Source: Journal of Midwifery & Women’s Health Publication

“antenatal perineal massage appears to have some benefit in reducing second or third degree tears or episiotomies and instrumental deliveries. This effect was stronger in the age group 30 years and above.”

Source: http://www.childbirth.org/articles/massageref.html

“The practice of antenatal perineal massage showed neither a protective nor a detrimental significant effect on the occurrence of perineal trauma. “

Source: http://www.ncbi.nlm.nih.gov/pubmed/18751626

• It increases the elasticity of the perineum. This improves the perineum’s blood flow and capacity to stretch more easily and less painfully during birth
• Helps you to focus on relaxing and opening of the perineum
• Perineum is less likely to be painful after birth

• Massaging too aggressively (to the point of a painful or burning sensation) can cause micro tears in the perineal tissues which may (but not likely) lead to the body forming scar tissue or less pliable tissue in it’s place during the healing process
• Emotional or psychological consequences of fear and/or bodily inadequacy that could affect a woman in birth
• Uncomfortable, according to several studies approximately 70% of women claimed they did not enjoy or would not choose to do perineal massage on their own. 
• Massage should not be performed if there is an active vaginal infection or there is any possibility that membranes (water bag) have broken for risk of spreading bacteria

• http://www.nurturingheartsbirthservices.com/blog/?p=1362
• http://www.scienceandsensibility.org/?p=5899
• http://www.ajog.org/article/S0002-9378(99)70260-7/abstract
• http://www.naturalbabypros.com/article/552/perineal-massage/
• http://pregnancy.about.com/cs/episiotomy/a/perimassage.htm

Image Source: http://yoniart-dana.blogspot.com/2009/03/birth-art.html

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®.

Hospital gown: A short collarless gown that ties in the back, worn by patients being examined or treated in a doctor's office, clinic, or hospital. Hospital gowns are generally disliked by patients as skimpy, ugly, ill-fitting garments often leaves one's backside ignominiously exposed.

• Hardy enough to withstand multiple washes at very high temperatures
• Hard to stain
• Inexpensive
• Mostly modest
• Easy access for cleaning and exams
• Low-shed so they don’t contaminate wounds

• You don’t have to worry about packing clothing for labor and delivery
• You don’t have to do the laundry
• You can unsnap the shoulder and pull down the front for breastfeeding

• You fit the look of “a patient” in the hospital system, plain, ordinary, nondescript, instead of an individual
• You are wearing something with a questionable, unknown, and undeterminable history
• Your backside is exposed until you can get a second gown to wear as a front-opening garment - even then you are a mess of snaps and strings
• Your breasts are exposed if you unsnap the shoulder to breastfeed – may not feel very dignified or comfortable for a first-time breastfeeding mother.

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®.

What is the Hepatitis B vaccine?

• Birth (spread from an infected mother to her baby during birth)
• Sex with an infected partner
• Sharing needles, syringes, or other drug-injection equipment
• Sharing items such as razors or toothbrushes with an infected person
• Direct contact with the blood or open sores of an infected person
• Exposure to blood from needle sticks or other sharp instruments

"In 1981, the FDA approved a more sophisticated plasma-derived hepatitis B vaccine for human use. This “inactivated” type of vaccine involved the collection of blood from hepatitis B virus-infected (HBsAg-positive) donors. The pooled blood was subjected to multiple steps to inactive the viral particles that included formaldehyde and heat treatment (or “pasteurization”). Merck Pharmaceuticals manufactured thisplasma vaccine as "Heptavax", which was the first commercial hepatitis B virus vaccine. The use of this vaccine was discontinued in 1990 and it is no longer available in the U.S.

 

In 1986, research resulted in a second generation of genetically engineered (or DNA recombinant) hepatitis B vaccines. These new approved vaccines are synthetically prepared and do not contain blood products - it is impossible to get hepatitis B from the new recombinant vaccines that are currently approved in the United States."

Quoted From http://www.hepb.org/professionals/hepatitis_b_vaccine.htm

"Rates of acute Hepatitis B in the United States have declined by approximately 82% since 1990. At that time, routine Hepatitis B vaccination of children was implemented and has dramatically decreased the rates of the disease in the United States, particularly among children."

"Most newborns that become infected with Hepatitis B virus do not have symptoms, but they have a 90% chance of developing chronic Hepatitis B. This can eventually lead to serious health problems, including liver damage, liver cancer, and even death."

