To eat or not to eat…That was the question for families planning a hospital birth.  When you are laboring at home or a birth center, you have the freedom to eat as your appetite dictates.  If you choose to have a hospital birth, you are at the mercy of your doctor’s orders and the nurse’s interpretation of the hospital protocol.  

"Most healthy women can skip the fasting and, in fact, would benefit from eating a light meal during labor, suggests research being presented at the ANESTHESIOLOGY® 2015 annual meeting. Improvements in anesthesia care have made pain control during labor safer, reducing risks related to eating, researchers note."

ASA Press Release, "Most healthy women would benefit from light meal during labor", October 24, 2015

For other reading,  HERE is some research I had found before this 2015 press release to make the case for eating and drinking in labor (in case you want to do more poking around the subject).

Science and the ASA catch up to Dr. Bradley:

"The research suggests that the energy and caloric demands of laboring women are similar to those of marathon runners, Harty said. Without adequate nutrition, women’s bodies will begin to use fat as an energy source, increasing acidity of the blood in the mother and infant, potentially reducing uterine contractions and leading to longer labor and lower health scores in newborns. Additionally, the studies suggest that fasting can cause emotional stress, potentially moving blood away from the uterus and placenta, lengthening labor and contributing to distress of the fetus."  

From the press release:

"Researchers said aspiration today is almost nonexistent, especially in healthy patients. In the United States, there was only one case of aspiration associated with labor and delivery between 2005 and 2013, involving a complicated case of a woman who was obese and had pre-eclampsia (a precursor to eclampsia, or high blood pressure that can lead to seizures), according to the American Society of Anesthesiology’s Closed Claims Project database. Researchers also noted that no cases of death due to aspiration were reported in the United Kingdom between 2000 and 2005, compared to 1.5 cases per 1,000 during the 1940s. They say this is likely due to advances in anesthesia care, including increased use of epidurals and spinal blocks in place of providing anesthesia through a mask over the nose and mouth. Before these improvements, women were more likely to need a tube placed in the windpipe for breathing, which potentially increased the risk of aspiration." 

What the ASA recommends:

"A light meal could include fruit, light soups, toast, light sandwiches (no large slices of meat), juice and water. Most women lose their appetites during very active labor, but can continue to drink fluids such as water and clear juices, researchers said." 

- Honey sticks.  According to honey.com, “Honey is also a rich source of carbohydrates, providing 17 grams per tablespoon, which makes it ideal for your working muscles since carbohydrates are the primary fuel the body uses for energy. Carbohydrates are necessary in the diet to help maintain muscle glycogen, also known as stored carbohydrates, which are the most important fuel source for athletes to help them keep going.” [2]

- Trail mix.  You get the nice variety of nuts, dried fruits and if you want, candy, in one bag.  I found myself picking out my favorite nuts and fruits and snacking on them – literally one or two at a time – as we got into the active phase of first stage labor.

- Protein bars or chews.  Look for bars that are low in carbs and added sugars –the key is to provide an energy boost without an energy crash afterwards. We have had students that use the “PowerBar” brand Energy Bites, as well as Gel Blasts that are bite size energy foods.

- Popsicles.  While working hard in labor, a popsicle can be refreshing.  To prevent an energy crash, look for a brand that uses natural fruit as a sweetener instead of added sugars.  Added bonus: you can also push it against the top of your palate to stimulate oxytocin production.

- Applesauce cups.  Provide potassium along with a little protein.  The nice thing about applesauce is that while some people prefer them cold, they don’t need to be refrigerated.  Again, look for naturally rather than artificially sweetened sauces.

- Soup or clear broth.  Campbell’s came out with the “Soup at Hand Cups” that are single serve, portable and microwaveable.  They were a God-send during our third birth.  The nurse didn’t want me to eat “just in case”, but she was okay with me drinking – hence, I could drink my meal and stay nourished through our 34 hours at the hospital.

The material included on this site is for informational purposes only.

I am going to direct you to THIS article about how oxytocin helps to reduce stress and promote peace.  It's no surprise that oxytocin is the same hormone that is released when we make love, arguably a great stress reliever and a promoter of peace for couples.  A lovely consequence of making love when the timing is right: welcome, baby, some 36+ weeks later!

Breastfeeding:  If you have an older sibling who is nursing, you can nurse them during labor.  Nursing stimulates the production of oxytocin, so I encourage you to be mindful of any contractions it stimulates.  You do not want to trigger an early labor, so pay attention if you feel a pattern developing and it’s not time for baby to make an appearance just yet.

