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Info Sheet: Vaginal Exams

Posted on March 4, 2016 at 2:01 PM Comments comments (269)
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson
Pelvic or Vaginal Exam during Pregnancy (3rd Trimester)

According to Mayo Clinic, “as your due date approaches, your prenatal visits might  include pelvic exams. These exams help your health care provider check the baby's position and detect cervical changes.”


*History

Pelvic examination during pregnancy is used to detect a number of clinical conditions such as anatomical abnormalities and sexually transmitted infections, to evaluate the size of a woman’s pelvis (pelvimetry) and to assess the uterine cervix so as to be able to detect signs of cervical incompetence (associated with recurrent mid-trimester miscarriages) or to predict preterm labour (see Section 11.3).

In an RCT that assessed the relationship between antenatal pelvic examinations and preterm rupture of the membranes (PROM), 175 women were assigned to no examinations and 174 women were assigned to routine digital pelvic examinations commencing at 37 weeks and continuing until delivery.233 In the group of women who had no pelvic examination, ten women developed PROM (6%) compared with 32 women (18%) from the group of women who were examined weekly. This three-fold increase in the occurrence of PROM among women who had pelvic examinations was significant. 

Based on the above study the NCBI concluded, “Routine antenatal pelvic examination does not accurately assess gestational age, nor does it accurately predict preterm birth or cephalopelvic disproportion. It is not recommended.” 

Another study completed by the NCBI concluded, “In patients with a US-documented viable pregnancy, the pelvic examination did not contribute to the patient's immediate obstetric treatment. Occult cervical pathogens may be present in these patients.” 

Sources:

*PROS

Vaginal Exams can possibly measure:


  • Cervical Dilation
  •  Cervical Ripeness
  • Cervical Effacement
  •  Station of baby (position in relation to pelvis -5 to +5)
  • Position of the baby (anterior vs. posterior)
  • Position of the cervix
  • May find cervical anomalies, like early dilation and effacement, so that appropriate changes can be made to the woman's care, including bedrest, hospitalization, tocolytics, etc.
  • May stimulate the cervix so that a medical induction does not become "necessary"



*CONS

  • Increased risks of infection, even when done carefully and with sterile gloves
  • Increased risk of rupturing the membranes
  • May stimulate the cervix prematurely
  • Information collected does not accurately predict when labor will begin and may excite or disappoint women unnecessarily 

Sources:

*Links to explore

Pelvic Exams Near Term: Benefit or Risk? Talking to Mothers About Informed Consent and Refusal

Premature rupture of membranes at term. Retrospective study of 88 cases

Chorioamnionitis in the delivery room

Bacterial vaginosis and intraamniotic infection

Premature rupture of the membranes and ascending infection

Did you have vaginal exams in your third trimester before your labor started? Thoughts?
Please leave us a comment - it will be moderated and posted. 
 

Disclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson

To Test or Not to Test: 5 Need-To-Know Questions to choose for YOU

Posted on July 23, 2015 at 8:11 PM Comments comments (49)

I saw the question come up again in a chat group:

Should I get "X" test? Should I decline "X" medication?

You could also substitute the words 
"procedure" or "intervention" in those phrases.

As childbirth educators, we make every effort to keep our opinion out of the equation whether that question comes up in a live class, or when we see it on message boards and chat groups.  The bottom line is that YOU are the only one that can make decisions about your body and your baby.

As the natural childbirth movement has grown, families are becoming aware that a lot about birth works.  After all, we have survived as a species long before birth became a medical event.  Along with raising awareness of how physiological birth proceeds without any medical intervention in most cases, the birth movement has also encouraged patients to advocate for themselves: question everything. 

To be fair, there are tests for many of the things that used to be devastating to mothers and infants: gestational diabetes, Group B Strep, Rh factor to name a few.  There are newborn screens that can be done so that any genetic diseases can be caught and treated early before they take full effect and harm the child.

The challenge is as it usually is: the blanket treatment, "If it works for one, then it works for all." Which then leads to over-treatment and over-medicalization, and sometimes more complications than if we had left Mother Nature alone to begin with.  As patient advocates, we encourage our students to insist on beineg treated as individuals - we are all unique.

Somehow, somewhere, there is a growing thread that is saying: "Deny Everything".  I find this concerning because despite some negatives, there are some positives to today's birth climate.  So I decided to share the list of questions that I share with our students.  

Ask these questions of your care provider so that you can make an informed decision about personalized care for YOU in your unique situation. 

1.) Why was this test/intervention/medication/procedure ("TIMP") developed in the first place?

2.) Has this TIMP been effective in affectng the problem it was designed to solve?

3.) What is the treatment plan if I say yes to the TIMP?  What is the treatment plan if I say no to the TIMP?

4.) If something happens in spite of saying yes to the TIMP, will the treatment be any different than if I didn't have the TIMP?

5.) How do my personal lifestyle/career choices affect my chances of needing this TIMP? If I want to decline it, is there anything I can do to improve my chances of not needing it?

There are usually several alternative to consider instead of a flat "no".  We have several Pros/Cons/Alternatives listed in our Info Sheets.  You can find a complete listing to them HERE, or click on the "Info Sheet" category on the left side of this blog.

I wish you all the best for a safe and healthy pregnancy.  Also remember that these 5 questions can also be applied to options for newborn care, postpartum care, and really any care you or your children may need in the future!

Disclaimer: 
Bradley Method® natural childbirth classes offered in Arizona: convenient to Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, PaysonThe material included in this blog 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 in this video and on our blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.
 

Info Sheet: Oral Glucose Challenge Test

Posted on July 17, 2015 at 7:42 AM Comments comments (309)
Please note that today’s info sheet is about the 1-hour screening procedure, not the 3-hour test used to determine whether or not a patient has gestational diabetes.

Image Source: http://babybearbulletin.com/2013/01/28/one-hour-glucose-test/

*Definition
"The oral glucose challenge test is performed to screen for gestational diabetes. This test involves quickly (within five minutes) drinking a sweetened liquid (called Glucola), which contains 50 grams of glucose. A blood sample is taken from a vein in your arm about 60 minutes after drinking the solution. The blood test measures how the glucose solution was processed by the body."
Source: http://my.clevelandclinic.org/services/oral_glucose_tolerance_test/hic_oral_glucose_tolerance_test_during_pregnancy.aspx

Find a list of alternatives to Glucola at the end of today's post

*History
From Diapedia:
“The first documented evidence of the effects of hyperglycaemia in pregnancy in the modern era was in 1824, when Bennewitz recorded a case of severe fetal macrosomia [large baby] and stillbirth in a 22 year old multigravida woman in Berlin. She had symptoms of severe hyperglycaemia, but he was only able to estimate this by boiling the urine to dryness[1]. The symptoms disappeared after the delivery. Until the discovery of insulin in 1923 there was no effective treatment for this condition, and the outcome of pregnancy for both mother and fetus was usually disastrous. These adverse effects have been gradually but not completely alleviated by intensive multidisciplinary care from both diabetologist and obstetrician, but complete normalisation of maternal glucose metabolism has not yet been achieved. By the 1940’s it was becoming recognised that lesser degrees of maternal hyperglycaemia were also a risk to pregnancy outcomes, with retrospective studies showing increases perinatal mortality some years before the diagnosis of overt diabetes mellitus. This led to the term ‘prediabetes in pregnancy’, and to poorly defined concepts of ‘temporary’ or ‘latent’ diabetes.”

