At the ICAN conference this past weekend, we had the pleasure of meeting the Kegel Queen. She has a wonderful book out on how to make sure you are doing your kegel exercises the right way and the benefits of doing so. She interviewed us and put her video up on the site. It is a must see for sure!

http://kegelqueen.com/videos/video_ICAN_bocce_balls.html

Want to know more about doing kegels – the why, the when, the how, and the how often- check out her site!

“Nuchal Cord: A nuchal cord is an umbilical cord that is wrapped around the fetus’s neck. A nuchal cord occurs in about one fourth of deliveries. Normally, the baby is not harmed.

Before birth, a nuchal cord can sometimes be detected by ultrasonography, but no action is required. Doctors routinely check for it as they deliver the baby. If they feel it, they can slip the cord over the baby’s head. Sometimes if the cord is tightly wrapped, it is clamped and cut before the shoulders are delivered.”

Recently I have heard about several women who had to have a cesarean birth due to the baby having the cord around the neck. But it happens according to this research a fourth of the time. So why does it cause issues for some and not others? In fact my grandson was born with the cord around his neck four times- without any issues at all.

What happens is if the baby is not allowed to maneuver and stretch the cord- making his or her way down the birth canal on his or her own time. But what happens is a mom gets an epidural and then is limited in her ability to move- helping the baby move. If we want to move the baby we move the mom. But if she is immobile then that is limited at best. Then the epidural slows labor down, especially if given too early. And the need for pitocin is increased. And since she is medicated now to not feel the pain, the use of pitocin is usually much more accelerated than it is when a woman does not have an epidural and needs to be able to manage the augmentation.

Pitocin can sometimes slam a baby down into the birth canal and there is no time for the cord to be able to stretch or the baby to move to accommodate having the cord around his or her neck. So the very interventions that are selected can end with an unnecessary surgical birth due to a baby going into distress.

So, just having the cord around the neck of the baby is not a reason for a cesarean birth. I know for me as a doula, I have seen nuchal cords at least 20% of the time. It is easily slipped over the head of the baby or the baby easily slides through the loop as he or she is being born. How often are cesareans performed that could have been avoided if the laboring mom was not induced or augmented during her labor- therefore causing the very problem that would not have been a problem otherwise. Sad.

Many women feel if they go past their due date- they are late. Many times providers will put pressure on a mom when she goes past her due date… please before you read this read my article on due dates- so you totally understand you are due within a four week period- week 38 to week 42… so going past the magical date is not being late at all.

Today I received a text from a mom who is 10 days past her magical date assigned to her by her doctor as her due date. She sees her doctor tomorrow and she wanted to review some induction methods prior to going to the doctor. So I thought I would share them in this blog and hope others will chime in with more.

I think there are several methods- so I will start with the least invasive first… Relaxation- just realizing that the pressure needs to be lifted will help some moms relax enough to begin labor on their own. I sell a cd from Earth Mama Angel Baby called “Getting Labor Started.” The relaxation methods on it along with the guided imagery will help many moms begin to let go and begin to release what it may be that is holding them back. The mind body connection is a strong one. It can cause labor dystocia if you are not able to allow your body to begin the work that it needs to do.

When one sees herself as normal- and relaxed… letting go of the preconceived notion that she is no longer beautiful or sexual- she may be able to also have some great sex. The prostaglandins in semen help to ripen the cervix and nipple stimulation in foreplay along with the orgasm that hopefully follows or accompanies the sex releases oxytocin. Pitocin is the synthetic form of oxytocin- but one that does not pass through the blood brain barrier. Trust me oxytocin is much nicer than Pitocin!

Making sure the baby is lined up properly will also help. This is especially important if you have been having lots of “false starts” to your labor. If the baby is not quite lined up right it could cause your labor to not only begin but could also cause a longer labor. We offer a class based on Gail Tully’s knowledge (www.spinningbabies.com). So make sure the baby is lined up great.

Evening Primrose Oil is taken by some women orally – first day with breakfast- then day two with breakfast and lunch- then day three with each meal and then on day four adding it vaginally from week 37 on. This is considered a natural prostaglandin and certainly could help to ripen your cervix. If you already have a diet rich in good oils- Vit E, Fish Oil. Omega 3 oils- this may make little difference. Some say it increases the chance of meconium with the baby- but that is still undetermined.