Touch: one of the cornerstones of The Bradley Method® is relaxation.  Among the 11 specific relaxation techniques that we teach during the course, two of them are massage and stroking.  Even if a mother does not want to be spoken to, a Coach can use those techniques.  If she doesn’t want that either, the simple act of holding her hand is listed as a way to boost oxytocin.

Daydream:  Another relaxation technique we teach is related to daydreaming.  We ask coaches to recount a past experience or a future dream that makes mother feel like she is in her “happy place”.  It might be a trip, an experience, dreams you have about your life as a family together...anything that is calming, encouraging and would elicit a smile.

Pleasant smells:  This one has the added benefit of paying dividends at your birthplace.  One of the suggestions we make in Bradley™ class is to eat your favorite meal when you think you might be in labor.  The other one is baking some yummy treats to share with your care providers.  Hopefully both of those things will generate smells that you welcome in labor.  Either way: you are producing oxytocin, mama is well fed if it’s the beginning to have energy for the duration of labor, and your care providers get treats.  We found that feeding them kept them happy and that always made for positive birth experiences for us.

Music:  Mamas or Coaches can take the time to generate a play list to use in their birth space.  I have seen couples use a music app to choose the music for them in labor – it saved them from the planning/organizing time at the outset while still providing the music that was soothing to mama.  Find something that works for you and remember to put it on your packing list so the music makes it to your birth space. 

P.S. Doula and Music Therapist Laura Pruett offers playlist creation as a stand-alone service or as part of her doula service.

The material included on this site is for informational purposes only.

Thank you to one of my colleagues, Rachel Davis, for suggesting this topic.  

Their situation underscores the importance of having a well-thought out and written birth plan no matter what kind of birthplace you have chosen.  Wherever you are planning to give birth, Bruss and I suggest that you think about writing two birth plans.  Write one for a normal, uncomplicated birth at your chosen birth place. Also consider writing one that has your wishes written down in the event of complications, and that factors in hospital care if you are planning to birth at home or birth center..  Once you have talked these out between yourselves and your care providers, write them down and have a copy handy at all times.

- to considerate and respectful care.

- to obtain from physicians and other direct caregivers relevant, current, and understandable information concerning diagnosis, treatment, and prognosis. 

- to ask and be informed of the existence of business relationships among the hospital, educational institutions, other health care providers, or payers that may influence the patient's treatment and care.

- to make decisions about the plan of care prior to and during the course of treatment and to refuse a recommended treatment or plan of care to the extent permitted by law and hospital policy and to be informed of the medical consequences of this action.

- to be informed of any potential direct or indirect effects, risks or hazards to herself or her unborn or newborn infant which may result from the use of a drug or procedure prescribed for or administered to her during pregnancy, labor, birth or lactation.

- to be informed, not only of the benefits, risks and hazards of the proposed therapy but also of known alternative therapy.

- to be informed about how a drug or procedure may adversely affect her unborn baby, directly or indirectly, and that there is no drug or chemical which has been proven safe for the unborn child.

- if Cesarean birth is anticipated, to be informed that minimizing her intake of nonessential pre-operative medicine will benefit her baby.

- to be informed of the areas of uncertainty if there is NO properly controlled follow-up research which has established the safety of the drug or procedure with regard to its effect on the fetus and the later physiological, mental and neurological development of the child.

- to be informed of the brand name and generic name of the drug in order that she may advise the health professional of any past adverse reaction to the drug.

- to determine for herself, without pressure from her attendant, whether she will or will not accept the risks inherent in the proposed treatment.

- to know the name and qualifications of the individual administering a drug or procedure to her during labor or birth.

- to be informed whether that procedure is being administered to her because a) it is medically indicated, b) it is an elective procedure (for convenience, c) or for teaching purposes or research).

- to have her baby cared for at her bedside if her baby is normal, and to feed her baby according to her baby's needs rather than according to the hospital regimen.

- to be informed if there is any known or indicated aspect of her or her baby's care or condition which may cause her or her baby later difficulty or problems.

•    The processes contemplated by the physician as treatment, including whether the treatment is new or unusual.

•    The risks and hazards of the treatment,

•    The chances for recovery after treatment.

•    The necessity of the treatment.

•    The feasibility of alternative methods of treatment.”

• “How is (Mother’s Name) doing?  Are her vitals still within an acceptable range?”
• “How is (Baby’s Name) doing?  Are his or her vitals still within an acceptable range?”
• “Do we have to make a decision right now?  How much time do we have?”

• “What is the problem?”
• “What are the symptoms or test results causing concern?”
• “Could this be normal?”
• “What is the most likely cause?  Are there any other possible causes?”