From Evidence-Based Birth:
“In 1964, O’Sullivan and Mahan proposed that pregnancy changes the metabolism of carbohydrate, and that these changes are different than what happens outside of pregnancy. They published a study with 752 women who took a 100-gram 3-hour glucose test in the 2nd or 3rd trimester. In this study, the researchers tried out different cut-offs for GDM.” [1]

“Now the most common method of screening for gestational diabetes in the United States is the 50-gram, 1-hour glucola test, also called the glucose challenge test. This test was first introduced in 1973. To take glucola test, you eat a normal diet beforehand. Then you drink 50 grams of a glucose polymer solution. One hour later, your blood is drawn to measure the glucose level (O’Sullivan, Mahan et al. 1973). If your blood glucose is 130-140 mg/dL or higher, then you have screened positive for gestational diabetes, and you qualify for a follow-up 3-hour oral glucose tolerance test (OGTT) to officially diagnose the condition. The 75-gram and 100-gram OGTTs are the gold-standard for diagnosis of gestational diabetes.” [2]

Quote from American Family Physician:
“Gestational diabetes (GDM) occurs in 5 to 9 percent of pregnancies in the United States and is growing in prevalence. It is a controversial entity, with conflicting guidelines and treatment protocols. Recent studies show that diagnosis and management of this disorder have beneficial effects on maternal and neonatal outcomes, including reduced rates of shoulder dystocia, fractures, nerve palsies, and neonatal hypoglycemia. Diagnosis is made using a sequential model of universal screening with a 50-g one-hour glucose challenge test, followed by a diagnostic 100-g three-hour oral glucose tolerance test for women with a positive screening test.”

Sources:
American Family Physician http://www.aafp.org/afp/2009/0701/p57.html
Diapedia: http://www.diapedia.org/other-types-of-diabetes-mellitus/history-of-gdm
Evidence Based Birth:
[1] http://evidencebasedbirth.com/diagnosing-gestational-diabetes-the-nih-consensus-conference-day-1/
[2] http://evidencebasedbirth.com/gestational-diabetes-and-the-glucola-test/

*PROS

  • Since [2005], 2 large randomized, controlled trials have found that screening and treatment of GDM have decreased the risk of large babies and shoulder dystocia. [1]
  • Treatment for GDM decreases the risk for gestational hypertension and preeclampsia. [2]
  • There are many non pharmaceutical options for treatment including: limited carbohydrate diets, regular exercise, blood sugar level monitoring, fetal growth monitoring, and more in depth check ups with your care provider. [1]

Sources: 
[1] http://www.webmd.com/baby/tc/gestational-diabetes-treatment-overview
[2] http://evidencebasedbirth.com/diagnosing-gestational-diabetes-the-nih-consensus-conference-day-1/

*CONS
  • Potential adverse effects are nausea (30%), vomiting, bloating, diarrhea, dizziness (11%), headache (9%), and fatigue (Lamar, Kuehl et al. 1999). [2]
  • Un-pleasant nature of the exam and the cost. [2]
  • Based on the findings of a meta-analysis conducted in 2012, we can conclude that the 50-g glucola test by itself can be used as a screening test, but not as a diagnostic test.  A positive result needs to be followed up with the 3-hour diagnostic test. It’s important for you to understand that if your doctor diagnoses you with gestational diabetes based on the 1-hour glucose test, then you should request the 3-hour test to confirm the diagnosis. [2]
  • In the 2001 gestational diabetes guidelines, ACOG says that if you are low-risk and meet all of these following criteria you may not need to be screened: Age less than 25, not a member of an ethnic group with an increased risk, BMI <= 25, no history of abnormal glucose tolerance or macrosomia, and no known diabetes in a first-degree relative. 
However, if you use these criteria, then only 10% of pregnant women would be exempted from screening. ACOG says that because only 10% would be exempt, “many physicians elect to screen all patients as a practical matter.”
Therefore, you are being screened by your physician as a practical matter. It may also be that your physician wants you to have the test just for legal liability reasons. [2]
  • In the universal 1 hour 50 g oral glucose test a value above 130-140 mg/dL is considered positive, but in a study of 2,226 cases from universal screening of 11,084 pregnant women using a cut off value of 145 mg/dl the False Positive Rate (FPR) is 80.4%. [1]
  • In the above mentioned study when Glucose Challenge Test (GCT) result was above 200 mg/dL, the probability of women having Gestational Diabetes (GDM) was still only 64.5%. [1]
  • The frequency of GDM really depends on how it’s diagnosed. If you have different cut-points, you will have different numbers of diagnoses. In looking at population data, we rarely know what test or what cut-off people used to diagnose GDM. In some studies, where we know what test people used to diganose GDM, the rates of GDM have remained stable. [3]
  • Based on test results there could be increased intervention (more prenatal visits, more inductions of labor)
  • Increased tendency to perform a C-section (Donovan et al. 2012) [3]

Sources: 
[1] http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0CCgQFjAB&url=http%3A%2F%2Fwww.researchgate.net%2Fpublication%2F23308206_A_50-g_glucose_challenge_test_is_there_any_diagnostic_cut-off%2Flinks%2F09e41505844135f56f000000&ei=CPAxVOq9IM6fyATawoDgAw&usg=AFQjCNHgBzxOxv8Z2Vo_IEqQ7_Oxwa9MlA&bvm=bv.76802529,d.aWw
[2] http://evidencebasedbirth.com/gestational-diabetes-and-the-glucola-test/
[3] http://evidencebasedbirth.com/diagnosing-gestational-diabetes-the-nih-consensus-conference-day-1/


*Links for more reading
From Cochrane Review: Screening for gestational diabetes and subsequent management for improving maternal and infant health
http://summaries.cochrane.org/CD007222/PREG_screening-for-gestational-diabetes-and-subsequent-management-for-improving-maternal-and-infant-health