Quoted from http://www.cdc.gov/hepatitis/b/bfaq.htm

• http://www.cdc.gov/hepatitis/B/bFAQ.htm#overview
• http://www.vaccines.gov/diseases/hepatitis_b/
• http://www.cdc.gov/vaccines/vpd-vac/hepb/fs-parents.html

• In instances in which the birth mother has a Hepatitis B infection almost all cases of Hepatitis B can be prevented if the baby receives the necessary shots at the recommended times. The infant should receive a shot called Hepatitis B immune globulin (HBIG) and the first dose of Hepatitis B vaccine within 12 hours of birth.
• The complete vaccine series induces protective antibody levels in more than 95% of infants, children and young adults. Protection lasts at least 20 years and is possibly lifelong.
• In many countries, where 8–15% of children used to become chronically infected with the hepatitis B virus, vaccination has reduced the rate of chronic infection to less than 1% among immunized children.
• If contracted as an infant there is greater risk of the infection becoming chronic, 80–90% of infants infected during the first year of life develop chronic infections
• Hepatitis B vaccine is 95% effective in preventing infection and its chronic consequences
• If a birth mother unknowingly has the Hepatitis B infection routine infant vaccination can help prevent spread to the infant

• http://www.cdc.gov/hepatitis/B/bFAQ.htm#overview
• http://www.who.int/mediacentre/factsheets/fs204/en/
• http://journals.lww.com/pidj/pages/articleviewer.aspx?year=2008&issue=10000&article=00002&type=abstract

• According to the American Academy of Pediatrics (AAP) in 1996: The toxic threshold of aluminum in the bloodstream may be lower than 100 mcg per liter. The Hepatitis B vaccine currently contains 250 mcg of aluminum.
• Hepatitis B is not common in childhood in the U.S. and is not highly contagious in the same way that common childhood diseases like pertussis and chicken pox are contagious.
• In the United States, hepatitis B is primarily an adult disease, and risk is highly dependent on lifestyle. Risk factors include: multiple sex partners, drug abuse, an occupation involving frequent exposure to blood, or having a hepatitis-B infected mother. The disease is not spread by casual contact.
• According to federal government statistics, serious adverse reactions to the vaccine-including 48 deaths-are reported three times as frequently as cases of hepatitis B in children under the age of 14

• http://www.whale.to/vaccine/sears.html
• http://www.aapsonline.org/press/nrohvac.htm
• http://www.nvic.org/vaccines-and-diseases/Hepatitis-B.aspx

• http://www.askdrsears.com/topics/health-concerns/vaccines/hepatitis-b-vaccine-and-disease-do-newborns-need-vaccine-sexually-transmitted
• http://www.nytimes.com/2013/12/26/world/asia/china-investigates-vaccine-maker-after-infant-deaths.html?_r=0
• http://vactruth.com/2013/07/24/hepatitis-b-vaccine-deaths/
• http://www.aapsonline.org/testimony/hepbcom.htm
• http://beckymaher.wordpress.com/hpv-vaccine-research/

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®.

"Male circumcision (from Latin circumcidere, meaning "to cut around")[1] is the surgical removal of the foreskin (prepuce) from the human penis.[2][3][4] In a typical procedure, the foreskin is opened and then separated from the glans after inspection. The circumcision device (if used) is placed, and then the foreskin is removed. Topical or locally injected anesthesia may be used to reduce pain and physiologic stress.[5]"

“The origination of male circumcision is not known with certainty. It has been variously proposed that it began as a religious sacrifice, as a rite of passage marking a boy's entrance into adulthood, as a form of sympathetic magic to ensure virility or fertility, as a means of enhancing sexual pleasure, as an aid to hygiene where regular bathing was impractical, as a means of marking those of higher social status, as a means of humiliating enemies and slaves by symbolic castration, as a means of differentiating a circumcising group from their non-circumcising neighbors, as a means of discouraging masturbation or other socially proscribed sexual behaviors, as a means of removing "excess" pleasure, as a means of increasing a man's attractiveness to women, as a demonstration of one's ability to endure pain, or as a male counterpart to menstruation or the breaking of the hymen, or to copy the rare natural occurrence of a missing foreskin of an important leader, and as a display of disgust of the smegma produced by the foreskin. It has been suggested that the custom of circumcision gave advantages to tribes that practiced it and thus led to its spread.[1][2][3] Darby describes these theories as "conflicting", and states that "the only point of agreement among proponents of the various theories is that promoting good health had nothing to do with it.”

