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Uterine Rupture: Assessing the Risks
| Posted on April 26, 2016 at 10:18 AM |
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 This was in posted April 2012 - updated April 2016Uterine 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®.  |
In Their Own Words: Annika's Story
| Posted on April 15, 2016 at 4:10 AM |
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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®. |
Info Sheet: Vaginal Exams
| Posted on March 4, 2016 at 2:01 PM |
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 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.”
*PROS Vaginal Exams can possibly measure:
*CONS
*Links to explore Pelvic Exams Near Term: Benefit or Risk? Talking to Mothers About Informed Consent and Refusal 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®. |
Q&A with SPB: Healthy Pregnancy How-to
| Posted on March 17, 2015 at 4:31 AM |
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 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. My favorite resource is Rhondda Hartman's "Natural Childbirth Exercises". 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. 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 |
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In light of a research study published this week, we are highlighting this blog post today, originally written on May 28, 2013. An excerpt from the article New Research: Direct Correlation Between Labor Pain Medications and Breastfeeding:
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.  May 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
BUPIVACAINE: Category C
CLONIDINE: Category C
FENTANYL: Pregnancy Category C
SUFENTANIL: Pregnancy Category C
DEMEROL: Pregnancy Category: B; D if used for prolonged periods or near term
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.  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®. |
Information Sheet: Non Per Os
| Posted on September 24, 2013 at 1:51 AM |
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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]:
*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]:
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]
*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:
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]
*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®. |
Meet the Doula: Laura
| Posted on June 2, 2013 at 5:34 AM |
comments (3)
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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) Email: [email protected] 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. 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®. |
Peace on Earth
| Posted on June 15, 2012 at 9:01 AM |
comments (4)
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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: |
Natural Labor Coping Techniques
| Posted on June 8, 2012 at 10:27 PM |
comments (1)
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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.  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.
 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.  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.
 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.
 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.
 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 (0)
|
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.
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:
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:
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®. |