From PubMed: Glucose challenge test for detecting gestational diabetes mellitus: a systematic review.
http://www.ncbi.nlm.nih.gov/pubmed/22260369

From the American Diabetes Association: Gestational Diabetes Mellitus
http://clinical.diabetesjournals.org/content/23/1/17.full#ref-3

From Aviva Romm: Glucose Tolerance Testing in Pregnancy: What you should know
http://avivaromm.com/glucose-testing-pregnancy

From Birth Without Fear: Gestational Diabetes - To Test or Not To Test
http://birthwithoutfearblog.com/2013/06/21/gestational-diabetes-to-test-or-not-to-test/

From Birth Without Fear: The Truth About Gestational Diabetes and Why It's Not Your Fault
http://birthwithoutfearblog.com/2013/06/24/the-truth-about-gestational-diabetes-and-why-its-not-your-fault/

From Modern Alternative Mama: Healthy Pregnancy Series: Gestational Diabetes Test
http://www.modernalternativemama.com/2011/03/16/healthy-pregnancy-series-gestational-diabetes-test/


*Alternatives to Glucola, aka The Orange Drink
Women who are striving to avoid harmful substances are starting to seek alternatives to the ingredients in Glucola:

Image Source: www.foodbabe.com

From Pub Med: 
Jelly Beans offered as an alternative to a fifty-gram glucose beverage for gestational diabetes screening.
http://www.ncbi.nlm.nih.gov/pubmed/10561636
Note: a mama seeking to avoid harmful substances could opt for jelly beans with natural ingredients and food-based coloring

From Today's Mama ~ Boston
Combine the following foods to make 50 g of glucose:
  • 30g - 6 oz Grape juice
  • 15g - Slice of bread
  • 30g - cup of cereal
  • 20g - banana
  • 12g - cup of milk
  • 30g - two slices of bread
  • 40g - 16 oz orange juice
  • 40g - 8 oz apple juice
Source:http://boston.todaysmama.com/2011/08/third-trimester-glucose-test-alternatives/

From My Green and Natural Pregnancy: 
Alternative beverages
  • 20 oz. of a natural ginger ale
  • 14 oz. of orange juice not from concentrate
  • 10 oz. of cranberry juice
  • 10 oz. of grape juice
Source:http://mygreenandnaturalpregnancy.blogspot.com/2012/04/dont-drink-that-orange-glucose.html

Krystyna’s Note: 
Maple Syrup
This is one that I have heard talked about in the green living community.  Below is the nutrition information for 1 Tablespoon of maple syrup from nutritiondata.com so you can get a general idea.  You would have to talk to your care provider about figuring out how “sugars” translate into “glucose” to determine how much you would need to consume in order to substitute maple syrup for the orange drink.



Disclaimer:
Bradley Method® natural childbirth classes offered in Arizona: convenient to Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, PaysonThe material included in this blog 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 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 in this video and on our blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.

Info Sheet: Amniotomy

Posted on February 6, 2015 at 9:23 AM Comments comments (663)
Amniotomy, Artificial Rupture of the Membranes, AROM - Info sheet for Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson
*Definition
Amniotomy, also known as Artificial Rupture of the Membranes (AROM) is the surgical rupture of fetal membranes to induce or expedite labor.

Source: 
American Heritage Medical Dictionary

 
*History
Amniotomy is used to start or speed up contractions and, as a result, shorten the length of labour.
 
Artificial rupture of the amniotic membranes during labour, sometimes called amniotomy or ’breaking of the waters’ was introduced in the mid-eighteenth century, first being described in 1756 by an English obstetrician, Thomas Denman (Calder 1999). Whilst he emphasized reliance on the natural process of labour, he acknowledged that rupture of the membranes might be necessary in order to induce or accelerate labour (Dunn 1992). Since then, the popularity of amniotomy as a procedure has varied over time (Busowski1995), more recently becoming common practice in many maternity units throughout the UK and Ireland (Downe 2001; Enkin 2000a ; O’Driscoll 1993) and in parts of the developing world (Camey 1996; Chanrachakul 2001; Rana 2003). The primary aim of amniotomy is to speed up contractions and, therefore, shorten the length of labour.
 
The first recorded use of amniotomy in the United States was in 1810; it was used to induce premature labor. Amniotomy and other mechanical methods remained the methods of labor induction most commonly employed until the 20th century. Amniotomy, or artificial rupture of the amniotic membranes, causes local synthesis and release of prostaglandins, leading to labor within 6 hours in nearly 90% of term patients. Turnbull and Anderson found that amniotomy without additional drug therapy successfully induced labor in approximately 75% of cases within 24 hours.
 
Sources: 
 
PROS
  • Amniotomy was associated with a reduction in labour duration of between 60 and 120 minutes in various trials
  • There was a statistically significant association of amniotomy with a decrease in the use of oxytocin: OR = 0.79; 95% CI = 0.67-0.92 in several randomized trials
  • AROM does not involve any type of medication to mom or baby and is considered by some to be the most “natural” means of induction in a hospital setting.
 
CONS
  • In several randomized trials there was a marked trend toward an increase in the risk of Cesarean delivery: OR = 1.26; 95% Confidence Interval (CI)=0.96-1. 66.
  • Trial reviewers suggest that amniotomy should be reserved for women with abnormal labour progress.
  • In 15 studies containing 5583 women there was no clear statistically significant difference between women in the amniotomy and control groups in length of the first stage of labour
  • Evidence does not support routinely breaking the waters for women in normally progressing spontaneous labour or where labours have become prolonged.
  • [Once membranes are broken} most obstetricians want the baby birthed as soon as 6 hours post-onset to reduce the risk of infection from the introduction of bacteria into the vagina due to repeated vaginal exams. Some obstetricians will wait as long as 24 hours but that is less common. In contrast, midwives, who do not routinely perform cervical checks unless specifically indicated or requested, thus limiting the chance of infection, will often allow up to 36-48 hours as long as no indications of an active infection are present.
  • A large study of 3000 women’s opinions of the intervention was conducted by the National Childbirth Trust (1989). Two thirds of the women in this study reported an increase in rate, strength and pain of contractions following membrane rupture; they found these contractions more difficult to cope with, needed more analgesia and felt that the physiology of labour was disturbed.
  • When there is concern that labour is slowing down, benign measures to intensify contractions such as positional changes and movement may prevent the need for more invasive interventions (Simkin 2010). The Cochrane review of maternal positions and mobility during first stage labour supports the positive impact mobility has in shortening labour (Lawrence et al. 2009).
  • Smyth et al. 2007 studies showed that amniotomy is not an effective method of shortening spontaneous labour and increases the risk of caesarean section and more fetal heart abnormalities
 
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?
 

Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, PaysonDisclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.
 

Info Sheet: Water Birth

Posted on January 2, 2015 at 4:02 AM Comments comments (10)
Perfect info sheet to share this month - if you are considering a water birth, you are not alone.  Today's pictures are from Cassandra's first birth journey...wishing her and baby #2 all the best as they prepare to journey together this month.


*Definition of Waterbirth: 
Immersion in water during labor and childbirth, giving birth immersed in water.
Sources:


*History: 
Water or 'hydrotherapy' has been used in the form of hot springs and warm baths for centuries in an effort to heal the body and relax the mind. How long it has been used to help women in labour is unknown.

Janet Balaskas, a writer on water births, describes legends of South Pacific Islanders giving birth in shallow seawater and of Egyptian pharaohs born in water. In some parts of the world today, such as Guyana, in South America, women go to a special place at the local river to give birth.

The first documented water birth occurred in France in 1805, when a woman, exhausted after a 48 hour labour, climbed into a warm bath to relax, giving birth to her child into the water shortly afterwards. Before this and for the next 150 years afterwards there has been little written on water birth, although it has probably occurred unreported for women birthing at home.

According to a 2012 Cochrane Review, "Water immersion during the first stage of labour significantly reduced epidural/spinal analgesia requirements, without adversely affecting labour duration, operative delivery rates, or neonatal wellbeing. One trial showed that immersion in water during the second stage of labour increased women's reported satisfaction with their birth experience.

"Both the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives support labouring in water for healthy women with uncomplicated pregnancies. The evidence to support underwater birth is less clear but complications are seemingly rare. If good practice guidelines are followed in relation to infection control, management of cord rupture and strict adherence to eligibility criteria, these complications should be further reduced."

Sources:


*PROS:
  • Water birth offers perineal support for a birthing mother, which decreases the risk of tearing and reduces the use of episiotomy.
  • Warm water is soothing, comforting, relaxing.
  • The effect of buoyancy lessens a mother’s body weight, allowing free movement and new positioning.
  • Water relaxes the mother's muscles and improves blood flow.
  • Since the water provides a greater sense of privacy, it can reduce inhibitions, anxiety, and fears.
  • Benefits for baby: Provides an environment similar to the amniotic sac [believed by some to be a more peaceful transition out of the mother’s body]

Sources:



*CONS
  • infection from contaminated water (contaminated levels of bacteria from initial water source or e.coli from feces eliminated during labor)
  • Electrolyte problems from the baby swallowing water
  • Although babies should not take their first breath until they hit air, some babies with unrecognized hypoxia may gasp underwater resulting in water aspiration. Delivery in water should not take place if baby is in any type of distress.

Sources:



*Links to explore:




Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, PaysonDisclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.

Info Sheet: Alcohol & Caffeine in Pregnancy

Posted on September 5, 2014 at 10:32 AM Comments comments (176)

Today we look at two of the substances many of us are concerned about using during pre-conception and pregnancy:  Alcohol and Caffeine.

If you are having a hard time giving up your caffeine, read more about consumption levels HERE

Consuming Alcohol during Pregnancy
ACOG (American College of Obstetricians & Gynecologists) & the CDC’s (Center for Disease Control) position on alcohol is:
“There is no known safe amount of alcohol use during pregnancy or while trying to get pregnant. There is also no safe time during pregnancy to drink. All types of alcohol are equally harmful, including all wines and beer. When a pregnant woman drinks alcohol, so does her baby.”
Sources: 
  1. http://www.cdc.gov/ncbddd/fasd/alcohol-use.html
  2. http://www.acog.org/~/media/For%20Patients/faq170.pdf?dmc=1&ts=20140528T2119482271

Consuming Caffeine during Pregnancy
"Moderate caffeine consumption (less than 200 mg per day) does not appear to be a major contributing factor in miscarriage or preterm birth. The relationship of caffeine to growth restriction remains undetermined. A final conclusion cannot be made at this time as to whether there is a correlation between high caffeine intake and miscarriage."
Source: ACOG 
  1. https://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/Moderate_Caffeine_Consumption_During_Pregnancy

*HISTORY
Alcohol:
According to ACOG, federal government warnings about the need to abstain from alcohol use in pregnancy were first issued in 1984. ACOG has recommended screening for alcohol early in pregnancy since 1977. Drinking or smoking during pregnancy increases the risk of SIDS; also, infants exposed to secondhand smoke are at greater risk for SIDS.8
According to national data collected in 1999 by the Behavioral Risk Factor Surveillance System (BRFSS), a telephone survey of the noninstitutionalized U.S. population, 12.8 percent of pregnant women consumed at least one alcoholic drink during the past month, a decrease from 16.3 percent reported in 1995 (Centers for Disease Control and Prevention [CDC] 2002a).

An intervention for women who drank heavily during their first pregnancy with the intention to reduce the women's drinking during their next pregnancies findings indicate that the brief intervention protected the next pregnancy by reducing alcohol consumption and improving infant outcomes.

Sources: 
  1. http://www.acog.org/About_ACOG/News_Room/News_Releases/2008/All_Patients_Should_be_Asked_About_Alcohol_and_Drug_Abuse
  2. http://www.nichd.nih.gov/health/topics/preconceptioncare/conditioninfo/pages/healthy-pregnancy.aspx

Caffeine:
Excerpt from ACOG Publication:
"Because caffeine crosses the placenta (1) and increases maternal catecholamine levels, concerns have been raised about a potential relationship between caffeine exposure and the incidence of spontaneous miscarriage. Studies also have investigated whether caffeine contributes to intrauterine growth restriction (IUGR).
Two large studies have [also] been performed to assess the relationship between caffeine intake and preterm birth. A randomized double-blind controlled trial of caffeine reduction in 1,207 women evaluated birth data for 1,153 singleton live births (6). An average intake of 182 mg per day of caffeine did not affect length of gestation. Additionally, a prospective, population-based cohort study conducted by Clausson et al evaluated the effect of caffeine consumption on gestational age at delivery in 873 singleton births (7). Again, no association was found between caffeine and preterm birth. Consequently, it does not appear that moderate caffeine intake is a contributor to preterm birth."
Source:
  1. https://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/Moderate_Caffeine_Consumption_During_Pregnancy