Getting your membranes “stripped” may be a good way once you go past your due date. Some care providers do this without really even talking to you about it first. You must be at least one centimeter dilated to help make this make a difference. But they insert their finger in your cervix- no this is not a comfortable event. It is also not without risks- infection, breaking your water by mistake, causing contractions that do not produce anything if your uterus is sensitive, etc.. but it can also help to release some prostaglandins to help get labor started. But keep in mind if you take your panties off and get up on the exam table this could happen if you don’t have a conversation prior to taking your panties off.

Getting the party started by having your colon begin the party is another way that some women resort to in order to avoid a medical induction. You may take castor oil- it is done in numerous ways- in root beer- in the blender with orange juice and ice- spread on toast with nutella, in the pan when you cook eggs, etc- or you may take borage oil instead. This is also why an enema may cause your labor to begin. What it does is start your colon contracting and thus the party begins and your uterus jumps in as well. Ask a mom who has been up all night with diarrhea if this is a good way to begin labor. If you are going to do this- I would suggest at least having a ripe cervix and beginning it early in the day so it kicks in before the middle of the night. (See my article on fatigue being an issue with the need for medication in labor to understand why a lack of sleep is never a good way to begin labor.)

Some natural prostaglandins can be found in foods as well. Fresh pineapple- rich in bromelain, eggplant, flaxseed, nuts and seeds…foods rich in Omega 3 Oils are great for this. We have always known that a great diet does effect pregnancy and certainly can effect labors.

Acupuncture and acupressure can be useful in helping to get labor started. As doulas we have some areas we may use to help get labor to kick in if your water is broken and you are on a time crunch. There are several places that can help to align your body rhythms to help your body ready for labor to begin. A good acupuncturist is imperative- www.grdhealth.com, dr khalsa is my personal acupuncturist. A good massage therapist can also massage certain areas that will help to get your labor going as well. If you insist on seeing a female massage therapist I can recommend Regina Elvis at themiracleofmassage.com and if you want an active KMI type massage I can recommend Harry Kramer at www.kmiatlanta.com.

There are several herbal things that can be taken. Since I am not an herbalist, I will encourage you to seek one out if you need guidance with the use of herbs.

Now if these things don’t work- and your care provider begins to look at the need for medical inductions there are several methods. One is to break your water to help begin labor. My suggestion is to ask the questions- What are the risks? What is the time frame they require before they begin the next intervention? Often labor when it starts by having your water break on it’s own- will begin within 8-12 hours- but when it is broken artificially that is not always the case.

You may ask about ripening a cervix by having a foley catheter inserted to help to stretch your cervix or having cervidil- tampon type method that is embedded with prostaglandins- inserted may be the next step prior to any other intervention. This increases your bishop score and therefore allows for a more favorable chance for an induction to end with a vaginal birth. If either of these cause a problem they can be immediately removed. Some believe that cervidil does cause your cervix to be irritated, causing vaginal exams afterwards to be possibly more painful.

There are some care providers who still use the very controversial Cytotec or misoptrostil. Although the manufacturers of the gastro medication warn severely of using it with pregnant women for induction- and 60 minutes and 20/20 have both done exposes against it’s use… it is still be done. The small pill is inserted vaginally or orally and once in your blood stream could possibly cause problems that could be very dangerous. Once it is in your blood stream the removal is virtually non existent. I will encourage you to do a google search and read about it for yourselves.

Pitocin is a most used method for induction. It requires constant monitoring. Whenever constant monitoring is involved- keep in mind it is because there are inherent dangers. This is given intravenously and can be closely monitored. But some care providers use it gently and increase it very slowly- therefore mimicking natural labor often. But often times it is given very actively since the care provider does not feel you need to be going without an epidural and senses that rapid infusion will help you get that epidural sooner than later. If Pitocin causes problems, it can be discontinued.

