Birth and Babies

See how ovulation occurs - it has actually been caught on camera.  This is pretty neat - it appears as though ovulation happens similar to birth. 

http://news.bbc.co.uk/2/hi/health/7447942.stm

Advantages & Disadvantages to having baby at home

Studies have shown that homebirth is safe for low risk pregnant women and their unborn babies.  There are many reasons couples choose to have their babies at home.  These days, homebirth is becoming increasingly popular!  Midwives are trained to handle many complications, but they are also trained to detect problems before they become serious so they can transport or call for help if needed.

Advantages for Baby

• Baby is more likely to be born vaginally, without breathing difficulties often cause my cesarean birth or anesthesia.
• Less likelihood of infection.
  • Why? Fewer, if any, vaginal exams and intervention involving the vagina are performed on mom, which can introduce bacteria and cause an infection.   As well, babies are kept with them other after birth and not transported to a nursery, where illness can also be spread.
• Baby’s experience at birth can be recognized and made as gentle as possible. 
  • Low lighting, low voices, birth happening slowly and naturally without force, etc.
  • Routine procedures such as deep suctioning, Vitamin K shot, scrubbing the baby, etc. can be avoided.
• The mother-infant bond is allowed to occur naturally as the baby never leaves mom, can nurse immediately and can have constant skin-to-skin contact with mom as long as needed.
  
  

Advantages for Mom

• Mom is not subject to routine procedures such as electronic fetal monitoring, IV’s, bed or food restrictions.
• Mom can eat, walk freely and give birth physiologically – her body works with nature.  She can birth in a position she feels is best – not on her back unless she chooses, which is a traditional hospital birthing position.
• Mom will have continuity of care with her attendants, increasing safety.
• Mom and labor will be evaluated on an individual basis.  She won’t be sacrificed to protocols or be forced to labor on a time limit.
• Mom is much more likely to birth naturally, without medication, episiotomy, instrumental or cesarean delivery.
• Mom will be more comfortable in her own surroundings.
• There is less chance for infection.
• No traveling to/from a hospital while in labor or recovering from birth.
• Mom won’t be woken up while sleeping for the routine checks done after delivery, and the frequent removal of her infant for weighing and temperature taking, etc.
• Postpartum depression is less common  since there is no seperation.

Advantages for the family

• Husbands are in their own home and can participate as fully as they want.  Many times, the husband is encouraged to catch his baby!
• Other children can be present.
• Other family and friends can be present during labor and birth if requested.
• Life can go on as usual, as much as possible, during labor.  Meals can be prepared for everyone, the family is in their own surrounding and knows the location of anything they may need, and can move from room to room, or alternate between indoor and outdoor settings as they please.

Disadvantages

• A homebirth requires a higher level of responsibility and effort from the family
• Homebirth is not often supported by society or doctors
• Homebirth is not often covered by insurance, requiring the family to pay out of pocket or in some cases barter services
• Access to some emergency equipment can be delayed and require transport.

Minimizing the risk

Birth at home, as in a hospital, carries some degree of risk.  These risks can be minimized by the following ways:

·         Following good nutrition with a quality vitamin designed for pregnant women.

·         Do not smoke, drink alcohol, or use drugs.

·         Get good prenatal care

·         Find a good midwife who is skilled, confident and experienced with birth at home.

·         Inform yourself about pregnancy, birth and postpartum through reading, childbirth and new parent classes, videos, and asking questions.

·         Make sure you have all the supplies you will need at home well before your estimated delivery date.

·         Make sure you don’t have any problems or complications that could put you at risk during a homebirth. 

·         Make sure your baby is in a favorable position (head down, unless your midwife is very experienced with breech births)

·         Have adequate support during labor, birth, and postpartum.

·         Have an emergency back up, with numbers and clear directions posted by the phone and/or in easily found areas such as your refrigerator or family message board.

Induction is the term used for artificially starting the labor process.  This is used for babies that are “post dates” or “late”, are expected to get too large before the expected due date, are experiencing certain complications (either mom or baby), or for moms who want to plan the date of their baby’s birth.  As with everything that changes the course of nature, induction certainly has its side effects.