 

• Easier hygiene. Circumcision makes it simpler to wash the penis. Washing beneath the foreskin of an uncircumcised penis is generally easy, however.

• Decreased risk of urinary tract infections. The overall risk of urinary tract infections in males is low, but these infections are more common in uncircumcised males. Severe infections early in life can lead to kidney problems later on.

• Decreased risk of sexually transmitted infections. Circumcised men might have a lower risk of certain sexually transmitted infections, including HIV. Still, safe sexual practices remain essential.

• Prevention of penile problems. Occasionally, the foreskin on an uncircumcised penis can be difficult or impossible to retract (phimosis). This can lead to inflammation of the foreskin or head of the penis.

• Decreased risk of penile cancer. Although cancer of the penis is rare, it's less common in circumcised men. In addition, cervical cancer is less common in the female sexual partners of circumcised men.

• http://www.webmd.com/parenting/baby/what-about-circumcision
• http://www.mayoclinic.com/health/circumcision/MY01023/DSECTION=risks

• The foreskin might be cut too short or too long
• The foreskin might fail to heal properly
• The remaining foreskin might reattach to the end of the penis, requiring minor surgical repair
• Pain
• Risk of bleeding and infection at the site of the circumcision
• Irritation of the glans
• Increased risk of meatitis (inflammation of the opening of the penis)
• Risk of injury to the penis
• Studies show that circumcision is significantly painful and traumatic, resulting in large increases in heart rate, blood pressure and stress hormone levels.
• Some infants don't cry because they go into shock.
• Penile anesthetic injections, if used, don't completely eliminate pain. 
• The trauma can cause behavioral and neurological changes and disrupt mother-child bonding and feeding.
• It could interfere with the establishment of breastfeeding if the child is in too much pain to want to nurse.

• http://www.webmd.com/parenting/baby/what-about-circumcision
• http://www.mayoclinic.com/health/circumcision/MY01023/DSECTION=risks
• http://www.webmd.com/sexual-conditions/guide/circumcision
• http://online.wsj.com/news/articles/SB10001424127887324798904578531063301112102

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®.

The two blades of the forceps are individually inserted, the posterior blade first, then locked. The position on the baby's head is checked. The fetal head is then rotated to the occiput anterior position if it is not already in that position. An episiotomy may be performed if necessary. The baby is then delivered with gentle (maximum 30 lbf Newton[6]) traction in the axis of the pelvis.

The cervix must be fully dilated and retracted and the membranes ruptured. The urinary bladder should be empty, perhaps with the use of a catheter. The woman is placed on her back, usually with the aid of stirrups or assistants to support her legs. A mild local or general anesthetic is administered (unless an epidural anesthesia has been given) for adequate pain control. Ascertaining the precise position of the fetal head is paramount, and though historically was accomplished by feeling the fetal skull suture lines and fontanelles, in the modern era, confirmation with ultrasound is essentially mandatory. 

The accepted clinical standard classification system for forceps deliveries according to station and rotation was developed by ACOG and consists of:

• Outlet forceps delivery, where the forceps are applied when the fetal head has reached the perineal floor and its scalp is visible between contractions.[8] This type of assisted delivery is performed only when the fetal head is in a straight forward or backward vertex position or in slight rotation (less than 45 degrees to the right or left) from one of these positions.[9]

• Low forceps delivery, when the baby's head is at +2 station or lower. There is no restriction on rotation for this type of delivery.[9]

• Midforceps delivery, when the baby's head is above +2 station. There must be head engagement before it can be carried out.[9]

High forceps delivery is not performed in modern obstetrics practice. It would be a forceps-assisted vaginal delivery performed when the baby's head is not yet engaged.[9]

The woman is placed in the lithotomy position and assists throughout the process by pushing. A suction cup is placed onto the head of the baby and the suction draws the skin from the scalp into the cup. Correct placement of the cup directly over the flexion point, about 3 cm anterior from the occipital (posterior) fontanelle, is critical to the success of a VE.[2] Ventouse devices have handles to allow for traction. When the baby's head is delivered, the device is detached, allowing the accoucheur and the mother to complete the delivery of the baby.