Remember that inductions are not without risks. Certainly there is a risk to going more than 42 weeks as well since it does increase the risk of stillborn births. One of the best ways to determine how your baby is doing is to do agree to a non stress test and biophysical. This test is one that is able to let you know how your baby is really doing- how the environment of the womb is doing. Often I have been at inductions for postdates to see a baby born with tons of vernix and showing signs of not being late at all. Due dates are subjective. Your normal gestation is also subjective.

I walked around 70% effaced and 3 centimeters dilated for over three weeks with my first two babies. You may wonder about my third pregnancy. I did not allow anyone to check my cervix since I did not value the findings as being information that was needed. I was ten days “late” with each of my babies. My first grandson was born to my youngest ten days past her magical date. My oldest daughter gave birth to her first two babies four days early and her last baby on her magical date. So… what does that all mean… that labors are all individual. That you are an individual and so is your baby.

Enjoy the last weeks or days of your pregnancy. Change your phone message to “No baby yet, we will update this message when He/She is born with the details. Don’t leave a message unless it is urgent as we are nesting.” And then don’t answer your phone. When sharing your due date- share a due month instead. Don’t let others determine how you feel about the last weeks of growing your baby.

Please feel free to comment to this entry. I would love to hear what worked or what did not work for you personally. Thanks!

Well I figured I write about this all of the time- maybe it would be good to share another professional’s view of induction. Here is a link to her blog as well http://gaildahl.wordpress.com/

10 Reasons to Avoid Induction

A common decision today’s parents will face during childbirth is birth induction. A birth induction happens when the labor of a pregnant woman is artificially started. Today’s parents need to know why it is important to avoid birth induction and why it is important to allow labor to begin normally and naturally without any interference. Here are the reasons you would want to avoid induction in childbirth:

1. If you induce the birth of your baby you will be at risk of delivering a premature baby. New studies are showing that babies who are even slightly premature have more problems at birth and beyond. There is no proven health benefit to forcing your baby from the womb before your baby has had enough time to properly develop. Even in the last few days before the birth of your baby, last minute finishing touches are ongoing. The final layers of fat are placed, the lungs are receiving the finishing touches even as you are going through labor. All of this will help your baby to be comfortable in a change of environment. Your baby will most likely be ready ten days after your estimated due date, especially if you are a first time mother. There are no studies showing any benefit whatsoever to artificially starting labor and there are many studies showing the risk of premature birth to every baby. Wait for your labor to begin normally and naturally.

2. If you induce your labor, your labor will become more painful and prolonged. Your contractions will be too long, too strong and too close together causing your baby to have difficulty breathing and your contractions to be less effective.

3. If you induce your labor you may not be ready physiologically or emotionally to give birth without your baby signaling to your body the exact time it is ready and able to labor. Inducing labor, by any means, will cause unnecessary stress on your body and your baby.

4. If you induce your labor, your baby may experience harm caused by the mechanical force of the artificial contractions that can damage your baby’s brain and affect your baby’s ability to breathe.

5. If you induce your labor you may be at risk of secondary infertility due to the increase of the risk of damage to your uterus caused by uterine rupture.

6. If you induce your labor you may be at risk of bleeding throughout your labor and after childbirth because of the damage caused to your uterus by the induction drugs creating a greater difficulty in caring for the new baby along with the increased possibility of prolonged postnatal depression caused by the induction drugs.

7. If you induce your labor you will not be able to experience a natural birth due to the increased pain during labor. The narcotics used in a epidural cross the placenta and cause increased stress on your baby as the narcotics hit your baby’s immature liver and brain causing a decrease in the cardiac and brain function. Your baby will find it hard to breathe because of this. Your baby will have great difficulty breastfeeding because of the afterlife of the narcotics. Very few women are able to have an induced birth without additional drugs to handle the increased pain from the artificial contractions.

8. If you induce your labor you will unknowingly trigger a cascade of medical interventions like, strong medications to force your cervix open, multiple narcotic drugs for increased pain, continuous fetal monitoring, forceps delivery or the use of a vacuum extractor; when the attempt at the induction fails.

