Labor is Good for Babies

A nice concise summary of Why Labor is Good for Babies.

Cesarian Sections

The Academic OB/Gyn has an interesting, if somewhat technical, discussion of single vs. double layer suturing to close up the uterus after a c-section. For what it's worth, my birth plan includes a request for double-layer suturing should surgery be necessary.

And speaking of surgical births, the Philadelphia Inquirer this week published Dangerous delivery shows peril of multiple C-sections:

The case points out a fundamental truth about surgical delivery: a first cesarean for most women leads to a cesarean with every pregnancy. And while a first section is quick, easy to perform, and rarely complicated, each repeat surgery carries greater risk.

A risk which, sadly, most women are not made aware of.

More "news" we already knew: Don't lie on your back when you are in labor

Remaining active and mobile during labor can shorten the first stage and results in less discomfort for moms:

Women who walk, sit, kneel or otherwise avoid lying in bed during early labor can shorten the first stage of labor by about an hour, according to a new Cochrane evidence review.

Women who labored out of bed during the early stages were also 17 percent less likely to seek pain relief through epidural analgesia, the review found.

This is not only for physiological reasons, such as widening the pelvis and optimizing fetal position, but "[o]ther research has found that feeling in control and able to make choices reduces pain and psychological distress in general." If fact, lying on your back during labor can be dangerous:

[l]ying flat on one's back during labor can put a great deal of pressure on the blood vessels in the abdomen. "There is widely accepted physiological evidence that the supine position may be harmful in late pregnancy and labor," [lead review author Annemarie] Lawrence said.

According to the reviewers, the supine position puts the entire weight of the pregnant uterus on the blood vessels that supply oxygen to both mother and child, which could potentially lead to problems with heart functioning in the mother and reduced oxygen to the baby. These outcomes could be serious in extreme cases. Lying on one's side has no link with such problems, however.

So why do so many women labor in bed?

[Teri] Stone-Godena[, director of midwifery at the Yale School of Nursing,] said that despite all the attention given to empowering women to have the type of birth experience they prefer, medical professionals still pressure women into lying in bed during labor, because it is more convenient this way for nurses and doctors - and makes fetal monitoring easier.

"I think this research is very vindicating of women being allowed to assume positions of comfort," she said. "Listening to their bodies is what they need to do. Most of time when we limit people's activity, it isn't for reasons that are soundly based on evidence."

She added, "This clearly shows that there are no advantages in staying in bed unless that's where you want to be."

Generally speaking, if a particular labor position causes you increased pain or discomfort, it's not a good one to be in - for you or the baby. Pain is your body's way of letting you know you need to change what you are doing.

Link to article.

But what if the test is wrong?

Kathy at Woman to Woman Childbirth Education has posted several great articles recently, including What does natural birth sound like and C-sections and Mastectomies. But I really wanted to focus on "But what if the test is wrong?" which reminds women to get a second opinion,

One question to keep in mind with this sort of thing is always, “What’s the false positive rate?” Because if a recommendation is made to you to induce or perform a C-section or have some other intervention based on one thing alone, and that “thing” is wrong almost half the time, then how confident can you — and the doctor, for that matter — be in the diagnosis and subsequent intervention. If, however, there is a low false-positive rate, then you can be more confident that your diagnosis is indeed accurate.

and to be wise in evaluating the risks of their options:

It’s one thing for doctors to say that having some medical condition or refusing some intervention “doubles your risk” — which sounds very bad — but it’s another to find out that the “risk” is still only 1 in 50,000 (which is double the risk of 1/100,000). Sure, nobody wants to be that one, but that means that 99,999 mothers and babies are subjected to an intervention which also carries risk. It’s about perspective — a balance — a trade-off between two different courses of action. Nothing in life is guaranteed (except death and taxes); and there are risks and benefits for every course of action. It’s up to you to choose which risks are acceptable for the proposed benefit.

I could not have said it better myself.

Cord Blood Banking

Hat tip to Giving Birth Naturally for posting ACOG Revises Opinion on Cord Blood Banking:

It is refreshing to see that ACOG can make some improvements in judgment, albeit small ones. While they still won't take a stance for or against it, their revised opinion on the scam that is private cord blood banking is a small nudge in the right direction.

I especially like the statement, "ACOG also advises physicians who recruit patients for for-profit cord blood banking to disclose their financial interests or other potential conflicts of interest to pregnant women and their families."

Read the text of the news release here.

My major concern with cord blood banking is the necessity of cutting the umbilical cord earlier than might be optimal in order to preserve the cord blood, thereby depriving the newborn of the blood. A representative from a cord blood-banking company may be speaking to our homebirth group this year; it will be interesting to see what they have say on these issues.

Oxytocin

Hathor's been doing some neat comics lately on Oxytocin - the "Love Hormone". She just came back from the Trust Birth Conference which I really wish I could have gone to. She heard Michel Odent speak, and he really rocked her world, as he did mine when I heard him speak a couple years ago at a local conference. Hathor came across this article, over a year old and just a rat study, but still important:

The massive surge in the maternal hormone oxytocin that occurs during delivery might help protect newborns against brain damage, a new study in rats suggests.