For proper use of the ventouse, the maternal cervix has to be fully dilated, the head engaged in the birth canal, and the head position known. 

In recent decades, the VE has progressively replaced forceps as the instrument of choice for many practitioners.

Egyptian, Greek, Roman, and Persian writings and pictures refer to forceps that were originally used for extraction following fetal demise to save the mother’s life.

The credit for the invention of the precursor of the modern forceps to be used on live infants goes to Peter Chamberlen of England (circa 1600) though. Modifications have 

led to more than 700 different types and shapes of forceps. In 1745, William Smellie described the accurate application to the occiput, rather than the previously performed pelvic application, regardless of the position of the head. In 1845, Sir James Simpson developed a forceps that was designed to appropriately fit both cephalic curvatures and pelvic curvatures. In 1920, Joseph DeLee further modified that instrument and advocated the prophylactic forceps delivery. In an era in which many women labored and delivered under heavy sedation, forceps deliveries became common.

Typically, forceps are used when a singleton fetus in the cephalic position fails to progress or when delivery needs to be expedited in the second stage of labour because of fetal distress.

Forceps had a profound influence on obstetrics, as it allowed for the speedy delivery of the baby in cases of difficult or obstructed labor. Over the course of the 19th Century, many practitioners attempted to redesign the forceps, so much so that the Royal College of Obstetrics and Gynecologists' collection has several hundred examples.[16] 

In the last decades, however, with the ability to perform a cesarean section relatively safely, and the introduction of the ventouse or vacuum extractor, the use of forceps and training in the technique of its use has sharply declined.

VE has a long history. The initial applications of vacuum techniques in deliveries began in the 18th century, derived from the ancient technique of cupping. However, designing a vacuum-based instrument for obstetric use proved difficult. A successful extraction required the development of techniques for the transvaginal application of a cup to the fetal head (and occasionally, in premodern times, the buttocks) as a means to apply traction, and the ability to periodically reinforce the vacuum due to inevitable imperfections of the seal.

James Young Simpson, the Edinburgh professor of obstetrics already famous for his forceps design, introduced the first successful obstetric VE in 1849. His "air tractor" was most likely derived from breast pump and consisted of a metal syringe attached to a soft rubber cup. The device was placed against the fetal head, the syringe was evacuated, and traction was then applied to the neck at the base of the cup and the infant extracted. This device did prove marginally successful, but technical problems existed, illustrating the difficulties facing the inventors of such devices.

VE has gained popularity as it is seemingly easy to use, requires less anesthesia/analgesia, has lower maternal morbidity, and is commonly believed to be safe. Less fortunately, the importance of correct VE technique and of the potential risks of the procedure are less well recognized. Large differences are observed in the popularity of instrumental delivery and of the specific type of instrument used in varying parts of the United States. This reflects the biases introduced by original training, the inherent conservatism of practitioners in embracing different techniques, and the absence of fixed guidelines for instrumentation.[3]

• Evidence suggests that forceps are associated with less failure than vacuum extraction (table).

• The American College of Obstetrics and Gynecology has recommended training in instrumental delivery to control and reduce the rates of caesarean section.

• Delivery by forceps is also quicker than by vacuum extraction, which may be of critical importance with fetal distress.

• Women who have instrumental vaginal deliveries typically have a shorter hospital stay and fewer readmissions than women who have caesarean sections.

• A Cochrane meta-analysis found that women who experienced vaginal delivery were less anxious about their babies and more satisfied with the birth than women who had a caesarean section. Women who had a vaginal delivery were also more likely to breast feed, have more positive reactions to their infants immediately after birth, and interact with them more at home.

• Pain in the perineum — the tissue between your vagina and your anus — after delivery

• Lower genital tract tears and wounds

• Difficulty urinating or emptying the bladder

• Short-term or long-term urinary or fecal incontinence

• Anemia — a condition in which you don't have enough healthy red blood cells to carry adequate oxygen to your tissues — due to blood loss during delivery

• Injuries to the bladder or urethra — the tube that connects the bladder to the outside of the body

• Uterine rupture — when the baby breaks through the wall of the uterus into the mother's abdominal cavity

• Weakening of the muscles and ligaments supporting your pelvic organs, causing pelvic organs to slip out of place (pelvic organ prolapse). While most of these risks are also associated vaginal deliveries in general, they're more likely with a forceps delivery.