9. If you induce your labor you will become a high risk for emergency cesarean delivery, (as high as 50%) as many induced labors fail and leave both mom and baby in medical distress. In the case of an extreme medical emergency, for either mom or baby, consider bypassing induction and going right to a cesarean section. Adding induction drugs to an already stressed mother and baby may cause additional damages to both. Allowing a woman to labor naturally before a cesarean section will help to further develop the baby’s lungs.

10. If you don’t induce your labor, and allow your labor to begin normally; your labor will be less painful, your labor will be shorter and more productive, (your body will be ready for it), your baby will be able to breathe, you will reduce your risk of cesarean section, you will reduce the health costs associated with your birth, you will have less need for pain medication, you will have a shorter delivery, you will have a faster recovery and you and your baby will be healthier as a result. Your baby will breastfeed more easily and you will find it easier to bond and attach to your new baby. If you are anxious about your baby’s arrival, make sure everything is ready for the baby’s arrival, the house is clean, groceries are purchased, banking done, extra food prepared, official registration papers for your baby and the myriad of other things you will need to take care of at this time. Avoiding a labor induction is one of the best secrets to having a safe and gentle labor and delivery for both mother and baby.

Secrets Newsletter 2008. Gail J. Dahl, “Pregnancy & Childbirth Secrets”.

There was a neonatal physician on the local 5 o’clock news this week who made this statement, “Having a baby as few as four days early increases the newborn complications risk by 20%!” and the statement was made that, “Northside Hospital the nations busiest labor and delivery center with over 18,000 births per year supposedly issued a new rule that women can not schedule an elective c-section or be induced before their 39th week of pregnancy.” But my experience working with moms who give birth in the Atlanta metro area- and yes even at Northside is that is not being done. Doctors seem to be able to find a medical reason for an induction even when the birth later shows the risks were not there.

Who is doing all of these inductions? What is causing this to happen? I believe it is not only the doctors who schedule inductions and cesareans for factors that include convenience as well as malpractice concerns, but it is women who are demanding it. The doctor in this interview eludes to moms getting tired during their pregnancy and wanting to have the baby born. So, do no harm should mean that the doctor advises a mom that this is risky. That not only will an induction lead to more of a chance of a surgical birth, but more risks that she will not be bringing her baby home when she is discharged.

I can tell you that I have conversations almost weekly from moms who were induced or told to have a surgical birth due to their baby being too big. Then the baby is born and is well within the normal range of size. She then goes on to have a vaginal birth with a subsequent child who is much larger than the first. What happened? Did her pelvis get larger the next pregnancy?

This is a link to the original newscast:
http://www.myfoxatlanta.com/myfox/pages/News/Detail?contentId=8311537&version=2&locale=EN-US&layoutCode=TSTY&pageId=3.5.1

The news story went on to state, “The number of Cesarean sections has skyrocketed in recent years. One out of every three babies is now delivered surgically. New research shows women may want to think twice about scheduling an early delivery.”

The news reporter, Beth Glavin states that “a pregnancy is considered full term at 37 weeks.” But since often a woman does not know exactly when she conceived or when she actually ovulated it is difficult to know for sure if she is 37 weeks or 36 weeks and three days for example.

One OB online states “A normal pregnancy should last 38 weeks if you count from the day of conception. However, the day of conception is not always easy to determine, especially in the ancient past. Therefore, people then have used 40 weeks from the first day of the last menstrual period, on the assumption that women have 28 day cycles and they conceive 14 days after the start of their menses.This traditional way of counting has been in use till now.

Therefore, when we say you are 10 weeks pregnant, you have actually conceived 8 weeks ago. Based on this type of calculation, a pregnancy will have the expected date of delivery at 40 completed weeks but a pregnancy that has completed 37 weeks is considered full term already.

Beth states that “the recommendation is that a woman wait until she is 39 weeks to consider having a planned cesarean.” But since inductions can lead to a cesarean = then shouldn’t a woman wait until 39 weeks to consider even being induced? The doctor on the news report says every week of early birth due to inductions can cause the risks to the newborn escalate. It is due to lung and brain development. “Before 39 weeks the baby is just not ready.”