• Paraphrase it back to ensure you understand what the recommendation is.

•  You want to listen well, and paraphrase again.  You can also ask if their opinion is based on fact or observation.

• Ask to see the insert if it is a drug and there is time to read it – you may be surprised at what is in the fine print and the care provider fail to mention.

• Side effects are very important to know, especially if it is something whose short-term or long-term effects on an unborn child or a newborn are unknown.

• Again, care providers have routines based on what their protocol is – sometimes there are other options that they don’t mention, not from malice, it could be simply because they are not accustomed to being asked for alternatives.

• Who are you talking to?  Nurses come in many varieties: a student nurse, an LPN (one year of schooling), an ASN nurse (two years of schooling), a BSN (four years of schooling).  Beyond that, how long have they been working as a nurse?  If you are talking to a doctor: are they a resident (student) doctor, or an attending (more experienced) physician?  How long have they been a resident or an attending? 

• Knowing the level of experience of the information giver is an especially important question to ask if you are in a teaching hospital.  Every family needs to make a decision regarding their comfort level with students literally practicing on you based on their individual preferences.  On a personal note, while I am all for medical students learning, when it come to my body and our child, I want a trained and experienced professional to work on us.  I am okay if a student wants to observe, however, only someone with extensive experience and knowledge is going “to do” something or administer something to us.

• In the interest of full disclosure, here are other very important questions:  1.) You want to know how they will measure the efficacy of the intervention.  2.) When you accept one medical intervention, it is likely that other interventions or compromises will follow.  If there is time, you want to hear all of the other interventions or protocol they will have to follow that may be a result of the first intervention you agree to have. 

• Back to full disclosure – there are ways to phrase things that force you to make an immediate decision.  If you ask "how will you know it's working, and what happens next" questions, it provides the opportunity for the care provider to tell you the other side of the story, or the whole story in regards to their recommendations.

 1.  If you have done your research and you have heard the benefits and the risks of a procedure or drug, and you are confident in your decision and want to refuse, hospitals have documents called “Against Medical Advice” that you can sign.  You accept the risks inherent in your decision and relieve the hospital of liability.

2.  You can ask for an Independent Patient Advocate.  This person acts as a liaison between the patient and the care providers.  It puts someone in between you and the care provider, and it is implied that they would convey information in a neutral way.  Sometimes taking away the “authority” of the person conveying the information relieves the pressure and lets a patient make a decision without feeling the pressure of “The Doctor” or “The Nurse”.

Disclaimer:  

There are two types of midwife in the United States:

**Nurse-midwives are educated and licensed as nurses first, and then complete additional education in midwifery. They are known as Certified Nurse-Midwives (CNMs). CNMs are licensed to practice in all 50 states. They are usually licensed in individual states as Nurse Practitioners (NPs).

**Direct-entry midwives are educated or trained as midwives without having to become nurses first. They may be Certified Professional Midwives (CPMs) or Certified Midwives (CMs). The legal status and requirements for direct-entry (non-nurse) midwives vary from state. They are usually licensed in individual states as Licensed Midwives (LMs) or Registered Midwives (RMs). The Midwives Alliance of North America tracks the laws and regulations in each state for direct-entry midwives.

"A midwife is…a health care provider and a doula is more of a childbirth coach. You might choose to have a midwife instead of an OB for prenatal care and to deliver your baby — midwives can deliver babies in hospitals, birthing centers or even in your home. A doula, on the other hand, doesn’t replace your healthcare practitioner but rather can add extra services, such as helping you with techniques to manage pain during labor and even providing support and help during baby’s early days." 

A midwife's main scope of practice is the health and well-being of the Mother and the Baby.  She is doing "watchful waiting" through the pregnancy and birth, ensuring that everything is proceeding and staying healthy and low-risk.  If things start to vary or complications develop, depending on the midwife and whether they are home- or hospital-based, they may encourage the family to seek co-care or transfer care to an obstetrician who is trained to manage pregnancy that is moving away from low-risk.  

The first study to compare birth outcomes between midwifery and obstetrical care was published in 1998.  Here are the conclusions:

"Among 16,924 women who planned home births at the onset of labor, 89.1% gave birth at home. The majority of intrapartum transfers were for failure to progress, and only 4.5% of the total sample required oxytocin augmentation and/or epidural analgesia. The rates of spontaneous vaginal birth, assisted vaginal birth, and cesarean were 93.6%, 1.2%, and 5.2%, respectively. Of the 1054 women who attempted a vaginal birth after cesarean, 87% were successful. Low Apgar scores (< 7) occurred in 1.5% of newborns. Postpartum maternal (1.5%) and neonatal (0.9%) transfers were infrequent. The majority (86%) of newborns were exclusively breastfeeding at 6 weeks of age. Excluding lethal anomalies, the intrapartum, early neonatal, and late neonatal mortality rates were 1.30, 0.41, and 0.35 per 1000, respectively."

