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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 (0)
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



Q&A with SPB: Water

Posted on March 8, 2016 at 9:22 PM Comments comments (0)






 


Water is essential for good health. Pure water (nothing mixed in) is best for re-hydration of the body. Bottled or filtered water may be necessary, depending on your water source at your home or workplace. In the mother, water acts as a solvent and catalyst for biological reactions.  In the baby, water accounts for 75% of your baby's total body weight at birth.
 
Lack of water leads to dehydration, which can lead to over a 20% reduction of energy output (can you see why this could be a problem in pregnancy and/or labor?). Dehydration may also contribute to the headaches some women experience as a discomfort of pregnancy. Some of the complications a water deficiency can lead to are declined circulation (low blood flow which then affects what is *not* getting to the placenta), hypovolemia (low blood volume), and oligohydramnios (low amniotic fluid volume), which can trigger premature labor.
 
Note: water without adequate salt intake leads to an imbalance, making it hard for your body to absorb and retain fluids.
 
Be careful about your source of water – how much chlorine is in your municipal water? You can request a report from your town or city if they don’t send you an annual quality report.
 
Be careful of some bottled water. Read the labels. Some of them have additives such as magnesium sulfate (MgSO4), which is a laxative, muscle relaxant, and is used to stop labors. This common name for this additive is Epsom Salts.
 
Your water needs depend on your weight, your climate, and your energy output.

  • Formula: weight/2 = how many ounces of water you need
  • If you want to find out how many glasses of water that is, divide it by 8 ounces in a cup
  • Climate: is it humid or dry where you live? How much water are you perspiring?
  • Energy: again, perspiration also how much is being used by your body in the activities in which you participate?

Did you know that the color of your urine could be a hydration test?  If your urine is clear, pale or straw-colored, *and* you feel well overall, there is a good probability that you are adequately hydrated. If your urine is dark yellow or even orange, it's time to start drinking up some good, clean water. Strive for even more fluids if you have an active lifestyle, if it’s hot outside or both.
 
Note on oligohydramnios: if you are being told that your fluid levels are low, it might be a real thing.  Know that your amniotic fluid is not a closed system – your body is constantly making more and replenishing amniotic fluid.  I’ve read anywhere from 1 hour to every 3-4 hours for that process.  So, if you drink more water, you could potentially increase the amount of fluid in the uterus. However, if you have been drinking a lot of water and your fluid levels are still low, then definitely have an honest conversation with your care provider about your options.
 
Links to explore:
Importance of Water written by my Bradley colleague Lisa Pearson, AAHCC


Fluid Levels in Pregnancy via mamabirth.com



Disclaimer: 
The material included in this blog and 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 (0)
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: Writing a Birth Plan

Posted on October 20, 2015 at 7:18 AM Comments comments (0)

Q: How do I write a birth plan?
A: Have a good conversation with your partner and your care provider, write down a wish list, and then be prepared for your birth journey, taking into consideration there might be a detour or two!





Here are the basics of what we share with our students:

1. EXAMINE YOUR FEELINGS
What is important to you?
What would you be willing to compromise?
What are your absolutes?

2. CONSIDER YOUR PRIORITIES
List your choices in order - Mother ranks hers, Coach/Birth Partner ranks theirs, and then compare notes and arrive at some sort of compromise.

3. EVALUATE YOUR SITUATION
Are your choices realistic given yoru choice of birth setting?
Does your birth team support your wishes?
If you find yourself wanting to make changes in birth setting or care provider, what are your options?

4. MEET WITH YOUR CARE TEAM
Ask for etra time during the "birth plan" appointment.
Bring a draft of your wish list to get their input, and listen with an open mind and a grain of salt - more on that below.

5. PREPARE FOR A POSITIVE EXPERIENCE
Are you doing daily exercise?  Bradley Method Exercise Program
Are you eating the best whole food diet possible?  Brewer Diet for a Healthy Pregnancy

Those two things are the foundation for the possibility of a low-risk labor. Add in daily meditation for a good measure of positive energy for your upcoming birth journey.

6. BE FLEXIBLE
Bruss's mantra: "You are the birth that you bring with you."  Consider going into your birth journey with the idea that something is going to surprise you, something will disappoint you, and at the end of the day, transform you into the parent you need to be for your child.

Consider this: what is more important - sticking to your plan at all costs? Or, surrending to the birth journey, wherever it may lead you, and discovering something new about yourself? For the birth journey is an initiation of sorts; however it happens, it transforms us from maiden to mother, or from stag to father.

So, as instructors, we encourage our students to at least go through the process of preparing a wish list.  It allows the birthing family the opportunity to discover their priorities, evaluate whether or not they are in the right setting and with the right care provider for their dream of their birth, and then sets the compass for the general direction you want to travel along on this upcoming journey. This is the left-brain preparation for the birth journey.

Then, when the birth journey starts, there is a guideline to evaluate the path that is being traveled. When the birth partner has to take over being the mother's voice, they know what's important, what is not.  The birthing mother is free to surrender her unnecessary baggage along the way. I imagine it kind of like the settlers of old, leaving what they really did not need along the side of the road to arrive at their destination.  As we go deeper into "laborland", we surrender to the right brain that turns off the lists, turns off expectations, and simply does what needs to happen to birth this baby, wherever the path may lead.

