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REVIEW: ACOG Committee Opinion on Approaches to Limit Intervention During Labor and Birth
| Posted on March 7, 2017 at 6:24 PM |
comments (199)
|
Note: all words in this piece that are in “quotation marks”
are excerpts or quotes from the ACOG Committee Opinion published February 2017. HERE is that article. The American College of Obstetrics and Gynecology just came
to a very important conclusion in THIS Committee Opinion that was published in
February 2017:  “Many common obstetric practices are of limited or uncertain
benefit for low-risk women in spontaneous labor. In addition, some women may
seek to reduce medical interventions during labor and delivery. Satisfaction
with one’s birth experience also is related to personal expectations, support
from caregivers, quality of the patient–caregiver relationship, and the
patient’s involvement in decision making (57). Therefore,
obstetrician–gynecologists and other obstetric care providers should be
familiar with and consider using low-interventional approaches, when
appropriate, for the intrapartum management of low-risk women in spontaneous
labor.”FINALLY. Yes, it is a little frustrating that it has taken years for
the doctors who manage pregnancy, labor and birth to acknowledge that less
intervention is best for birth outcomes.
However, I am grateful that ACOG has caught up with Dr. Bradley and all
the other proponents of dignity in birth that know “It’s not nice to fool
Mother Nature.” The part that interests me the most as a childbirth educator
is how they treat the topic of pain relief and coping techniques in labor. There is the acknowledgement that, “pharmacologic
methods mitigate pain, but they may not relieve anxiety or suffering. “ And
then this statement: “None of the nonpharmacologic techniques have been found to
adversely affect the woman, the fetus, or the progress of labor, but few have
been studied extensively enough to determine clear or relative effectiveness.” So there is finally the recognition that nonparmacologic
techniques do not adversely affect the woman, the fetus or the progress of
labor. And to CYA, they have to state that there is no conclusive study to
determine effectiveness. Be that as it
may, it doesn’t matter to me as a childbirth educator if a study can measure
the effectiveness. What I do know as an
educator and a doula is that if the mother perceives a pain coping practice as
effective, it is being effective for her in that moment. The key to continuing that pain coping practice hinges on two
questions: “Is the mother okay? Is the baby okay”” As long as both the mother
and the baby continue to tolerate the intensity of labor, then the conclusion effectively
says LEAVE THEM ALONE. In the article there are two distinctions between pain coping
practices: The pain coping practices that have been studied and, “have
all demonstrated statistically significant reductions in pain in many studies” Water immersion consistently has been found to lower pain
scores (8, 34). Intradermal sterile water injections Relaxation techniques Acupuncture Massage “Other techniques may help women cope with labor more than
directly affect pain scores” Childbirth education Transcutaneous electrical nerve stimulation [TENS] Aromatherapy Audioanalgesia Here are some more areas of discussion in the committee
opinion that bring obstetric care into the humane versus management for their
convenience. I have included the
corresponding bullet points from the summary and also provided some lay-person
translation as needed. Latent Labor: Labor
Management and the Timing of Admission ·
“For
a woman who is at term in spontaneous labor with a fetus in vertex
presentation, labor management may be individualized (depending on maternal and
fetal condition and risks) to include techniques such as intermittent
auscultation and nonpharmacologic methods of pain relief.” IN OTHER WORDS: If your baby is head-down when you start
labor, then your labor management can be individualized and include intermittent
fetal monitoring (freedom to move as labor indicates) instead of continuous
fetal monitoring (thus anchored to the bed) AND mother is free to try any
method of pain relief of non-drug pain relief that she would like to try. ·
“Admission
to labor and delivery may be delayed for women in the latent phase of labor
when their status and their fetuses’ status are reassuring. The women can be
offered frequent contact and support, as well as nonpharmacologic pain
management measures.” IN
OTHER WORDS: If your labor has started and your bag of waters is intact, there
is no rush to admit you to the labor and delivery ward. If the mother is okay and the baby is okay,
phone contact and support from your care provider is the order of the day, and
the mother is free to continue with any non-drug pain coping practice that is
working for her. Term Premature Rupture of
Membranes ·
Obstetrician–gynecologists
and other obstetric care providers should inform pregnant women with term
premature rupture of membrane (PROM [also known as prelabor rupture of
membranes]) who are considering a period of expectant care of the potential
risks associated with expectant management and the limitations of available
data. For informed women, if concordant with their individual preferences and
if there are no other maternal or fetal reasons to expedite delivery, the
choice of expectant management for a period of time may be appropriately
offered and supported. For women who are group B streptococci (GBS) positive,
however, administration of antibiotics for GBS prophylaxis should not be
delayed while awaiting labor. In such cases, many patients and
obstetrician–gynecologists or other obstetric care providers may prefer
immediate induction. IN OTHER WORDS: If your bag of water breaks and you are not GBS-positive,
