 20,000. 

To clamp or to delay clamp? That is the question.  One of the many decisions you'll make for your newborn on the Journey of Life.  What will you do?

Thursday, March 14, 2013


I attended a water birth presentation and listened to numerous stories of how relieving and peaceful labor was for mothers who used water; I would share them but couldn't begin to do justice to their beauty! Is water birth right for you?? If you enjoy baths to de-stress, if warm showers relax you, if you like to swim or just love water in general the answer may be yes!  Do you have to birth in the water in order to benefit from it? No- water is an amazing tool throughout labor; when it comes time to push women will quite often just not want to get out.

Benefits for babe

Babies who are born in the water experience a smoother transition into the world; they are born from the water into the water.  When you labor in the water there tends to be less stress on the baby due less pressure on the umbilical cord during contractions.  The sacred space provided for the mother by the birthing tub also results in a sacred space for the baby- tubs put a bit of distance from everyone else allowing for more intimate bonding while still being accessible enough for assessing their health and assisting in birth if desired.  Being born in the tub may make it more possible for mom or dad to 'catch the baby.' 

Benefits for mom

Pain relief- moms describe getting into the water as instant relief.  The Water decreases the pressure of the contractions and provides relaxation, even decreasing the length of your labor.  Some women describe this natural form of pain relief as an "aquadural."  Mom's who labor in the water are not only more relaxed but they have better mobility due to the buoyancy.  The water provides a natural lubricant and decreases the pressure on the perineum, resulting in less tearing. There is a decrease in the risk of infection because the water holds a sort of sacred space for them resulting in less vaginal exams and intrusions; home births in general have less chance of infection because you are in your own environment.

Benefits for midwife

I was reading an article about water births in Midwifery today about the relaxing warmth and whole body support of water; the best part of the whole article was the Q & A which I must share with you:
Q: Why do you prefer waterbirth?
A: Aside from easing mamas in labor and allowing them the freedom to move about, to control their own space and to catch their own babies, there is the prized easy clean-up you don’t get with a land birth!
--Charlie Rae Young of Barefoot Birth
Do you have a water birth testimonial?  Share your experiences on this Journey of Life with laboring and/or birthing in water here.

Sunday, March 3, 2013

Where is a pregnant woman to go?


A home birth is an excellent choice for a low-risk pregnancy.  Midives attend home births. They tend to have a hands-off approach and trust birth. Licensed midwives take only a certain number of births per month and you can expect individualized care.  You will want to interview midwives to find one whom you share a common view of birth with.  Midwives are trained to attend natural labors and have many years of knowledge passed down to them.  At a home birth routine interventions are avoided and the body’s physiology is relied upon as opposed to technology. Your midwife will bring what is needed to your birth.

Hospitals provide a medical model of care relying on technology to monitor patients. If you have a high-risk pregnancy you may need to seek out a physician (OB) and birth at a hospital.  CNM’s also attend births at hospitals.  Interview your care provider to determine what their philosophy is on birth. Technology will be used to monitor your labor and you will be mostly attended by on-staff nurses.  Hospitals provide standardized care for women.  When finding a hospital to birth at, be sure to find out what policies, procedures and interventions are common for them as well as from you care provider.    
Birth Center

Not comfortable with birthing at home but don’t want to go to the hospital?  A birth center may be just the choice for you.  Birth Centers show a reduced incidence in c-sections and provide the midwifery model of care.  Commonly they are located near a hospital in case of emergency. 

Hospital Birth Center

Choose carefully to determine whether standardized or individual care will be offered and what policies and procedures are typical.  These may offer a home-like feel within the same building of the technology.

Frequently, women face controversy from well meaning friends and family when choosing where to birth.  This is a tough predicament for women to be in as most want to maintain their relationships with your family; who wouldn't?- They can be an intricate part of your birth/support team but that's the key, they have to support you. In order to do so you can take the initiative to provide them with evidence and knowledge and reasons to understand your choice but in the end it's your choice and their job, once given the knowledge, is to either support you or hold their peace.

In the 1920's birth in the United States was moved into the hospital.  This move was pushed forward by new and exciting options for pain management during labor, such as "the blessed ether" and "twilight sleep" but like many of today's hospital interventions those were not fully tested when made available to the public.  Today, we are still learning the ramifications of the epidural and having more negative than positive affects from the standardized electronic fetal monitors.  So are all hospitals evil??  No!! Medical interventions such as cesareans, iv's, pitocin and more have a time and place- when complications arise.  When there's a need these medical interventions can be life saving measures for both moms and babies and we are blessed to have access to them; the problem arises when the need for intervention is created by interventions. Hospitals offer technology that may be imperative to high-risk pregnancies; in low-risk pregnancies a hospital might be a good choice for a woman who wants to be nearest to the technology or who is desiring to birth with medication or who simply wants the immediate access to help in the case of an emergency like cord prolapse.

