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®.

 

Birthing From Within and Bradley Method® natural childbirth classes offered in Arizona: convenient to Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale

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.  

 

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. 

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.

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:  

In honor of Cesarean Awareness Month, I am going to devote the next two Tuesday posts with some information on cesareans.  I am not going to write a lot on how to avoid one in the first place or the specifics of a Vaginal Birth After Cesarean (“VBAC”) since there is already a wealth of information at the International Cesarean Awareness Network (“ICAN”) and Childbirth Connection websites. Instead I will offer an introduction to the topic for people who are not aware that cesareans are performed at an alarming high rate, and offer a quick look at causes and precautions.  At the end of the post you will find several links for more detailed information.

 

Here is a brief introduction:

In this country, the cesarean rate in 2009 was 32.9%.  It means that over 1.4 million women and families welcomed their children into the world via a surgical procedure.  It marked the 13 consecutive year of a rise in cesarean rates in the United States.  For a look at cesarean rates by the numbers, click here.

 

The good news is that for the first time in 14 years, the preliminary data in the statistical year 2010 shows that the cesarean rate went down by 0.1% (from 32.9% to 32.8% - still means over 1.3 million cesareans).  It doesn’t sound like very much, yet by the numbers, that means approximately 405,700 more women had vaginal births instead of a surgical procedure to birth their babies.  There are lots of different factors that contributed to the decline; my Pollyanna is hopeful that all the good work of ICAN, and other educators, is providing information to help mothers avoid what is termed the “unnecesarean”.  For those moms in whom a true emergency situation warrants a cesarean birth, I continue to be grateful for the medical knowledge that allows for a Healthy Mom, Healthy Baby outcome.

 

The World Health Organization recommends that the cesarean rate should be around 15% (See Reference 1 below).  This is what it estimates to be the more accurate percentage of instances when performing an operation instead of allowing for a vaginal birth saves a mother and/or child’s life.

 

So are all the cesareans performed in the United States life saving?  Here is a look at how we rank internationally: the "World Health Statistics 2010 identified 33 countries with lower maternity mortality ratios than the United States, while 37 countries had lower neonatal mortality rates, 40 had lower infant mortality rates...” (2)

 

So working strictly off the numbers, our predominantly medically managed and intervention based hospital model (which includes a high incidence of cesareans) does not equate to a better outcome for mothers and babies.  It is quite shocking to realize that some third-world countries have much better outcomes with their approach to labor and birth in comparison to ours.

 

Dr. Berman, who sits on the board of the American Academy of Husband-Coached Childbirth®, taught me a healthy respect for what a cesarean really is as opposed to how it is perceived in today’s society.  We had the privilege of hearing him speak at our Bradley Method® training in Anaheim.  According to him, if you were to sustain the injuries and the trauma associated with a cesarean surgery outside of the operating room, you would have a fatal injury that very few people could survive.  Cesareans are a surgical procedure and carry all the risks associated with surgery (see link list below).

 

Here are six leading causes of cesareans identified by The Academy of Husband-Coached Childbirth®,

 

How do you prepare yourself and avoid facing these in your labor?

Inability to relax: attend a childbirth preparation class, like The Bradley Method® series, that teaches you about the process of labor so that you are educated.  Knowledge eases fear and has the potential to break the Fear-Tension-Pain cycle that stops relaxation.  The Bradley Method® also prepares couples with twelve different relaxation techniques – if a couple attends classes and does their homework, they will have several tools to use until they find the one that best relaxes the mother and allows her body to work with her labor.

 

CPD:  True CPD is a real medical complication.  It is usually found when a woman has experienced severe malnutrition.  However, it cannot be accurately diagnosed until a mother has had a trial of labor, which has a very ambiguous definition (3).  Know how long your care provider will let you labor before coming to this conclusion. 

 

In addition, we need to remember and trust that our pelvis is a comprised of moving parts, and that there are hormones made by our bodies that relax the tendons so that those parts can stretch and mold with our babies, and then return back to the proper alignment and shape after we give birth.  We also need to remember that labor works best with gravity.  If a mother has been lying on her back and fighting gravity, she will be more tired and her body will be less likely to function as it was designed to do.

 

If you hear this term in relation to your labor, ask for the time (as long as mom and baby are not at risk) to try different positions and see what your body is capable of.   Chances are good of a vaginal birth if you get a mother off of her back and into positions that open the pelvis and work with gravity, i.e. walking, upright and squatting positions.  With these, her pelvis will be more likely to open and expand to welcome her child vaginally.

 

I recently learned that a possible indicator for CPD might also be a swollen cervix.  You can read a conversation between midwives here .  I thank my lucky stars that I am not a medical professional when I read their dialogue.  I am always open to sharing information – so please take the time to read this so you can consider possible options you want to ask for if you face CPD in your labor.