*PROS and CONS
Alcohol
PROS of avoiding alcohol during pregnancy
  • Because of the unknowns the the CDC, the U.S. Surgeon General, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics advise pregnant women not to drink alcohol at all.
  • The potential effects of small amounts of alcohol on a developing baby are not well understood.
  • When a pregnant woman drinks alcohol it quickly reaches the fetus through the placenta. In an adult, the liver breaks down the alcohol. A baby’s liver is not fully developed and is not able to break down alcohol.
Alcohol can put your child at risk of:
  • Fetal Alcohol Spectrum Disorders including but not limited to:
    • Abnormal facial features, such as a smooth ridge between the nose and upper lip (this ridge is called the philtrum)
    • Small head size
    • Shorter-than-average height
    • Low body weight
    • Poor coordination
    • Hyperactive behavior
    • Difficulty with attention
    • Poor memory
    • Difficulty in school (especially with math)
    • Learning disabilities
    • Speech and language delays
    • Intellectual disability or low IQ
    • Poor reasoning and judgment skills
    • Sleep and sucking problems as a baby
    • Vision or hearing problems
    • Problems with the heart, kidney, or bones
  • An increased chance of Sudden Infant Death Syndrome

Sources: 
  1. http://www.webmd.com/baby/features/drinking-alcohol-during-pregnancy
  2. http://www.cdc.gov/ncbddd/fasd/alcohol-use.html
  3. http://www.acog.org/~/media/For%20Patients/faq170.pdf?dmc=1&ts=20140528T2119482271

CONS of avoiding alcohol during pregnancy
  • Social implications
  • Desire to relax or de-stress similar to before becoming pregnant
  • Alcohol withdrawal symptoms may be present in women consuming multiple drinks per day. Alcohol withdrawal may be associated with adverse maternal and neonatal outcomes; therefore, medical withdrawal of alcohol-dependent pregnant women needs to be conducted in an inpatient setting (Center for Substance Abuse Treatment, 1993):

Source: 
  1. https://knowledgex.camh.net/primary_care/toolkits/addiction_toolkit/alcohol/Pages/faq_treatment_management_pregnancy.aspx#manage_during_pregnancy


Caffeine
PROS of avoiding caffeine during pregnancy
  • Changes in fetal heart rate and breathing patterns have been noticed even when maternal intake of caffeine is moderate and when it has no apparent effects on the mother.
  • Caffeine and its metabolites are known to cross the blood-brain barrier readily in adults and fetuses alike.
  • Intake of caffeine during pregnancy or the early postnatal period would be expected to have similar or more profound cardiovascular and neurobehavioral effects on fetuses and infants than on the caffeine-consuming mothers [because] of caffeine's ready passage through the placenta, its presence in breast milk, and its increasing half-life during pregnancy (up to 11 hours late in pregnancy) and in infants (up to 100 hours), the smaller body mass of fetuses and infants, and the inability of the fetus and neonate to detoxify caffeine. 
  • The relationship of caffeine to growth restriction remains undetermined.
  • It is difficult to measure caffeine exposure accurately.

Sources: 
  1. The New England Journal of MedicineNovember 25 1999;341:1639-1644, 1688-1689.
  2. https://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/Moderate_Caffeine_Consumption_During_Pregnancy
  3. http://www.nytimes.com/2001/07/17/health/conflicting-views-on-caffeine-in-pregnancy.html

CONS of avoiding caffeine during pregnancy
  • May not be necessary, the subject has long been contentious, with conflicting studies, fuzzy data and various recommendations given over the years.
  • Quitting caffeine can cause a number of unpleasant symptoms, including headache, fatigue and an inability to concentrate.

*Links for more reading

http://online.wsj.com/news/articles/SB10001424127887323514404578652091268307904

Alcohol


Caffeine


What are your thoughts about caffeine or alcohol use in pregnancy?
Please leave us a comment - it will be moderated and posted. 
 
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, PaysonDisclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.
 

The Dirt on Diaper Wipes

Posted on May 30, 2014 at 10:59 AM Comments comments (86)
Diaper Wipes – A closer look at what are you putting on your Sweet Pea's bum 

As a Bradley Method® instructor, we teach our students to avoid harmful substances in order to have a healthy, low-risk pregnancy.  Our own green journey started when we were Bradley Method® students nine years ago...so naturally, we continued the effort to keep our environment healthy and low-risk once our Sweet Pea was earthside.
 
Little did I know I was going to be in for a rude awakening when I read a Healthy Tips List from Environmental Working Group that listed the top ingredients to avoid in personal care products.  On a whim, I decided to check our products, because seriously, we weren’t at risk…we used products labeled “natural” and “-free”.
 
I was devastated to discover that labeling and product marketing had duped us, the trusting consumer.  I learned to read every label…including the labels on products that were going to touch any part of our children.  Part of our “going green” journey included a switch to reusable wipes and having a cleaning solution in a bottle.
 
If after reading through the ingredients you decide to make the switch to reusable products like we did, there are many options.  We have seen them in the “big box” stores, however since we strive to shop local, we support a mama-preneur and buy our reusable cloth goods from Shannon’s Cloth and More.  You can see her on our blog HERE and HERE.
 
So today I am sharing a list of what is in the “natural” line of the most recognized names in diapers, Huggies™ and Pampers™, plus a big box brand.  
  • If you are not ready to make the switch yet, we have found a store option that we will use when a washing machine is not available.  The ology™ brand available at Walgreen’s passed muster.  
  • The final product listed is the Baby Bits Wipes Solution – truly “free” of the harmful ingredients we want to avoid for our family’s long-term health.  We buy ours from Go Go Natural, a cloth diaper website run by another local mama-preneur.
 
If you want another motivation to switch, HERE is an eye-opening article from WebMD about the little thought of ingredients in conventional wipes – preservatives that are added to the product to minimize bacteria in a perpetually moist environment.  Children are breaking out in rashes due to an allergic reaction in supposedly harmless ingredients.
 
Ingredients to avoid from the Healthy Tips article.  I take an in-depth look at what they are and the motivation to avoid them HERE. 
 
Start at the end, with preservatives. Avoid:
- Words ending in "paraben"
- DMDM hydantoin
- Imidazolidinyl urea
- Methylchloroisothiazolinone
- Methylisothiazolinone
- Triclosan
- Triclocarban
- Triethanolamine (or "TEA")
 
Check the beginning of the ingredients lists, where soaps, surfactants, and lubricants show up. Try to avoid ingredients that start with "PEG" or have an "-eth" in the middle (e.g., sodium laureth sulfate).
 
Read the ingredients in the middle. Look for these words: "FRAGRANCE," "FD&C," or "D&C."
 
Also from the EWG database: I included a quick synopsis of each ingredient in the list below, as well as the ingredient rating. 
 