For us, the compass was always set to "Healthy Mom, Healthy Baby". Each birth achieved that in a different way, and each one grew me in just the direction I needed to be the mother of our new family.

Here are some resources to consider:

A priority exercise we use in our classes HERE

A list of possible options to learn more about and prioritize for your wish list HERE

A starting point for writing a wish list HERE.  We encourage our students to use a list like this to clarify what they are dreaming of, and then using their own words when they write their dream down on paper.  Try to keep it to one page; if you go beyond one page, print on the front side only so that it is easily read when it's inserted into your file.

Finding the right care provider:
If you are getting red flags from your care provider when you start talking about the dream for your birth, consider if there resistance to your preferences is aligned with evidence-based care or personal opinion.  Explore their resistance: what experiences are filtering their response to your requests? And then listen to them: they have been around birth and have seen a lot of outcomes as trained professionals.

When you sit quitely with all the information you have gathered, what does your intuition say? If it's telling you that your requests are not extreme and you know that other families have been supported in them, go on a fact-finding mission: who was their care provider? How did that choice work out for them when they look back at their experience? If your fact-finding mission comes to the conclusion that you need to change providers, then change: you only have one journey to birth this baby.  Surround yourself with the right care for the path you are about to embark on.

Good resources to find about local care providers are childbirth educators or doulas in your area, any "birth circle" type gatherings, or your area ICAN chapter.  The birth community in your area will have an idea of who you might want to consider as your care provier for the birth journey that you are dreaming of for your family.



Please do not hesitate to reach out to us if you have questions about care providers in the Phoenix area:  [email protected]

We wish you all the best as you prepare for your birth journey with your Sweet Pea.

Disclaimer: 
Bradley Method® natural childbirth classes offered in Arizona: convenient to Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, PaysonThe material included in this blog and 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®.

The Family-Centered Cesarean

Posted on April 30, 2015 at 9:40 AM Comments comments (0)
For today...another one from the archives, originally published in April 9, 2013.  Updated April 30, 2014 to include information about microbiome seeding; and a gentle cesarean checklist of options to review with your provider and prepare for a cesarean birth journey.

A "Family-Centered" cesarean?  A "gentle" cesarean?  A procedure that is Woman and MotherBaby-centered?  What?  Did you just read that correctly?  

Yes, you did.  There is a "new" trend in cesareans that is hitting the mainstream consciousness here in the United States.

While a lot of the focus during Cesarean Awareness Month tends to center on Vaginal Birth After Cesarean (VBAC), I also want to acknowledge that a VBAC is not the choice that all mothers want to make.  Here is an option for mothers who know they want, or are considering, a repeat cesaran birth.  It is also an option if a healthy, low-risk labor starts to change it's course and there is time for non-emergent cesarean.

I have linked to THIS post about a "natural" cesaran more than once in previous posts, and today I want to be a little more specific about what a "natural" cesarean is and why a family might opt for this.

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

A family-centered, or natural cesarean strives to capture these components of a vaginal birth:

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

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

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

So while your initial reaction might be one of surprise and disgust, think about it.  Please take a minute to read both of the excerpted articles and have a discussion with your partner and your care provider before you make up your mind one way or another.

Here are some of the benefits that are causing mothers to request this kind of cesarean option:
  • Less traumatic birth experience
  • Moms get to *see the birth* of their baby
  • Greater sense of satisfaction in regards to their birth
  • Establishment of the MotherBaby dyad immediately after the birth
  • Better breastfeeding outcomes
  • Someone who had an emergency cesarean with a previous child and does not feel comfortable with anything other than a repeat cesarean
  • A family with a known complication who wants to allow labor to start on the day of baby's choosing, but knows they will have a cesarean delivery
  • A family who planned a natural birth and had their course of labor  change before they were in an emergent situation

If you would like to have a conversation with your care provider about planning for a gentle cesaean as your birth plan or "just in case" plan, HERE is a list of options for you to discuss with them, provided by ICAN of Phoenix chapter leader Jenni Froment.  

I also want to mention: these are evidence-based recommendations.  If your care provider scoffs at you and laughs you out of the room, thank them very much for their time and go have a conversation with another provider in your area.  Your local ICAN chapter or ICAN international are great resources for respectful, family-centered providers.

What do you think?
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.   

Link List:
http://www.youtube.com/watch?v=m5RIcaK98Yg

ARTICLES
ICAN
http://blog.ican-online.org/2012/04/14/the-family-centered-cesarean/

MIDWIFE THINKING
http://midwifethinking.com/2014/01/15/the-human-microbiome-considerations-for-pregnancy-birth-and-early-mothering/

MAMASEEDS
http://mamaseeds.com/blog/antibiotics/how-seed-your-baby-healthy-microbiome-last-lifetime/

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



Birth Story: Marathon Labor

Posted on January 23, 2015 at 9:45 AM Comments comments (0)
Christine & BJ Bollier 
Bradley Method© Birth Story

Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, PaysonOur goal is to prepare families to have a natural birth by teaching a mom and her loving coach to labor together.  The reality is that even with the best preparation, birth is unique, fluid and unpredictable.  Our experience as natural childbirth educators is that even if your birth does not go according to your plan, a comprehensive education like The Bradley Method® will pave the way for you to have your best possible birth with a Healthy Mom, Healthy Baby outcome.
 