• Easier to learn / Ease of Placement (easier to place than forceps)

• Less maternal genital trauma

• Less maternal discomfort

• Fewer neonatal craniofacial injuries

• Less anesthesia required

• Some investigators have suggested that vacuum-assisted vaginal delivery results in less bowel incontinence compared to forceps delivery; most likely, this is due to potential for more vaginal trauma with forceps. The forceps-assisted vaginal delivery is more likely to result in vaginal tears that partially involve or even completely transect the anal sphincter and rectal lining. This type of injury is referred to as a fourth-degree laceration and can be associated with long-term anal sphincter dysfunction, resulting in occasional leakage of stool or gas.

• Vacuum extraction exposes the baby to less traction in comparison to forceps delivery.  One study found that vacuum extraction exerted approximately 40% less force to the baby's head than forceps delivery. Although vacuum delivery may be associated with development of a bruise on top of the baby's head, the forceps may cause similar injuries and may result in more serious nerve or skull injuries.

• When the second stage of labor has been prolonged, it is common to find that the baby's head has a significant amount of swelling at the presenting point. Although this is a normal part of labor, if the swelling is significant, it may be difficult to obtain an optimal application of the cup against the baby's head and the cup may become detached. Improper placement of the vacuum cup may also result in detachment.

• Vacuum traction should be applied only during contractions; therefore, vacuum-assisted vaginal delivery may be slower than forceps delivery. Forceps delivery may be performed with very little maternal effort, while vacuum-assisted delivery requires maternal participation.

•  Several large trials comparing the success of forceps delivery with that of vacuum-assisted delivery confirmed that forceps are more often successful in delivering the baby.

• It has been well documented that the risk of serious bleeding inside the baby's skull is greater with vacuum than forceps. Due to the pressure of the suction cup applied to the baby's head, a particular type of serious bleeding, though rare, is more common with and unique to vacuum delivery 

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®.  

"Armed with this 'proof' that vitamin K deficiency caused HDN (Haemorrhagic Disease of the Newborn) now known as VKDB (Vitamin K deficiency-related bleeding), vitamin K was synthesized and various trials were commenced to ascertain which was the most effective amount and route to use in prophylaxis.

It is difficult for us to assess these trials nowadays as they were mostly neither double blind nor well controlled.  The dosage of vitamin K given, the route of administration and the time of administration all varied.  In many cases, the conclusions did not seem to match the results.  

 

Occurrence of vitamin K deficiency bleeding (VKDB) in the first week of the infant's life is estimated at 0.25 to 1.7%, with a prevalence of two to 10 cases per 100,000 births."

"Some of the studies assessed the effect on neonatal vitamin K levels if the mother was given vitamin K during labour. Results varied, with the effectiveness of the vitamin K given depending on how soon the woman gave birth and the dosage given.  More recent studies have shown increases in cord blood levels where mothers were supplemented antenatally with vitamin K. Two showed a significant difference between the supplemented and unsupplemented groups and found that the effect of prenatal vitamin K persisted until the fifth day after birth.  

 

Because of the variations in results from these early studies, further research focused on treating the baby after birth.  One particular study done in 1942was intended to determine the minimal effective oral dose of Synkavite (K), a water-soluble synthetic form of vitamin K.  The results showed that very small daily doses were effective and that a dose of 5mg daily would probably prevent the development of HDN, except in early onset cases.  The study also found that 1.25mg was effective in lowering an excessively high prothrombin time to normal.  However, the author admitted that several workers found prothrombin deficiencies in babies with no abnormal bleeding.  

 

By 1950, most maternity units had a policy of giving infants oral vitamin K (usually Synkavite) immediately after birth. This prevented the fall in prothrombin levels that occurred in the first few days and, presumably, the risk of excessive bleeding.  This risk was higher in male babies because of routine circumcision, and, indeed, vitamin K proved to be of great clinical value in preventing post-circumcision bleeding. "

"According to the age of onset, early VKDB presents within 24 hours of birth and is almost exclusively seen in infants of mothers taking drugs [that] inhibit vitamin K. These drugs include anticonvulsants (carbamazepine, phenytoin and barbiturates), antituberculosis drugs (isoniazid, rifampicin), some antibiotics (cephalosporins) and vitamin K antagonists (coumarin, warfarin). The clinical presentation is often severe with cephalic haematoma and intracranial and intra-abdominal haemorrhages16. The incidence of early VKDB in neonates of mothers taking these drugs without vitamin K supplementation varies from 6% to 12%17,18.