 
Huggies™ Natural Care – Kimberly Clark
Water
Amodimethicone (0) - Amodimethicone is a silicon-based polymer – used as a hair conditioning agent
Polysorbate 20 (3) - a surfactant and emulsifier used in cleaners and personal care products Other HIGH concerns: Contamination concerns; Other LOW concerns:Data gaps, Organ system toxicity (non-reproductive)
Sodium Methylparaben (4) - Parabens mimic estrogen and can act as potential hormone (endocrine) system disruptors. Other HIGH concerns: Endocrine disruption; Other MODERATE concerns: Biochemical or cellular level changes; Other LOW concerns:Data gaps
Malic Acid (3-4)- Irritation (skin, eyes, or lungs)
Sodium Laurel Glucose Carboxylate (no rating available) – surfactant derived from coconut or corn - More about this HERE 
Lauryl Glucoside (0) - Surfactant - Cleansing Agent - This ingredient is a sugar- and lipid-based surfactant.
Methylisothiazolinone (5) - It is a widely-used preservative; has been associated with allergic reactions. Lab studies on the brain cells of mammals also suggest that methylisothiazolinone may be neurotoxic.
Aloe Barbadensis Leaf Extract (1) - Aloe vera leaf extract is produced from the succulent leaves of the aloe plant, Aloe barbadensis
Tocopheryl Acetate (Vitamin E in the form of tocopheryl acetate) (3) - Skin-Conditioning Agent  - Human skin toxicant or allergen - strong evidence; One or more animal studies show tumor formation at high doses
 
 
Huggies™ Simply Clean – Kimberly-Clark
Water
Potassium Laureth phosphate (2) - Surfactant - Cleansing Agent; Contamination concerns with ethylene: Irritation (skin, eyes, or lungs), Organ system toxicity (non-reproductive); and  The carcinogen 1,4-dioxane contaminates up to 46% of personal care products tested (OCA 2008, EWG 2008). The chemical is an unwanted byproduct of an ingredient processing method called ethoxylation used to reduce the risk of skin irritation for petroleum-based ingredients
Glycerin
Polysorbate 20 (3) - a surfactant and emulsifier used in cleaners and personal care products Other HIGH concerns: Contamination concerns; Other LOW concerns: Data gaps, Organ system toxicity (non-reproductive)
Tetrasodium EDTA (2) - a chelating agent, used to sequester and decrease the reactivity of metal ions that may be present in a product; Other MODERATE concerns: Organ system toxicity (non-reproductive)
Methylparaben (4) - in the paraben family of preservatives used by the food, pharmaceutical, and personal care product industries. Parabens mimic estrogen and can act as potential hormone (endocrine) system disruptors. HIGH concerns: Endocrine disruption; Other MODERATE concerns: Biochemical or cellular level changes
Malic acid (3-4) – Irritation (skin, eyes, or lungs)
Methylisothiazolinone (5) - It is a widely-used preservative; has been associated with allergic reactions. Lab studies on the brain cells of mammals also suggest that methylisothiazolinone may be neurotoxic.
Aloe barbedensis leaf extract (1) - Aloe vera leaf extract is produced from the succulent leaves of the aloe plant, Aloe barbadensis
Tocopheryl Acetate (Vitamin E in the form of tocopheryl acetate) (3) - Skin-Conditioning Agent  - Human skin toxicant or allergen - strong evidence; One or more animal studies show tumor formation at high doses
 
 
Pampers™ Sensitive – Proctor & Gamble
Claim: Alcohol Free – Hypoallergenic
Water
Glycerin
Aloe barbadensis leaf juice (1) - Aloe vera leaf extract is produced from the succulent leaves of the aloe plant, Aloe barbadensis
Disodium EDTA (0) - is a chelating agent, used to sequester and decrease the reactivity of metal ions that may be present in a product. GRAS
Citric Acid (2) – alpha hydroxyl acid - used in personal care products to adjust the acidity or promote skin peeling and re-growth in the case of anti-aging products
PEG-40 Hydrogenated Castor Oil (3) - polyethylene glycol derivative of castor oil; may be contaminated with potentially toxic impurities such as 1,4-dioxane.
Sodium Citrate (0) Cosmetic manufacturers use sodium citrate to adjust the acidity of a product. Citrate, in the form of citric acid, is also found in citric fruits and juices.
Phenoxyethanol (4) – preservative – suspected neurotoxin - More about that HERE 
Ethylhexylglycerin (1) - Ethylhexylglycerin is a glyceryl ether used as a weak preservative and skin conditioning agent. HIGH concerns: Irritation (skin, eyes, or lungs)
Benzyl Alcohol (5) - Benzyl alcohol is a naturally ocurring and synthetic ingredient used as solvent and preservative; has been associated with contact allergy.
Xantham gum (0) - Binder; Emulsion Stabilizer
Sodium benzoate (3) – preservative – low concern: non-reproductive organ system toxicity
BIS-PEG/PPG-16 Dimethicone (3) - lubricant and conditioning agent.
Caprylic/Capric Triglyceride (1) - Fragrance Ingredient; Skin-Conditioning Agent 
Bisabolol (0) - Fragrance Ingredient; Skin-Conditioning Agent 
Chamomilla recutita (matricaria) flower extract (0) - Fragrance Ingredient; Skin-Conditioning Agent 
 
Parent’s Choice Baby Wipes – Walmart
Water
Glycerin – generally considered non-toxic
Phenoxyethanol (4) – preservative – suspected neurotoxin - More about that HERE 
Sodium benzoate (3) – preservative – low concern: non-reproductive organ system toxicity
Potassium sorbate (3) – preservative - low concern: non-reproductive organ system toxicity
Sodium cocyl Apple amino acids (0) – no info available
Pentadecalactone (1) - Other MODERATE concerns: Organ system toxicity (non-reproductive);
Suspected to be an environmental toxin and be persistent or bioaccumulative
Aloe barbadensis leaf extract- (1) - Aloe vera leaf extract is produced from the succulent leaves of the aloe plant, Aloe barbadensis
Chamomilla recutita (matricaria) flower extract - (0) - Fragrance Ingredient; Skin-Conditioning Agent
Tocopheryl acetate (3) - Skin-Conditioning Agent  - Human skin toxicant or allergen - strong evidence; One or more animal studies show tumor formation at high doses; Other HIGH concerns: Contamination concerns; Other LOW concerns: Data gaps, Ecotoxicology
Citric acid (2) – alpha hydroxyl acid - used in personal care products to adjust the acidity or promote skin peeling and re-growth in the case of anti-aging products
 