This story is a great example of making your wishes known, persevering through a long labor that stalled (The Bradley Method® calls “the stall”, aka “failure to progress”, a “Natural Alignment Plateau” or "NAP"), and making decisions as the labor progressed for a Healthy Mom, Healthy Baby birth experience.  Even with an intervention they did not initially want or anticipate, they were able to have the vaginal, unmedicated birth they had prepared for.
 
One of my favorite quotes from the video is Christine’s statement, “I was tired, but I was never scared, because I knew what to expect.”
 
 Link to video: http://youtu.be/PmlPITHsFio

Here is a quick summary of their labor:  She started with contractions around 15 minutes apart on a Thursday morning.  They went to their doctor’s appointment that afternoon and decided to go home and let their labor progress. On Friday, they were timing contractions throughout the day.  When they got to five minutes apart, they decided to go to the hospital because of the impending blizzard (they live in Payson, AZ).  By the time they were all checked into their room, it was 2:30 am on Saturday.  By Saturday evening at 6:00 pm, they hit a NAP at around 8 cm dilation.  They made the decision to accept an amniotomy (breaking the bag of waters) at 10:00 pm.  Their son was born on Sunday morning at 3:30 am.
 
When the Bollier's time their labor, they call it 36 hours from the contractions that were 6 minute apart  on Friday afternoon to the time when he was born on Sunday morning.  They both stayed awake for the whole of that time, save a few cat naps that happened between contractions when they were both exhausted.  It is good to note that they did sleep on Thursday night when contractions were still in the "putsy-putsy" stage.
 
I am so glad she talks about how she experienced contractions – that’s a big question mark for first-time moms.  Christine says she felt them as rhythmic and internalized them – she says she could have painted you a picture of the contractions.  I love that perspective!
 
HIGHLIGHTS
Birth plan

  • They did their work throughout and after Class 7 when we talk about writing the Birth Plan. 
  • They got great ideas, and then took it to their care provider and asked her, “Is everything realistic on here?”  She went through it line by line and said it was all in-line with what was possible in a hospital setting. 
  • Care provider signed off on plan, put it in file, sent it to hospital to give the staff their a heads up on their desires for their birth. 
  • When it was “go time”, they arrived at hospital with several copies of plan and 3 dozen cookies.
  • Everyone who walked into the room was offered cookies and a birth plan

 
Changing the Plan

  • “Going in, we knew there might be a possibility that things were not going to go to plan.”
  • Came to terms with making an adjustment
  • Once the bag of waters was broken, contractions completely changed and things progressed quickly
  • Christine reasoned with herself, “This isn’t going to be how I planned it, but if I give up one thing, the birth can still happen unmedicated like I want it to”

 
Christine’s Insight:
Q: What did BJ do as a Coach that helped you the most?
A: He kept me from freaking out when it had gone on for so long.  
As she explains, he kept her on track through the exhaustion. BJ kept her calm with reassurance; he also pointed out the progress they had made. 

Loosely paraphrasing: [The hard part] wasn’t the pain – it was the exhaustion.  I knew the pain was purposeful because I was getting a baby.  [Contractions] came in bursts and they were not constant - it wasn’t miserable pain or constant pain from an injury that hurts all the time. Looking back a year later, [a contraction] was such a short period of time.
 
BJ’s nuggets of wisdom
Education & knowledge quell fear – having notes at my fingertips kept me from getting scatterbrained while I was watching (coaching) my wife through labor.
 
Postpartum advice for the husbands: Don’t be proud – just say yes.  Don’t be too proud to accept help – it’s a gift.
 
On the lighter side, you’ll hear the inauguration of the term “The Splash Zone” – now that we know our student’s perception of watching all the birth videos from the first row of chairs, it’s what we call that front line when we show birth videos in class - lol.
 
QUESTIONS FROM THE CLASS:
Q: Were you both awake the whole [36 hours of progressive labor]?
A: Yes…If I had it to do over again – we would rest throughout labor.  You’ll hear it in class that you should rest.  Seriously – REST.  After the baby is born, you are playing catch-up with sleep.
 
Q: What can you tell us about breastfeeding a newborn?
A: Get your hands on reading material, borrow books, have phone numbers of support people you can call, have a good structure around you to encourage, inspire, and inform you.
 
Invest in good bras – wear a tank top with shirt underneath at this age (son is about 11 months old in this video), after the infant stage the nursing cover is not staying on!
 

Did you have a long labor?  What labor management tips would you share with first-time parents?
 Please leave us a comment - it will be moderated and posted. 
 
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®.


 

Can I eat and drink in labor?

