Science & Sensibility » Can We Prevent Persistent Occiput Posterior Babies? Today, regular contributor Henci Goer, co-author of the recent book, Optimal Care in Childbirth; The Case for a Physiologic Approach, discusses a just published study on resolving the OP baby during labor through maternal positioning. Does it matter what position the mother is in? Can we do anything to help get that baby to turn?
Henci lets us know what the research says in today’s post. – Sharon Muza, Community Manager In OP position, the back (occiput) of the fetal head is towards the woman’s back (posterior). Sometimes called “sunny side up,” there is nothing sunny about it. Does maternal positioning in labor prevent persistent OP? This month, a study titled “Is maternal posturing during labor efficient in preventing persistent occiput posterior position? The good news is that regardless of group assignment, and despite virtually all women having an epidural (94-96%), 76-78% of the babies eventually rotated to OA.
Why didn’t this work? Do we have anything else? 5 Things Your L&D Nurse Wishes You Knew | THE TAPROOT DOULA PROJECT. When it comes to labor and birth, sometimes you get more when you know what to ask for. As an L&D nurse, it is my job to ensure that a woman is informed, empowered and autonomous throughout her labor and birth process. It is my role to help HER (and her partner) make the best decisions about her care. I can’t make decisions for her, but I can help inform her so that she can make the best decisions for herself. Here is the wisdom and research behind 5 birth practices that every expecting family should consider: 1) Patience is a Virtue Induction of Labor.
Many providers recommend induction of labor at 39 weeks and beyond without medical need for the simple reason it enables them to schedule a baby’s birth. The possibility of scheduling their baby’s birthday is incredibly seductive for a huge, pregnant woman who is aching, uncomfortable and anxious about the entire process. But is induction the best option for you and your baby? Photo: Paul Go Images 3) Sometimes Low-Tech is Best Like this: Early Labour - 8 Tips For A Low Stress Early Labour At Home | BellyBelly. During early labour, you might feel a wide range of emotions.
Anxious, uncertain, relieved, scared, excited, frustrated, nervous — even all of those things at once! Rest assured, they’re all normal and common feelings. It’s so important to try and relax, rest and play down any early labour signs (unless you’re concerned about your or your baby’s health), and maintain as much normality as possible. Labour is exactly that – hard work. This is the beginning of what will likely be a long, exhausting and intense process. Especially for first time mothers, pre-labour can last for hours or even days.
This is a common reason why you might hear horror stories from other women, who said they were in labour for days. Ask yourself this: do you know of any marathon runners who begin their race with a sprint? Of course you don’t. If marathon entrants began their race with a sprint or bolt, they wouldn’t finish the race – they’d burn out! How Long Will Early Labour Last? Find out what causes labour to start. De beste standjes: geboorteposities tijdens de bevalling | De Geboortenis – Het begin van gezond samen leven. Al eeuwen bevallen vrouwen rechtop en wisselen zij posities af als hurken, zitten, liggen, en staan. Maar als we de media mogen geloven bevallen we allemaal plat op onze rug met de benen omhoog in de steunen, ook wel de lithotomy positie genoemd. Heel charmant en comfortable!
Maar voor wie eigenlijk en is dat wel nodig? The lithotomy position is the best. Here the patient lies with her legs in stirrups and her buttocks close to the lower edge of the table. The patient is in the ideal position for the attendant to deal with any complications which may arise (Oxorn and Foote, 1975). Deze positie is in andere woorden een ideale positie voor de doktoren om interventies te plegen, zoals een knip zetten, de forceps gebruiken en het doen van vaginaal onderzoek. Hoe kan het dat deze positie dan nog steeds zoveel wordt toegepast. Ik ben in het onderzoek gedoken en kwam tot de volgende resultaten. Duidelijk! Posities die gebruik maken van zwaartekracht Staan, lopen en dansen Zitten De baarkruk Hurken. Hormonal Physiology of Childbearing | Transforming Maternity Care. No Benefit for Fetal ECG Monitoring During Childbirth.
Action Points Fetal electrocardiographic (ECG) monitoring used in conjunction with conventional fetal heart rate monitoring did not reduce complications, including operative-delivery rates, during childbirth.The ECG technology was designed to demonstrate fetal ECG ST-segment elevation and increased T-wave amplitude reflecting fetal acidemia. Fetal electrocardiographic (ECG) monitoring used in conjunction with conventional fetal heart rate monitoring did not reduce complications during childbirth, according to a large U.S. clinical trial funded by the National Institutes of Health.