 
Ology Bamboo Baby Wipes – Walgreen’s

Purified Artesian Aquifer Water
Polysorbate 20 (3) - a surfactant and emulsifier used in cleaners and personal care products Other HIGH concerns: Contamination concerns; Other LOW concerns: Data gaps, Organ system toxicity (non-reproductive)
Vegetable glycerin (0) GRAS
Lavandula angustifolia (lavender oil) (0)
Citrus sinensis (sweet orange) oil (0)
Aloe barbadensis (organic aloe vera) leaf extract (1) - Aloe vera leaf extract is produced from the succulent leaves of the aloe plant, Aloe barbadensis
Calendula officinalis flower extract (1) - Fragrance Ingredient
Potassium sorbate (3) – preservative - low concern: non-reproductive organ system toxicity
Sodium benzoate (3) – preservative – low concern: non-reproductive organ system toxicity
Citric acid  (2) – alpha hydroxyl acid – used in personal care products to adjust the acidity or promote skin peeling and re-growth in the case of anti-aging products

 
Baby Bits Wipes Solution
Coconut oil glycerin soap (0)
organic plantain herb (0)
chickweed herbs (0)
virgin olive oil (1) – may cause irritation
pure essential oil of tea tree (0)
pure essential oil of lavender (0)
 


I hope it goes without saying...just in case...please refer back to this post if you are going to share the information - thank you for respecting the time and effort it took to pull this information together. ~Krystyna


Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson Disclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.

Info Sheet: Choices in Childbirth Education

Posted on May 16, 2014 at 6:00 AM Comments comments (185)
What! A Bradley Method® teacher writing about other kinds of childbirth education??  Yes, absolutely!

Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, PaysonThe Bradley Method® is designed for families who are planning to have One Mama who wants to prepare for a natural birth + One Coach who is invested and wants to be the main coach for the mother, and in some cases we train assistant coaches as well. There are so many other dynamics and variations in mothers and in their pregnancy.  Today’s information sheet will look at the different childbirth preparation options and offer links to find out more about the different courses offered if The Bradley Method® is not the right fit for you.
 
Why would I do an information sheet on this topic and allow other educators to "brag on" their classes?? It is because I believe that there is no “one size fits all” childbirth education class.  If one method were perfect, there wouldn’t be so many options out there.  

Each method speaks to the people who are attracted to the principles offered in that course.  When we do presentations about natural childbirth and our classes, we offer an evaluation guide so that families can weigh any method against their own values and desires for their birth.  Just like individuals are unique, they must find the education that fits their personality, timeline and budget.

HISTORY:
Once upon a time, birth was a community event.  Children were born at home; families and neighbors experienced birth with all of it's beauty, goopiness, noise (or lack thereof) and rare complications (most complications of birth happen at a rate of 2% or less).  Birth happened to us and around us - it was part of life and living.

Then birth started to move to the hospital.  Parents went away to have babies, and came back with siblings.  Children were no longer privy to what happened during birth.  And birth changed - it became medically managed because true, uncomplicated childbirth has a very hard time showing up when you take a mother to a place where she has to birth with an audience of strangers.  We began to lose our knowledge and trust in birth - many of us have never experienced a live birth until it happened to us.

Hence, the "birth" of childbirth education classes: to teach mothers and their partners how birth looks, sounds, and is likely to proceed if it is allowed to happen as nature intended.  Little by little, hospitals and care providers in the hospital setting are open to the idea that interfering with birth is the problem, not the process of birth itself.

PROS
Most courses will cover provide some, if not all, of these benefits:

  • You learn about your body and how it works in labor; develop confidence in your body's ability to birth.
  • It is a bonding experience with your partner - although they may never experience pregnancy, they learn how they can play an active role in your pregnancy and birth 
  • Learn positions and techniques for labor
  • Learn comfort measures and pain relief options (natural and medical) 
  • Learn about interventions and how to evaluate them
  • Learn how to advocate for mother and baby with positive communication techniques
  • Learn about variations and complications of childbirth
  • Learn how to embrace your birth experience, even if it deviates from your plan


CONS

  • You are an educated consumer - some care providers are not as excited about that as you might imagine.


A closer look at the choices in childbirth education 
Note: this section will be updated as I receive first-hand descriptions of the courses from educators in our area who teach these classes. 
 
In our area (Phoenix, AZ), most childbirth education courses run between $250 - $350, regardless of length.  Most courses are 3-6 weeks long.  If you do the math to figure out the cost per hour, that makes our 12-week Bradley™ course the best value for the money! However, budget is only one factor when considering a childbirth education course. 
 
Here are some questions you can ask when you are considering which class is best for you:
 
Asking these questions first will pre-qualify any classes you may be considering:
- Do you have a class that fits my due date?
- Is it offered at a convenient time, place, and location?
- If not, do you offer private instruction?
 
If you are a good fit so far, consider asking these questions next
- What are your qualifications, training and experience?
How many children have they had using this method, how did they receive training in the method (reading, correspondence course, in-person training (who was their trainer?), webinar), how many courses/couples have they taught?
- Who do you work for?
Are they independent or paid by a third-party? Are they representing information or are they promoting an experience?
- How do your methods and techniques work in labor? What are your method’s natural birth rates?
Most educators have a statistics sheet from their organization, or they may have an account from their students.
 
To ensure the best quality of instruction, it might be important to know if the childbirth educator you are considering is a current affiliate with the certifying organization, or if they were just trained and never completed their certification.  For example, we must carry our most recent affiliation certificate with us when we teach.  We are required to re-certify every year.  Someone thinking about Bradley™ classes would want to know if the class is a Bradley Method® class, providing the most current workbook and updated information (our organization publishes updates to our course outline every year), or is it a class “just like Bradley™” taught by a former instructor who no longer has access to the most current information and might only be teaching their favorite parts of what the method offered them?
 
Here are descriptions of the most common childbirth education methods.  Each of the websites listed below has links to find an affiliated instructor in your area for that “brand” of childbirth instruction.  
 
The Bradley Method®
Teaches about the process of a healthy, low-risk natural childbirth and views birth as a natural process. It is our belief that most women with proper education, preparation, and the help of a loving and supportive coach can have the best birth possible while striving to have a natural birth. The Bradley Method encourages mothers to trust their bodies. Families are encouraged to have a healthy, low-risk pregnancy based on the foundation of nutrition, exercise, and the avoidance of harmful substances. As part of a comprehensive education couples are taught the stages and physiology of labor, comfort measures, and how to use natural breathing + relaxation techniques during pregnancy/labor. (See our course outline HERE)
12 classes @ 2.5 hours each
 
Lamaze
Ferdinand Lamaze was a French obstetrician who in the 1950s developed a method of childbirth preparation using behavioral training to reduce pain and anxiety in labor.  Modern-day Lamaze focuses on six Healthy Birth Practices.  From their website: “The Lamaze Healthy Birth Practices help simplify your birth process with a natural approach that helps alleviate your fears and manage pain. Regardless of your baby’s size, your labor’s length and complexity, or your confidence level, these care practices will help keep labor and your baby's birth as safe and healthy as possible.” 
 