Posted on September 10, 2013 at 7:48 AM Comments comments (0)

We had a great question come up in class on Friday, one that bears writing about because at least one student every session plans to give birth at a hospital where they are told to have a good meal before they come in, because their food will be restricted or prohibited once they check into the labor and delivery department. 

To begin with, even having to ask that title question begs another question: why are we asking permission?  The female body, left to it’s own devices, will naturally shut down appetite as the serious work of labor progresses.  Dr. Bradley teaches to eat to appetite if you are hungry, drink if you are thirsty.  Even after mom is no longer asking for water, Dr. Bradley admonishes coaches to keep mamas hydrated so that the labor progresses with ample hydration to circulate all the hormones that keep labor on track.

As students of natural birth, we know that as labor gets harder and moves closer to birth, the body shuts down appetite because it needs to focus on the work of labor, not digestion.  If labor is prolonged, maybe mom will want literally “a bite” of something: a bite of banana, a bite of cheese, a bite of fruit, a couple of nuts, etc.; definitely not a full meal.  Since we had long labors, we found that clear broths or simple soups (thin tomato soup in my case) were a great compromise.  Although I wasn’t hungry, the liquids gave me a few calories to lend some energy to continue to labor, while also meeting my hydration needs.

Science confirms that hospital policies need to catch up with evidence-based care.  Here are excerpts from the Cochrane Review, plus two other articles for you to consider as you decide what is best for your family.

From the review, “Restricting oral fluid and food intake during labour” [1]
In some cultures, food and drinks are consumed during labour for nourishment and comfort to help meet the demands of labour. However, in many birth settings, oral intake is restricted in response to work by Mendelson in the 1940s. Mendelson reported that during general anaesthesia, there was an increased risk of the stomach contents entering the lungs. The acid nature of the stomach liquid and the presence of food particles were particularly dangerous, and potentially could lead to severe lung disease or death. Since the 1940s, obstetrical anaesthesia has changed considerably, with better general anaesthetic techniques and a greater use of regional anaesthesia. These advances, and the reports by women that they found the restrictions unpleasant, have led to research looking at these restrictions. In addition, poor nutritional balance may be associated with longer and more painful labours, and fasting does not guarantee an empty stomach or less acidity. This review looked at any restriction of fluids and food in labour compared with women able to eat and drink. The review identified five studies involving 3130 women. Most studies had looked at specific foods being recommended, though one study let women choose what they wished to eat and drink. The review identified no benefits or harms of restricting foods and fluids during labour in women at low risk of needing anaesthesia. There were no studies identified on women at increased risk of needing anaesthesia. None of the studies looked at women's views of restricting fluids and foods during labour. Thus, given these findings, women should be free to eat and drink in labour, or not, as they wish.

From the Science Daily article, “Restricting Food and Fluids During Labor Is Unwarranted, Study Suggests” [2]
"There should be no hospital policies which restrict fluids and foods in labor; nor should formal guidelines tell women to take specific foods, such as energy drinks," states one of the study's authors, Gillian ML Gyte, M.Phil, of the department of women and children's health at the University of Liverpool in the U.K.

She and her co-authors point out that prior research has shown that many women in labor do not feel like eating, but for others the notion of long hours without any food or drink can be anxiety provoking.” …

"Our study found no difference in the outcomes measured, in terms of the babies' wellbeing or the likelihood of a woman needing a C-section," said Gyte. "There is no evidence of any benefit to restricting what women eat and drink in labor." The researchers also emphasize the value of allowing women to make choices regarding these matters. 

From the Science Daily article, “Eating and Drinking During Labor: Let Women Decide, Review Suggests” [3]
Throughout much of the last century, eating and drinking during labour was considered dangerous and many maternity units operated "nil by mouth" policies or restricted what women in labour were allowed to eat and drink, regardless of women's preferences. This was largely due to concerns about possibly fatal damage to the lungs caused by "Mendelson's syndrome," where particles of regurgitated food are inhaled under general anaesthetic during Caesarean sections. Recently, however, attitudes have begun to change and in many maternity wards, particularly in the UK, women are now allowed to eat and drink what they want during labour…

"Since the evidence shows no benefits or harms, there is no justification for nil by mouth policies during labour, provided women are at low risk of complications," said lead researcher Mandisa Singata, who is based at the East London Hospital Complex in East London, South Africa. "Women should be able to make their own decisions about whether they want to eat or drink during labour, or not."…

"While it is important to try to prevent Mendelson's syndrome, it is very rare and not the best way to assess whether eating and drinking during labour is beneficial for the majority of patients. It might be better to look at ways of preventing regurgitation during anaesthesia for those patients who do require it," she said. 

So what is a couple to do when the hospital has a policy that restricts food and drink during labor?  Do you feel confident in your choice to eat and drink?  Do you want to circumvent the system by bringing in “Coach’s Food”?

That is a very individual choice.  You can labor at home as long as possible and follow your own cues if you want to prolong going to the hospital where your intake is going to be restricted.  You can pack some “Coach’s Food” and circumvent the system by snacking out of the coach’s cooler.  You can do neither and go with the system.  You can also talk to your care provider, bring in the scientific literature, and see if they will sign off on a birth plan that allows you to eat and drink in the hospital in spite of the policy.  Their hands may be tied, and it may not be a possibility, however as the saying goes, you won’t know unless you try.

