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Sweet Pea Births

Chandler, Arizona

Sweet Pea Births

...celebrating every swee​t pea their birth

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Uterine Rupture: Assessing the Risks

Posted on April 26, 2016 at 10:18 AM Comments comments ()
Uterine Rupture: Assessing the RisksThis was in posted April 2012 - updated April 2016
Uterine rupture is a topic that came up when I was pregnant with Otter that I was not ready to allow into my consciousness until she was safely in our arms.  After enough time had passed and we have proven to ourselves that homebirth can be a safe option when a person is healthy and low risk, I am ready to write about it.   

I gave Stephanie Stanley, former facilitator of the East Valley ICAN group, byline credit for this because I am using her research from a uterine rupture presentation she did at a meeting for my post today.  ICAN, the International Cesarean Awareness Network, is a non-profit organization that strives to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, as well as educate about Vaginal Birth After Cesarean (VBAC) and options for what is called a "gentle cesarean" where the event is honored as a birth even though it's via a surgery.  ICAN’s goal is to see a healthy reduction of the cesarean rate that is patient-driven.  By providing education and support, they hope that more women making evidence based, risk appropriate childbirth decisions will lead to an overall reduction in the rate of cesareans performed.   

Uterine rupture seems to be the leading reason why care providers are hesitant to allow a mother to have a trial of labor (TOL) after a previous cesarean.  In Arizona, a licensed midwife or certified professional midwife can attend a homebirth with a mom who is striving to have a VBAC only if the mother meets certain criteria. Arizonana for Birth Options is leading a grassroots efforts to change this so that as per the ICAN vision, women living here can make evidence based and risk appropriate decisions.  They want all options to be available: for a hospital birth if mom feels that is the best option, or a homebirth if both mom and midwife agree that they are a good candidate for VBAC.   

Uterine rupture is defined as an anatomic separation of the uterine muscle with or without symptoms.  What this means for baby is that the uterus ceases to function as a sealed protective container from the rest of the blood and organs surrounding the baby.  The function of the placenta and umbilical cord may also be compromised.  Mom is subject to blood loss and shock.  A decision also has to be made about repairing the uterus or performing a hysterectomy.   

Another term used when talking about uterine rupture is “dehiscence”.  A dehiscence is the splitting or incomplete opening of the cesarean scar.  It can happen without complication for mom or baby and sometimes it is only discovered after the delivery.  It is also called a “window” by some care providers.   

As it turns out, while uterine rupture is a consideration when you are preparing for a birth after a cesarean, it's not the only one your care provider should be having a conversation about. You can read THIS post to see where the risk for uterine rupture falls in comparison to other risks of pregnancy and labor. 

So what does the research say?   

Here is the overarching conclusion: anyone can be at risk, whether you have an unscarred or scarred uterus.  At most, your risk rate is 2%.  2 percent!  Why then is it that this is such a big deal?  I believe it lies with the potentially devastating circumstance a family will find themselves in if the uterus does rupture.  While 98% of the population may have a successful VBAC, the worst case scenario of a uterine rupture is the loss of the baby and possibly a hysterectomy for mom which makes future pregnancies impossible.   Another point to ponder is that the statistics listed below are close to other statistics for labor emergencies, such as placenta accreta, placental abruption, miscarriage; for a longer list click here.   

Statistics for the risk of uterine rupture – see links at the end of this post for references: 
 VBAC: .5% - .7% 
 VBA2C: 1.7%  (vaginal birth after 2 cesareans) 
 VBAMC: 1.2%  (vaginal birth after multiple cesareans) 
 Previous VBAC: .4% - .5%  (if you had a previous successful VBAC) 
 VBAC + Augmented labor:  .9%  (stats for first attempt) 
 VBAC + Induced labor: 1%  (stats for first attempt)   

 Here is a link to the comparison of risk rates for VBAC, CBAC (a cesarean birth after a trial of labor) and ERC (elective repeat cesarean) http://www.sciencedirect.com/science/article/pii/S0002937808004213   

The risk factors when considering whether or not to do a trial of labor after a cesarean are: 
 The type of scar you have: the most favorable is a low transverse scar.  Classical T-shaped scars, vertical scars or high uterine scars are said to have a higher risk of rupture.   

 Induction of labor using cervical ripening agents, i.e., Cytotec, Cervidil: the prostaglandins that soften the cervix may also soften the scar tissue.  In addition, ripening agents can cause uterine hyperstimulation, meaning contractions that are much more intense and frequent than the uterus is designed to withstand in the course of an unmedicated labor.   

 More than one cesarean: as you can see from the statistics above, there is a slight increase of risk.   

Among factors that are disputed in medical literature are: 
 - Age of mother: if a mother is over 30 she may be considered at higher risk for uterine rupture. 
 - Obese women 
 - Size of baby: more than 8 pounds, 14 ounces 
 - Post-term baby: 40+ weeks gestation from last menses   

To compare, here are the stats and risk factors for an unscarred uterus:   “The normal, unscarred uterus is least susceptible to rupture. Grand multiparity, neglected labor, malpresentation, breech extraction, and uterine instrumentation are all predisposing factors for uterine rupture. A 10-year Irish study by Gardeil et al showed that the overall rate of unscarred uterine rupture during pregnancy was 1 per 30,764 deliveries (0.0033%). No cases of uterine rupture occurred among 21,998 primigravidas, and only 2 (0.0051%) occurred among 39,529 multigravidas with no uterine scar. 

A meta-analysis of 8 large, modern (1975-2009) studies from industrialized countries revealed 174 uterine ruptures among 1,467,534 deliveries. This finding suggested that the modern rate of unscarred uterine rupture during pregnancy is 0.012% (1 of 8,434). This rate of spontaneous uterine rupture has not changed appreciably over the last 40 years, and most of these events occur at term and during labor. An 8-fold increased incidence of uterine rupture of 0.11% (1 in 920) has been noted in developing countries. This increased incidence of uterine rupture has been attributed to a higher-than-average incidence of neglected and obstructed labor due to inadequate access to medical care. When one assesses the risk of uterine rupture, this baseline rate of pregnancy-related uterine rupture is a benchmark that must be used as a point of reference.” 

If you choose to have a VBAC, or realistically for any woman in labor since the statistics show she has a slight risk, here are the signs that may help you recognize that a uterine rupture is occurring or may have occurred: 
 - Excessive vaginal bleeding 
 - Extreme pain between contractions – these may or may not be felt through an epidural block, though due to severity of pain it’s possible they may be felt 
 - Contractions that slow down or become less intense 
 - Abdominal pain or tenderness 
 - Baby’s head moves back up the birth canal 
 - Bulge in the abdomen, bulge under the pubic bone, or pressure on the bladder where the baby’s head may be coming through the tear in the uterus 
 - Sharp onset of pain at the site of the previous scar 
 - Uterus becomes soft 
 - Shoulder pain 
 - Heart decelerations in the baby 
 - Maternal tachycardia (rapid heart rate) and hypotension (low blood pressure)   

 If you have a true uterine rupture, then an emergency cesarean will be required.  A Chandler doctor told the ICAN group that the care provider has 5 – 7 minutes to get the baby out safely, although in reading for this post I saw some estimates as 10 – 37 minutes.    

According to a 2010 National Institutes of Health study, there have been no maternal deaths in the US due to uterine rupture. Overall, 14 – 33% will need a hysterectomy.  6% of uterine ruptures result in perinatal death, and for term babies this risk was put at less than 3%. **   

 If you do have a uterine rupture, it will have an effect on your future pregnancies.  Each cesarean a mother has increases the risk for future complications of cesarean surgery.  If you have a hysterectomy, you will not be able to carry any more children.  In today’s medical climate, a uterine rupture will most likely result in all future pregnancies being delivered via repeat cesarean.   

 There are a lot of points to ponder as a new mom or as a mom considering a VBAC.  Our Bradley® mantra is: Healthy Mom, Healthy Baby.  We teach that as long as you make all your decisions with those two goals in mind, you are likely to make the choices that have a positive outcome for both Mom and Baby. 

 What are your thoughts on VBAC and/or uterine rupture?   