As a general rule, induction should only be used when absolutely necessary to protect the mother and baby.  It carries serious risk and can create additional problems.

There are a variety of ways labor can be induced.  It is a great idea to study up on induction while pregnant so you are aware of your options and the process should this happen to you.

Here are some questions you should ask, when faced with the suggestion of an induction from your care provider:

Questions to ask before an induction: 1.   Why is this being recommended?2.   What are the benefits of inducing labor and what are the possible risks?3.   Is this something that I need to make a decision about now or can I have time to think about it and discuss it with my partner?4.   Are there ways that I can get more information about how my baby is doing? 5.   What is my time frame?6.   If I did agree to the induction, how would it be done?7.   If I did agree to the induction, would I be able to use a telemetry unit?  Would I be able to move around, use the shower or get into the labor tub?

8. If Pitocin is used, would we be able to turn it off once the labor got active and see if I could continue laboring without it?
9. What are my options?

            As a husband or birth partner, you are probably wondering what you can do to comfort and help the laboring woman.  As an expectant mom, you’re probably wondering what you might like during your labor!  There are far too many things to list for every possible condition, but here are a few ideas to get you started.             If the mother is tolerant of you touching her, experiment with different rubs, touches, squeezes and the like. 

• Prayer
• Communication: Talk with the woman and find out what she would like at the time – she is the best way to learn how to comfort her!  Ask questions (though not during a contraction) to make sure certain things aren’t bothering her
  • Are the lights too bright or dim?
  • Is the room to hot/cold?
  • If lying in bed – Would you like the bed up/down?
  • Advocate for her if that is her desire
• Massage
• Touch Relaxation
• Imagery – did she bring a few pictures to look at to help relax her? 
• Visualization Relaxation – do you have a tape or a script to read for visualization exercises?
• Hot/Cold washcloths on the forehead/face
• Keeping the hair out of her eyes, put her hair back in a ponytail
• Bring a rolling pin and pad it with a towel, use that to help massage her back.
• Back scratching, lightly scratching the arms and legs can also bring relaxation
• Offer drinks and snacks
• Encourage her, tell her she’s doing a great job
• Encourage her to get up and stay up and active, change position often
• Match her mood – when she becomes serious and quiet, her birth partner(s) should too
• Give the mother undivided attention
• Breathe with her           
• Encourage vocalization through the contractions
• Encourage the mother to change position, use a birth ball, take a shower
• Counter pressure
• Hot and cold compresses in areas of tension – neck/shoulders, back, groin
• Bounce and sway on a birth ball, kneel on the floor and lean over the birth ball
• Have your favorite music available
• Change scenery often, walk indoors and out
• Aromatherapy
• Affirmation
• Pelvic Rocking
• Showering
• Show dancing

My latest craze these days is a household notebook I’ve created.  This isn’t a new idea by any means, but I am finding the organization exciting and want to tell everyone about it!  If you read my lastest post over in Home Life, you can visit a great link that is an amazing resource for household notebooks.

Anyway - a household notebook can be great for pregnancy and postpartum.  Many women find it hard to remember things during their pregnancy and also during the postpartum period.  Having a notebook where everything important is stored (along with prenatal appointments, belly and baby stats, etc.)

A daily, weekly and monthly to do list helps keep track of regular and routine tasks.  Make a note of all of the things you need to get done, when they need to get done, and their priority so you can take a peek when you’re having an “I don’t know what to do next” moment.  If you have a checklist of your cleaning tasks divided by room and frequency of needing cleaned, this can be VERY helpful during the postpartum period for your partner or other people eager to help.  All of your regular chores will be written down so they can take a look at your list and do something on it.

Keep a running list of items you want to buy before baby.

Make notes of things you’d like to try during your labor and birth, and postpartum if necessary.  Sitting down to write up a birth plan is helpful, but generally you won’t remember all of the details.  It’s great to keep a running list through pregnancy so you can avoid the “Oh, I wanted to try that!” afterwards.

Keep a list of favorite recipes and what cookbooks they can be found in.  Start planning some freezer meals so you don’t need to cook (or rather, your partner or family) after the baby is born.