This is another story – more reseach showing the risks of early inductions and cesarean births:
http://www.foxnews.com/story/0,2933,477687,00.html?sPage=fnc/health/pregnancy

The study showed, “More than a third of the C-sections were performed before 39 weeks, the researchers found. Those delivered at 37 weeks were twice as likely to have health problems, including breathing troubles, infections, low blood sugar or the need for intensive care. Fifteen percent of those born at 37 weeks and 11 percent born at 38 weeks had complications, compared to 8 percent of the babies delivered at 39 weeks.”

A dream of mine would be for women to trust their bodies. For babies to select their day to be born. If a mom is more high risks, sure do non stress tests and biophysicals to insure that the baby is doing great. But the stress of going “late” and having a baby “on time” needs to end. We need to embrace that nature did not make a mistake. That MD does not stand for minor deity. That we can decide if we are going to get on that induction train or not. That the induction police don’t come and pick us up to drag us to have our babies. We must begin to take responsibility for our health and the health of our babies.

It begins with trusting our bodies. And it also goes to trusting our care providers. So if a care provider says an induction or cesarean is needed- ask more questions. Know the risks. Weigh their guestimations with knowledge and with what the studies show- wait if you can.

Due Dates
How accurate is your Due Date?

How are due dates calculated?

In the 1850’s, a Dr. Naegele determined the average length of human gestation was 266 days from conception, or 280 days (40 weeks) from last menstrual period. He assumed that the average woman had cycles that lasted 28 days and that she ovulated on Day 14 of her cycle. He used his data to come up with a mathematical calculation for due dates:

((1st day of your last menstrural period -LMP + 7 days) – 3 months) = Due Date. EX: ((January 1, 1996 + 7 days) – 3 months) = October 8, 1996

This is still the standard method used to calculate due date, despite the fact that it doesn’t take into account: that many women are uncertain of the date of their last menstrual period and not all women ovulate on day 14. Other factors which affect term are: mother’s age, ethnicity, prenatal care, prenatal nutrition, number of prior pregnancies.

Another Calculation

A more recent study (Mittendorf, 1990) indicates that term for uncomplicated pregnancies in first-time, Caucasian mothers, averages 274 days from ovulation. It averages 269 days for mothers who’ve given birth before. The abstract says non-Caucasian pregnancies are shorter than Caucasian, but doesn’t give statistics.

*To calculate a due date: Take starting date of last menstrual period. Subtract 3 months. Add 15 days. (10 days if you’re non-white, or this is not your first baby.)

What else can be done to determine fetal age?

If ultrasound is performed in the first half of pregnancy, it can indicate fetal age within a range of 7 – 10 days.

Fetal heart tones can be heard through Doppler starting at 9-12 weeks and by stethoscope at 18-20 weeks.

Some believe the baby will come five months after quickening, the first time the mother feels the baby move. This is hard to evaluate, as women can be more or less sensitive to these sensations, and may notice them at different times in their pregnancies. (First time mothers typically notice movement around 18-20 weeks. Mothers who have been pregnant before notice it as early as 16 weeks.)

Fundal height, the measurement of the uterus done throughout pregnancy, can indicate the size of the baby, which can give insight about fetal age.

When will my baby be born?

Only 4% of babies are actually born on their “due dates”. 6-10% of babies are born early – prior to 37 weeks; 4-14% of pregnancies last more then 42 weeks.

If this leaves you very confused, just realize that predicting due dates is a very inexact science, and it’s probably best to plan ahead of time for the baby to come anywhere between 2 weeks before and 2 weeks after your due date.

For more on due dates, read: Calculating Due Dates and the Impact of Mistaken Estimates of Gestational Age

Sources: “How long is too long?” by Penny Simkin, Childbirth Forum, Spring 1993. Abstract for “The Length of Uncomplicated Human Gestation” by Mittendorf et al
Obstetrics & Gynecology, V.75, N.6, June 1990. “When will my baby be born?” found at http://pregnancy.about.com/library/weekly/aa042197.htm “Pregnancy past your due date” by Terri Isidro-Cloudas on www.americanbaby.com

If you go to the hospital childbirth classes…usually you will hear that you need to go to the hospital when your contractions are five minutes apart, lasting a full minute for at least an hour =511… If you do this you will usually be about 4-5 centimeters dilated and arriving just in time to get your epidural.