Pregnancy is not an illness!  Michel Odent, renowned French Physician said, "One cannot help and involuntary process. The point is not to disturb it."{Do No Harm} For this very reason many women choose not to birth in a hospital. The Cascade of Interventions is becoming a commonly known phrase, and not just in the birthing community, for a reason. Women who wish to avoid this cascade so as not to create problems in a low-risk pregnancy and birth will hire or doula or choose to birth outside of a hospital or both. A guest blogger on Banned From Baby Showers says,

Looking back, having a baby at home was the best experience possible. We didn't have to worry about the drive to the hospital. We didn't have to deal with any cranky hospital personnel poking and prodding all hours of the day and night. We didn't have to deal with hospital regulations, the nursery, and the list goes on. And I never had to deal with any bloody mess whatsoever!

The U.S holds the one of the highest maternal mortality rates in the developed world. Hospitals did not reduce that number but increased it. Compare us to Holland, where birth is common at home and it becomes shockingly apparent that hospitals are not the safest place to birth. Hospitals have a higher rate of infection, high nurse to patient ratio and many protocols that treat women like cattle rather than individuals. That may sound harsh but they are required to follow standardized care for all women regardless of individualism and that creates added risk in an uncomplicated birth. The nurses in a hospital rely on machines, that were introduces before fully understood, to monitor labor. In America our cesarean rate is 32% while the WHO recommends below 15%. You can research hospitals in your area to see their individual rates but the numbers hash out to 25-30% of women who give birth in a hospital setting end in a cesarean compared with 6% of those who choose a birth center to give birth in.

Birth Centers are licensed and/or accredited by ACOG as safe places for giving birth. The care provided is individualized; laboring mothers are closely watched and the midwives who watch over them are trained in knowing if a complication is beginning to arise. Instead of being monitored by machines, women in birth centers are watched over by their care providers. Birth centers have a transfer rate of 2%, the majority of which are non emergency transfers and can commonly be for prolonged labors that end in vaginal births. The risk for infection at a birth center is higher than of that at home but significantly lower than that of a hospital. Accredited birth centers have emergency medical equipment on hand and sometimes even a house physician. Accredited centers also have agreements with hospitals in case the need for a transfer arises and it is possible that your midwife will have privileges at the hospital of transfer resulting in no interruption of care.

Even more important than where you give birth is who you choose to attend your birth. Midwives are trained in birth, OB's are trained in medicine. That doesn't go without mentioning some midwives are extremely medicalized and some OB's are great at sitting on their hands; what's important is to find a care provider with a birth philosophy similar to yours who will be there to support the choices you make.  This alone is evidence to the safety of home births.  Home births are attended by midwives who have earned their degrees and/or license by their training, knowledge and experience.  This title wasn't handed over to them lightly, they worked for it and birth is their passion.  A good home birth midwife isn't out to manage your labor and deliver your baby but to walk beside you and support you in your pregnancy, labor, birth and postpartum period.

You birth your baby- where you choose to do this is your prerogative.  If you're most comfortable in your home, in your bed, with your comforts and surroundings, then in a low-risk pregnancy this could be the best choice for you.  Birthing at home doesn't mean you have to go with out all medical equipment; midwives carry oxygen, pitocin and other supplies should the need arise.  As said before, they are trained to know if a transfer is necessary and like birth centers, most transfers from home birth are not full scale emergencies.  Questions about how your care provider handles a transfer are something you'll want to discuss prior to making your decision to birth at home just like questions about cesarean rates and induction percentages should be asked prior to choosing to birth in a hospital.

After you've provided your family and friends with information, you can kindly ask them if they aren't going to be supportive to refrain from input. Pregnancy and birth are sacred and should be treated as such; to influence a woman negatively is not only disrespectful to her, it can also be harmful.

Today's evidence for birth centers is amazing! Congratulations on your decisions and pregnancy! Best of luck on your journey.

For a much more detailed analysis and what you need to know about choosing a place of birth:

Where will you begin your baby's Journey of Life?

Contact info

Jennifer Valencia | Labor & Postpartum Doula | 928.300.1337


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