Carnival of Natural Mothering
April 2014: What You Wish You Knew

Remember when you got your first positive pregnancy test? What do you wish that woman knew? Write a letter of love and encouragement to that awesome mama just starting her journey.

Birth: Find a comprehensive childbirth class that prepares you and your coach for a positive birth experience.  Connect with the ICAN group in your area and learn how to avoid a primary cesarean, because an unnecessary one can be heartbreaking.  Read up on placenta encapsulation and the postpartum period.

Breastfeeding and Parenting: Find a group of women and/or families to build your village.  The best lesson I ever got was to ask questions and take advice from the parents that are already doing/have done what you want to do.  If you want to breastfeed, don’t get advice from someone who made a different choice.  Connect with breastfeeding mothers at La Leche League or a breastfeeding support group.  If you want to babywear, don’t seek out a person who is always pushing a stroller.  Connect with a babywearing group in your area, or find a group online.  If you want to practice gentle parenting, read up on attachment parenting, and in this day and age, you can connect with the experts online.  Two of my favorites are Dr. Laura Markham and L.R. Knost. 

 

Maternity Leave: Are you going to work outside the home after a maternity leave?  Connect with the women who have made that choice and have the breastfeeding/parenting relationship you want with your child.  As far as I know, there are no support groups for that.  I have a cadre of students who have breastfed/are breastfeeding and practice attachment parenting while working out of the home full-time.  Please feel free to contact me to connect with them – several are willing to share their stories and mentor new mothers.

The decisions you can make and be in control of:

Eating a whole food, balanced diet: as much as possible, skip the processed foods.  Here’s an illustration: if your great-grandmother wouldn’t recognize it as food, do not eat it. Or, try this one: if it has more than ten ingredients, or more than one you cannot pronounce without concentrated effort, then put it back on the shelf. Check out our posts on nutrition HERE.

Exercise every day: even 10-20 minutes of cardio is better than none.  You are going to be part of an athletic event...train for it intentionally. Engage in both stamina-building and pregnancy-specific exercises to equip you for a stronger pregnancy and birth.

Avoid harmful substances: back to all those things you cannot pronounce.  Pregnancy is a great time to go green…one change at a time.  Start by looking at your personal care products…then your kitchen…then your cleaners (both at home and in your school and/or workplace).  Commit to yourself and to your baby that once a month, you will make a change that will make just one more thing in your life non-toxic.  By the time you are holding your Sweet Pea, there are at least 7-8 changes that are now healthy habits.

Choose the right care provider and birth space: if you know you want a natural birth, do your homework now. Find a care provider that supports your choice. The other thing to evaluate is whether your birth space and your birth vision are aligned.  If either of these is a NO, you can change providers and/or birth spaces – no permission slip necessary.

Pain is not normal: your body can do pregnancy pain-free. Are you uncomfortable? Look into chiropractic care, acupuncture, pregnancy massage, aromatherapy...decide what you will do to eliminate any physical pain or anxiety so you can prepare for a positive birth experience.

Pamper yourself: Say YES when it comes to being kind to yourself.  Get the pedicure, go out to dinner, eat your favorite foods that are safe in pregnancy.  You won't know when you are ready, willing or able to afford those things after your Sweet Pea arrives.  Do it now while you still only have your schedule to manage.

About the things you cannot possibly know or control...

How long you will be pregnant: you were given an estimated due date…it’s a guess at best.  It is definitely NOT an expiration date.  Each day inside you is a day your Sweet Pea is growing and preparing to live earthside.  As long as you are okay, and they are okay, inside is a great place to be.  Find ways to enjoy being pregnant, even if your due date comes and goes.

How long your labor will be: if only there was a magic wand for this!  I love Dr. Bradley’s “formula” for labor…whether you have a “sprint”, a “marathon” or something in between, your energy and your rest determine how you manage the duration of your labor.  It is intense work, it is athletic work…so eat if you are hungry and definitely sleep, even in the excitement of “I think I’m in labor!” Eat something, drink something, go for a walk, take a bath or shower to relax you…and then go to bed!  I promise you that you cannot sleep through an unmedicated labor.  Your body will wake you up when it’s time to start that cycle again…until you can’t sleep anymore because you are working.  If you slept as suggested, you will have all the energy you need to have the birth you prepared for.  If you do not sleep, then you will have to dig down even deeper to see your birth through the way you want to – totally possible as well.  If you can, just trust me and sleep – it makes for a better birth!

When you surrender control: let go, give in, and let your baby come out.  At some point, we must let go of the present and give into the primal timelessness of birth.  I know! It sounds completely hippie-hoodoo right now.  Take it from me – I am Miss Priss and Miss Always-in-control…it makes for a LONG birth.  Your body can only get down to the real work of birth when we are willing to be vulnerable, to feel, to surrender all of the control to the bigness that is birth.  Let go – even though you are not in the driver’s seat, it does happen…without you.  It is the one time in your life when you can connect to all the birthers that have gone before you.  When I would finally surrender, I would feel all the energy in the Universe around me.  That energy sustained me, it pushed through the fear of no control, to the absolute bliss of working with our baby and my body to just Be.  A little secret: you can control your breath.  Focus on making it as deep as possible…then just feel.

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®.

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?

I got a desperate text this week from an alumni mom.  A mama in her circle heard these words from her OB, “Nothing good happens after 40 weeks,” as a reason for her to schedule an induction.

All I could think, was, "WOW!" and how grateful I was that our care providers did not have that belief.

 I want to preface this post by 

1. PubMed offers an ABSTRACT of a Harvard Study that questions the current method of establishing due dates.  Their study found that white, low-risk women delivered after their due date.  The median for first time moms (primipara) was found to be 8 days past the estimated due date.  Moms in their 2+ pregnancy (multipara) were 3 days past.
2. Childbirth Connection offers an evidence-based analysis of the concerns, methods and options available to birthing families when faced with the choice of induction.

• Keep in mind that this list may also apply during labor, when you may be “failing to progress” per the expected dilation measurements.  The Bradley Method® offers the possibility that your body might have a Natural Alignment Plateau while mama and baby make their last adjustments.  This period with no measurable dilation is often followed by an acceleration of labor and the birth – more about that HERE.
  
  

1. Take the time to read the information offered by Childbirth Connection on induction – and read ALL of it.  HERE is that link again.
2. LISTEN to your care provider, which is why it is so super important to choose a provider you trust implicitly.  They are the expert in pregnancy and labor.  They have prior experience and training that leads them to make the recommendations they are making to you today.  If you know your care provider is using evidence-based practice, then you know that they are asking you to consider actions supported by research and probably not asking you to do something for their convenience.

• http://www.ncbi.nlm.nih.gov/pubmed/2342739

• http://childbirthconnection.org/article.asp?ck=10651

• http://www.utsouthwestern.edu/newsroom/news-releases/year-2004/fetal-lungs-provide-a-signal-initiating-labor-ut-southwestern-researchers-find.html

• http://www.marchofdimes.com/pregnancy/getready_atleast39weeks.html