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®.

• Did you and your partner labor well up to the point your wish list deviated? 
• Did you get to preserve some elements of your natural birth: low lights, immediate skin-to-skin, breastfeeding soon after birth? 
• Did your child benefit from delayed cord-clamping? 
• What did your Sweet Pea look like – smell like – feel like? 
• When did your eyes lock in instant recognition? 
• How did it feel to kiss this amazing creation of love and miracles? 
• When did you and your partner share a kiss of joy as you welcomed your newest family member?

A bigger selection of topics today...check out the news if you are "trying" to get pregnant, and more motivation to keep your pregnancy healthy, low-risk and as stress-free as possible.  Also, new study from ACOG that shows that there may be risks with the use of Pitocin.

“Previous research has shown that what mothers eat during pregnancy affects the health of their offspring. But now, a new study suggests that a father's diet prior to conception could also play an important role in their child's health, particularly when it comes to consumption of folate.”

"The early childhood diet and that of the mother during pregnancy determines the health of a child later life. This is the claim that the EU-funded research project Early Nutrition is trying to substantiate by the time it is due to be completed in 2017." 

“As a newborn passes through the birth canal, the microbiome of a mother’s vagina ends up in the offspring’s gut. In the first study, the team, led by Tracy L. Bale, PhD, Professor of Neuroscience in the Perelman School of Medicine, Department of Psychiatry and the School of Veterinary Medicine Department of Animal Biology at Penn, found that changes in the microbiome produced by stress in pregnant mice altered the microbe population in the newborn’s gut and correlated to changes in the developing brain.”

…

“In a parallel animal study, Bale and colleagues were looking for predictive biomarkers of maternal stress and found that a specific protein in the placenta, OGT, may have implications for brain development in offspring. The single enzyme is known as O-linked-N-acetylglucosamine transferase or “OGT,” which is important in a wide variety of regulatory functions, including development.

The researchers found that placentas associated with male mouse pups had lower levels of OGT than the placentas associated with female pups, and levels of OGT in the placenta were even lower when their moms were stressed.”

"A Swedish study of children admitted to hospital within the first year of life for lung infection has found that the increased risk this poses for later development of asthma is exacerbated by low gestational age.

Early respiratory infection and preterm birth are both known to be markers of increased subsequent asthma risk, but the relationship between these two factors has been unclear."

"These results suggest that Pitocin use is associated with adverse effects on neonatal outcomes. It underscores the importance of using valid medical indications when Pitocin is used.”

"Maternity care may play a role in determining a mother’s overall level of satisfaction during birth and months after labor. A mother’s decision on the mode of baby delivery and whether they opt for pain relief during labor will affect her overall happiness. A recent study finds a vaginal birth without epidural anesthesia increases the odds of happiness for new moms."

"For the third straight year the United States has fallen in rank in the World Health Organization’s international ranking for maternal mortality. The U.S. currently ranks 58, meaning in 57 nations women have a better chance of surviving childbirth than they do here. The U.S. fares a little better in infant mortality, ranking 34 in the world at keeping infants alive through the birth process. If this sounds outrageous, consider also that the U.S. spends more money on maternity health care than any other developed nation. Licensed midwife Sondra Londino, who recently opened Birthroot Midwifery, a private practice in the Fall Creek area, explains why out-of-hospital births have increased by 41 percent from 2004-2010 and how a midwifed home birth provides a safe and satisfying birth experience." 

“Our report suggests that progestin prophylaxis can reduce the rate of recurrent spontaneous preterm birth when barriers to care and treatment are aggressively removed and that the gestational age at initiation may affect the success of progestin prophylaxis," the authors write.”

“When people find out that I'm an at-home Dad, there's often an image that comes to mind that is not quite accurate, and is largely fueled by the "TV depiction" of stay-at-home and work-at-home Dads: A group of four or five guys standing around a park with outward-facing babies dangling from their chests. If this happens anywhere, I have not witnessed it, nor been a part of such a gathering in the past 4+ years of my career as a parent. When I have seen babies worn by other parents (and sometimes myself), the big question has always been "which way is the right way - inward or outward." It's been the subject of vigorous debate among parents, but the folks at Boba Family just might have the answer, and that answer is inward.”

“Professor Christophe Lacroix at the Institute for Food, Nutrition and Health, ETH-Zurich, led a study which found  the important good bacteria that babies receive from breast milk comes from their mothers gut. This is part of the innate support that assists babies with acquiring strong immune systems. It is also part of building colonic health and the babies gut.”