Researchers say the findings should encourage scientists to investigate whether elective caesarean sections, which lack this oxytocin surge, disrupt normal brain development.

Also, I found Hug the Monkey, a whole blog devoted to the subject of Oxytocin; and an article entitled 5 Ways Pitocin is Different than Oxytocin which, in honor of list month, I will include here:

1. Pitocin is released differently. Oxytocin is released into your body in a pulsing action. It comes intermittently to allow your body a break. Pitocin is given in an IV in a continuous manner. This can cause contractions to be longer and stronger than your baby or placenta can handle, depriving your baby of oxygen.
2. Pitocin prevents your body from offering endorphins. When you are in labor naturally, your body responds to the contractions and oxytocin with the release of endorphins, a morphine like substance that helps prevent and counteract pain. When you receive Pitocin, your body does not know to release the endorphins, despite the fact that you are in pain.
3. Pitocin isn't as effective at dilating the cervix. When the baby releases oxytocin it works really well on the uterine muscle, causing the cervix to dilate. Pitocin works much more slowly and with less effect, meaning it takes more Pitocin to work.
   
4. Pitocin lacks a peak at birth. In natural labor, the body provides a spike in oxytocin at the birth, stimulating the fetal ejection reflex, allowing for a faster and easier birth. Pitocin is regulated by a pump and not able to offer this boost at the end.
   
5. Pitocin can interfere with bonding. When the body releases oxytocin, also known as the love hormone, it promotes bonding with the baby after birth. Pitocin interferes with the internal release of oxytocin, which can disturb the bonding process.
   

I knew, like, three of those already. And for some really hair-raising stories, try Knitted in the Womb's Rant on Pitocin (with comments).

Six Practices for a Healthy Birth

If you haven't seen a copy of Lamaze International's new quarterly publication, Pregnancy, Birth & Beyond, I highly suggest you try to get a copy. I was mightily impressed by the inaugural issue.

Lamaze has identified six care practices that promote, support and protect normal birth. These are:

1. Labor should begin on its own.
2. Laboring women should be free to move throughout labor.
3. Laboring women should have continuous support from others throughout labor.
4. There should be no routine interventions during labor and birth.
5. Women should not give birth on their backs.
6. Mothers and babies should not be separated after birth and should have unlimited opportunity for breastfeeding.

Detailed information about each of these Care Practices are available here.

Top 10 Childbirth Myths

The Journey Of An Apprentice Midwife posts a very excellent Top 10 Childbirth Myths, with references.

How Safe Are Epidurals?

The Guardian posted a recent article, "How safe are epidurals?":

There are, however, downsides. An epidural literally paralyses you and the effects of it can be, according to the National Childbirth Trust, "an increase in assisted vaginal birth rate". There is some evidence that "sleepiness arising from the opiate may delay successful breast feeding". Some mothers also complain of having headaches and/or debilitating drowsiness for days afterwards. The natural-birth lobby will tell you that 23% of women will experience complications. The pro lobby will tell you that an epidural is one of the safest anaesthetics around.

I have to say I felt pretty cock-a-hoop straight after my epidural but, some hours later, my head felt as though someone large and heavy had been sitting on it. The next three times I gave birth, I had them all drug-free and at home. Did they hurt? Hell yes, but I felt so much better afterwards.

Cord Clamping

Soon after a baby is born, the umbilical cord is clamped, and then cut. Research continues to show what many have long believed, that delayed cord clamping is beneficial to the infant. However, current obstetrical practice is to clamp the cord right away. As long as the cord is pulsing, the baby is continuing to receive blood and oxygen from the placenta. For babies who are born healthy and crying, it may not make much of an apparent difference. But for babies who do not breathe right away, clamping the cord means that they must breathe - or else be deprived of oxygen. Delayed clamping eases the baby's transition into the world. In fact, cutting the cord at birth is not necessary at all - the cord will clamp itself off when it stops functioning.

For research into cord clamping, try these sites:

Gentlebirth Archives - Perhaps the most comprehensive list of resources on cord clamping available, but you will also get about 50 different opinions.

Cordclamp.com - Lots of good, technical info, but advocates the idea that premature cord clamping is responsible for autism, cerebral palsy, mental retardation, and the fact that more women than men get college degrees. Also contains the archives of the now-defunct, oft-linked-to cordclamping.com.

Cochrane Review information on Cord Clamping in Preterm Infants, Cord Clamping in Term Infants, and Topical Cord Care.

Lotus Birth from Answers.com

Lotus Birth from Wikipedia.

Umbilical Cord from Wikipedia.

And for the last word on the issue, a recent study published in the JAMA - Late vs Early Clamping of the Umbilical Cord in Full-term Neonates: Systematic Review and Meta-analysis of Controlled Trials (March 21, 2007):

Delaying clamping of the umbilical cord in full-term neonates for a minimum of 2 minutes following birth is beneficial to the newborn, extending into infancy. Although there was an increase in polycythemia among infants in whom cord clamping was delayed, this condition appeared to be benign.