you as the patient can decline immediate induction and this committee opinion
instructs the care provider to support the patient in that choice. If you are informed, you also know this
includes declining vaginal exams that have the potential to introduce infection
and that water immersion is an available pain coping practice (see Henci Goer’s
Thinking Woman’s Guide to a Better Birth”). What bothers me a little is that if a woman is not
informed, it sounds like they are going to railroad her into the immediate
induction route. Yuck. As for women who are GBS-positive, the recommendation is
to admit the patient and start the administration of antibiotics. The committee says that the preference is for
immediate induction, but it doesn’t say one way or the other that it is the
best practice. You can go back to those
two important questions, “Is mom okay? Is baby okay?” If you get YES answers to
both of those questions, you may think about getting the antibiotics and then
postponing anything else that is offered until there is a medical indication “to
do something”. Continuous Support During
Labor ·
“Evidence
suggests that, in addition to regular nursing care, continuous one-to-one
emotional support is associated with improved outcomes for women in labor.” IN OTHER WORDS: LET
THE DOULAS IN THE ROOM!!! Routine Amniotomy ·
“For
women with normally progressing labor and no evidence of fetal compromise,
routine amniotomy need not be undertaken unless required to facilitate
monitoring.” IN OTHER WORDS: Amniotomy is the artificial breaking of
the bag of waters. You can read the info
sheet on this procedure HERE. What this committee opinion states clearly is
that THERE IS NO REASON to break the bag of waters if labor is progressing and
there is no evidence of fetal compromise.
Not to “help things along”. Not
to “speed labor”. Not “to see what
happens”. NONE. DO NOT break the bag of waters. The only reason stated for breaking the bag of waters is
in the case of the need of an internal fetal monitor. This monitor is screwed
into the baby’s fontanel, so in order to facilitate access to said fontanel, the
bag of waters needs to be out of the way. Intermittent Auscultation ·
“To
facilitate the option of intermittent auscultation, obstetrician–gynecologists
and other obstetric care providers and facilities should consider adopting
protocols and training staff to use a hand-held Doppler device for low-risk
women who desire such monitoring during labor.” IN OTHER WORDS: Get with the program and learn how to do
labor evaluation with a hand-held Doppler device. P.S.: Midwives have been doing this for
years. There are many risks associated with continuous fetal
monitoring – for more information I recommend you read THIS Cochrane review
that shows how a decrease in fetal monitoring increases positive birth
outcomes. There are many cases of false
positives with continuous fetal monitoring.
These false positives result in a more aggressive management of labor
that often leads to an increase in unnecessary cesarean birth outcomes. While there is a time and a place and much
gratitude for cesarean births that are needed, it is devastating for a mother
to read her operative report and realize that her cesarean birth could have
been avoided with a different approach to her care. Techniques for Coping With
Labor Pain ·
“When
women are observed or admitted for pain or fatigue in latent labor, techniques
such as education and support, oral hydration, positions of comfort, and
nonpharmacologic pain management techniques such as massage or water immersion
may be beneficial.” IN OTHER WORDS: Don’t push the epidural if the patient
wants to try some other things first. ·
“Use
of the coping scale in conjunction with different nonpharmacologic and
pharmacologic pain management techniques can help obstetrician–gynecologists
and other obstetric care providers tailor interventions to best meet the needs
of each woman.” IN
OTHER WORDS: Treat your patients as individuals!! What works for one does not
work for all. And pain is not the only
marker for labor management. As stated
in the committee opinion, “pharmacologic methods
mitigate pain, but they may not relieve anxiety or suffering.“ If the mother can handle the pain and is
doing something that does reduces anxiety or suffering, that is ok. It may be hard to watch, however, doing
nothing is fine as long as the mother and the baby are doing well. Hydration and Oral Intake in
Labor “Women in spontaneously progressing labor may
not require routine continuous infusion of intravenous fluids. Although safe,
intravenous hydration limits freedom of movement and may not be necessary.” IN OTHER WORDS: Routine use of IV fluids is
out!! Yeah!! The whole tone of this committee opinion is to treat patients as
individuals, so if there is no medical indication and the patient declines
routine IV, then leave her to labor without IV fluids. HERE is the summary of research presented at the Anesthesiology® 2015 Annual
Meeting. It states that, “most healthy women can skip
the fasting and, in fact, would benefit from eating a light meal during labor…improvements
in anesthesia care have made pain control during labor safer, reducing risks
related to eating”. Maternal Position During
Labor ·
“Frequent
position changes during labor to enhance maternal comfort and promote optimal
fetal positioning can be supported as long as adopted positions allow
appropriate maternal and fetal monitoring and treatments and are not
contraindicated by maternal medical or obstetric complications.” IN OTHER WORDS: As long as labor is progressing and mom
and baby are well, let a mom labor in whatever position she deems useful. When it’s time to monitor the baby, any
position that allows for monitoring to happen is still acceptable. The easiest for
the nurse and the most uncomfortable position for the mother/baby is to have the
mother lie on her back (supine).