Therapy Dogs Help Students De-Stress During Finals

"Whether it's taking a break from the books, the workplace, or even the crowds at some of the country's busiest airports, four-legged friends are being used to help people feel good.

Scientifically, that's exactly what they're doing. Dr. Katherine Zupancic is a professor at SCC and says when people play with animals during stressful times, a hormone called Oxytocin is released that makes people happy."

From 1011HD http://bit.ly/1h3m6cs

"Getting pregnant may take longer for women with asthma, a new study from Denmark suggests.

Researchers analyzed information from more than 15,000 women in Denmark, including 950 who had asthma.

When asked whether they had ever spent more than a year trying to become pregnant, 27 percent of women with asthma said yes, compared to 21 percent of women without asthma."

“A recent study done in the United Kingdom and published in an American Heart Association Journal, found that by checking the placental protein levels, doctors may be able determine whether a woman will develop preeclampsia.”

“One of the main mechanisms the body uses to protect itself against cancer is to switch off defective cells by making them senescent; these cells do not die but stop dividing: their life cycle stops. A team of researchers from the Spanish National Cancer Research Centre (CNIO) in Madrid and another one from the Centre for Genomic Regulation (CRG) in Barcelona have discovered, and are publishing in two articles in the journal Cell, that this switching-off mechanism also takes place in embryos, and not as a response to cell damage but as part the normal process of development…The occurrence of senescence during embryonic development has important implications for understanding how the body grows and is shaped.”

"Chromosomal aberration screening could be done between 8 and 10 weeks in the first trimester, to screen for trisomy 13, 18, and 21. It is pretty darn remarkable that there are 4 simple blood tests capitalizing on the cell-free DNA from the fetus in that 1 tube of maternal blood, from which we can determine chromosomal aberrations and gender as well as a whole lot more in terms of sequencing the fetal genome."

...

"This is a very exciting time. Until now, we have completely relied on amniocentesis and chorionic villi sampling, which carry a significant risk, although low. And, of course, expense, all sorts of trepidation, and anxiety are factors. To be able to do this noninvasively with a tube of blood, with accuracy that is as good as amniocentesis, is pretty darn remarkable."

In most hospitals, continuous external fetal monitoring (cEFM) is part of the protocol for women having a VBAC. It can also be necessary for reasons such as induction or other medical concerns. One common misconception about cEFM is that you have to stay in bed in order to be monitored. This might be something the nurses tell you, or just something you think and the nurses don’t bother to correct you on. Either way, mobility and gravity are your best friends in labor. Though the monitors do limit you to a small radius where the cords will reach, there are many positions that can still be used for your comfort and to help labor progress. (Also, don’t forget frequent bathroom breaks!)

"Waiting only one minute to cut the umbilical cord for a pre-term baby greatly reduces complications, says Alberta Health Services.

"Since delayed cord clamping was introduced at the Royal Alexandra Hospital in 2008, fewer babies are experiencing complications related to their bowels and core temperature.

“Now, in that minute before we clamp the cord, a baby takes his first breaths and pulls in some blood from the placenta. This extra blood stabilizes the baby’s blood pressure and it is thought that the stem cells help fight infection and repair damaged cells.”

"European studies show that the delayed cord clamping also significantly reduces the risk of brain injury and hospital-acquired infection. And it cuts the need for blood pressure support in babies born between 22 and 36 weeks of gestational age."

“Evan Rachel Wood has praised her husband, Jamie Bell, for supporting her during childbirth.

“The 'Charlie Countryman' actress decided to welcome their son into the world naturally in July at their home in Los Angeles, and revealed her husband, 27, was ''wonderful'' during the experience.”

“Babies born to women who've had weight-loss surgery are more likely to be premature and to have low birth weights, a new study found.

“These pregnancies should be considered at-risk and require careful monitoring by doctors, said the researchers at the Karolinska Institute, in Sweden.

…

“But the study authors also pointed out that weight-loss surgery has numerous benefits for mothers, such as reducing the risk of diabetes, heart disease, cancer and stroke. In addition, obesity is a known risk factor for both mother and baby during pregnancy and childbirth.”

“Together with the Máxima Medical Center (MMC), Eindhoven University of Technology has developed a prototype wireless 'baby jacket' for very premature babies in intensive care units. The jacket, which includes monitoring sensors, is comfortable to wear and was designed to reduce the baby's stress and make it easier for the parents to hold their baby outside the incubator. This is expected to benefit the later development of the baby.”