 

FTP: This is a clear instance where knowing what your care provider and birthplace consider “normal” is of utmost importance.  If one or both of them expect all moms to deliver by a certain timeline, find another care provider or birthplace.  All bodies are unique and all babies are unique.  Each labor will be exactly as long as it needs to be – and if you are expected to fit into a particular timeframe or else face the knife, trust your instinct that is telling you that this is an unrealistic expectation.

 

Fetal Distress:  This is another situation that could be a real medical complication.  Fetal monitors were designed to be used intermittently, and specifically in instances when distress was suspected.  Instead, monitors are used as a continuous procedure unless you make a specific request in your birth plan to have it otherwise.

 

The word “labor” applies to both the mother and the baby – and as we all know, hard work causes stress.  Most babies will handle the stress of labor beautifully when the mom has stayed low-risk and eaten a well-balanced diet throughout her pregnancy. It is important to read and educate yourself on what true fetal distress is and what the causes are so you can make an informed decision if you start to hear that term during your labor.

 

If fetal distress is indicated solely due to the tape the machine is spitting out, the first thing to do is ask if you have time.  If the clear and urgent answer is no, then you decide what you want to do for a Healthy Mom, Healthy Baby outcome.  If there is time, then you can ask for a second opinion, and/or ask for them to listen to the baby by other means, such as a fetoscope or a Doppler.  The monitors can give false readings by the simple fact that they are just a machine interpreting the signs from the baby instead of a trained set of hands and a human ear that feels and listens to the baby.

 

Prolonged Labor: This is a situation when knowing what your care provider or birthplace considers “prolonged”, and also when having a supportive coach and a support team makes a huge difference.  The mother and coaches attitude about having a prolonged labor will affect how a choice for or against a cesarean.  The questions to consider here are: Is the mother okay? Is the baby okay? Do we believe that our labor is what our baby needs?  Are we willing to give baby the time he or she needs to be born? What else could we do/try before we agree to a cesarean?

 

Every couple will make their own choice under these circumstances.  Their list of things to do or try before they accept a cesarean will depend on their training and the experience of coach or any assistant coaches the couple has with them.  If the mom and baby are not in distress after a prolonged labor, there is no right or wrong answer in this case – it is entirely up to the parents to decide which path they want to choose.  If either the mom or baby is showing signs of distress, the path forward is clearer when you are central goals are a Healthy Mom, Healthy Baby outcome.

 

Pain: I would be lying to you if I told you that childbirth is painless.  However, the pain is bearable and welcomed when you focus on the result of the work you are doing and when you are surrounded by the love and care of your coach and any assistant coaches.  There are times when the pain changes, and an excruciating pain that doesn’t break and/or that is accompanied by bright red blood and/or large blood clots is a true complication. It could be a life-threatening complication like placental abruption or a uterine rupture.  These clearly indicate a cesarean to attempt to save the life of the mother and the child.

 

If the pain increases in intensity, but it continues to ebb and flow with the strength of the contractions, then the team needs to evaluate if maybe the baby is malpositioned and needs to be encouraged to move again.  The other cause of intense yet manageable pain could indicate an emotional component of labor that the mom needs to address before labor can resume its normal course.

 

The bottom line is that you, as a consumer of medical services, need to educate yourself, ask questions of your care provider, and advocate for the choices you want.  If your requests are reasonable, chances are high that you will be able to find a care provider who supports your choices and only uses cesarean surgery in the emergency situations for which it was intended.

 

ANNOUNCEMENT FROM ICAN: ICAN of Phoenix will be offering a Cesarean Prevention Class on Saturday May 19th from 2-4pm. Location is TBA but will be in the East Valley this time. Cost will be $25 per couple, your other half is strongly encouraged to attend (your doula may attend too, no cost for bringing her). There will be a sign up form on the website as soon as the location is set, but you may rsvp if you already know you will attend. If you need more details please email Stephanie Stanley at [email protected] 

 

Things you can do to avoid an unnecessary cesarean:

 

Risks associated with cesarean:

 

More information on cesareans and related topics:

 

 

ICAN Facebook page:

 

ICAN Phoenix Facebook page

 

(1)  World Health Organization. Appropriate technology for birth. Lancet 1985; 2: 436-7.

(2) http://transform.childbirthconnection.org/wp-content/uploads/2011/03/factsandfiguresapril2011.pdf

(3) http://medconditions.net/trial-of-labor.html

 

I used the provisional 2010 number and multiplied it by 0.01%

 

Number of births in the US

Preliminary Data (11/17/11) 2010 was 4,000,279

Feb 2012 update: 4,057,000 for the 12-month period ending June 2010  4,057,000 - 32.8% = 1,330,696 cesareans

Final 2009 Data (11/03/11): Number of births: 4,130,665

4,130,665 – 32.9% = 1,358,989 cesareans

 

Comparing 2010 to 2009 

2010 Birth rate: 2% lower

2010 Cesarean rate: 0.1% lower

 

 

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