Classical VKDB occurs between 24 hours and 7 days of life and is associated with delayed or insufficient feeding. The clinical presentation is often mild, with bruises, gastrointestinal blood loss or bleeding from the umbilicus and puncture sites. Blood loss can, however, be significant, and intracranial haemorrhage, although rare, has been described15. Estimates of the frequency vary from 0.25% to 1.5% in older reviews19 and 0–0.44% in more recent reviews20."

“Recent studies, using a standardized definition, seem to show that the condition is not now very common, even in communities where prophylaxis is not yet available. It is certainly not nearly as common as some authoritative reports claim. Two studies in Japan before the introduction of routine prophylaxis had suggested that one in every 6000 breastfed babies might sustain a late bleed when more than two weeks old. The true risk of bleeding in the first week of life (the “classic” presentation) remains less clearly defined.”

• VKDB is a rare but very serious disease. It affects about 1 in 10,000 babies if they are not given vitamin K at birth.  More than half of all babies who bleed have a hemorrhage into their brain (intracranial bleeding). This is likely to cause brain damage, and often the baby will die. [1]
• Some babies appear to be at increased risk of VKDB and doctors believe these include [2]:
  • Babies born before 37 weeks of pregnancy.
  • Babies whose birth involved the use of forceps, [vacuum] or caesarean, where bruising might occur.
  • Babies who had trouble breathing and did not get enough oxygen when they were born.
  • Babies whose mothers are taking anticonvulsants, anti-coagulants, or drugs to treat tuberculosis.
  
  

• The amount of vitamin K injected into newborns is 20,000 times the needed doseiv . Additionally, the injection may also contain preservatives that can be toxic for your baby’s delicate, young immune system. [1]
• An injection creates an additional opportunity for infection in an environment that contains some of the most dangerous germs, at a time when your baby’s immune system is still immature. [1]
• Hemolysis, jaundice, and hyperbilirubinemia in neonates, particularly those that are premature, may be related to the dose of Vitamin K1 Injection [2]
• Injection contains preservatives and other ingredients.
• Each milliliter contains phytonadione 2 or 10 mg, polyoxyethylated fatty acid derivative 70 mg, dextrose, hydrous 37.5 mg in water for injection; benzyl alcohol 9 mg added as preservative. May contain hydrochloric acid for pH adjustment. pH is 6.3 (5.0 to 7.0). Phytonadione is oxygen sensitive. [3]

• http://www.ncbi.nlm.nih.gov/pubmed/12598491
• http://www.sunrisemidwifery.net/links-and-information-midwifery/vitamin-k-shots/
• http://www.givingbirthnaturally.com/newborn-vitamin-k.html

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®.

“Nil per os (alternatively nihil/non/nulla per os) (NPO) is a medical instruction meaning to withhold oral food and fluids from a patient for various reasons. It is a Latin phrase which translates as "nothing through the mouth". In the United Kingdom, it is translated as nil by mouth (NBM).

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

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

“In 1946 Dr. Curtis Mendelson hypothesized that the cause of pneumonia following general anesthesia was aspiration of the stomach contents, due to delayed gastric emptying in labor. He noted that food could be vomited 24-48 hours after being eaten. Dr. Mendelson experimented on rabbits to examine the effects of content in their lungs. Aspiration (taking the particles into your lungs) of undigested food could cause obstruction, but not aspiration pneumonia, and no deaths were due to aspiration of fluids with a neutral pH. The rabbits only died when they aspirated materials containing hydrochloric acid. He said by forbidding food and drink in labor you could reduce stomach volume, thereby decreasing the risk of maternal problems from acid aspiration while under general anesthesia. We also found that there were two factors that increased the risk of maternal problems:

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

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

“The risks of aspiration are only a problem when general anesthesia is used (3.5-13% of cesareans), and the technique has improved. Anesthesiologists now have more quality control.

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

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

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

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

II. Aspiration Prevention

Clear Liquids.

There is insufficient published evidence to draw conclusions about the relationship between fasting times for clear liquids and the risk of emesis/reflux or pulmonary aspiration during labor. The consultants and ASA members both agree that oral intake of clear liquids during labor improves maternal comfort and satisfaction. Although the ASA members are equivocal, the consultants agree that oral intake of clear liquids during labor does not increase maternal complications.

