Relaxation Techniques

Sometimes, the best way to understand something is to see it! Here is a short video demonstrating some great positions to use in labor. All of these promote relaxation and proper alignment.

Watch the You Tube video below.

Lydia Rhodes and Kate Scott, certified nurse-midwives at the Olson Center for Women's Health demonstrate a few relaxation techniques and positions for mothers during labor.

http://youtu.be/s1daFjsKH1M

Premature rupture of membranes

Premature rupture of membranes (PROM) refers to the bag of waters breaking prior to the onset of labor. Usually labor starts soon after, most often within the first 24 hours- though not always. In my class I provide a copy of a study that shows no higher risk of infection/complication in 12 hours or 72 hours of managed labor after PROM.

I came across this very thorough look of studies related to PROM.  LOTS of information to read through, but worth it to educate yourself in how you would handle this situation should it happen to you.

Premature Rupture of Membranes at Term

Belly Tales

Answers to common objections to delayed cord clamping

Most Bradley students include in their birth plan that they desire delayed cord clamping. Sometimes they are met with objections from their birth team. Here is an article, siting recent research, that pediatrician Mark Sloan, MD wrote refuting common objections.

Unclamped cord over the course of 15 minutes

Please click on the title to read the full article.

Common Objections to Delayed Cord Clamping – What’s The Evidence Say?

November 13th, 2012 by Sharon Muza

Goto commentsLeave a comment

by Mark Sloan M.D.

Today’s guest post is written by Dr. Mark Sloan, pediatrician and author of Birth Day: A Pediatrician Explores the Science, the History and the Wonder of Childbirth.  Dr. Sloan shares information and current research on delayed cord clamping after birth, in a helpful Q&A style format that consumers and professionals can use to discuss this important topic.

_____________________

photo credit pattiramos.com

Many maternity care providers continue to clamp the umbilical cord immediately after an uncomplicated vaginal birth, even though the significant neonatal benefits of delayed cord clamping (usually defined as 2 to 3 minutes after birth) are now well known.

In some cases this continued practice is due to a misunderstanding of placental physiology in the first few minutes after birth. In others, human nature plays a role: We are often reluctant to change the way we were taught to do things, even in the face of clear evidence that contradicts that teaching.

Though there is no strong scientific support for immediate cord clamping (ICC), entrenched medical habits can be glacially slow in changing. Here are some often-heard objections to delayed cord clamping (DCC), and how an advocate for delayed clamping might respond to them:

Little-to-no evidence for the use of a saline lock during an un-medicated labor

Read the full article for more information to help you make an informed decision about having a hep-lock. The article sites other research. I encourage you to read the article in it's entirety, but here is a part (for you cliff note readers)

Evidence for the Saline Lock during Labor

http://evidencebasedbirth.com/the-saline-lock-during-labor/

Benefits of having a saline lock:

• If you change your mind and decide you want an epidural, most anesthesiologists want you to have a fluid bolus prior to the epidural and you will become “more high risk” with an epidural and need the IV
• There is an overall 2.9% risk for post-partum hemorrhage (the risk is much less if you have a vaginal delivery and no risk factors), in which case an IV will need to be inserted for fluids, Pitocin (which can also be given in a muscle injection), and (very rarely) blood products
• If you do get really thirsty or tired and can’t hold anything down, you can be given IV fluids for a bit of a boost
• If you do decide you want a saline lock, Dr. Shannon recommends, “Get it placed earlier in labor when you are more comfortable, as you may desire or need IV medications later on (such as for nausea, pain, or hemorrhage) when placing an IV may be more difficult (of course, Pitocin can be given by muscle injection if necessary for post-partum hemorrhage).

Risks of having a saline lock:

• It hurts to have the IV placed, and some women find it uncomfortable and distracting during their labor
• It may cause bruising or small amount of bleeding at the IV site
• The vein can become inflamed (phlebitis) which can cause redness and pain (risk = 7-10%) (Rickard et al. 2010)
• If the IV is used for medication or fluids, these may leak out of the vein and into the tissues, also known as extravasation (risk = 30-33%) (Rickard et al., 2010)
• Infection at the IV site resulting in a severe bloodstream infection (risk = 0.1%) (Maki et al. 2006)
• Having a saline lock might make it easier for your doctor or nurse to initiate unnecessary interventions, like IV fluids or Pitocin for augmentation
• The saline lock could be viewed as a symbol that the woman is “sick” and a “patient” instead of a healthy woman giving birth, and this symbol may have consequences for the woman’s mindset for giving birth– and may also adversely affect caregivers’ attitudes towards the laboring woman  (Newton et al., 1988)

In the end, I think it comes down to this. There is little-to-no evidence for the use of a saline lock during an un-medicated labor. However, there are risks and benefits to having the saline lock. The ultimate decision for whether or not to have a saline lock should come from you. If you want one and feel safer or more comfortable by having a saline lock just in case it is needed for medications or IV fluids, then that is your right to make that choice. If you have reviewed the risks and benefits and feel that you do not want a saline lock, then that is your right to make that choice. You are a consumer, and you have educated yourself on the risks and benefits, and you do have a say in this matter!