 **NOTE: Stephanie’s presentation called out these statistics as inflated as the Landon study (2004) included women who had pre-labor stillbirths included in the statistics.  IN other words, women whose babies had passed away before labor and still delivered via VBAC rather than choosing a repeat cesarean were counted in the perinatal death statistics.  Please read Henci Goer’s analysis for more information   

 For the resource list, click here

 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. 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®.    

Bradley Method classes offered in Arizona: convenient to Chandler, Tempe, Mesa, Gilbert, Ahwatukee, Scottsdale, Phoenix and Payson, Arizona



In Their Own Words: Annika's Story

Posted on April 15, 2016 at 4:10 AM Comments comments ()
April is Cesarean Awareness Month.  As such, the blog topics this month will focus around cesarean birth journeys, and options that cesarean birth warriors have for subsequent pregnancies.  

If you would like to submit your story for our In Their Own Words series, please send your submission to krystyna{at}sweetpeabirths{dot}com.

Here is Annika's story of her primary cesarean, and her VBAC journey with her second child:

When you are pregnant with your first child you have all these wonderful naive concepts about birth…well, at least I did. Not to say I had a traumatic birth with my first child, but I would say it definitely was a sobering lesson for my husband and I.
 
Our plan was to have Landan in a birthing center with minimal intervention and in a birthing tub. The entire idea of a water birth and a welcoming atmosphere to me was literally heaven and I would dream about it almost daily. At our 39 week check up our midwife seemed a bit puzzled when she was examining my belly and feeling around for Landan's position and promptly concluded after a ultrasound that he was in fact breech and very comfortably nesting in my right rib cage. So with a referral in hand and a last minute appointment with Dr. Medchill we made our way to his office for another ultrasound to determine if I was a good candidate for an external cephalic eversion (aka, external flipping or rotating of the baby).
 
Much to our delight, Dr Medchill concluded that there was sufficient fluid surrounding Landan and the umbilical cord was not wrapped around his neck. So off we were to the OB Triage at St Joe's to attempt flipping Landan with our bags packed "just in case." While the idea of externally having my baby flipped was not appealing, I really didn't have a whole lot of time to really understand the gravity of what I was about to experience, nor do I think I would have cared to be honest.
 
I had my mind made up that this was going to work and I was going to get my beautiful peaceful water birth I had been dreaming about for 9 months. With my husband sitting at my head, Dr Medchill on my right side pushing Landan's head and upper body, and a head resident pushing Landan's legs and butt, they attempted 4 times to flip Landan with no avail. My son was perfectly comfortable where he was at, and no one was going to convince him to move otherwise. At this point, my husband and I had been dealing with this ordeal all day and both of us were so incredibly burned out. I was shaking thanks to the muscle relaxers they gave me so they could perform the procedure and I didn't even want to dare to think about how sore my belly was going to be once the pain medication wore off. So, seeing our exhaustion, Dr Medchill offered to perform a cesarean birth within the hour.
 
Looking back on it now, I am actually very grateful for his willingness to help us in the midst of our exhaustion. Let me be clear, he was not pushy by any means and if you have ever encountered Dr. Medchill he is the most kind, but honest, human being on this planet. In his professional opinion especially since I had showed no sign of labor, my cervix was completely shut, minimal effacement, and Landan was definitely not going anywhere from his comfy spot, the chances of my body kicking into natural labor and Landan flipping and descending through the birth canal was really minimal.
 
Since I had never had a vaginal birth to begin with, I also had what the medical community deems as an "untried pelvis," which essentially means no baby has ever passed through. Which can diminish your chances of having a successful natural breech birth even farther.
 
So, my husband and I decided to go for the compromise and I was prepped for surgery before the ink was dry on the consent papers. Looking back on it now, I'm actually incredibly grateful for how quickly they moved as my husband and I weren't really given the chance to think too much about what was going on. The cesarean birth, from what I remember, was rather uneventful. I remember being extraordinarily cold, and feeling very alienated being so exposed on the table, but the staff was really pleasant and made me feel comfortable.
 
Once Landan was born he was quickly cleaned, weighed, and swaddled, and brought over to me where we snuggled our heads together for a fleeting moment. My husband was allowed to take him from there to the OB Triage area to have skin-to-skin contact while I was being put back together. Granted, I would have loved to have that contact with Landan myself, but stepping back from that, it really was a special time for Danial and Landan. They definitely formed an unbreakable bond and for that I am absolutely thankful for. That was such a special gift that Danial was able to have with Landan and I wouldn't take that away from him ever.
Fast forward 5 months and we were a busy family with a new(Ish) baby still taking over our house. Since having Landan I hadn't really thought much about his delivery or the ordeal much as I was happy to have my son earthside safely. It was when I found out I was pregnant with our second child that month that my feelings and emotions about Landan's delivery and my upcoming delivery would soon start to bring to the surface all sorts of emotions.
 
Luckily for us, we decided to stay with Dr. Medchill and continue care through him as he was most familiar with us, and our previous experience with him was really outstanding. He didn't hesitate when I asked if I had the option of attempting a normal VBAC and said that I was a really good candidate and that he actually would encourage me to at least try.
 
Let me tell you, that was music to my ears! But at the same time, the question in my head was "what exactly am I going to expect?" I couldn't have the water birth that I had fantasized about during Landan's pregnancy, and I was definitely not going to get a very birth center like atmosphere in the hospital, so what exactly COULD I expect?
 
That's where getting involved with the ICAN chapter in Phoenix really helped me wrap my head around my options but also internally deal with some unresolved feelings from Landan's delivery that I didn't even know I had. Also, getting involved with ICAN really gave me confidence to ask questions that I didn't even know were subjects I could ask!
 
For example, I had no idea that I could ask to have intermittent monitoring which would allow me to get in and out of the shower along with walking freely without being attached to a machine all the time. So armed with information, my husband and I navigated the months leading up to Adaline's birth with optimism and trust in our care provider that we could have a fair trial of labor.
 
I'm not going to lie, while we had an amazing support group around us from our care provider, to our doula, to our family, there was some SERIOUS fear in me of the entire process. No matter how you look at it, the incision is always going to be there. It doesn't go away and that doubt of whether or not that area will be able to withstand labor and birth is constantly lingering no matter how many statistics you look at of the success of VBACs.
 
I can say with confidence that there were MANY times where I just wanted to schedule a cesarean birth and go with what I knew and could expect. That is so much less scary then embarking on the marathon of labor and delivery where you have no idea what to expect. But, there was a really large part of me that just really wanted to experience the beauty of labor and be able to say that I could do it on my own.
 
So, I stuck to my guns and kept drawing from my support group of my husband, my doula, and my care provider. Much to my delight, on October 1, 2014 my water broke (which is definitely not a glamorous experience like Hollywood claims it is!!) and labor started with gusto about an hour later. My husband, doula and I made our quick exit to the hospital as my contractions were coming on with force and relatively quickly.
 
After a marathon of 17 1/2 hours of hard, active labor, my daughter was born on October 2, 2014 and was the most beautiful VBAC baby I could ever ask for. She absolutely made me work for my VBAC and I truly couldn't have done it without my doula and my husband, who stayed up with me the entire night going between the shower, birthing ball, holding the puke bin between contractions, making sure I drank water, and listening to me when I was so tired that I could feel my body giving in after 15 hours and asking for an epidural simply so I could take a 30 min power nap.
 
I have clients that ask me all the time how I was able to get through that VBAC and it’s really plain and simple to me. There is no part of me that hesitates when I say that I absolutely drew from the strength of my husband and my doula the entire time. Having my support group really helped me get through the toughest parts of that labor and then also being at peace with getting an epidural and taking a nap. When it boils down to it, that's what my body needed and having my support group there allowed me to listen to my body.
 
There is nothing I regret from Adaline's birth and in a way it was so healing for me and resolved so much self doubt from Landan's birth that I didn't even know existed in me until I was faced with the option of having a normal VBAC.

Now we are weeks away from meeting #3 and my husband and I feel so comfortable and armed with such confidence that we do know our options and are going into this second vaginal birth. I know, and for the first time, feel absolutely confident in my body; that it knows what to do and I also know how to listen to it as well. We have moved to a different state so having to switch providers was nerve racking until my husband and I really sat down and realized that we were completely confident with the criteria that we wanted and were setting for ourselves and also that we would find a care provider who was just as amazing as Dr Medchill was.
 