Did your birth place have a policy that restricted food and drink?  What did you do; how did you handle it?
Please leave us a comment – it will be moderated and posted.

[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.

[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

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


Rally to Improve Birth 2013

Posted on July 16, 2013 at 6:59 PM Comments comments (0)
Did you know that there is a national organization advocating evidence-based care and humanity in childbirth? 

I first became aware of ImprovingBirth.org when they held their first rally last year.  In order to bring awareness to the maternity health care crisis in our country, the organizers chose the date of Labor Day for the national event.  This year, they are truly nation-wide – there is at least one rally planned in all 50 states, and as of today, it looks like they are up to eight international locations.

What maternity health care crisis in the United States, you ask?  Here is a look at the numbers.  In the world:
  • We are 34th in maternal mortality rates:  33 countries have lower maternal mortality than we do.
  • We are 38th in neonatal mortality rates: 37 countries have lower neonatal mortality rates than we do.
  • We are 41st in infant mortality rates: 40 countries do a better job at keeping newborns alive than we do.
  • We are 66th in birth weight: 65 countries do better than us when it comes to birthing babies at healthy birth weights.
  • We are 33rd in the breastfeeding: 32 countries had higher rates of exclusively breastfeeding at six months.

So do you know why I find this so infuriating?
“ Despite the poor international ranking, the International Federation of Health Plans recently reported that average U.S. payments for vaginal birth were far higher than all other countries reported, including Canada, France, and Australia (7).”


















Are you motivated to stand with women, children and coaches to rally for change? 
On September 2, 2013, from 10 a.m. – 12 noon local time, cities across the states are going to host a Rally to Improve Birth.  The rally is not to promote one kind of birth over other kinds of births.  It is not about bashing care providers and birthing facilities.

“It’s about women being capable of making safer, more informed decisions about their care and that of their babies, when they are given full and accurate information about their care options, including the potential harms, benefits, and alternatives.  It’s about respect for women and their decisions in childbirth, including how, where, and with whom they give birth; and the right to be treated with dignity and compassion.”
-Rally To Improve Birth

What is the message that Improving Birth is striving for?  Here are some of the messages they hope to get across that day (hint...ideas for rally signs):
  • Lower the C-Section Rate
  • Respectful Maternity Care 
  • Question Your Induction
  • Informed Consent is My Right 
  • Evidence-Based Birth

You can click HERE to find your local rally (readers in the Phoenix, AZ area - local info at the bottom of this post):
http://rallytoimprovebirth.com/find-a-rally-near-you/

If you can’t stand side-by-side with the families attending the rally, you can still participate.  All the rallies are 100% volunteer organized – even a donation of $10.00 can help buy water to hydrate all the mamas, babies, coaches and care providers standing under the hot sun on Labor Day to bring awareness and change to the maternal healthcare system.
Donate HERE to the national organization:

Donate HERE to the local Phoenix Rally:
http://rallytoimprovebirth.causevox.com/phoenix

HERE is a story from an "eye-roller" at last year’s rally, to a supporter at this year’s rally.  I would like to think that these stories are few and far between.  Unfortunately, I know they are not.  Due to my involvement in the birth community at large, I have personally heard stories from several women who felt completely violated by their care providers and the current standard of care.  We can make a difference.  We can stand together and insist that it is time to humanize birth again, to use evidence-based care, and to involve the birthing family as partners in their birth story. For more information, please visit their main website:

Readers in the Phoenix, AZ area
Here is the info on our local event:
September 2, 2013
10:00 am to 12:00 pm
Tempe Beach Park
54 West Rio Salado Parkway
Tempe, Arizona 85281

To stay up-to-date on the local event, visit the Facebook Page.



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: Induction Drugs

Posted on June 7, 2013 at 4:20 PM Comments comments (0)
This is the second post in the series that looks at the small print on the drug information sheet for consumers.  In our first post, we looked at the details of drugs used in epidurals.  Here is the fine print for the drugs used by hospital practitioners to induce labor.  This may be offered for a variety of reasons.  

Whenever a drug or procedure is offered, we encourage our students to look at the benefits and the risks.  There are circumstances where the benefits clearly outweigh the risks.  It is up to each family to individually decide what works best for them and their baby.  In the spirit of informed consent, here is the fine print and FDA Pregnancy Category for Cervadil (Brand Name for a form of Dinoprostone), Dinoprostone, Cytotec (Misoprostol) and Pitocin.


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.  As with last week, everything is in direct quotes because the information is pulled from the drug information made available by the Federal Drug Administration (USA).

CERVADIL: Pregnancy Category C
http://www.drugs.com/pro/cervidil.html
Cervidil is contraindicated in:
"- Patients with known hypersensitivity to prostaglandins.
- Patients in whom there is clinical suspicion or definite evidence of fetal distress where delivery is not imminent.
- Patients with unexplained vaginal bleeding during this pregnancy.
- Patients in whom there is evidence or strong suspicion of marked cephalopelvic disproportion.
- Patients in whom oxytocic drugs are contraindicated or when prolonged contraction of the uterus may be detrimental to fetal safety or uterine integrity, such as previous cesarean section or major uterine surgery (see PRECAUTIONS and ADVERSE REACTIONS).
- Patients already receiving intravenous oxytocic drugs.
- Multipara with 6 or more previous term pregnancies."