Delayed Cord clamping : ACOG review

Number 543, December 2012

Committee on Obstetric PracticeThis Committee Opinion was developed by the Committee on Obstetric Practice with the assistance of the American Academy of Pediatrics. The American Academy of Pediatrics endorses this document. This information should not be construed as dictating an exclusive course of treatment or procedure to be followed.

PDF Format

Timing of Umbilical Cord Clamping After Birth

ABSTRACT: The optimal timing for clamping the umbilical cord after birth has been a subject of controversy and debate. Although many randomized controlled trials in term and preterm infants have evaluated the benefits of delayed umbilical cord clamping versus immediate umbilical cord clamping, the ideal timing for cord clamping has yet to be established. Several systematic reviews have suggested that clamping the umbilical cord in all births should be delayed for at least 30–60 seconds, with the infant maintained at or below the level of the placenta because of the associated neonatal benefits, including increased blood volume, reduced need for blood transfusion, decreased incidence of intracranial hemorrhage in preterm infants, and lower frequency of iron deficiency anemia in term infants. Evidence exists to support delayed umbilical cord clamping in preterm infants, when feasible. The single most important clinical benefit for preterm infants is the possibility for a nearly 50% reduction in intraventricular hemorrhage. However, currently, evidence is insufficient to confirm or refute the potential for benefits from delayed umbilical cord clamping in term infants, especially in settings with rich resources.

---

Before the mid 1950s, the term “early clamping” was defined as umbilical cord clamping within 1 minute of birth, and “late clamping,” as umbilical cord clamping more than 5 minutes after birth. In a series of studies of blood volume changes after birth carried out by investigators in Sweden, the United States, and Canada, it was reported that in healthy term infants, more than 90% of blood volume was achieved within the first few breaths the infant took after birth (1). Because of these findings and the lack of specific recommendations regarding the optimal timing, the interval between birth and umbilical cord clamping began to be shortened. In most cases, umbilical cord clamping is performed within 15–20 seconds after birth, with the infant maintained at or below the level of the placenta. Although many randomized controlled trials of term and preterm infants have evaluated the benefits of immediate umbilical cord clamping versus delayed umbilical cord clamping (generally defined as umbilical cord clamping performed 30–60 seconds after birth) (2–26), the ideal timing for umbilical cord clamping has yet to be established and continues to be a subject of controversy and debate (21, 27–29).

Concerns exist regarding universally adopting delayed umbilical cord clamping. Delay in umbilical cord clamping may jeopardize timely resuscitation efforts, if needed, especially in preterm infants. However, because the placenta continues to perform gas exchange after delivery, sick and preterm infants are likely to benefit most from additional blood volume derived from a delay in umbilical cord clamping. Another concern has been raised that delay in umbilical cord clamping increases the potential for excessive placental transfusion, which can lead to neonatal polycythemia, especially in the presence of risk factors for fetal polycythemia, such as maternal diabetes, severe intrauterine growth restriction, and high altitude. Additionally, delayed umbilical cord clamping (with the infant placed at or below the level of the placenta) may be technically difficult in some circumstances. Another issue is that delayed umbilical cord clamping might interfere with attempts to collect cord blood for banking. However, the routine practice of umbilical cord clamping should not be altered for the collection of umbilical cord blood for banking (30).

Delayed Cord clamping

In Bradley classes you will learn that delayed cord clamping is beneficial for the baby. Delaying the cord clamping allows for the baby to get the proper blood volume and additional iron. The link below is a scientific study of the benefits of the delayed cord clamping (in this case only 45 seconds!) for premature infants, delivered by cesarean. Not only was it found safe, but beneficial.

A randomised controlled trial of delayed cord clamping in very low birth weight preterm infants

European Journal of Pediatrics

September 2000, Volume 159, Issue 10, pp 775-777

If you don't want to buy and read the entire study:
Conclusion Delayed cord clamping of 45 s is feasible and safe in preterm infants below 33 weeks of gestation. It is possible to perform the procedure at caesarean section deliveries and it should be performed whenever possible. It reduces the need for packed red cell transfusions during the first 6 weeks of life.