Luckily for us, we did find an amazing care provider and he is definitely on the same page as we are with this delivery. My hope and prayer for every single mother going through her VBAC whether it be after one or multiple cesarean births is that you really find your voice and find your support. I know that's what helped me navigate this incredible journey that I've been on the past 3 1/2 years and I only can hope that every single mother finds that strength as well.

Photographer Name: Allie Hannah Photography

Henna: Pheobe Sinclair 

Disclaimer: 
The material included in this video is for informational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The viewer 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 and video contain information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained in this video and on our blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.
 
 Bradley Method® natural childbirth classes offered in Arizona: convenient to Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson


 

Info Sheet: Vaginal Exams

Posted on March 4, 2016 at 2:01 PM Comments comments ()
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson
Pelvic or Vaginal Exam during Pregnancy (3rd Trimester)

According to Mayo Clinic, “as your due date approaches, your prenatal visits might  include pelvic exams. These exams help your health care provider check the baby's position and detect cervical changes.”


*History

Pelvic examination during pregnancy is used to detect a number of clinical conditions such as anatomical abnormalities and sexually transmitted infections, to evaluate the size of a woman’s pelvis (pelvimetry) and to assess the uterine cervix so as to be able to detect signs of cervical incompetence (associated with recurrent mid-trimester miscarriages) or to predict preterm labour (see Section 11.3).

In an RCT that assessed the relationship between antenatal pelvic examinations and preterm rupture of the membranes (PROM), 175 women were assigned to no examinations and 174 women were assigned to routine digital pelvic examinations commencing at 37 weeks and continuing until delivery.233 In the group of women who had no pelvic examination, ten women developed PROM (6%) compared with 32 women (18%) from the group of women who were examined weekly. This three-fold increase in the occurrence of PROM among women who had pelvic examinations was significant. 

Based on the above study the NCBI concluded, “Routine antenatal pelvic examination does not accurately assess gestational age, nor does it accurately predict preterm birth or cephalopelvic disproportion. It is not recommended.” 

Another study completed by the NCBI concluded, “In patients with a US-documented viable pregnancy, the pelvic examination did not contribute to the patient's immediate obstetric treatment. Occult cervical pathogens may be present in these patients.” 

Sources:

*PROS

Vaginal Exams can possibly measure:


  • Cervical Dilation
  •  Cervical Ripeness
  • Cervical Effacement
  •  Station of baby (position in relation to pelvis -5 to +5)
  • Position of the baby (anterior vs. posterior)
  • Position of the cervix
  • May find cervical anomalies, like early dilation and effacement, so that appropriate changes can be made to the woman's care, including bedrest, hospitalization, tocolytics, etc.
  • May stimulate the cervix so that a medical induction does not become "necessary"



*CONS

  • Increased risks of infection, even when done carefully and with sterile gloves
  • Increased risk of rupturing the membranes
  • May stimulate the cervix prematurely
  • Information collected does not accurately predict when labor will begin and may excite or disappoint women unnecessarily 

Sources:

*Links to explore

Pelvic Exams Near Term: Benefit or Risk? Talking to Mothers About Informed Consent and Refusal

Premature rupture of membranes at term. Retrospective study of 88 cases

Chorioamnionitis in the delivery room

Bacterial vaginosis and intraamniotic infection

Premature rupture of the membranes and ascending infection

Did you have vaginal exams in your third trimester before your labor started? Thoughts?
Please leave us a comment - it will be moderated and posted. 
 

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®.

Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson

Q&A with SPB: Healthy Pregnancy How-to

Posted on March 17, 2015 at 4:31 AM Comments comments ()
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson
Today's VLOG is all about the things that you *can* control in the very unplannable process of pregnancy, labor, birth and the childbearing year.











LINKS

What can you control?
1. Pay attention to your nutrition
This is just as important for the father as it is for the mother.  A better diet creates higher quality sperm, and a well-nourished mother can feed her growing embryo-fetus-baby as it develops from zygote stage through pregnancy.  A breastfeeding mother is also growing her infant's brain - mindful nutrition is just as important after the Birth-Day.

HERE is the pregnancy nutrition program that we teach in The Bradley Method®.

2. Engage in an exercise program
Your ability to give birth does not hinge on whether or not you are an exercise fanatic before you conceive.  A mother who wants to prepare her belly, back and bottom to give birth can follow a pregnancy-specific exercise program. Even doing a few minutes a day of this low-impact, low-stress program can be a game-changer for mamas and their overall strength as they go into their labor.  


 
What can you influence?
1. Your experience
You have the responsibility to choose the right care provider and the right birth setting for you.  If you have a nagging feeling that persists, or if you see/hear/feel red flags at your prenatal appointments that your provider is not right for you, GO WITH IT.  Believe in yourself and your instinct.  Ask people you respect and who felt supported in their births who they chose and why...and then, maybe take a risk! Go on some interviews to see if maybe you want to make a switch.

2. Relaxation and Pain Coping
We do not know what kind of labor card you are going to draw.  What we do know is that all labors and births can benefit from mindfulness.  Whether you have a natural birth, a cesarean birth, or anything in between, there is a surrender.  There is a point when you will have to dig deep and say YES to the journey that you are on. 

There are many ways to prepare for your journey - HERE is an info sheet that explores the variety of classes available to birthing families.

What is part of the journey?
The rest of your story is entirely up to your baby, your body, and The Fates.  A story is about to unfold - and what a story it will be.  However you birth, that day is one day in the rest of your lives as a family.  Be open to the experience, look for the joys, and also watch for the surprises.  

It is in the unexpected and the trials that growth and transformation happen...a transformation that is necessary as we experience a rite of passage.  Before children, you are you.  After they are in your lives, you are now Mother, Father, or which ever name you choose for yourself.

I wish you a childbearing year that surprises you, grows you, and leads you to discover more about yourself than you knew when you started.



Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, PaysonDisclaimer: 
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®.




Warning Labels: Epidural Drugs

Posted on May 23, 2014 at 3:22 PM Comments comments ()
In light of a research study published this week, we are highlighting this blog post today, originally written on May 28, 2013.

"Mainly, in all of the groups of labor pain medications and delivery method, we found that mothers who received labor pain medications were 2-3 times more likely to report [delay in the onset of lactation] DOL compared to mothers who did not use labor pain medications and delivered vaginally."

As stated below, this information is shared in the interest of true informed consent.  If a mother adds another piece to the puzzle, she may decide to choose other pain relief tools aside from pain medication, or do everything to delay pain medication as long as possible in order to give her and her baby their best opportunity to get breastfeeding off to a good start.

Bradley Method classes offered in Arizona: Chandler, Tempe, Mesa, Gilbert, Scottsdale, Ahwatukee, PaysonMay 28, 2013:
I am sharing the information below in the interest of furthering our goal that all our students have true informed consent: knowing all the benefits and risks of a drug or procedure.  It is very rare for anyone to read the drug information insert that comes in all drug packages.  To save you time and squinting, we are doing a “drug warning labels” series for the most commonly used drugs during labor and birth.  There will be two more installments in this series.  Next week we will look at the drugs used for induction, and we will conclude with drugs used for augmentation of labor.

We are passionate about helping families have their Best Possible Birth.  By that we mean the path that leads that individual family to a Healthy Mom, Healthy Baby outcome.  We want families to have a toolbox full of tips and techniques that help them manage the ebb and flow of labor.  We want them to be comfortable with the path of a normal, low-risk labor.  We want them to have true informed consent by having an open line of communication with their care providers.

Why do we spend time and energy preparing couples for natural birth, even when some of them will end up choosing an epidural, or maybe needing a cesarean for their Healthy Mom, Healthy Baby outcome?  We know that the longer drugs can be delayed or avoided completely, the less likely it is that mother and baby will be exposed to drugs that have never been proven safe for mother and baby.  As one of my favorite class handouts says, “When used wisely and at an optimal time, an epidural can give a laboring woman much needed relief and sleep.  But if you are not prepared for some of the risks, you may end up wishing you had known a little more.”  (read in more detail about epidurals HERE and HERE)

Unfortunately, some families don’t know the side effects or possible complications of the drugs that are used in childbirth today.  We assume that since they are offered, they must be safe.  After all, our care provider would not purposely put us in harm’s way, right?