"Warnings
Women aged 30 years or older, those with complications during pregnancy and those with a gestational age over 40 weeks have been shown to have an increased risk of postpartum disseminated intravascular coagulation. In addition, these factors may further increase the risk associated with labor induction (See ADVERSE REACTIONS, Post-marketing surveillance). Therefore, in these women, use of dinoprostone should be undertaken with caution. Measures should be applied to detect as soon as possible an evolving fibrinolysis in the immediate post-partum period.
The Clinician should be alert that use of dinoprostone may result in inadvertent disruption and subsequent embolization of antigenic tissue causing in rare circumstances the development of Anaphylactoid Syndrome of Pregnancy (Amniotic Fluid Embolism)."

"Precautions
General: Since prostaglandins potentiate the effect of oxytocin, Cervidil must be removed before oxytocin administration is initiated and the patient's uterine activity carefully monitored for uterine hyperstimulation. If uterine hyperstimulation is encountered or if labor commences, the vaginal insert should be removed. Cervidil should also be removed prior to amniotomy.
Cervidil is contraindicated when prolonged contraction of the uterus may be detrimental to fetal safety and uterine integrity. Therefore, Cervidil should not be administered to patients with a history of previous cesarean section or uterine surgery given the potential risk for uterine rupture and associated obstetrical complications, including the need for hysterectomy and the occurrence of fetal or neonatal death.

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

"Post-marketing surveillance:
Immune System Disorders: Hypersensitivity
Blood and lymphatic system disorders: Disseminated Intravascular Coagulation (See WarningsSection)
Reproductive system: Reports of uterine rupture have been reported in association with use of Cervidil some required a hysterectomy and some resulted in subsequent fetal or neonatal death.
Vascular Disorders: Hypotension
Pregnancy, Puerperium and Perinatal Conditions: Amniotic fluid embolism"
"Contraindications:
Hypersensitivity to dinoprostone, prostaglandins, or any components of the product; patients in whom oxytocic drugs are contraindicated or when prolonged contractions of uterus are considered inappropriate; ruptured membranes; placenta previa; unexplained vaginal bleeding during current pregnancy; when vaginal delivery is not indicated; acute pelvic inflammatory disease; active cardiac, pulmonary, renal, or hepatic disease (suppository only)."

"General advice:
Carefully examine vagina to determine degree of effacement and appropriate length of endocervical catheter to be used for application of gel (10 mm if 50% effaced, 20 mm if no effacement).
Patient should be in dorsal position for administration and remain supine for 15 to 30 min after administration of cervical gel.
Following administration of vaginal suppository, the patient should remain in the supine position for 10 min.
Following administration of the vaginal insert, the patient should remain in a recumbent position for 2 h.
Inserts do not require warming prior to administration.
Suppositories and gel must be brought to room temperature. Do not use external sources of heat (eg, hot water bath, microwave oven) to decrease warming time.
Wait at least 6 to 12 h after administration of gel before using IV oxytocin; a dosing interval of at least 30 min is recommended after removal of insert.
Do not use dinoprostone vaginal suppository for extemporaneous preparation of any other dosage forms or for cervical ripening or other indications in the patient with term pregnancy."

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

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

"Lactation: Undetermined."

"Special Risk Patients
Use with caution in patients with asthma, glaucoma, or raised IOP, hypotension or hypertension, CV or renal or hepatic impairment, anemia, jaundice, diabetes, epilepsy, compromised uterus, infected endocervical lesions, acute vaginitis, in patients with cases of non-vertex or non-singleton presentation, and in patients with a history of previous uterine hypertony.
-Anaphylactoid syndrome of pregnancy Intracervical placement of dinoprostone may result in inadvertent disruption and subsequent embolization of antigenic tissue, and rarely leads to development of anaphylactoid syndrome of pregnancy (amniotic fluid embolism).
- Incomplete pregnancy termination If dinoprostone pregnancy termination is incomplete, take other measures to ensure complete abortion.
- Postpartum disseminated intravascular coagulation An increased risk has been described in patients whose labor was induced by physiologic means. Women who are 30 y and older, those with complications during pregnancy, and those with gestational age more than 40 wk are at risk.
- Pyrexia Transient pyrexia (temperature elevations in excess of 2°F), possibly due to the dinoprostone effect on hypothalamic regulation, was observed in 50% of patients receiving suppositories at the recommended dosage. Temperature returned to normal on discontinuation of therapy.
- Ruptured membranes Exercise caution when administering dinoprostone cervical gel or vaginal insert to patients with ruptured membranes.
- Uterine hyperstimulation Placement of dinoprostone cervical gel into the extra-amniotic space has been associated with uterine hyperstimulation. When using the vaginal insert, if uterine hyperstimulation is encountered or if labor starts, the vaginal insert should be removed."

