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

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

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.

C-Section Options

During the 12 weeks of instruction students get in my Bradley classes, we cover choices and options they have regarding their birth. During the week we cover variations and complications, couples are often surprised to know that just because their birth veers from their natural birth plan, doesn't mean they stop having a say in how things go! Parents should be able to give informed consent to all aspects of the birth. In class, we learn how to do that and cover many of the options parents have. I'm sharing on the blog an article that helps parents who have learned they must have a planned cesarean section. It may be disappointing, and a little scary, but when done for the mother's or baby's safety know that you have done what was necessary.

Here are tips for having The Best Cesarean Possible

Don't forget that the American College of Obstetricians and Gynecologists (ACOG) now states, "Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including some women who have had two previous cesareans."