Did you know that most drugs used in childbirth is used “off-label”?  There is no drug that has been proven safe for childbirth – you can’t run a control study on pregnant women by allowing some to be drug-free and then having others use the drug.  It would be highly unethical as the difference in outcomes might be devastating to the women and children involved.

In today’s post, I have pulled out five of the most common drugs used for epidural anesthesia.  I am not passing judgment on families that choose an epidural.  There are definitely times when the benefits outweigh the risks.  Each family has to make the choice that is right for them.

To be clear – we are not anti-care provider or anti-drug.  We are grateful for modern medicine that saves lives in circumstances when Mother Nature needs help.  It exists for a reason, and we are thankful for the opportunity to meet all the Healthy Moms and Healthy Babies when we hold a class reunion.

Please read and consider this information as you prepare for the birth of your baby.  I included the link to find the complete drug label on-line.  Everything underneath the drug name is in quotations because I *literally* pulled it off the label available online and onto this entry.

LIDOCAINE: Category B
“Lidocaine readily crosses the placental barrier.”

“Systemic toxicity may result in manifestations of central nervous system depression (sedation) or irritability (twitching), which may progress to frank convulsions accompanied by respiratory depression and/or arrest.” 

“The adverse experiences under Central Nervous System and Cardiovascular System are listed, in general, in a progression from mild to severe.”

“Central Nervous System: CNS reactions are excitatory and/or depressant and may be characterized by light-headedness, nervousness, apprehension, euphoria, confusion, dizziness, drowsiness, tinnitus, blurred or double vision, vomiting, sensations of heat, cold or numbness, twitching, tremors, convulsions, unconsciousness, respiratory depression and arrest. The excitatory reactions may be very brief or may not occur at all, in which case, the first manifestation of toxicity may be drowsiness, merging into unconsciousness and respiratory arrest.”

“Cardiovascular System: Cardiovascular reactions are usually depressant in nature and are characterized by bradycardia, hypotension and cardiovascular collapse, which may lead to cardiac arrest.”

BUPIVACAINE: Category C
“Local anesthetics rapidly cross the placenta, and when used for epidural, caudal, or pudendal block anesthesia, can cause varying degrees of maternal, fetal, and neonatal toxicity.”

“Maternal hypotension has resulted from regional anesthesia. Local anesthetics produce vasodilation by blocking sympathetic nerves. Elevating the patient’s legs and positioning her on her left side will help prevent decreases in blood pressure. The fetal heart rate also should be monitored continuously and electronic fetal monitoring is highly advisable.”

“Epidural, caudal, or pudendal anesthesia may alter the forces of parturition through changes in uterine contractility or maternal expulsive efforts. Epidural anesthesia has been reported to prolong the second stage of labor by removing the parturient’s reflex urge to bear down or by interfering with motor function.   The use of obstetrical anesthesia may increase the need for forceps assistance.”

“The use of some local anesthetic drug products during labor and delivery may be followed by diminished muscle strength and tone for the first day or two of life. This has not been reported with bupivacaine.”

CLONIDINE: Category C
“Clonidine Hydrochloride Injection (epidural clonidine) is not recommended for obstetrical, postpartum, or peri-operative pain management.  The risk of hemodynamic instability, especially hypotension and bradycardia, from epidural clonidine may be unacceptable in these patients.  However, in a rare obstetrical, post-partum or peri-operative patient, potential benefits may outweigh the possible risks.”

“Clonidine readily crosses the placenta and its concentrations are equal in maternal and umbilical cord plasma; amniotic fluid concentrations can be 4-times those found in serum.  There are no adequate and well-controlled studies in pregnant women during early gestation when organ formation takes place.  Studies using epidural clonidine during labor have demonstrated no apparent adverse effects on the infant at the time of delivery.  However, these studies did not monitor the infants for hemodynamic effects in the days following delivery.  Clonidine should be used during pregnancy only if the potential benefits justify the potential risk to the fetus.

“Labor and Delivery:  There are no adequate controlled clinical trials evaluating the safety, efficacy, and dosing of clonidine in obstetrical settings. Because maternal perfusion of the placenta is critically dependent on blood pressure, use of clonidine as an analgesic during labor and delivery is not indicated (see WARNINGS).”

“Nursing Mothers:  Concentrations of clonidine in human breast milk are approximately twice those found in maternal plasma.  Caution should be exercised when clonidine is administered to a nursing woman.  Because of the potential for severe adverse reactions in nursing infants, a decision should be made to either discontinue nursing or to discontinue clonidine.”
 
FENTANYL: Pregnancy Category C
Labor and Delivery
“Fentanyl readily passes across the placenta to the fetus; therefore, DURAGESIC® is not recommended for analgesia during labor and delivery.” 

“Serious or life-threatening hypoventilation may occur at any time during the use of DURAGESIC® especially during the initial 24-72 hours following initiation of therapy and following increases in dose.”

“Respiratory depression from opioids is manifested by a reduced urge to breathe and a decreased rate of respiration, often associated with the “sighing” pattern of breathing (deep breaths separated by abnormally long pauses). Carbon dioxide retention from opioid-induced respiratory depression can exacerbate the sedating effects of opioids. This makes overdoses involving drugs with sedative properties and opioids especially dangerous.”

SUFENTANIL: Pregnancy Category C
“Skeletal muscle rigidity is related to the dose and speed of administration of sufentanil. This muscular rigidity may occur unless preventative measures are taken (see WARNINGS).”

“Decreased respiratory drive and increased airway resistance occur with sufentanil. The duration and degree of respiratory depression are dose related when sufentanil is used at sub-anesthetic dosages. At high doses, a pronounced decrease in pulmonary exchange and apnea may be produced.”

"There are insufficient data to critically evaluate neonatal neuromuscular and adaptive capacity following recommended doses of maternally administered epidural sufentanil with bupivacaine. However, if larger than recommended doses are used for combined local and systemic analgesia, e.g., after administration of a single dose of 50 mcg epidural sufentanil during delivery, then impaired neonatal adaption to sound and light can be detected for 1 to 4 hours and if a dose of 80 mcg is used, impaired neuromuscular coordination can be detected for more than 4 hours."

"The use of epidurally administered sufentanil in combination with bupivacaine 0.125% with or without epinephrine is indicated for labor and delivery. (See INDICATIONS AND USAGE and DOSAGE AND ADMINISTRATION.) Sufentanil is not recommended for intravenous use or for use of larger epidural doses during labor and delivery because of potential risks to the newborn infant after delivery. In clinical trials, one case of severe fetal bradycardia associated with maternal hypotension was reported within 8 minutes of maternal administration of sufentanil 15 mcg plus bupivacaine 0.125% (10 mL total volume)."

DEMEROL: Pregnancy Category: B; D if used for prolonged periods or near term
“Lactation: excreted in breast milk”

Side effects: “Nausea, vomiting, constipation, dry mouth, flushing, sweating, lightheadedness, dizziness, drowsiness, and pain/redness at the injection site may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly… Tell your doctor right away if you have any serious side effects, including: slow/irregular/fast heartbeat, mental/mood changes (e.g., confusion, hallucinations, nervousness), numbness, shakiness (tremors), trouble urinating, severe stomach/abdominal pain, change in the amount of urine.  Get medical help right away if you have any very serious side effects, including: slow/shallow breathing, fainting, seizures.”

“Before using this medication, women of childbearing age should talk with their doctor(s) about the risks and benefits. Tell your doctor if you are pregnant or if you plan to become pregnant. During pregnancy, this medication should be used only when clearly needed. It may slightly increase the risk of birth defects if used during the first two months of pregnancy. Also, using it for a long time or in high doses near the expected delivery date may harm the unborn baby. To lessen the risk, use the smallest effective dose for the shortest possible time. Tell the doctor right away if you notice any symptoms in your newborn baby such as slow/shallow breathing, irritability, abnormal/persistent crying, vomiting, or diarrhea."

"This drug passes into breast milk and is unlikely to harm a nursing infant. Consult your doctor before breast-feeding.”