According to this committee opinion, other positions are now within
range of acceptable. Positions such as side
lying, hands and knees, or tailor sitting are all examples of other positions
that allow for fetal rotation and engagement in the pelvis while keeping the
mother still enough to undergo fetal monitoring. Second Stage of Labor:
Pushing Technique ·
“When
not coached to breathe in a specific way, women push with an open glottis. In
consideration of the limited data regarding outcomes of spontaneous versus
Valsalva pushing, each woman should be encouraged to use the technique that she
prefers and is most effective for her.” IN OTHER WORDS: Don’t tell a woman how to push. If she follows her instincts, the baby will
come out. Valsalva pushing is when a
woman is directed to do forceful pushing during a contraction for a certain
count with no regard to what her body is doing physiologically. Physiological pushing allows for a woman to
work with her contractions: as she feels the peak, she will push as long as is
comfortable. End of story. Immediate Versus Delayed
Pushing for Nulliparous Women With Epidural Analgesia ·
“In
the absence of an indication for expeditious delivery, women (particularly
those who are nulliparous with epidural analgesia) may be offered a period of
rest of 1–2 hours (unless the woman has an urge to bear down sooner) at the
onset of the second stage of labor.” IN OTHER WORDS: “Nulliparous” means a woman that has not
given birth before. Unless there is a
medical reason for the baby to be born as soon as possible, women, including
those who have epidural analgesia, are to be allowed a time period between the
time they are completely dilated (10 cm) and pushing. If the woman is monitored and both she and
baby are shown to be well, up to two hours can be allowed for the baby to
descend into a position that creates the urge to push, thus making the pushing
phase more effective. Sometimes the cervix is open and the baby is still high
in the pelvis, thus there is no urge to push.
When the pushing phase begins before there is an urge to push, this
effectively “starts the clock” by which a care provider or hospital policy may
deem it necessary to intervene with a vaginal operative birth (vacuum or
forceps delivery) or a cesarean birth. I hope this little review offers you the confidence as a consumer to advocate for what you know is right for you and your baby. Our inner wisdom about birth is present and powerful if we can allow it a voice in our labor space. Disclaimer:
Birthing From Within and Bradley
Method® natural childbirth classes offered in Arizona: convenient to Chandler,
Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale
|
VBAC Preparation: Ask the Midwife
| Posted on April 29, 2015 at 7:16 PM |
comments (618)
|
Our posts for Cesarean Awareness Month continue. With their permission, I am sharing notes today that I took at an
ICAN meeting presented by some Phoenix-area midwives in 2012. The main presenters and most of what you see below are the paraphrased words of Diane Ortega, CNM
and Belinda Hodder, CNM. They are midwives at Valley Women for Women, whose overall cesarean rate in 2014 was 7% in the midwife practice.* Also in
attendance and adding commentary to some of the answers was another CNM in the
area. While all three midwives believe
in and support the natural process, all of these women have had a cesarean
themselves. It seems to me that it lends them an
extra dose of vestment in their patient’s goals for a vaginal birth after
cesarean.
The format of this meeting was question and answer. Below is a paraphrase of the midwives’
answers to the questions posed by the women in attendance at the ICAN meeting
on October 24, 2012 in Tempe, AZ.