“Neonatal intensive care units are full of life-saving equipment and people. It could be that the noise that the equipment makes also helps new-borns recover from serious health conditions.

…

“At the end of the study, the researchers found that babies who stayed in private rooms had less mature brains than those who stayed in an open ward. With the private rooms, the researchers are of the opinion that the noise abatement effort made things too quiet for these babies. This matches other research which indicates that babies need stimulation to thrive.”

My note: List of several common questions asked by breastfeeding mothers.  Don’t necessarily agree with some of the opinions scattered within (i.e., “follow your doctor’s vaccine schedule”) – for the most part, great stuff and lots of other external links to explore.

Cervidil is contraindicated in:

"- Patients with known hypersensitivity to prostaglandins.

- Patients in whom there is clinical suspicion or definite evidence of fetal distress where delivery is not imminent.

- Patients with unexplained vaginal bleeding during this pregnancy.

- Patients in whom there is evidence or strong suspicion of marked cephalopelvic disproportion.

- Patients in whom oxytocic drugs are contraindicated or when prolonged contraction of the uterus may be detrimental to fetal safety or uterine integrity, such as previous cesarean section or major uterine surgery (see PRECAUTIONS and ADVERSE REACTIONS).

- Patients already receiving intravenous oxytocic drugs.

- Multipara with 6 or more previous term pregnancies."

"Warnings

Women aged 30 years or older, those with complications during pregnancy and those with a gestational age over 40 weeks have been shown to have an increased risk of postpartum disseminated intravascular coagulation. In addition, these factors may further increase the risk associated with labor induction (See ADVERSE REACTIONS, Post-marketing surveillance). Therefore, in these women, use of dinoprostone should be undertaken with caution. Measures should be applied to detect as soon as possible an evolving fibrinolysis in the immediate post-partum period.

The Clinician should be alert that use of dinoprostone may result in inadvertent disruption and subsequent embolization of antigenic tissue causing in rare circumstances the development of Anaphylactoid Syndrome of Pregnancy (Amniotic Fluid Embolism)."

"Precautions

General: Since prostaglandins potentiate the effect of oxytocin, Cervidil must be removed before oxytocin administration is initiated and the patient's uterine activity carefully monitored for uterine hyperstimulation. If uterine hyperstimulation is encountered or if labor commences, the vaginal insert should be removed. Cervidil should also be removed prior to amniotomy.

Cervidil is contraindicated when prolonged contraction of the uterus may be detrimental to fetal safety and uterine integrity. Therefore, Cervidil should not be administered to patients with a history of previous cesarean section or uterine surgery given the potential risk for uterine rupture and associated obstetrical complications, including the need for hysterectomy and the occurrence of fetal or neonatal death.

2. Drug Interactions: Cervidil may augment the activity of oxytocic agents and their concomitant use is not recommended. A dosing interval of at least 30 minutes is recommended for the sequential use of oxytocin following the removal of the dinoprostone vaginal insert. No other drug interactions have been identified."

"Post-marketing surveillance:

Immune System Disorders: Hypersensitivity

Blood and lymphatic system disorders: Disseminated Intravascular Coagulation (See WarningsSection)

Reproductive system: Reports of uterine rupture have been reported in association with use of Cervidil some required a hysterectomy and some resulted in subsequent fetal or neonatal death.

Vascular Disorders: Hypotension

Pregnancy, Puerperium and Perinatal Conditions: Amniotic fluid embolism"

"Contraindications:

Hypersensitivity to dinoprostone, prostaglandins, or any components of the product; patients in whom oxytocic drugs are contraindicated or when prolonged contractions of uterus are considered inappropriate; ruptured membranes; placenta previa; unexplained vaginal bleeding during current pregnancy; when vaginal delivery is not indicated; acute pelvic inflammatory disease; active cardiac, pulmonary, renal, or hepatic disease (suppository only)."

"General advice:

Carefully examine vagina to determine degree of effacement and appropriate length of endocervical catheter to be used for application of gel (10 mm if 50% effaced, 20 mm if no effacement).

Patient should be in dorsal position for administration and remain supine for 15 to 30 min after administration of cervical gel.

Following administration of vaginal suppository, the patient should remain in the supine position for 10 min.

Following administration of the vaginal insert, the patient should remain in a recumbent position for 2 h.

Inserts do not require warming prior to administration.

Suppositories and gel must be brought to room temperature. Do not use external sources of heat (eg, hot water bath, microwave oven) to decrease warming time.

Wait at least 6 to 12 h after administration of gel before using IV oxytocin; a dosing interval of at least 30 min is recommended after removal of insert.