Recommendations.

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

http://americanpregnancy.org/pregnancycomplications/groupbstrepinfection.html

Early-onset disease (EOD) — occurs during the first week of life.

Late-onset disease (LOD) — occurs from the first week through three months of life.

http://www.cdc.gov/groupbstrep/guidelines/downloads/Figure_1_GBS_Decline.pdf

Most cases of neonatal group B streptococcal disease with early onset have an intrapartum pathogenesis. Attack rates are increased substantially in infants born to mothers with prenatal group B streptococcal colonization and various perinatal risk factors (premature labor, prolonged membrane rupture, or intrapartum fever). In a randomized controlled trial, we studied the effect of selective intrapartum prophylaxis with ampicillin in 160 such high-risk women.

We conclude that intrapartum ampicillin prophylaxis in women with positive prenatal cultures for group B streptococci who have certain perinatal risk factors can prevent early-onset neonatal group B streptococcal disease.

http://www.ncbi.nlm.nih.gov/pubmed/3520319

In a recent study, Berardi et al found that preterm neonates have higher rates of group B Streptococcus (GBS) late-onset disease (LOD):

Moreover, the authors found that the earlier the presentation of LOD, the higher the risk for neonatal brain lesions and death. Approximately 64% of mothers carried GBS at the rectovaginal site at the time of LOD diagnosis, suggesting peripartum delivery at this site as the major route of maternal-fetal transmission of GBS-LOD, and 6% of mothers had GBS mastitis. Administration of intrapartum antibiotics was associated with delayed presentation of symptoms and milder LOD.

http://emedicine.medscape.com/article/229091-overview

• You will know whether or not it is recommended that you receive at least one round of antibiotics during labor.  This is generally recommended at a minimum of four hours before you deliver.
• Here is a look at the probabilities of your newborn being infected by GBS if you are “colonized” near the time of birth from the CDC website:

"A pregnant woman who tests positive for group B strep and gets antibiotics during labor can feel confident knowing that she has only a 1 in 4,000 chance of delivering a baby with group B strep disease. If a pregnant woman who tests positive for group B strep does not get antibiotics at the time of labor, her baby has a 1 in 200 chance of developing group B strep disease. This means that those infants whose mothers are group B strep positive and do not get antibiotics have over 20 times the risk of developing disease than those who do receive preventive antibiotics."

http://www.cdc.gov/groupbstrep/about/prevention.html

• If you are positive, it will be strongly suggested that you receive IV antibiotics during labor.  Receiving IV drugs inhibits your movement while it is administered, it probably means you will have at the very least a heparin lock for the duration of your labor and into the postpartum period, and you need to consider how you feel about your baby being exposed to antibiotics inutero.  Penicillin is a Category B drug.
• Not really a con, more FYI: If you are negative, you can continue on with your birth plan, whatever your feelings about receiving drugs and/or interventions in labor.

"There is no group B strep vaccine currently available to help mothers protect their newborns from group B strep disease. Researchers are working on developing a vaccine, which may become available one day in the future. Antibiotics taken by mouth instead of through the vein, and antibiotics taken before labor and delivery are not effective at preventing newborn group B strep disease. Birth canal washes with the disinfectant chlorhexidine do not reduce mother to baby transmission of group B strep bacteria or the risk of having a baby with early-onset disease. To date, receiving antibiotics through the vein during labor is the only proven strategy to protect a baby from early-onset group B strep disease."

http://www.cdc.gov/groupbstrep/about/prevention.html

“Vaginal cleansing with chlorhexidine before or during delivery prevents vertical transfer of GBS to the neonate. The Swedish Chlorhexidine Study Group explored the minimum inhibitory and bactericidal concentrations of chlorhexidine,[39] described postcleansing vaginal concentrations of chlorhexidine and its residual effect on GBS carriage,[40,41] and demonstrated that trace levels of chlorhexidine could be absorbed through the vaginal mucosa.[42] Pilot studies showed that vaginal washing with chlorhexidine reduced newborn colonization with GBS compared with those born to nonwashed controls.”

http://www.medscape.com/viewarticle/542430_4

FINDINGS:

Rates of neonatal sepsis did not differ between the groups (chlorhexidine 141 [3%] of 4072 vs control 148 [4%] of 4057; p=0.6518). Rates of colonisation with group B streptococcus in newborn babies born to mothers in the chlorhexidine (217 [54%] of 401) and control groups (234 [55%] of 429] did not differ (efficacy -0.05%, 95% CI -9.5 to 7.9).