There is not a lot of opinion offered here.
It was a presentation of information so that a woman considering a vaginal birth after cesarean (VBAC) could consider
the information as she prepared for her next birth journey. This information is offered a starting
point for the previous cesarean birth woman to do her own research so that she could make the decision that
is right for her unique situation.
VBAC Planning and Preparation
Q: What are the best methods to prepare for a VBAC? A: There are several things you can do to prepare:
 Q: What can I do to prepare my body for a VBAC?
A: There are a few things you can do
Q: Will the type of sutures I have determine whether or not I can have a VBAC?
A: Whether an obstetrician will do a
single-layer or a double-layer of sutures depending on how they are trained,
and sometimes it depends on what the uterus looks like. As long as you have a low, transverse scar,
or the status of your scar is “unknown” than you can have what is called a
“trail of labor”. If you have a vertical
scar, the standard is to have a repeat cesarean. Uterine Rupture
Q: Will my chance for a uterine rupture increase with the length of labor?
A: There is no evidence in the research that supports that. (At this point, ICAN leader Stephanie Stanley mentioned that a uterine rupture can happen at any time, with or without a previous cesarean – HERE is her research on that topic). Q: What are signs of uterine rupture? A: Pain that doesn’t go away after the contraction is over,
and a decrease in the baby’s movement an/or heart rate.
Q: How long does it take to heal from a uterine rupture? A: Like a cesarean; maybe there will be a little more bleeding.
Going Past 40 Weeks
Q: What is the concern about going postdate? A: ACOG guidelines are that babies should be born by 42 weeks gestation. While the literature does not show an increase of risk for uterine rupture, it does indicate that a baby does not tolerate a labor as well after 42 weeks. There are more issues with meconium, the umbilical cord and the placenta after the 42-week mark. You could find a care provider that is willing to let you go past 41 weeks as long as you are having ultra-sounds and non-stress tests done.
Q: What is the policy for induction if a
mother wants a trial of labor after multiple cesareans? A: That usually depends on the personal beliefs of your doctor(s). The use of prostaglandins or Cytotec is not indicated. In reality, there are no guidelines, only protocols to consider and to follow.
Q: How do I know if I am really “past” my estimated due date? A: The ultrasound at 9-10 weeks is considered to be the most accurate predictor of your estimated due date. If you know the history of your menstrual cycle (menses), or if you used an ovulation kit, you might have another data point for establishing your conception date, and thereby having another way to estimate your due date.
Q: What are strategies for inducing labor for a VBAC mom? A: Things that are done in office and then allow you to go home and labor there: a foley bulb (aka foley ball) or a stripping of the membranes. In the hospital and you stay at the hospital: foley ball, artificial rupture of membranes, and in some cases, you could use Pitocin.
About Labor
Q: What is the most common reason for a repeat cesarean after a trial of labor? A: A slow progress of labor with no real signposts that labor is going to progress. Keep in mind that if you come to the hospital early in labor, you start chipping away at your chances for a VBAC.
Q: Why do I have to be continually monitored? A: Our hands are tied by hospital policy – any VBAC patient has
to have continuous electronic fetal monitoring.
We work in a community that is frightened of litigation.
On the upside, if everyone looking in from the outside can “see” that mom and
baby are doing fine, this can buy you more time.
There are options in monitoring. There
are waterproof monitors that can be used in water during labor, and there are
also some hospitals that use wireless monitors.
HERE is a great visual on all
the different positions you can labor in even if you are continuously
monitored.
In reality, the amount of monitoring is specific to the hospital. You have to decide how you feel about going
Against Medical Advice (AMA) if you feel strongly about not having a continuous
monitor.
Q: What are your thoughts on an epidural?
A: You want to try to get into labor on your own at the beginning since
epidurals tend to slow your labor down.
When we say “get into labor” we mean dilation to at least a 6 with a
good, established pattern of contractions.
Pain is one of the indicators that can tell you something is going wrong
right away. If a mom has an epidural,
bradycardia (slow heart rate) in the baby is the only indicator we have that
things are not staying low risk. The use
of Pitocin to augment a slowed labor can also increase your chance of uterine
rupture.
Q: How long can I go with ruptured
membranes (broken bag of waters)?