Do not use dinoprostone vaginal suppository for extemporaneous preparation of any other dosage forms or for cervical ripening or other indications in the patient with term pregnancy."

"May augment effect of other oxytocic agents; avoid concomitant use. For the sequential use of oxytocin following dinoprostone cervical gel administration, a dosing interval of 6 to 12 h is recommended. A dosing interval of at least 30 min is recommended for the sequential use of oxytocin following the removal of the dinoprostone vaginal insert."

"Pregnancy Category C. Contraindicated if fetus in utero has reached viability stage except when cervical ripening is indicated."

"Lactation: Undetermined."

"Special Risk Patients

Use with caution in patients with asthma, glaucoma, or raised IOP, hypotension or hypertension, CV or renal or hepatic impairment, anemia, jaundice, diabetes, epilepsy, compromised uterus, infected endocervical lesions, acute vaginitis, in patients with cases of non-vertex or non-singleton presentation, and in patients with a history of previous uterine hypertony.

-Anaphylactoid syndrome of pregnancy Intracervical placement of dinoprostone may result in inadvertent disruption and subsequent embolization of antigenic tissue, and rarely leads to development of anaphylactoid syndrome of pregnancy (amniotic fluid embolism).

- Incomplete pregnancy termination If dinoprostone pregnancy termination is incomplete, take other measures to ensure complete abortion.

- Postpartum disseminated intravascular coagulation An increased risk has been described in patients whose labor was induced by physiologic means. Women who are 30 y and older, those with complications during pregnancy, and those with gestational age more than 40 wk are at risk.

- Pyrexia Transient pyrexia (temperature elevations in excess of 2°F), possibly due to the dinoprostone effect on hypothalamic regulation, was observed in 50% of patients receiving suppositories at the recommended dosage. Temperature returned to normal on discontinuation of therapy.

- Ruptured membranes Exercise caution when administering dinoprostone cervical gel or vaginal insert to patients with ruptured membranes.

- Uterine hyperstimulation Placement of dinoprostone cervical gel into the extra-amniotic space has been associated with uterine hyperstimulation. When using the vaginal insert, if uterine hyperstimulation is encountered or if labor starts, the vaginal insert should be removed."

"Generic Name: misoprostol (MYE-soe-PROST-ol) Brand Name: Cytotec Do not take Cytotec to reduce the risk of stomach ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs) if you are pregnant. Cytotec may cause abortion, premature birth, or birth defects if taken during pregnancy. Life-threatening..."

(My note: yes - this is just how it appears - with the ellipsis there)

"Misoprostol has been assigned to pregnancy category X by the FDA. Animal studies have failed to reveal evidence of fetotoxicity and teratogenicity. In studies of women undergoing elective first trimester abortion, the administration of misoprostol 400 mcg for two doses caused increased uterine contractions and bleeding in 41% of cases, and partial or complete expulsion of uterine contents in 11% of cases." 

"Breastfeeding Warnings

Misoprostol is rapidly metabolized in the mother to misoprostol acid which is biologically active and is excreted in human breast milk. There are no published reports of adverse effects of misoprostol in breast-feeding infants of mothers taking misoprostol. The manufacturer recommends that caution should be exercised when misoprostol is administered to a nursing woman."

"What should I discuss with my healthcare provider before receiving Pitocin (oxytocin)?

You should not receive this medication if you have ever had an allergic reaction to oxytocin."

"To make sure oxytocin is safe for you, tell your doctor if you have:

genital herpes;

diabetes;

• high blood pressure;
• a heart rhythm disorder;
• a history of cervical cancer;
• a history of severe infection in your uterus;
• a history of difficult labor because you have a small pelvis;
• if you have ever had surgery on your cervix or uterus (including a prior C-section);
• if your pregnancy is less than 37 weeks; or
• if you have had 5 or more pregnancies.’’

"Tell your caregivers at once if you have a serious side effect such as:

fast, slow, or uneven heart rate;

excessive bleeding long after childbirth;

headache, confusion, slurred speech, hallucinations, severe vomiting, severe weakness, muscle cramps, loss of coordination, feeling unsteady, seizure (convulsions), fainting, shallow breathing or breathing that stops; or dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure)."

"Less serious side effects may include:

• nausea, vomiting;
• runny nose, sinus pain or irritation;
• memory problems; or
• more intense or more frequent contractions (this is an expected effect of oxytocin)."

"For Health Professionals

Hepatic side effects have included neonatal jaundice."