This concludes the highlights I pulled out from the drug inserts.  I encourage you to click on the links and read the whole insert for yourself.  Going in with all the information may help you make the right decision for your family.  

I want to re-iterate that our perspective (Krystyna & Bruss) is that drugs are a tool, to be used wisely and at the optimal time, i.e., when the benefits outweigh the risks.  If you are going to use any of these as a tool, then educate yourselves on dosage.  You can ask questions like, "Is mom going to get the suggested dose all at once or over a time period?"  "What can we do if she needs more than the suggested dose?"  "Are there any other options?"

We have had students use an epidural as a tool after a prolonged and/or especially painful labor.  The epidural provided the rest and/or relief they needed, and some of them went on to have a quick progression to second stage and a vaginal birth.  Their births are no less "Bradley" than our mothers who had epidural-free births.  All the couples used their communication skills to make the Healthy Mom, Healthy Baby choice for their family.  

It all boils down to the same question, "Which choice is right for our family in the unique instance of our birth?"  When you choose with a Healthy Mom, Healthy Baby filter, you can help clarify which choice works for you.

Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, PaysonDisclaimer: 
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®.



Information Sheet: Non Per Os

Posted on September 24, 2013 at 1:51 AM Comments comments ()
Info Sheet: NPO non per os nil by mouthRestricting food and drink is still a common practice in many hospital settings.  Here is our presentation of the information so you can make an informed decision for your labor:

Definition:  Non Per Os or Nil By Mouth
From Wikipedia [1]:
Nil per os (alternatively nihil/non/nulla per os) (NPO) is a medical instruction meaning to withhold oral food and fluids from a patient for various reasons. It is a Latin phrase which translates as "nothing through the mouth". In the United Kingdom, it is translated as nil by mouth (NBM).

Typical reasons for NPO instructions are the prevention of aspiration pneumonia, e.g. in those who will undergo general anesthetic, or those with weak swallowing musculature, or in case of gastrointestinal bleeding, gastrointestinal blockage, or acute pancreatitis. Alcohol overdoses that result in vomiting or severe external bleeding also warrants NPO instructions for a period.

When patients are placed on NPO orders prior to surgical general anesthesia, physicians would usually add the exception that patients are allowed a very small drink of water to take with their usual medication. This is the only exception to a patient's pre-surgery NPO status. Otherwise, if a patient accidentally ingested some food or water, the surgery would usually be canceled or postponed for at least 8 hours.”

*History
Why was it adopted in labor?  What was it supposed to treat? 
Restricting food and drink was supposed to prevent Mendelson’s Syndrome.  It is a condition…it is a theory that there is an increased risk of the stomach contents entering the lungs…here is a little history from About.com [2]:
“In 1946 Dr. Curtis Mendelson hypothesized that the cause of pneumonia following general anesthesia was aspiration of the stomach contents, due to delayed gastric emptying in labor. He noted that food could be vomited 24-48 hours after being eaten. Dr. Mendelson experimented on rabbits to examine the effects of content in their lungs. Aspiration (taking the particles into your lungs) of undigested food could cause obstruction, but not aspiration pneumonia, and no deaths were due to aspiration of fluids with a neutral pH. The rabbits only died when they aspirated materials containing hydrochloric acid. He said by forbidding food and drink in labor you could reduce stomach volume, thereby decreasing the risk of maternal problems from acid aspiration while under general anesthesia. We also found that there were two factors that increased the risk of maternal problems:


    • A volume of an aspirate of 25+ mm
    • A pH of 2.5 higher (biggest problem)

However, in the 40's and 50's general anesthesia was used much more often for labor and delivery. For example, most forceps were done under general anesthesia. Gases were given with a face mask, often opaque, which hampered the anesthesiologist's view of the airway. Dr. Robert Parker, in 1950, largely blamed aspiration on poor anesthetic technique and poor quality of the practitioners.


Has it been effective: as in, has the incidence decreased or has a problem been solved as a result of the intervention/procedure/test?
From About.com [2]
“The risks of aspiration are only a problem when general anesthesia is used (3.5-13% of cesareans), and the technique has improved. Anesthesiologists now have more quality control.

So the two solutions that have been the most popular have been the IV and antacids before a cesarean surgery.

IV fluids are not always reasonable solution to hydration problems, as they have problems of their own: over load, closer monitoring of intake and output, hyperinsulinism in infants after 25 g of glucose, and the salt free solutions can result in serious hyponatraemia in mom and baby. And the antacids are usually given in the quantity of 30 mm, a volume known to increase the risks of aspiration pneumonia.

We also know that restricting food in labor can cause problems of its own. Besides the stress factors, restricting intake during labor can cause dehydration and ketosis.”

*Pros and Cons
Pros:
Theoretically: if you have an empty stomach, you are easier to treat.  In reality: very hard to justify one.  The idea of an “empty stomach” is a fallacy, and anesthetic techniques and training are vastly improved since the initial hypothesis about the link between aspiration and pneumonia in the 1950’s.  You have to evaluate how you feel about this statement:  “Labor is not an illness to be treated – it is a natural event that needs to be supported.”

Cons:
  • Stress factors caused by denial of food and water
  • Dehydration
  • Ketosis
  • Longer labor: women who are allowed to eat and drink to comfort in labor have shorter labor (by an average of 90 minutes)
  • May need augmentation with Pitocin
  • May require more pain medications
  • In one study, babies had lower apgar scores than of those in the control group. [2]

Most telling is this practice guideline published by the anesthesiologist in 2007.  The folks doing the anesthesia are saying it is safe for low-risk mothers to eat and drink in labor, even with anesthesia, and go so far as to make recommendations about the type of foods that can be eater:

From the Practice Guidelines from An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia [3]
II. Aspiration Prevention
Clear Liquids.
There is insufficient published evidence to draw conclusions about the relationship between fasting times for clear liquids and the risk of emesis/reflux or pulmonary aspiration during labor. The consultants and ASA members both agree that oral intake of clear liquids during labor improves maternal comfort and satisfaction. Although the ASA members are equivocal, the consultants agree that oral intake of clear liquids during labor does not increase maternal complications.

Recommendations.
The oral intake of modest amounts of clear liquids may be allowed for uncomplicated laboring patients. The uncomplicated patient undergoing elective cesarean delivery may have modest amounts of clear liquids up to 2 h before induction of anesthesia. Examples of clear liquids include, but are not limited to, water, fruit juices without pulp, carbonated beverages, clear tea, black coffee, and sports drinks. The volume of liquid ingested is less important than the presence of particulate matter in the liquid ingested. However, patients with additional risk factors for aspiration (e.g., morbid obesity, diabetes, difficult airway) or patients at increased risk for operative delivery (e.g., nonreassuring fetal heart rate pattern) may have further restrictions of oral intake, determined on a case-by-case basis.

*Links 
Resources with other options to explore if you want to negotiate for unrestricted eating and drinking in labor – maybe you will “compromise” and get “clear fluids”.  These are more studies and articles that demonstrates that eating and drinking in labor is a sound evidence-based practice:

1.) Singata M, Tranmer J, Gyte GML. Restricting oral fluid and food intake during labour. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD003930. DOI: 10.1002/14651858.CD003930.pub3.
http://summaries.cochrane.org/CD003930/eating-and-drinking-in-labour

2.) Health Behavior News Service, part of the Center for Advancing Health (2013, August 22). Restricting food and fluids during labor is unwarranted, study suggests. ScienceDaily. Retrieved September 10, 2013, from http://www.sciencedaily.com/releases/2013/08/130822141954.htm

3.) Wiley-Blackwell (2010, January 22). Eating and drinking during labor: Let women decide, review suggests. ScienceDaily. Retrieved September 10, 2013, from http://www.sciencedaily.com/releases/2010/01/100119213043.htm

4.) Summary of these three articles in our blog post “Can I Eat and Drink in Labor?”

Did you eat and/or drink during your labor?  Did you worry about it?  What was your thought process? 