Keep a list of books and movies you want to read.  After the baby is born if you’re nursing, there will be a lot of downtime.  If you’re not gazing at your baby (and that will be a lot!), you can catch up on some good books!

If you want to keep track of your new baby’s feedings and diaper changing, you can print off some pre-made charts (you can find some at chartjungle.com) and have them ready to go.

Start off on the right foot and print off health record forms to have ready for your baby.  Document important things like birth weight, length, blood type, and more.  If you choose to vaccinate,

Check out this link (it’s older) about gentle cesareans and how we can make them better for the parents and baby.  How great would it be if these happened here in the states?!?!

I wanted to share with you a book i wrote for my children as one of the many ways I am preparing them for our homebirth coming up next month.  The book is not professionally edited or proofed.  it is not going to be published. It is just available free on my website for other moms to download if they are looking for a way to help prepare their children for a homebirth.

The book does contain actual birth photos from my last homebirth. The book is written from a Christian perspective. 

You can download it from www.motherhoodnaturally.com/store and click on the “Freebies” section.  You will also find a free, downloadable business directory there if you’re shopping for cloth diapers or supplies.

So there are ways to try and reduce the possible side effects you or your baby may experience from an epidural.  here are a few ways:

• Labor as much as possible naturally before you accept the epidural.  While it may be more painful in the end to have to sit still for the procedure, the longer you can stay up and active (which helps reduce pain on its own) the length of labor time you have left (and as a result, the amount of exposure to the medication), will be less.
• Request lighter medication
• The staff will monitor you and your baby

The following intervention can/will take place:

• Restriction to bed
• frequent checks of blood pressure and oxygenation
• Monitoring mothers heart w/ EKG
• Restriction of food & usually drink
• IV fluids
• Bladder cath
• continuous electronic fetal monitoring
• aggressive use of pitocin to prevent a stall in labor
• additional drugs to counteract itching, nausea, low blood pressure
• forceps, vacuum, cesarean, episiotomy
• if mother has a fever, baby will be taken to nursery for observtion, septic workup and IV antibiotics
• issues with breastfeeding may occur as a result of the medication

As I mentioned before, epidurals have pro’s and con’s.

I think the obvious “pro” is pain relief.  When administered correctly, most women are able to stay awake and alert while experiencing no pain.  Women are also able to sleep.  In long or difficult labors, an epidural can prevent exhaustion, allow the mom to relax while her body continues to labor, and still allow her the ability to have a peaceful and positive birth experience.

Epidurals are not without their con’s, however. I am typing this up as these come to me and may be out of the order of events… I tried to cut/paste some segments where they should be and for some reason I can’t. 

• Epidurals may not always work.  Women may experience windows of pain, or pain on half of their body.  Your experiences can differ from one birth to the next, so you can’t count on an epidural for complete pain relief.
• Epidurals slow labor, which increases the use of pitocin to stimulate stronger contractions (because you will be unable to stimulate stronger contractions on your own laying in bed).  Increased use of pitocin leads to higher episiotomy rates, instrumental delivery (forceps or vacuum), and cesareans.
• Epidurals easily pass into the maternal blood vessels  and crosses the placenta into the babys circulation.  Once there, it may slow the fetal heart.
• Other issues, such as a catheter or needle piercing a blood vessle, needle going further than it should, or catheter migrating inward can cause convulsions, respiratory paralysis, and/or cardiac arrest. This can happen as commonly as 1 in 3000 cases!  Interesting to note that drugs causing serious adverse reactions in this range have been take off the market or forced into restricted use.
• Allergic shock is a possibility.
• You generally aren’t able to move around to keep your labor moving.  In some instances you can still walk with assistance, but your movement will be severely limited.  You will also be hooked up to a fetal monitor, blood pressure cuff and IV which restricts your movement even more.
• Body temperature rises over time, so you are more likely to develop a fever (which can also signal uterine infection and will cause your baby to undergo observation, blood tests, spinal taps and other testing/procedures to ensure the baby does not have an infection). 
• Test doses and some of the tests done to be sure the epidural is properly placed can cause problems. 
• Some women will experience a significant drop in blood pressure (even with the IV fluid given to try and avoid this, which in its self also carries risks such as fluid overload, pulmonary edema, possible excessive breast engorgement, excessive urine production, neonatal tachypnea and others.)
• Postpartum complications can involve urinary incontinence, nerve injury, hematoma, spinal headache (a debilitating headache which can last for days, interfere with bonding and breastfeeding and overall quality of life).  In the newborn, adverse physical and behavioral effects may be noted, including trouble with breastfeeding, sleeping, self soothing and adjustment. 
• Other side effects of an epiural in the mother include inability to push, itching and nausea (if narcotics are used), and psychological effects (with all that is involved in getting an epidural and monitoring, what was a normal process is now a high-tech event that the mother no longer has control over).  Loss of internal pelvic muscle tone can lead to unfavorable positioning of baby which can lead to longer labors or cesarean deliveries.
• in the fetus, other side effects ine heart rate decelerations, hypoxia (from a drop in moms blood pressure), tachycardia and fever (from mothers fever).
• Complications arrising from epidural use may lead to cesarean sections.