Read more at HERE 

"Genitourinary

Genitourinary side effects have included pelvic hematoma. Excessive doses have produced pelvic fracture, uterine hypertonicity, spasm, tetanic contraction and rupture."

"Hematologic

Hematologic side effects have included postpartum hemorrhage and fatal afibrinogenemia."

Read more HERE 

"General side effects have include low Apgar scores at 5 minutes. Fetal death has been reported."

Read more HERE 

• Is Mom okay?
• Is Baby okay?
• What are the benefits of using this drug?
• What are the risks of using this drug? (You have the right to read the drug insert for yourself in the care facility)
• What else is going to happen if we say yes? (Additional procedures, time in bed, time being monitored, position for mom, etc.)
• What are the expected results?  What if we don’t see them? 
• What are the alternatives if we choose not to do this?
• What does our intuition tell us?
• What happens if we choose to do nothing?

Excerpt:

“In the draft rules, there are a handful of tests that women need to take if she wants to have Licensed Midwifery services.  These tests (HIV, Hepatitis B, blood glucose, and blood Rh factor) are the only way for the midwife to establish that the birth will be low risk and safe for the health of the newborn and mom.  The mom-to-be can still refuse the tests, but that means she wouldn’t be able to have a Licensed Midwife present during the home-birth because it wouldn’t be possible to determine if the birth is low-risk and suitable for a home delivery.”

       ~Will Humble, Arizona Department of Health Services Director

"The ADHS is approaching birth as something that needs to be established as “low-risk” in order to proceed at home. Those of us who have had a homebirth, and the care providers who support us, have a belief that pregnancy and birth are low-risk from the outset.

The medical model wants birth to be proven safe; the midwifery model believes birth is safe until it is proven otherwise. We will continue to go around and around about what is best for mothers and babies until some sort of resolution is found between those two disconnected approaches to pregnancy and birth."

Maria Manriquez, MD, FACOG, President of ACOG Arizona: “In your explanation, that’s then inferring that you continue care of the neonate.  Does that imply that you are not providing the infant with a pediatrician or a doctor of it’s own at the appropriate time?  Correct me; I am assuming you are not implying that you then become the provider for the newborn?  You are practicing out of scope of practice! You’re not pediatricians or lay pediatricians!” 

Wendi Cleckner, CPM, points out that on page 24 of the May 24, 2013 version of the rules, the parameters of a midwife’s care for the newborn are clearly stated.  (There are 16 different clinical observations a midwife must make about the newborn, and if necessary, protocols for referrals that she will follow that are in the best interest of the baby, before she can say her role in that infant’s care is complete.)

Janice Bovee, CNM, MSN, “Midwifery, including Certified Professional Midwives and Certified Nurse Midwives, in our programs, and in our training; we include mother’s pregnancy, intrapartum care, birth, postpartum care and care of the newborn.  We are trained in that.  That is part of the midwifery model.”

Maria Manriquez, MD, FACOG, President of ACOG Arizona: “Is there any room for demonstrating actual; I know that you’re at least, that’s what Wendi has communicated, that you have to demonstrate physical competency?  So, all of the physician providers have to demonstrate competency.  So what physical competency is demonstrated by licensed midwives?  So there’s an exam, there’s NARM certification, but it doesn’t spell out specifically what and who signs off on that particular practitioner.”

Wendi Cleckner, CPM: “That’s what we’re adopting as the CPM process, is NARM.  The national organization does all of that and there is a clinical aspect; that you are in front of a qualified examiner who takes you through scenarios, you have to work on models, you have to demonstrate your clinical skills in front of them, and then they pass or fail you.”

Maria Manriquez: “We break it down even more specific.  So you can be knowledge, medical knowledge approved but not clinical, and vice versa.  So, is there an opportunity to have that information?”

Wendi Cleckner: “It’s on the website of NARM.”

Maria Manriquez: “So on the website, I could go and look you up and see that you had passed both the medical knowledge portion and the (unintelligible)?”

Wendi Cleckner: “If I did not pass all the sections, I would not be a CPM.  You would not be certified, you would not get your license, if you didn’t pass all the sections.”

Mary Langlois, CPM: “You also have to pass an apprenticeship.  So, you have a preceptor who is designated to oversee your competency.  So you’re taught by the preceptor, and the preceptor also does skills check offs and oversees you and helps you manage the deliveries.  So not only do you have to complete the clinical side, and then you would have to complete all your documentation, you take it to NARM, you take the practical examination, you pass that, then you take the written.”

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®.