CYTOTEC/MISOPROSTOL: Pregnancy Category X
http://www.drugs.com/search.php?searchterm=Cytotec
"Generic Name: misoprostol (MYE-soe-PROST-ol) Brand Name: Cytotec Do not take Cytotec to reduce the risk of stomach ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs) if you are pregnant. Cytotec may cause abortion, premature birth, or birth defects if taken during pregnancy. Life-threatening..."
(My note: yes - this is just how it appears - with the ellipsis there)

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

"Breastfeeding Warnings
Misoprostol is rapidly metabolized in the mother to misoprostol acid which is biologically active and is excreted in human breast milk. There are no published reports of adverse effects of misoprostol in breast-feeding infants of mothers taking misoprostol. The manufacturer recommends that caution should be exercised when misoprostol is administered to a nursing woman."
"What should I discuss with my healthcare provider before receiving Pitocin (oxytocin)?
You should not receive this medication if you have ever had an allergic reaction to oxytocin."

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

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

"Tell your caregivers at once if you have a serious side effect such as:
fast, slow, or uneven heart rate;
excessive bleeding long after childbirth;
headache, confusion, slurred speech, hallucinations, severe vomiting, severe weakness, muscle cramps, loss of coordination, feeling unsteady, seizure (convulsions), fainting, shallow breathing or breathing that stops; or dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure)."

"Less serious side effects may include:


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

"For Health Professionals
Hepatic side effects have included neonatal jaundice."
Read more at HERE 

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

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

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


As you can see from the insert information and the pregnancy categories assigned by the FDA, these are not inherently safe just because they are commonly used.  Any parent who is being asked to use these should do so after careful consideration of the risks and the benefits.  You can use this series of questions to help you determine if the benefits outweigh the risks:
  • Is Mom okay?
  • Is Baby okay?
  • What are the benefits of using this drug?
  • What are the risks of using this drug? (You have the right to read the drug insert for yourself in the care facility)
  • What else is going to happen if we say yes? (Additional procedures, time in bed, time being monitored, position for mom, etc.)
  • What are the expected results?  What if we don’t see them? 
  • What are the alternatives if we choose not to do this?
  • What does our intuition tell us?
  • What happens if we choose to do nothing?

Any advice to offer about being induced?
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, Payson
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®.


Planning Your VBAC – Where to Begin

Posted on April 2, 2013 at 4:02 PM Comments comments (0)
I open today's post with the reminder that April is Cesarean Awareness Month. The World Health Organization and evidence-based practice only supports a cesarean rate of 15% or less.

While a cesarean birth can be life saving and necessary, and we are so grateful for the technology when our students need this intervention, we encourage you to know the difference between a variation and complication. Is Mom okay? Is Baby okay? If yes to both questions, asking for time can spare both Mom and Baby from an "unnecesarean". 

The current cesarean rate in the US is around 32-33%, so our wish at Sweet Pea Births is that by raising awareness, only the necessary cesareans are performed, and that over time we see our national cesarean rate back down to at or under 15%.

If a VBAC is not an option you want to explore, I encourage you to explore the ideas and additional readings HERE to learn more about a family-centered cesarean that may be a gentler experience for both mother and baby.  With time and planning with your care provider, these are possible and a beautiful option for families that want and/or need a repeat cesarean.

On to the topic:  Where do you begin if you want to plan for a Vaginal Birth After Cesarean?  

These notes are from an ICAN meeting presented by ICAN of Phoenix chapter leaders Stephanie Stanley and Jessica Franks on January 23, 2013, hence they get the author by-line on this one.  Thank you, ladies, for your constant support of the cesarean community in the Phoenix area.  Here are the steps that Stephanie and Jessica identified in hindsight of their VBAC journeys.

Step 1:  Find a supportive care provider
Your options for finding a supportive care provider in Arizona include an obstetrician in a hospital setting, a Certified Nurse-Midwife in a hospital setting, and Naturopathic Doctor who also holds a Certified Professional Midwife license in a home setting.  In addition, you an interview at Women’s Birth and Wellness Center in Mesa, Arizona, to see if you are a candidate for a VBAC at their birth center.  If you are in the Phoenix area, you can check the ICAN Phoenix provider list HERE to see which care providers have been supportive as per first-hand experience from VBAC mothers.

Step 2: How do I know if someone is truly supportive?
The only way to really know if a care provider is going to go along with your choice for a trial of labor that you hope is going to lead to a vaginal birth is the interview them.  Schedule an appointment with them and meet them face-to-face.  Here are some questions you can ask – you want to keep them open-ended so that you hear their spontaneous answer.
  • How do you feel about letting a VBAC mom go to forty-two (42) weeks gestation?
  • How do you feel about natural birth?
  • What are specific protocols and what is the timeline you follow with a VBAC mother?
  • Which pushing position do you support when a mom is attempting a VBAC?
  • How do you feel about doulas in the labor and delivery space?
  • What are my options if I should need a repeat cesarean?
  It is important to get out of the mindset that the obstetrician or care provider as the authority over you.  You are the consumer.  You are hiring a person to care for you and your baby.  A big red flag warning is the statement, “Well, we’ll deal with that when we come to that.”  That usually means that, “When we get there, we are doing it my way,” so consider it a sign that it may be time to move on to the next person on your list.
Step 3: Be Healthy, Starting Now
Your nutrition is vital to your health, your pregnancy, your baby and your birth.  Maintain a healthy diet and exercise on a regular basis.