Why Early Cord Clamping?

Andru Ziwasimon of to the teeth posted this insightful discussion about a year ago, on early cord clamping, which I am just now getting around to mentioning.

Keeping Your Placenta

Jodi Selander gives advice on Bringing Your Placenta Home from the Hospital:

Women who give birth at home have the luxury of being in complete control over the care and handling of their baby’s placenta. A woman who births in a hospital has to adhere to the guidelines and policies in place at their facility of choice. In some cases, there is no written policy, and mothers are then subjected to the whim of the staff on duty at the time they deliver. If you want to take your placenta home after its birth, you must have a plan before you walk through the doors in labor. Your chance of success will increase greatly.

Women given unwanted episiotomies

A CNN Health article, "5 operations you don't want to get -- and what to do instead", covers episiotomies:

It can sound so simple and efficient when an OB-GYN lays out all the reasons why she performs episiotomy before delivery. After all, it's logical that cutting or extending the vaginal opening along the perineum (between the vagina and anus) would reduce the risk of pelvic-tissue tears and ease childbirth. But studies show that severing muscles in and around the lower vaginal wall (it's more than just skin) causes as many or more problems than it prevents. Pain, irritation, muscle tears, and incontinence are all common aftereffects of episiotomy.

Last year the American College of Obstetricians and Gynecologists released new guidelines that said that episiotomy should no longer be performed routinely -- and the numbers have dropped. Many doctors now reserve episiotomy for cases when the baby is in distress. But the rates (about 25 percent in the United States) are still much too high, experts say, and some worry that it's because women aren't aware that they can decline the surgery.

"We asked women who'd delivered vaginally with episiotomy in 2005 whether they had a choice," says Eugene Declercq, Ph.D., main author of the leading national survey of childbirth in America, "Listening to Mothers II," and professor of maternal and child health at the Boston University School of Public Health. "We found that only 18 percent said they had a choice, while 73 percent said they didn't." In other words, about three of four women in childbirth were not asked about the surgery they would soon face in an urgent situation. "Women often were told, 'I can get the baby out quicker,'" Declercq says, as opposed to doctors actually asking them, 'Would you like an episiotomy?'"

Wow.

Eating Durring Labor

A new study finds:

Women permitted to eat low-fat, low-residual foods during labor were no more likely than women who received only water to have labor, delivery, or neonatal complications in a randomized study conducted in the United Kingdom.

Moreover, women who ate rated their overall labor experience as significantly better than that of women who were only allowed to drink water, according to a study presented in poster form at the annual meeting of the Society for Gynecologic Investigation.

(link)

Delayed Cord Clamping

Delayed Cord Clamping at Birth May Reduce Neonatal Anemia

No Benefit to Fetal Oxygen Monitoring

This is an old article, but one that I think is important, and didn't get much press at the time:

New Childbirth Technology Tanks: A study finds no benefit from monitoring fetal oxygen during labor. The rate of Cesarean deliveries is not reduced.

Epidurals aren't for wimps

Epidurals aren't for wimps – labour can be different for every mother:

In everyday life, we respond in instinctive ways to pain. If you drop something on your foot, you automatically rub yourself because rubbing causes your body to make endorphins which are natural pain-killing substances. If you have a bad stomach ache, you would probably lie down and curl up in a ball with a heatpad because warmth and being in a particular position are very comforting. It would seem that pain tells us how to help ourselves recover from injury. In labour, there is no injury taking place, but the pain teaches the woman how to give birth. She is led by it to try a variety of positions to increase her comfort and by moving around and using different positions, she is also helping her baby's head to press down firmly all around the cervix so that it opens up evenly. Later in labour, her changes of position cause the baby to be shifted one way and then the other, helping him to find the easiest way down through the pelvis.

Epidurals May Negatively Affect Breast-Feeding

Researchers found that 93 percent of the women in the study breast-fed their baby in the first week after birth. However, women who had an epidural were significantly more likely to have difficulty breast-feeding during the first few days after delivery and to breast-feed less often than other women.

At 24 weeks, 72 percent of women who did not have an epidural were breast-feeding, compared with 53 percent who received pethidine or epidurals containing bupivacaine and fentanyl (an opioid).

(link)

Pat O'Brien, a spokesman for the Royal College of Obstetricians and Gynaecologists, said it was possible that fentanyl had an effect on the baby.

But he added: "There are other factors which may explain this link, including that if a woman chooses not to have an epidural, she may also be more motivated to persevere with breastfeeding.

"Also, a lot of those women who had epidurals also went on to have Caesarean sections which - unless you have a lot of support - make it difficult to breastfeed because it's harder for women to pick their babies up."

(link)

Birth Technology

Just came across this excellent article written by Dr. Marsden Wagner, former director of Women's and Children's Health for the World Health Organization, titled "Technology in Birth: First Do No Harm". The article is available from Midwifery Today and at Dr. Mercola's website. It is a long read, but worth the time, and is the kind of thing that makes you want to print it out and give it to all the pregnant women you know.