INTERPRETATION:

Because chlorhexidine intravaginal and neonatal wipes did not prevent neonatal sepsis or the vertical acquisition of potentially pathogenic bacteria among neonates, we need other interventions to reduce childhood mortality.

http://www.ncbi.nlm.nih.gov/pubmed/19846212

Evidence-based Birth: Group B Strep

http://evidencebasedbirth.com/groupbstrep/

Prevention of Group B Streptococcal Disease in the Newborn

http://www.aafp.org/afp/2005/0301/p903.html#afp20050301p903-b15

American Pregnancy Association: Group B Strep Infection

http://americanpregnancy.org/pregnancycomplications/groupbstrepinfection.html

Group B Strep Support

http://gbss.org.uk/index.php

Treating Group B Strep: Are Antibiotics Necessary?

http://www.drmomma.org/2009/09/treating-gbs-group-b-strep-are.html

The material included on this site is for informational purposes only.

Definition

http://www.chp.edu/CHP/P02669 - E

Source: http://evidencebasedbirth.com/is-erythromycin-eye-ointment-always-necessary-for-newborns/

 

• Erythromycin can reduce the risk of Chlamydia and Gonorrheal ON (Darling and McDonald 2010)
• Erythromycin prophylaxis may be helpful if the mother was not screened for Chlamydia/Gonorrhea, screening results were not correct, or if there is a sexual partner who may be re-infecting her (Medves 2002)
• Erythromycin prophylaxis may be especially helpful in geographic regions where rates of Chlamydia and gonorrhea are very high (Medves 2002)
• Erythromycin ointment is inexpensive (Darling and McDonald 2010)

• Prenatal detection and treatment of maternal Chlamydia and Gonorrhea is ideal, and may also prevent other adverse outcomes for mother and newborn.
• Evidence suggests that current North American laws mandating universal neonatal eye prophylaxis have limited benefit
• Universal prophylaxis will not prevent all cases of ON, and early identification and treatment of newborns infected with either GON or CON will also be necessary to prevent adverse outcomes caused by these infections.
• Systemic rather than topical antibiotic therapy is recommended for treatment of GON and CON.

Source: Arizona Department of Health Services

http://www.azdhs.com/als/midwife/documents/reports/resources/darling-et-al.pdf

Cord Clamping A little longer stump left - this baby pictured 30 minutes after birth

Cord Clamping A tight clamp done on baby's 2nd day

• http://www.cordclamp.org/Autismxx.htm
• http://www.cordclamp.org/ExpressCCPictArtGMMred.pdf
• http://motheroffact.wordpress.com/2011/12/13/evidence-based-medicine-immediate-cord-clamping/
• http://www.dailymail.co.uk/health/article-2302544/NHS-rules-say-immediately-cutting-umbilical-cord-early-putting-babies-risk.html#ixzz2XTIQ0Bbi
• http://www.babylifetime.com/article/7935/babies-benefit-from-delayed-cord-clamping/

http://www.webmd.boots.com/pregnancy/news/20130426/umbilical-cord-clamping-guidelines

http://www.who.int/elena/titles/cord_clamping/en/index.html

http://www.acog.org/About_ACOG/News_Room/News_Releases/2012/Time_to_Clamp_the_Cord

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004074.pub3/abstract

o   If infant is asphyxiated and needs to be moved immediately for resuscitation

 

o   Could possibly reduce risk of jaundice, bilirubin concentration has been found to be higher in infants in which cord clamping was delayed

*http://apps.who.int/rhl/pregnancy_childbirth/childbirth/3rd_stage/cd004074_abalose_com/en/

*http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003248.pub3/abstract

o   Trials have shown infants are deprived of 2.17 g/dl of hemoglobin on average, this puts them at risk for low iron levels during the first 6 months of life

http://apps.who.int/rhl/pregnancy_childbirth/childbirth/3rd_stage/cd004074_abalose_com/en/

o   Less need for transfusion

o   Better circulatory stability

o   Less intraventricular haemorrhage (all grades)

o   Lower risk for necrotising enterocolitis

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003248.pub3/abstract