Krystyna’s note:  A comprehensive childbirth education class, like The Bradley Method®, prepares mothers over the course of the twelve week series to eat well to build a strong body and a strong baby, and we have a pregnancy exercise program that builds stamina as well as the three major muscle groups that support pregnancy and labor: Back, Belly, and Bottom.

Step 4: Mental Health
Your mental health plays a significant role in your pregnancy and birth.
A childbirth preparation course can educate you on the course of labor so that there are *less* surprises – all labors have an unknown factor and you can’t be “completely” prepared.
  • Work through any fears you had going into your last birth, or that have arisen as a result of your previous birth.
  • Strive to reduce stress and tension in your daily life.
  • Surround yourself with supportive, positive, and helpful people.
  • Be honest with yourself and with your partner – you need to address how both of you are feeling in regards to your past birth and the preparations for a VBAC.
  • Identify what your needs are, and what needs to be addressed.  Do the same for your partner.
  • Evaluate your mindset: are you going to go along with what your doctor tells you to do, or are you going to educate yourselves as a team so that you can make informed decisions?

Step 5: Take A Childbirth Education ClassThere are several options for birthing families these days.  Here are some of the classes mentioned in the meeting:
  • Birthing From Within
  • The Bradley Method®
  • Hypnobirthing: might work better if you have a yoga background
  • Hypnobabies: some consider it a more “user-friendly” version of Hypnobirthing
  • Private Comprehensive Class taught by a doula or independent childbirth educator

Krystyna's Note:  The Bradley Method® is fabulous as a comprehensive preparation course. You can click HERE to see what is taught through the  course of the 12-week series.  However, we do not do anything in-depth to address any past birth trauma or fears that you may be bringing to the birth space.  If you are interested in The Bradley Method®, please contact me to discuss some additional resources I recommend for VBAC couples enrolled in our course.

Step 6:  Plan To Hire A Doula
Doulas are an essential part of your birth plan.  A doula is a woman whose only role is to support a family through their labor, birth and the choices they want for their birth.  They may offer ideas for labor positions, moral support and hands-on help, among other things.  Typically people hire their doula between 24-30 weeks.  There is no “right time” to hire a doula, so even if you are earlier or later than this window, you can make phone calls and find the right person to support you and your partner through your birth experience.  Some insurance companies cover the doula fee, so call them and ask!
Step 7:  Get Family Support
The support of the people closet in regards to your decision to VBAC is very important. 
  • Educate your family – invite them to come along to a cesarean support group meeting, such as ICAN.
  • Honestly express why this is important and what led you to this decision.
  • Understand that if something or someone is not helpful, supportive or positive, then it or they do not need to be a part of your birth.

Krystyna’s Note: My favorite line of conversation I have heard at an ICAN meeting, and that I know share with our students in regards to birth choices is this: 
“I have taken the time to educate myself and make the right choice for our family.  Do you really think that I would make a choice to intentionally harm myself, or our child?  If we cannot come to an understanding, or at least agree to disagree, this topic is off the table and no longer up for discussion.”


Step 8: Educate Yourself
Knowing the facts about VBAC will give you more confidence in your decision, as well as prepare you to educate those who may question the safety of your decision.
  • Read, read, read.
  • Read positive VBAC birth stories
  • Talk with your care provider – know their VBAC numbers
  • Ask questions and research the information you are finding

 Step 9:  From a Birth Plan
A birth plan is a great way to organize and prepare your goals.  It is a tool to help you articulate the vision you have for this birth.  Birth plans are typically written around 30 weeks, but there is no “right time” to write a birth plan.
  • Write your VBAC plan
  • Consider writing your cesarean birth plan
  • Talk with your care provider about your birth plan.  If your care provider is not on board, talk with them to explore if there is a way to make it workable.  What are your absolutes, and are your communicating them effectively?
If you are absolutely confident that other care providers have supported the choices you are making, then it may be time to interview other care providers.

Step 10:  Breathe
It will be okay!  Your body knows how to have babies.  In the swirl of activity, remind yourself to relax and enjoy your pregnancy!   
Krystyna’s Note:  However this birth is going to go, your body is still in the midst of the miracle of creating an entirely new human being over the course of the pregnancy.  You are an amazing, creative goddess – enjoy the glow and revel in your growing baby bump!
 
Are you planning/have you had a VBAC?  What is/was been important to you?
 
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Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson
LINK LIST
Family-centered Cesarean
http://blog.ican-online.org/2012/04/14/the-family-centered-cesarean/

ICAN of Phoenix Provider List
http://icanofphoenix.weebly.com/valley-resources.html    

Bradley Method Course Outline
http://www.bradleybirth.com/krystynabowman?Page=5

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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