Birth and Babies

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?

Amniocentesis

An amniocentesis is available for women over 35, for women with a family history of genetic disorders, and for expectant mothers who have had a quad-screen suggesting the possibility of a genetic disorder.   

Amniocentesis diagnoses the possibility of:

• Chromosome problems (such as Downs syndrome)
• Genetic diseases (such as cystic fibrosis, sickle cell disease)
• Neural tube defects (such as spina bifida)

Aside from testing for chromosomal abnormalities or birth defects, an amniocentesis can also test the baby’s lungs to see if they are mature if the mother is showing signs of premature labor, or if the mother will need to be induced early.  The amniocentesis can also determine the sex of the baby. 

How is it done?A needle, guided by ultrasound, is inserted through the abdomen into the amniotic sac to collect fluid surrounding the baby.  The amniotic fluid holds cells shed from the baby, and is an accurate way to test for chromosomal abnormalities and some birth defects.   

Results can be had in about 2-4 weeks, and findings are quite accurate. 

Amniocentesis is not without risk.  It can cause miscarriage in about 1-2 pregnant women out of 200.  There is also an increased risk of infection.

Chorionic Villus Sampling (CVS)

Having a CVS done will diagnose chromosomal abnormalities, such as Downs syndrome, Tay-Sachs disease, cystic fibrosis, or sickle cell anemia.  Because the placental tissue does not include amniotic fluid, some birth defects, such as spina bifida, can not be tested for. 

How is it done?A thin tube, guided by ultrasound, is inserted through the cervix and up to the placenta where a small amount of the placental tissue is removed (B) OR tissue is removed via a needle inserted through the abdomen (A) similar to the amniocentesis.   

This is generally done between 10-12 weeks, and  is available for women who will be 34 years of age or older when they deliver, or for those with a family history of genetic disorders diagnosed by CVS.  The CVS is not routinely available for pregnant women, and a meeting with a genetics councilor is required prior to the procedure.                                                                                                    CVS is considered more risky than the amniocentesis, causing more miscarriages, limb defects, and also carries the risk of infection.  Results can also be confusing to read, requiring more testing to understand the results. CVS is not as accurate as the amniocentesis, but the benefit for some is the chance to learn early in pregnancy that there could be chromosomal abnormalities.

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. 

Ok - my computer lived and then somehow i wasn’t able to blog here for a few days due to a ‘permissions’ issue of some sort… Luckily all is well and we’re back on track now!

I know I’ve mentioned I’d blog a little about prolapsed cords a while ago in our cesarean discussions, so I thought now would be a good time.

A prolapsed cord has two main types:

1. Presentation of cord - when the membranes are still intact, but the cord is between the baby’s presenting part (usually the head) and the cervix.  With every contraction pressure is being put on the cord and baby.
2. Prolapse of cord - when the cord actually comes out of the cervix, ahead of baby, after membranes have ruptured.  This puts pressure on the cord with every contraction also

How do you suspect a prolapsed cord?  Obviously, if you see it, that’s an obvious sign. However sometimes it can be quite high in the vagina and you may not see or feel it.  Fetal distress, especially the slowing of fetal heart tones during contractions, can be a good indication.

So whats a mom to do?  If you’re not already, get to a hospital. 10 minutes is the maximum time a baby can survive cord compression - but the length of time also varies by the degree of compression. 

If birth isn’t imminent, a cesarean will be done immediately.

Talk to your care provider, but in most cases mom should get into hands and knees position (even en route to the hospital if this happens at home).  If the cord is outside of the vagina, someone should insert their (clean) hand into moms vagina and hold the baby’s head off the cord, if possible.  The cord would be wrapped loosely in warm and moist washclothes or handtowels - avoid excess handling and letting it get cold.

A great way to avoid having a prolapsed cord is to avoid early artificial rupture of the membranes before baby is well engaged in the pelvis.  As the membranes are ruptured and the water escapes, the cord may also slip ahead of the baby’s head.