Most women are not told about epidural facts, especially in hospital-based childbirth classes.  It is important for you to think “outside of the box” and take a childbirth class given by an independent childbirth educator, in addition to the hospital class if you wish, so you are fully informed. 

Choosing an epidural is a highly personal choice, but one that should not be taken lightly.  We have the right in this day and age to exercise our rights.  We have options. Before we jump into them, let’s make a fully informed decision.  Epidurals are not “bad” when they are used for the right reasons, but it is up to each women to decide what those right reasons are. 

As an educator, I do think it is important for women to be educated about epidurals even if they are choosing a completely natural birth.  Complications or situations can arrise that might make an epidural favorable or necessary, in which case it is very helpful to be informed.  I also feel that students planning an epidural should  be well informed about natural childbirth and pain relief techniques in case they go into labor and cannot get their epidural as quickly, or incase the epidural does not work, then they are still prepared and can make the birth a positive experience.

In the next segment I will discuss how we can reduce the chances of complications, how the staff might also, and what intervention you will experience with epidural use. 

Ever wonder how an epidural is put in?

First you’ll likely have an IV and about a quart of fluid to try and prevent a fall in blood pressure.  Electronic fetal monitor will be used to pick up any problems that may arrise (this is the external device that attaches to your belly with the stretchy bands).  Your blood pressure will be closely monitored - in most hospitals the cuff will be placed and automatically take your blood pressure. You will be asked to get into position - either sitting on the edge of the bed or lying on your side.  Your back will be cleaned off with antiseptic and covered with a sterile drape.

You will be asked to arch your back as a local anesthetic is injected, then a large needle will push between two vertebrae just above the level of your waist.  It is vitally important that you hold absolutely still for this, even during contractions which are likely to occur during this time period.  The needle will be guided in slowly and carefully feeling for the epidural space.  Once placed, the anesthesiologist will perform one or more tests to ensure that the needle has not #1 peirced a blood vessel nor #2 gone below the epidural space which can cause life-threatening complications.

If all seems well, the anesthesiologist will guide a tiny flexible plastic catheter through the nddle and remove the needle.  Then the full dose of anesthetic will be injected, the catheter will be looped and taped to your back.

The quality of the anesthetic will be assessed.  If it is unsatisfactory, you will be asked to shift position to redistribute the dose, or more may be injected.  The area under anesthetic will be tested with pinpricks or ice.

If you are getting “continuous infusion” the catheter will be hooked up to syringe which will be hooked up to a pump to deliver a continuous flow of anesthetic.  Or, you may instead get “periodic top-ups” where additional anesthetic is injected when you feel the return of pain.

Ideally, you’ll feel no pain with the epidural.  However, some women experience pain only on one side of their body or windows of no anesthesia.

Ideally, when it comes time to push the anesthetic will be reduced so you can have a chance to push effectively .

The pain relief may not come for another 15-30 minutes after the epidural has been placed.  This means you will be contracting during the procedure and for a while afterwards.  In many cases, the anesthesiologist is not available immediately when you request an epidural, so there may be a wait before s/he even gets to your room. If the epidural was not placed correctly, or the anesthesiologist has to make several attempts, relief will take even longer.

In the next segment I’ll discuss the trade off of epidurals.  Stay tuned!