Birth plans

A great article of why birth plans DO matter and what to include for a natural, Bradley birth:

Writing a Bradley Method Birth Plan  original source
By CAITLINHTP | April 4th, 2012 at 9:50 pm

When you say the term “birth plan,” there are two general reactions: 1) “That’s a really good idea.  If you are sure you do or do not want certain things under certain circumstances, it’s helpful to write it out so your midwife, nurse, and doctor are aware,” and 2) “Birth plans are pointless. You can’t plan birth.  Just go with the flow.”  Since I’m writing a birth plan, I’m obviously in camp #1, but I can understand what those in camp #2 mean when they say you can’t plan birth.  It’s a natural process, things don’t evolve according to a chart, and sometimes, emergencies happen. 

That being said… This is my body and my baby.  I have a right to make informed medical choices.  And, quite frankly, I need to write a birth plan because the statistics regarding what commonly occurs in a hospital are not in line with my personal preferences regarding childbirth.  For example, in 2004, the episiotomy rate was 24.5% (an episiotomy is a surgical incision of the perineum).  I would rather use midwifery techniques to prevent tearing (massage, warm compress) or tear naturally than get an episiotomy (here’s why).  I want to be 100% sure that my midwife, nurses, and doctor are aware that I do not want an episiotomy preformed unless it is a true emergency.

I feel the need to preface the rest of this post by saying that my opinions about my ideal birth are just that… My opinions on my ideal birth. I’m not trying to preach about what other women should do or judge other choices.  Personally, I have always found it interesting to read about what women decide to do and why, even if they do something I would not choose for myself, so that is why I am sharing.

As I sit down to write my birth plan, I’m trying to integrate as much as the Bradley Method as possible.  I am waiting to write a complete summary post on the Bradley Method (probably post-baby), but I really love it so far and would recommend it to any expecting momma, even if you want an epidural, because the 12-week program gives you and your partner so much confidence regarding birth.  Bradley Method teaches natural childbirth techniques, and 90% of Bradley women who have a vaginal birth do it without medication – a pretty good success rate!

The #1 rule of the Bradley Method is not to go to the hospital too soon.  Basically, the later you arrive, the less chance of medical intervention (such as pain medication and drugs to speed contractions; remember, Bradley mommas are trying to avoid these things).  We are taught a variety of physical and emotional signposts to know when we should ideally go to the hospital.  Under normal circumstances, I’ll be laboring at home for as long as I can stand it and is safe – I really don’t want the Husband delivering the baby in our bedroom – and then my birth plan will kick in.

I’m not ready to share my final birth plan quite yet (if you’re interested in reading the draft, feel free to shoot me an email at caitlinjboyle at gmail.com), but here are some highlights.  Note that all of these items have been approved by my midwife; I can’t say that every doctor, midwife, nurse, or hospital would allow these things, but mine do.  Most of these items are in line with Bradley Method teachings, which is why I’m including them:

• Caitlin plans to have a medication-free labor. Please do not offer her an epidural. She does not want any drugs to speed along labor (i.e. Pitocin). If there is an issue, and you believe these medications are necessary, please discuss it with Kristien.
• Caitlin would like to labor out of bed and would like to be encouraged to try different laboring positions.  She may want to deliver out of bed.
• If water has not broken by the time Caitlin arrives, water should be allowed to break naturally. Breaking water should be discussed with Kristien first.
• Kristien would like to announce the gender of the baby to Caitlin.  Please do not spoil the surprise!
• Please do not clamp or cut cord immediately.  Wait at least three minutes prior to clamping or cutting.  (Side note: here’s why.)
• Please allow the placenta to come out naturally (no pulling or Pitocin injections, please).  We will be signing a medical release so we can take the placenta home. (Here’s why.)
• Baby should be placed on Caitlin’s stomach or chest immediately for a minimum of two hours of skin-to-skin contact.

I imagine that, at this point, many of you are thinking, “Dude, if you don’t want them to do anything to do, why aren’t you delivering at home or in a birthing center?”  Good question!  Ultimately, I truly understand that although I can write a birth plan, I cannot plan birth, and scary things do happen.  For me, the best place to be in that scenario is in the hospital with doctors and nurses who can help.  If there is a true medical emergency, I will trust these people to make the appropriate choices for me – screw the birth plan.

Another remark that I commonly hear about birth plans is that the birth doesn’t really matter that much.  All that matters is that the baby comes out, healthy and safe.  While I do think the ‘bottom line’ is true, I do believe that the birth matters, not only in regards to the physical health of my baby, but also for my emotional health.  The birth process does matter to me.  It doesn’t have to be perfect; it doesn’t have to follow my exact birth plan.  But I know this will be a transformative moment in my life, and I want the space around that moment to be one of positivity.  Leaving the hospital with our little boy or girl will be the most amazing thing in the entire world.  But if I can walk out those doors feeling protected, respected, happy, and healthy… then that’s just icing on top of the cake.