If you attend my classes… you will hear that you need to go to the hospital when your contractions are four minutes apart, lasting a full minute for at least an hour =411…If you do this you will be well established into labor and if you plan to go without medication you will not be at the hospital too early and yet not too late if you decided you wanted medication.

A midwife at my favorite practice recently told my client who desired a natural water birth… you should come to the hospital when your contractions are three minutes apart, lasting a full minute for at least an hour =311…If you do this you will be just in time to get in the tub and shortly push your baby out. (more…)


Gentle Birth Baby by Sarah Buckley

as summarized by Teresa Howard

Gentle Birth babies are effected for a lifetime.
www.sarahjbuckley.com

Mammalian births- we are all basically the same. (I thought it humorous that she said this in her speech. It immediately made me think about Ina May Gaskin saying if you wanted to watch real birth on t.v., you should watch the Animal Planet!)

Safety, ease and pleasure = species for survival basis. So birth should be relatively safe, easy and pleasurable in order for any species to make it!

Anxiety and fright = prolonged labor
A woman needs to feel Safe, Private and Unobserved = this is what she calls the Recipe for ease of Birth

If this is the situation, then we should release the Ecstatic Hormones. This cocktail = oxytocin + beta endorphin (natural pain killer) + epinephrine (adrenalin) + non epinephrine: these release catecholamines –these rise at transition and it stimulates labor and the fetal ejection reflex + prolactin (the love hormone for moms!)

What disturbs Mother Natures plan for birth? Pitocin, epidurals, opiates and cesareans.

In 2005
21-40 percent of women were induced
50 percent tried to get labor going or their caregiver did
99 percent had pitocin after birth

Receptors in a woman’s uterus will shut down if over stimulated by pitocin.

The altered state of a woman in labor is for it to be normal when “she goes out to the stars to collect the soul of the baby” (… this is what Pam England refers to as laborland.)

When an epidural is given, the pelvic floor muscles are relaxed and it numbs the lower vagina.

When mothers spent less time with their babies while in the hospital their moms felt their babies were less adaptable and more intense.

Bupivacaine, a drug used in most epidurals have a half Life 8 hours in the baby after the baby is born.

Dim lights, no numbers (dilation or time constraints), covering the clock, encourages instinctive behavior in the mom during labor.

The three things a woman in labor needs to focus on are: BREATH, making SOUND if she desires and MOVEMENT.

I heard Sarah speak at the Gentle Birth Congress in Portland a few years ago- these are my notes from that speech. She is coming to Atlanta to the ICAN conference this year. She is fabulous!

Another doula is publishing a book soon that has a chapter named “Labor, the hardest work you’ll ever love!” That made me think about what that means. It reminded me of the quote that Pam England shares in her Birthing From Within book- “Labor is hard work, it hurts and you can do it.”

Many folks don’t get why anyone would want to have a baby without medication being involved to numb or dull the pain. The comments about how you would not get a root canal without novacain are spouted by many. Do they realize a endodontist will not perform a root canal with novacain on a pregnant mom!

So how in the world is labor something you can say you love? Why would you want to do this unmedicated? Nurses many times will tell a mom she does not get a crown for doing it without an epidural. But is this really true? (more…)

I noticed my quote of the day “There’s a way to do it better – find it.” by Thomas A. Edison and I thought about birth… and doulaing…

There are so many ways we have screwed up the natural birth process these days for the sake of a better way… I think what Ina May Gaskin said- “if you want to understand birth, watch the Animal Channel.” is so right. Do not watch the Birth Story shows- no Maternity Ward, no Deliver Me! The television has propagated the lies of what normal birth looks like.

In fact normal birth today has become one of inductions, pitocin, epidurals, and cesareans. That is not normal birth. In fact if you step into most hospitals today you will be hard pressed to see normal birth.

I understand why the home birth movement is on the rise. Women want to take back their births. It has been taken away from them in the hospital settings.

When a woman calls her doctor in what appears to be early labor it is suggested she come on to the hospital early to be checked out. Upon arrival, after doing the neccessary paperwork, she is shuffled into a room and asked to disrobe and put on a hospital gown. (more…)