References:
[1] http://en.wikipedia.org/wiki/Nil_per_os

[2] http://pregnancy.about.com/cs/laborbasics/a/eatinginlabor.htm

[3] http://journals.lww.com/anesthesiology/toc/2007/04000
Anesthesiology:
April 2007 - Volume 106 - Issue 4 - pp 843-863
doi: 10.1097/01.anes.0000264744.63275.10

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®.
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson








Meet the Doula: Laura

Posted on June 2, 2013 at 5:34 AM Comments comments ()
Our featured doula this month is Laura Correia, CD(DONA).  Laura and I met through the Rights for Homebirth movement.  It is a pleasure to bring you her interview - this is a woman who knows her calling.  I found that her passion about birth and supporting families speaks through the page and to my heart.  Enjoy getting to know Laura!

About Laura:  I am a DONA certified birth doula in the greater north and west Phoenix metro area, including Scottsdale, Paradise Valley, Anthem, Glendale, Peoria, Surprise, Avondale, Litchfield Park, Tolleson, and Goodyear. I love to use my gifts and talents being able to help women have a satisfying and successful labor and birth. It's my goal to get to know a woman in such a way that I can encourage her in the way that allows her to have the very best birth experience she can. I consider it one of the best blessings to help a baby come into the world! Please email or call me at (480) 44-BABY4, for more information.

When was the first time you heard the word, “doula”? 
In 2002. I was pregnant with my 3rd baby, and going through Crisis Pregnancy Counseling training with a woman who became a friend. As we approached the end of my training, she said she was becoming a doula, and needed 3 certification births, and would I mind if she attended my labor? She was amazing! I never ended up becoming a counselor, but became a doula instead! 

How did you decide that becoming a doula was part of your journey?
After a typical hospital birth with epidural, an unmedicated hospital birth with a midwife, and then 2 birth center births, I realized there was a woman with me in some capacity in every single birth. My husband was a FANTASTIC coach, and I couldn't do it without him; at the same time, I really NEEDED a woman there (a nurse the first time, my childbirth instructor the second time, a doula the third time, and a midwife the last time). 

I decided to pursue doula work when my last child was 2. My oldest was old enough to babysit in a pinch (finding 24 hour childcare is often one of the biggest obstacles for doulas) and since they were all homeschooled and used to being home with each other, it worked. I had a supportive aunt who encouraged me and helped me with the cost of training. I also realized there were different needs in the community for different doulas. As a fairly calm, more quiet, strong-in-my-Christian-faith woman, and okay with hospital or medicated birth if the mom desired it, I would appeal to a certain type of laboring woman. I realized it's okay to celebrate our strengths and areas of expertise as doulas. :)

Are you a birth and/or a postpartum doula?
Birth doula.

How long have you been a doula?  
I have been a doula since 2008. I have been certified with DONA since 2010, and have Rebozo and TENS certifications with them as well. I have additional breastfeeding training, and I am Neonatal Resuscitation certified as part of my path to midwifery.  I have experience with hospital (planned medicated and unmedicated), birth center and homebirth. I have attended waterbirths, VBACs, teen or single moms; accompanied in cesarean section births and for expected stillbirth. 

What do you enjoy the most about being a doula?
I love being a part of the strength women and their partners’ find when being stretched beyond what they thought possible. It's a difficult journey for most, but women are amazed at when they've accomplished, and men look at the mom of their new baby with such awe at their perseverance and strength (unmedicated or otherwise)!  Helping a woman feel respected, educated, and informed is also a big part of the satisfaction I get as an attending doula.  And of course, it's always a blessing to see a new baby come into the world. 

What is your philosophy when you go to a birth space?
It's not my birth- it's hers! I am there to support her in HER choices, even if I personally wouldn't chose that path. My goal is to be an encouragement; to help mom feel empowered and confident in an uncertain journey; to make things as relaxing and calm as possible- whether through environment, thoughts/fears, communication or comfort measures; to validate her feelings.  My professional motto is "Seeking to enrich labor and birth experiences" and that can come in a variety of ways.

How do you work with and involve the Coach?
I have worked with coaches that are most comfortable sitting in a corner, and those that are catching their baby... and everything in between! My goal is to help the support person feel the most confident and comfortable they can, and to experience the labor/birth to the level of involvement they want. As a doula, I want to take the pressure off of the coach to be the source for all knowledge and physical help, because that doesn't allow them to experience the birth for themselves. I often will demonstrate how to massage gently, offer positions that he can aid in, and offer food and drink for him to provide for the laboring mom. It's also a comfort to both the coach and the mom to have me available for coach to take bathroom breaks, go on food runs, and take quick catnaps. Typically my biggest help for the coach is being a calm and experienced presence; letting him know that when things get intense, that it's all part of the process, and reassuring him that those are good signs!

What is the toughest situation you have ever dealt with?  How did you handle it?
I've had to call 911 for a mom that labored quickly and felt she was going to birth at home unexpectedly; been dismissed as a doula after a homebirth transport to the hospital; watched a family grieve with the loss of their firstborn; worked in births where the birth team was rude, loud, and demeaning. In all of these situations, I stay present for the mom and dad- a compassionate presence, and I validate their feelings and choices.  And then I go home, and cry, sleep, pray, journal, and/or talk with my mentors. I believe doulas HAVE to have those she can decompress with, otherwise there's too much pent up frustration and often, anger- towards choices made, providers, and "the system," and bitterness grows.

I develop an emotional connection with my clients, and so when they hurt, I hurt. I include a postpartum appointment in my services, and that is where we can talk about what, how, and perhaps why things happened the way they did. I validate mom (and often dad)'s feelings about a birth that went very different that planned. However, I also provide another perspective to things, which often helps them to perceive the experience differently. Lots of times, new moms overlook all the amazing things they did, or the strength they had, focusing only on where things DIDN'T go according to plan. I help her see the good choices she made, and encourage her in where things went "right."

What keeps you working as a doula?
Being there for women. I love helping laboring moms realize how strong they are, helping a couple (or mother/daughter) grow closer together through such an intimate time, and being a compassionate, experienced and non-judgemental guide in the process. Often my clients and I share similar spiritual beliefs, and they appreciate my sensitivity and ability to welcome God into their birth experience through prayer, music, and focus. I feel like my doula work is a gift and a calling - and a responsibility!- from the Lord, and that in itself keeps me going.

What does your fee cover – how many visits or hours?  Is there a different charge for a shorter labor or longer labor?
I charge $600, and it includes 2 prenatal appointments (usually 2 hours each), the entire labor and birth, 1-2 hours postpartum, and a separate postpartum visit one the family is home. I do not vary my fee depending on length of the birth; my quickest client was 10-15 minutes, and my longest was 29 hours. I don't want moms feeling pressured to "birth quicker!" because of financial considerations. 

I offer discounts to previous clients, active duty military, parents placing baby for adoption, and those in full-time Christian ministry. I have also been known to provide significant discounts -occasionally- for hardship situations, and accept barter as partial payment as the need arises. 

Do you offer any other services to your clients?
Placental encapsulation; a "birth journey" story for the baby book and/or to share electronically; all pictures, along with some that I edit. 

I am a Christian childbirth educator for an online format that I adapted from Jennifer VanderLaan's book, "The Christian Childbirth Handbook" and also teach a free one-day childbirth class for crisis pregnancy moms through New Beginnings Crisis Pregnancy/Post Abortion, 1-2 times a year. 

I am also a hobby-level photographer, and take pictures of labor and birth (with the parents' permission), for them to keep.

Just for fun, what do you do when you are not doula-ing? 
I danced professionally with a ballet company before I had kids, and still love to take a class at Ballet Arizona a couple times a year (usually when I'm dancing around my kitchen!). In the past 5 years I've taken up running and have done numerous 5Ks, 10K, and half marathons. I have completed 3 full marathons with my best time being a 4:06. I also like to hike, having done a rim-to-rim hike of the Grand Canyon, and a hike up Yosemite's Half Dome. Obviously, I love to push my body, I think because I see so much correlation in it to birth. 

My family is amazing, and made up of my 4 kids (ages 7-16) and an AMAZING husband who are so supportive and encouraging to me and my love for doula -and now student midwifery- work. Spending time with them is always a favorite, whether watching them cook with my husband, or reading books together, or watching House Hunters and the Cosby Show with them! After a year of dealing with a diagnosis of clinical depression, I am learning to heal from past hurts, and to again enjoy entertaining and spending time with friends and my church family. Other than birth, I have a passion for healthy marriages, mentoring, counseling, and non-judgmental, transparent (and often messy) Christianity. My husband is a pastor at West Greenway Bible Church in Glendale, and teaches Bible at Arizona Christian University, and combined with my work in the birth community, that keeps us hopping! 