The additional monitoring did not reduce the risk for a composite of outcomes including fetal and neonatal death, and it did not significantly impact the rates of cesarean or operative delivery, a team of investigators led by Michael Belfort, MD, PhD, of the Baylor College of Medicine in Houston, reported in the New England Journal of Medicine. "We chose the most severe outcomes to evaluate in this study. FETALNEONATAL : ADC Fetal & Neonatal Edition. Correspondence to Professor Stuart B Hooper, The Ritchie Centre, MIMR-PHI Institute of Medical Research, 27-31 Wright St, Clayton, VIC 3168, Australia; stuart.hooper@monash.edu Received 3 October 2014 Revised 27 November 2014 Accepted 1 December 2014 Published Online First 24 December 2014 Abstract Umbilical cord clamping at birth has a major impact on an infant's cardiovascular system that varies in significance depending upon whether the infant has commenced breathing.
As umbilical venous return is a major source of preload for the left ventricle during fetal life, recent experimental evidence has shown that clamping the umbilical cord severely limits cardiac venous return in the absence of pulmonary ventilation. As a result, cardiac output greatly reduces and remains low until breathing commences. Introduction Umbilical cord clamping (UCC) at birth is much more than a symbolic separation of the infant from the mother. Fetal cardiovascular function before birth Figure 1 Figure 2. Pitocin Is Not Oxytocin. “The Love Hormone”. Sounds important, no? Turns out that we know very little about the hormone oxytocin, beyond that it is incredibly relevant to multiple metabolic, behavioral, and endocrine functions. In a compelling review entitled Beyond Labor: The Role of Natural and Synthetic Oxytocin in the Transition to Motherhood, Bell et al explore the literature suggesting that, once again, we cannot outsmart, outdo, or circumvent nature with pharmaceutical products.
What is Oxytocin? One of the known roles of oxytocin is in the complex physiology of labor and birth. Perceived by the obstetrical establishment to be a “contraction chemical”, oxytocin’s effects are bodywide, and most notably, brain-based. So, when we manufacture a synthetic version of this hormone and commandeer a woman’s labor physiology, it should come as no surprise that there are unintended and poorly understood consequences.
Bell et al discuss a number of concerns related to the administration of synthetic oxytocin: The 60 Seconds That Could Make a Big Difference in Your Baby’s Health. “It’s a girl!” My midwife shouted as I inhaled sharply with sweet, sweet relief as my daughter slipped from my body into her waiting hands. I remember feeling amazed as they placed her on my chest, wondering how on earth I had ever lived without her before. Within seconds, we were mother and daughter, bonded forever. But in those brief moments of our first meeting, there was also a lot happening behind the scenes. Below my nether regions, my nurse-midwife busied herself with the process of severing the bond that had connected my baby to me for nine long months.
While I gazed in awe at my newborn baby, in a span of a few seconds, the midwife had clamped the pulsating umbilical cord with two special clamps that almost looked like scissors, one stacked on top of another to leave a small space for my husband to cut through. Before we had barely touched, we were separated and the blood supply that had been feeding, oxygenating, and nourishing my daughter, was gone. What do you think? No Cookies | dailytelegraph.com.au. How One Hospital Brought Its C-Section Rate Down Fast. NEWPORT BEACH, Calif.— Hoag Memorial Hospital Presbyterian, one of the largest and most respected facilities in Orange County, needed to move quickly. A big insurer had warned that its maternity costs were too high and it might be cut from the plan's network. The reason? Too many cesarean sections. "We were under intense scrutiny," said Dr. The C-section rate at the time, in early 2012, was about 38 percent. Within three years, Hoag had lowered its cesarean section rates for all women to just over a third of all births.
In medicine, this qualifies as a quick turnaround. Decreasing C-sections results in "better health to mothers and better health to babies and lower costs," said Stephanie Teleki, senior program officer at the California HealthCare Foundation, which helped fund the data collection and analysis by the California Maternal Quality Care Collaborative. Experts have long been troubled by the wide variation of C-sections among hospitals nationally. Focus on Physicians Dr. Dr. Continuous support for women during childbirth. Continuous support in labour increased the chance of a spontaneous vaginal birth, had no harm, and women were more satisfied. Historically women have been attended and supported by other women during labour and birth. However in many countries, as more women are giving birth in hospital rather than at home, continuous support during labour has become the exception rather than the norm.
This may contribute to the dehumanisation of women's childbirth experiences. Modern obstetric care frequently subjects women to institutional routines, which may have adverse effects on the progress of labour. Supportive care during labour may involve emotional support, comfort measures, information and advocacy. These may enhance physiologic labour processes as well as women's feelings of control and competence, and thus reduce the need for obstetric intervention. Continuous support for women during childbirth. Mobile.nytimes. Vaginal examinations: a symptom of a cervical-centric birth culture | MidwifeThinking. This post is about routine vaginal examinations (VE) during physiological birth ie. an uncomplicated birth without any medical intervention. The VE is a useful assessment in some circumstances, but it’s routine use in an attempt to determine labour progress is questionable. As birth knowledge evolves, and research challenges the current cervical-centric approach to labour progress, there is an opportunity to shift practice.