A: If you are GBS negative, you could wait up to 24 hours before coming
in. If you are GBS positive, then we
evaluate that on a case-by-case basis. (Krystyna’s note: the presence of GBS at the time of labor raises the
concern for mom/and or baby to develop an infection during labor since the bag
of waters in no longer intact and able to provide a barrier against infection.)
Q: What are ways to prevent tearing during the pushing phase?
A: Eat well – a good diet packed with fruits and vegetables. There is no evidence that shows that perineal
massage will prevent tearing. You could
avoid tearing by tuning into the natural “safety mechanism” known as the “Ring
of Fire”. By tuning into your body, you
will slowly ease the baby out. This is
another reason to consider going the natural route: you don’t feel the ring of fire
when you have an epidural. In closing, here are their "Words of Wisdom": CARE PROVIDER
WHAT IF…
If your VBAC doesn’t work out, be easy on yourself.
(Krystyna’s note:HERE is a family-centered cesarean on film.
What is a little startling about this is that one of the references is
dated 2008! At least we are doing our
part to bring awareness to this option.)
BELIEVE IN YOURSELF
*Rate for one baby, head down, for patients who wanted to have a vaginal birth was 7% in 2014. This marks the third year they have collected data and the rate has remained 8 % or below whilst their overall number of patients rises each year. What did you do to prepare for your VBAC/CBAC journey? What did you learn that you are willing to share? 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 Visual reference of labor positions during EFM http://www.icanofatlanta.com/?page_id=159 The Family-Centered Cesarean http://blog.ican-online.org/2012/04/14/the-family-centered-cesarean/ Video: The Family-Centered Cesarean http://www.youtube.com/watch?v=m5RIcaK98Yg  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®. |
Info Sheet: Amniotomy
| Posted on February 6, 2015 at 9:23 AM |
comments (289)
|
 *Definition Amniotomy, also known as Artificial Rupture of the Membranes
(AROM) is the surgical rupture of fetal membranes to induce or expedite labor. Source: *History Amniotomy is used to start or speed up contractions and,
as a result, shorten the length of labour.
Sources:
PROS
CONS
Sources:
*Link List For further exploration on your part
What do you think? Is this an option you would consider, or that you chose for during your birth? 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 (862)
|
Christine & BJ Bollier Bradley Method© Birth Story  Our 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.”
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
Changing the Plan
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. 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®. |
Rupture of Membranes
| Posted on October 16, 2012 at 5:06 PM |
comments (0)
|
 Today’s post is going to be short and sweet. We had a great question come up in class on
Friday night. Since we are not medical
professionals, I am going to remind you that my Bradley™ teacher hat requires
me to say that you are in charge of doing your own research and drawing your own
conclusions.The set up: We were
reviewing information from the previous class on vaginal exams, and reminding
students that *anything* going upstream once the membranes have ruptured has the
potential to introduce infection. We
were also reviewing what the pros and cons were to having an amniotomy
(artificial rupture of membranes) performed. The question: How long is too long to have your membranes
ruptured? The answer: Our
answer was to remind our students that once the membranes rupture, care
providers do not want patients putting anything in the vagina and discourage augmenting labor with intercourse (what!?). In addition, we have the privilege of having a pediatrician
in attendance in our classes (she is going to be the assistant coach for one of
our students), and I was happy to have her input. She said that there are several studies that
cite 48 hours as the time when the risk of infection rises. So I set out to find these studies and I did not find them. I did find that the medical term for one of the infections is chorioamnionitis, and this has been tied to risk associated with the number of vaginal exams in labor: "Chorioamnionitis is an inflammation of the fetal membranes (amnion and chorion) due to a bacterial infection. It typically results from bacteria ascending into the uterus from the vagina and is most often associated with prolonged labor. The risk of developing chorioamnionitis increases with each vaginal examination that is performed in the final month of pregnancy, including during labor." From Wikipedia Here is a link
that explains the risk of infection and the signs to look for that might
indicate that the mother is developing an infection:
Here some additional links that you might also like to
review:
In conclusion, we want all of our students and readers to
remember that it is up to them to educate themselves – what are the benefits
and risks to any of the procedures or protocols of pregnancy, labor and birth? It is up to you to read up on the variations
and complications of labor. Once you are
informed, then you can decide what course of action you may want to take in
regards to your own situation and use that as a starting point for discussion
with your care provider. Disclaimer: 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®. |