Oh, and I can also turn ANYTHING into a birth analogy. It's a gift, really. ;)

If you would like to contact Laura to schedule a complimentary interview, you can reach her via:
Phone: 480.442.2294 (480-44-BABY-4)

Was Laura your doula+?  Please let us know about your experience.
Please leave us a comment - it will be moderated and posted. 
*I think* that the amount of traffic you so generously generate has led to a lot of spam posting.  In an effort to keep the spam to a minimum, I am taking the time to moderate comments now.
 
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, PaysonDisclaimer: 
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®.


Peace on Earth

Posted on June 15, 2012 at 9:01 AM Comments comments ()
Today’s post is short.  I hope I will get some insightful answers to a question.  One that just occurred to me and I wonder if it has occurred to anyone else out there in the birth circles.   

 It started to tickle my brain as we entered the political season here in the U.S.  A time when I discover that although my birth and breastfeeding friends and I all share very similar beliefs about birth and breastfeeding, we are split into different voting parties.   

Then I took it another step back – when do these divisions happen?  Was there ever a time of peace on earth, when all were in harmony?  Has there ever really been a day without discord?   

There is a saying in the birthing community that goes like this, “Peace on earth begins at birth."  

I love that saying.  It is a grand goal – allow children births free from chemical influences, and births that are intentional and into the loving arms of their parents, and voila! Peace reigns.  As a Bradley™ teacher I would add "healthy pregnancy" somewhere, then again, it's hard to rhyme with pregnancy.  Anyway, a mom that avoids harmful substances and gets a whole food, nutritious diet for optimal fetal development will also help…I think you get my point.  The premise is that peaceful beginnings are the basis for a peaceful world.   

Put on the brakes…up until 200 years ago, all births were homebirths.  There was no access to pharmaceutical grade analgesics or anesthetics.  Most babies were breastfed by someone, because there was no formula.  And many cultures kept their babies close to a warm body as the babywearing practices of today and emulating.  Watch this interesting video from the CBC (1963!)in to see an anthropology of babywearing:

Reality check: Wars have raged since time immemorial…history classes teach us about the conquests and dominant periods of a variety of different cultures.   

I am in awe of mothers whose children serve in the militaries of the world.  My heart isn’t in it for sacrificing our flesh and blood.  As a mother I hope I will have it in me to support our children’s aspirations, down whichever path it may lead them, even if it includes military service.   

So, here is my question(s):  What is going to be different this time?  If we are going back to all the “natural” ways: intervention free births, breastfeeding, babywearing…what will we do differently with our children to ensure that we really and truly build a foundation for more peace and less fighting?   

Please share your thoughts in the comments – enlighten me!   

*For an update on the Rights for Homebirth movement, click here for the AZ Dept of Health Director’s blog post; for the original post on Rally Day click here.   

Disclaimer:  
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson  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®. 

Natural Labor Coping Techniques

Posted on June 8, 2012 at 10:27 PM Comments comments ()
Here are some of the ways we recommend our students manage their labor without analgesics or anesthetics.  Even when they are used in labor, we are so happy that our couples use them as tools to manage a long labor and their children are born nursing vigorously and with high APGAR scores.

Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson  Mom and Coach are informed. 
Through the course of The Bradley Method® class series, parents are taught about what to expect as “normal” in labor, what the variations on normal might be, the different options and interventions in labor, and how to recognize a complication that warrants a change in the plan for a Healthy Mom, Healthy Baby outcome.    

We also teach positive communication, something intended to strengthen the parental bond, as well as serve for positive interactions in the birth space with care providers and support personnel.  Our goal is that parents have the tools they need to evaluate labor, communicate their needs to care providers, and ask the questions they need to make informed decisions about the choices they may have to make in labor.   

Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson  Mom and Coach are athletes. 
An athlete with an eye on crossing the finish line does four things:  They train, they rest, they nourish and they hydrate.  Dr. Bradley called his patients “obstetrical athletes”.    

His nurse, Rhonda Hartman, designed a training program just for moms to prepare them for labor.  We are still teaching our couples this training program, starting with week one of class and continuing until the time of birth.  We also “train” relaxation.  Each couple is encouraged to take the weekly technique and practice at least 15 minutes per day so that there is muscle memory for relaxation when it is needed in labor.   

We continually harp on the importance of sleep in the weeks leading up to labor and once labor starts.  We learned this lesson the hard way, and as excited as we know our students are going to get as they anticipate the birth of their child, we want them to try to rest.  Getting to the magic number of “10 cm” is only the first part of labor – once they reach 10 cm, they also need energy for the second stage of labor to welcome their child into this world.   

We also echo Dr. Bradley’s advice to eat if you’re hungry, drink if you’re thirsty.  He makes the analogy that going through labor without eating or drinking is like playing a full game of football without any substitutions.  The body is working and burning energy to birth your baby, it makes sense to follow mom’s physical cues.  As long as mom is okay and baby is okay, we have found that mom’s appetite will naturally decrease as labor intensifies; and as with an actual marathon, that the need to hydrate is as important in early labor as it is when mom is close to crossing the finish line.   

Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson Water is your friend.
As stated above, a hydrated mother makes for an optimal obstetrical athlete.  She is hydrated for energy and optimal hormone distribution throughout labor.   

 Water is also a excellent relaxation tool.  It works magic in labor: the warmth and the sensation move tension away from the body and adding a layer of relaxation as it works to soothe the mother’s body.  I have heard it called, “The Midwives Epidural”.    

Many hospital moms now have access to the birth tubs that are used very effectively at birth centers or at home births.  If  using a birthing tub or home bathtub is not an option, then the shower can also be an effective tool.  The sensation of water will still massage and soothe the body.  With a shower hose attachment, the water can also be directed at the body where it is the most soothing for the laboring mother. 
  

Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson  Use abdominal breathing.
Abdominal breathing is taught in many settings to deepen relaxation – yoga, hypnosis, meditation, stress relief, and in The Bradley Method® of natural childbirth classes!  Abdominal breathing is also known as diaphragmatic breathing.  Basically, you are allowing your belly to rise and fall as you breath instead of your chest.  If you watch children breathe, or if you remember what it was like to breathe before someone told you that you needed to suck in your stomach, you will know what it means to breath with your abdomen.   

Abdominal breath is an important foundation for relaxation.  It slows down our mind and it allows or bodies to release tension.  We teach abdominal breathing in class 2 so we can build on it through the rest of the series.   

Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson  Coach is a relaxation expert. 
Coach needs to know what relaxes their partner.  Does mom respond to physical touch?  What kind of touch?  Does she like a strong counter-pressure or gentle effleurage?  Does she like a relaxation script, a prayer or a story read to her?  Does she feel safe in her birth space?     

By the end of The Bradley Method® class series, we have covered these, and many more questions, to help the Coach be a relaxation expert on their partner.  We also teach 11 different relaxation techniques for coaches to put into their “toolbox” to use as needed as labor progresses.   

Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson  Have a trusted assistant coach. 
Champion sports teams have a stellar assistant coaching staff.  The head coach doesn’t try to do it all – he delegates and finds the best person to train his team so that he can keep his eye on the big picture and continue leading and motivating his team.   

We have noticed that couples with an assistant coach generally end up with births that are closer to the birth wishes they made in preparation for their labor.  The extra set of hands, the extra energy in labor make a difference.  The couples that hire doulas also have an experienced birth professional to help them manage the map of labor.  A good birth doula doesn’t take over the birth, she will help the couple to recognize the signs of progress and make suggestions for coach to support the mom.   

Even if you feel like you want to be just Mom and Coach, you can benefit from an assistant coach coming in for a period in labor.  When we labored with Angelika, a dear friend of ours came in and labored with me when Bruss needed rest.  I had been laying down the first day, resting and napping since we know we have long labors.  Bruss had been checking in on me, taking care of our older children while we waited for family to arrive to tend to them, and he took care of feeding all of us.  He REALLY needed to sleep after dinner that night.  Andrea came, labored with me as long as she could, and when it was time for her to get back to her own family, Bruss was rested and ready to be head coach again.  I am forever grateful for her time that night – it allowed for Bruss to rest and restore for the long work we still had ahead of us.   

Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson  Break the Fear-Tension-Pain cycle. 
We break the Fear by teaching couples what to expect in a normal labor, along with the many variations on “normal”.  We also break the Fear by discussing the complications and sharing strategies and options for them to consider if they are among the small percentage of people that face complications in labor.   

We break the Tension by teaching Mom and Coach to be relaxation experts.  We break the Tension by teaching couples to communicate together, and how to communicate with their care team for effective and positive interactions.   

We break the Pain by reminding mothers that labor is an athletic event.  It isn’t always easy, however it is doable.  We invite couples from the previous class come share their stories with our current class.  I have seen the “light bulbs” click for both Moms and Coach when the other “first-timers” share their stories.  It makes it more realistic to hear that other newbies had Healthy Mom, Healthy Baby outcomes by using the information they learned in class.  It reassures them that the intensity is brief compared to the joy of holding their children.  The new parents confirm that the work is worth the effort, and that staying the course and/or making Healthy Mom, Healthy Baby choices are rewarded with a happy family outcome.    

We also encourage couples to find affirmations, prayers, scripts and/or music to draw energy from in labor.  Labor is an exercise in intensity that ebbs and flows.  Having something to focus on besides the intensity that is growing helps to focus mom on the work that she is doing.  They can also restore and encourage her when she wants to give into the pain.    

By having knowledge, training and tools, couples are well on their way to a Healthy Mom, Healthy Baby outcome.   

What was a natural labor coping technique that worked for you during your labor?   

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®. 

Failing to Progress or Naturally Aligning

Posted on June 1, 2012 at 4:52 PM Comments comments ()
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson  We have had a couple of students have had textbook “NAPS” in the last two classes…and since we still have several couples waiting for their babies, I thought this might be a reminder and an inspiration to them for their labors.  NAP – no, they didn’t take epic naps in labor (although I am a big advocate for sleeping in labor)…what it means is that they were very patient in their labors.   

One of the cornerstones of The Bradley Method® is a Healthy Mom, Healthy Baby outcome.  All of the discussion below only applies if Mom and Baby are not showing any signs of distress through labor.  Mom is maintaining a healthy temperature, heart rate and blood pressure, and Baby is also showing that it is doing well as per the monitoring that is being done.  If Mom or Baby are starting to demonstrate that their health is compromised, then parents are encouraged to make the best choices for their particular situation.   

The words “Failure To Progress” are the sound of doom to some of us (I say "us" because I heard this three times!).  They very often mean that interventions are going to start being suggested.  How a couple acts upon those suggestions is very individual.  Marjie Hathaway coined the phrase “Natural Alignment Plateau”, or “NAP” as an answer to the dreaded “diagnosis”: “FTP”, or “Failure To Progress”.    

Failure To Progress is based on the Friedman’s Curve*.  It looks like this: 
 As human beings, it is in our nature to see this neat, explainable graph and say, “It’s a rule!” This can have dire implications whilst in labor if you really want a natural birth.  There are no averages in the midst of a labor – each labor on is unique and individual.  

Mathematically, it’s unfair for all labors to be expected to fit the average.  That brings in another concept we teach in The Bradley Method® classes: consumerism and informed consent.  If there is time: ask questions, ask for time, and then communicate and evaluate what you have heard with your partner before you decide on a course of action.   

  • It is important to remember that the graph is AN AVERAGE representation of labor.  It indicates that a mom should dilate 1 cm per hour, and push an average of 3 hours – for an average length of labor that is between 12-14 hours long.    
  • Math class reminder:  The average number is the number you get when you add all of the data in a set of information, and then divide that total number by the number of units that provided the data.  Applied to laboring mothers: That means that there will be some people that have labors much shorter than 14 hours, and other people that have labors much longer than 14 hours, more will be around that number…and then a few will be right on with the average.  


When a mom does not progress in dilation from one vaginal exam to the next, or between several vaginal exams, she may be diagnosed with “Failure To Progress”, and along come the string of possible interventions.  They can include any or all of the following, along with other interventions: an Amniotomy (intentional rupture of the bag of waters), augmentation of labor with Pitocin, an Epidural to take of the edge of Pitocin-induced contractions, a Cesarean.  

A cesarean may also be suggested if the care team suspects that the baby may not fit through mom's pelvis.  Diagnosed as "CPD", this is the subject for another post altogether.  For now, check the link I listed below* for more information.

Instead of accepting the words, “Failure To Progress”, Marjie decided to suggest a new phrase to her students: “Natural Alignment Plateau”.  NAP instead of FTP.  Natural Alignment Plateau is a different way of approaching that point in labor when dilation does not change.  What we teach in class and hope that our students will remember when they face this crossroads is, "Labor is much more than dilation."   

Labor can be slow to start, dilation can stop and/or contractions can slow down for many reasons.  Here are some to consider: 

  •  Did you change locations where Mom is laboring? 
  •  Is Baby posterior? (Click here for ideas to move baby)
  •  Is Baby trying to figure out how to line up in the birth canal? 
  •  Is there an emotional component that hasn’t been dealt with? 
  •  Is Mom tired and does she need a nap? 
  •  Is Mom making more hormones for labor? 
  •  Is Mom's pelvis still stretching (and using the extra hormones) for baby to fit?
  •  Is the Baby's head still molding for the passage through the birth canal?
  •  Is Mom making more colostrum for baby? 
  •  Has Mom surrendered to the birth? 
  •  Has Baby accepted the birth process?  


If your labor has been slow to start after a spontaneous rupture of membranes, or if you are seemingly “stuck” at a measurement of dilation, it might be time to evaluate what could be going on and change tactics: 

  •  Try a new labor position. 
  •  Go for a walk to clear your heads. 
  •  Take a nap to conserve your energy (It’s hard for a care provider to argue with a dad or doula who is protective of a sleeping mom.)  
  •  "Talk" to your baby and encourage them that you are ready to meet him/her. 


If Mom and Baby are doing well, you can ask for time.  There is not a medical reason for an intervention if Mom and Baby are doing well in labor and your care team confirms that Mom and Baby are okay.  Here are two examples for you to consider and think about if you face a point in labor when there is no measurable progress.   

We had a mom from our Winter class go from 6 cm dilated (usually considered Active First Stage – not yet in Late First Stage) to holding her baby in 21 minutes.  Yes – you read that correctly.  She went from what most care professionals would consider mid-range in labor to holding her baby in 21 minutes…that meant she pushed within that time, too, folks.  Hers was an emotional component.  She was waiting for her mom to arrive.  Once her mom arrived at the hospital and stepped into the room where she and her husband were laboring, her baby and her body got busy.  They dilated a total of 4 cm from 6 cm to “complete” at 10 cm, then pushed, and they were holding their baby in 21 minutes.   

Our other story is from our Spring Class.  Mom had a slow start to labor.  She had started seeing some clear fluid on Sunday, noticed some more on Monday, and went to the hospital on Tuesday.  They tested her fluid and it was amniotic fluid.  Although they were in triage and barely 1 cm dilated, the couple was strongly encouraged to be admitted.  Now they are into the hospital and the expectations of “Friedman’s Curve.”  

This couple did a great job of asking, “Is Mom okay? Is Baby Okay?” After getting their “Yes” answers, then they followed up with, “That’s great!  Then let’s wait a couple more hours and see where we are.”  And sure enough, the next time the staff and their care provider checked in, they were a little further along in labor.  Once things got going, this mom went from being 4 cm dilated to 8 cm dilated in one hour!  Within two hours of that point, they were holding their baby.   

The great news about hitting the NAP is that once the Mom’s body and Baby “get organized”, labor seems to progress very quickly.  Again, remember what I said at the beginning – things go well when a Healthy Mom and a Healthy Baby are given the time they need.  If Mom or Baby start to indicate that “healthy” is losing out, then a family needs to make the best choice for their situation.   

What has been your experience – have you had a NAP in your labor?  What choices did you make?   

For a full explanation of Friedman’s Curve click here or enter this URL into your browser: http://allaboutbirth.net/pdfs/Failure-to-progress.pdf    

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®. 

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