I’m hoping this post will inspire readers to reconsider their beliefs and practices regarding cervixes and VEs. History: the rise of the cervix How did we get fixated on what one small area of the body is doing during the complex and multidimensional birth process? An article by Dahlen et al. (2013) discusses the history of VEs. It seems that midwives (and others) have been performing this intervention throughout recorded history. Now: new understandings and contradictions The cervical-centric discourse is so embedded that it is evident everywhere. Summary Like this: Life in the womb (9 months in 4 minutes) HD. When and How to Push: Providing the Most Current Information About Second-Stage Labor to Women During Childbirth Education. CC.NPWF.HPoC.Report-ExecutiveSummary.2015.pdf.
CC.NPWF.HPoC.Report-ExecutiveSummary.2015.pdf. Birth from the Baby’s Perspective | MidwifeThinking. Birth from the Baby’s Perspective Edited and updated: March 2013 Picture this… A mother sits holding her newborn son on a postnatal ward during visiting time. One of her visitors reaches forward, grasps the baby by the head and pulls him out of his mothers arms leaving him dangling by his neck. Can you imagine the reaction of the mother and those around? Yet no one raises an eyebrow when this occurs during birth. If we accept that human babies are people and have feelings (both physical and emotional) why do we accept how many babies are treated during birth? A medical approach to welcoming a baby to the world Once the baby has been ‘removed’ their first minutes are spent away from their mother being subjected to assessments (abuse): This interference with the mother-baby unit can result in long term implications for bonding, breastfeeding, maternal bleeding, baby’s skin colonisation with maternal bacteria (ie. infection, gut health).
A humane approach to welcoming a baby to the world. When and How to Push: Providing the Most Current Information About Second-Stage Labor to Women During Childbirth Education. American Obstetrics in the 1950's (to receive the password to this article, simply subscribe to the newsletter: www.evidencebasedbirth.com/newsletter) - Evidence Based Birth - All about pain relief options during labour - Kidspot. Table of Content Pain considerations and variations There’s no denying labour hurts, but how you experience the pain is very individual and can even differ between previous births [1].
While some women are keen to avoid drugs or other medical interventions, others are happy to consider all available options. For a woman having her first baby, the experience of labour (and her reaction to it) is unpredictable [2]. It is therefore important to have a flexible approach when planning how you hope to manage your pain during labour. Why labour hurts Pain during labour is caused by contractions of the uterus muscles and pressure on the cervix. Stages of labour and pain Your pain relief requirements may change as labour progresses, so it’s a good idea to have an understanding of the different stages of labour: Stage one In stage one of labour your cervix will begin to dilate.
Stage two The second stage of labour starts when your cervix is fully dilated. Stage three Back to top Medical pain relief options. Cord around the neck – what parents & practitioners should know | Delayed Cord Clamping. This article shares information about the common practice of checking for a nuchal cord during the second stage of labour, and unlooping or cutting the cord – interventions that are not evidence-based and can cause birth trauma. ********Updated Jan, 2012: This article focuses on theories and evidence where routine interventions associated with nuchal cord may be the cause of iatrogenic harm in otherwise-normal birth.
This is distinct from cases where umbilical cord entanglement or cord constriction may be the cause of pathological outcomes during gestation, development, progression/descent during labour and birth. It is important women are informed about nuchal cord ‘management’ in vaginal birth and how it may affect their baby. Information in this article may assist with birth planning; promote discussion with care providers and birth support; and help to avoid iatrogenic injury. A nuchal cord is when the umbilical cord is ‘coiled’ around the baby’s neck. Read Tyler’s birth story. 8 Reasons To WAIT Before Cutting Baby's Umbilical Cord. After seeing that gorgeous, pink slippery baby being placed on your chest, the last thing on your mind is what’s going on with the cord and placenta. But there are some really big, evidence-based reasons why you need to be clear about what happens to your baby’s cord and placenta.
Delayed cord clamping (which really should be normal cord clamping, since immediate cutting is a premature act) offers some massive health benefits to your baby, but many doctors and hospitals are yet to implement delayed cord clamping as standard practice as they just don’t want to wait. Here’s why you should insist that your caregiver should wait before cutting your baby’s cord. Reason NOT To Cut The Cord #1: Your Baby Will Have 32% More Blood Volume Thats right, 32% of the baby’s volume of blood will be where it belongs – in your baby and not discarded.
This study clearly states: Reason NOT To Cut The Cord #2: Your Baby Will Have More Iron, Which May Prevent Deficiencies This study found: Evidence Based Birth Evidence for using Moxibustion to turn Breech Babies - Evidence Based Birth. Childbirth All or Nothing BBC Documentary 2015. Birth from the Baby’s Perspective | MidwifeThinking.