~Excerpt from THIS article

Disclaimer: 

For today...another one from the archives, originally published in April 9, 2013.  Updated April 30, 2014 to include information about microbiome seeding; and a gentle cesarean checklist of options to review with your provider and prepare for a cesarean birth journey.

"The natural cesarean, or family centered cesarean, is a procedure developed in the UK which takes a “woman centered” approach to the surgery that now accounts for one third of all births in America, a cesarean. This approach to a c-section incorporates many important aspects of a vaginal birth, parent participation for one."

• Mother watches the birth of her child by having the surgical screen lowered at the time of delivery
• Baby is delivered slowly so that they can get some benefit from uterine contractions to clear fluid from the lungs and nasal passages
• Immediate skin-to-skin contact between mother and baby
• Delayed cord clamping
• Breastfeeding soon after birth
• Continuous contact between mother and baby
• "Seeding" of the mother's microbiome - read more about that HERE and HERE.

There is a difference between the microbiome of a baby born vaginally compared to a baby born by c-section (Azad, et al. 2013; Penders et al. 2006; Prince et al. 2014). During a vaginal birth the baby is colonised by maternal vaginal and faecal bacteria. Initial human bacterial colonies resemble the maternal vaginal microbiota – predominately Lactobacillus, Prevotella and Sneathia. A baby born by c-section is colonised by the bacteria in the hospital environment and maternal skin – predominately Staphylocci and C difficile. They also have significantly lower levels of Bifidobacterium and lower bacterial diversity than vaginally born babies. These differences in the microbiome ‘seeding’ may be the reason for the long-term increased risk of particular diseases for babies born by c-section.

~Rachel Reed, Midwife Thinking

• In the event of a c-section, be proactive. Mamas, we know this recommendation is not without its “icky-factor," but WOW it makes perfect sense when you think about it, and some believe it will be a standard recommendation in the future. Here goes: if your baby is born via c-section, consider taking a swab of your vaginal secretions and rubbing it on your baby’s skin and in her/his mouth. I know, ick. But when babies traverse the birth canal, they are coated in and swallowing those secretions/bacteria in a health-promoting way, so all you’re doing is mimicking that exposure. Don’t be afraid to ask your midwife or OB to help you collect the vaginal swabs—or do it yourself, if you’re comfortable. You have all the available evidence on your side.
  ~Michelle Bennet, MD, mamaseeds blog

• Less traumatic birth experience
• Moms get to *see the birth* of their baby
• Greater sense of satisfaction in regards to their birth
• Establishment of the MotherBaby dyad immediately after the birth
• Better breastfeeding outcomes

• Someone who had an emergency cesarean with a previous child and does not feel comfortable with anything other than a repeat cesarean
• A family with a known complication who wants to allow labor to start on the day of baby's choosing, but knows they will have a cesarean delivery
• A family who planned a natural birth and had their course of labor  change before they were in an emergent situation

Disclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.

What we do know and teach as part of the Bradley Method® curriculum is that water IS an effective labor tool for pain relief.  It is one of several comfort measures we discuss.  (Side note: It has many applications besides labor – think of the whole philosophy and practice of hydrotherapy.)  Personally, this is one we used effectively in all four of our labors. 

According to Penny Simkin, founder of DONA International and doula extraordinaire, “A warm shower anytime during labor is a marvelous soother and pain reliever, especially if you can sit on a stool and direct a hand-held shower head just where you want it (on your front or back). The warmth and skin stimulation reduce your awareness of the pain.” [1] (emphasis mine)

I think of it this way: Do you remember that experiment in science class when you put a tissue inside a glass, turned the glass upside down, and then put that glass in a bowl of water?  What happened if you pulled the glass straight up?  The tissue was dry!  Your vagina works in a similar way – there is air in the vagina that prevents things from going upstream unless they are forced (i.e, risk of infection from a vaginal exam).

My amazing husband/coach did his part by holding the shower head over my lower back and waving it back and forth in active labor – all four times.  I remember our homebirth best: as we got into active labor, we used a birth ball covered with a towel in the shower so I could rock through the contractions and have the water on my back.  As labor intensified, I made a nest with towels and did tailor sitting, and eventually lay down in a side relaxation position so that Bruss could focus the water on my hard-working uterus.  We labored that way until it was time to push.

Disclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.