Hypnobirthing
Also called the “Mongan Method”. It is a childbirth education curriculum that emphasizes self-hypnosis.  This method believes in trusting Nature’s way of birth and the simplicity of birth.  Only a few key techniques are taught because the premise is that repetition instead of variety is what gets best results.  
5 classes @ 2.5 hours each
 
Hypnobabies
The curriculum is adapted with permission from Gerald Kein’s “Painless Childbirth Program” techniques. Instead of using simple relaxation, breathing or guided imagery, hypnosis scripts are used as the primary tool for pain management.  Hypnobabies scripts are written to train the inner mind that contractions in labor will be felt only as pressure, tightening, pushing, pulling and normal baby movement sensations.  Scripts are meant to be listened to daily during pregnancy and through the process of labor. 
6 classes @ 3 hours each
 
Birthing From Within
The premise is to understand the power and life-long impact that "birthing from within" offers all participants in birth, therefore mothers/partners prepare for birth as a Rite of Passage.  One intention is to co-create holistic prenatal care that is informative, transformative, and builds a foundation for birthing in awareness in our birth culture, whatever the birth location or outcome or events of the birth.  Another intention is to prevent or minimize emotionally difficult births (for parents and professionals) through compassionate, honest preparation.
 
BirthWorks
From their website: “believe that the knowledge about how to give birth is born within every woman. Therefore, birth is instinctive and what is instinctive doesn’t need to be taught. We help women to have more trust and faith in their own body knowledge that already knows how to give birth. This is a unique approach that is empowering and transforming in nature.”
 
Independent Classes
Many doulas and former childbirth educators will do a one- or two-day intensive program, or they are available for private childbirth classes.  I have a running list of these options for the instance when we get a call from a family that doesn’t have twelve-weeks for a full Bradley Method® course.  Your area Bradley™ teacher may also keep this kind of list, or call a doula in your area to see if they or any of their colleagues teach private, non-branded childbirth classes.
 
Hospital Classes
Most hospitals that have labor and delivery units will offer childbirth classes.  In general, they are taught from the “this is how we do labor and delivery” and “how to be a patient” perspective.  You may hear about the most used options (epidurals) and common interventions in the hospital setting.  It is very rare to have these classes include preparation for true natural childbirth.  It may be beneficial to take this class to understand the birthing culture in the hospital if you are having a hospital birth.  It may give you a truer picture of what your hospital birth could be like than you will get from your care provider.  You are a patient in the hospital for the entirety of your hospital stay – they only show up for the last few minutes of your labor.  If you hear/see too many red flags, then you can consider other options: does your care provider have privileges at other hospitals? Maybe you want to take a closer look at birth centers in your area, or consider changing to a home setting?
 
The bottom line is that there are several options in childbirth education and preparation.  Choose the method that speaks to your heart – and get the information from the people that are passionate  about and currently affiliated with the method that they teach.

We wish you all the best as you do the research to find the best method of education for your Healthy Mom, Healthy Baby Birth-Day.


Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, PaysonDisclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.

Info Sheet: Stripping Membranes

Posted on April 18, 2014 at 7:04 PM Comments comments (213)


The information below is paraphrased and/or quoted from the listed sources.

*Definition of the procedure
Stripping Membranes
Stripping membranes, sometimes called "sweeping of the membranes" or "membrane sweeping", is a method used to try to start labor. The health care provider puts her or his finger into the cervix – the mouth of the uterus – and uses the finger to separate the bag of waters from the side of the uterus near the cervix. This releases local prostaglandins/hormones that can trigger contractions. It can be done in your doctor or midwife's office.
 
The National Institute for Health and Clinical Excellence (NICE) notes that for the purpose of it's guideline, membrane sweeping is regarded as an adjunct to induction of labor rather than an actual method of induction.
 
Sources: 
  1. http://www.midwife.org/ACNM/files/ccLibraryFiles/Filename/000000000669/Stripping%20Membranes.pdf
  2. http://www.medscape.com/viewarticle/703499
  3. http://www.webmd.com/baby/guide/inducing-labor?page=2
  4. http://www.guideline.gov/syntheses/synthesis.aspx?id=24079
 
 
*History
Sweeping (or stripping) the membranes (sometimes referred to as a 'strip and stretch') is an old method of induction that was first documented in the year 1810.

The available evidence suggests that sweeping the membranes promotes the onset of labor. For women thought to require induction of labor, a reduction in the use of more formal methods of induction could be expected. For women near term (37 to 40 weeks of gestation) in an uncomplicated pregnancy there seems to be little justification for performing routine sweeping of membranes. Sweeping of the membranes is probably safe, provided that the intervention is avoided in pregnancies complicated by placenta praevia or when contraindications for labor and/or vaginal delivery are present. There is no evidence that sweeping the membranes increases the risk of maternal and neonatal infection, or of premature rupture of the membranes. However, women’s discomfort during the procedure and other side-effects must be balanced with the expected benefits before submitting women to sweeping of the membranes.
 
According to the American College of Obstetricians and Gynecologists (ACOG), stripping membranes increases the likelihood of spontaneous labor within 48 hours and reduces the incidence of induction with other methods.
 
Sources: 
  1. http://www.birth.com.au/induced-labour/sweeping-the-membranes-for-induction-about#.UydpR_0q6DE
  2. http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0CC4QFjAB&url=http%3A%2F%2Fwww.update-software.com%2Fpdf%2Fcd000451.pdf&ei=42knU-W_B8vwoASYlIDYAw&usg=AFQjCNG1TDfgdKgCsUPnWdnaq63XUBCU6w&bvm=bv.62922401,d.cGU

 
*PROS

  • It is a drug free…method of stimulating labor
  • It may mean you avoid further intervention
  • You can have it performed at home or in your health care providers office
  • Spontaneous delivery is more likely
  • Has been found to reduce the risk of post term gestation, or pregnancy continuing past 41 weeks.

Sources:

  1. http://www.birth.com.au/induced-labour/sweeping-the-membranes-for-induction-about#.UydpR_0q6DE
  2. http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0CC4QFjAB&url=http%3A%2F%2Fwww.update-software.com%2Fpdf%2Fcd000451.pdf&ei=42knU-W_B8vwoASYlIDYAw&usg=AFQjCNG1TDfgdKgCsUPnWdnaq63XUBCU6w&bvm=bv.62922401,d.cGU

 
In a randomized trial of 274 women, the women who underwent membrane sweeping had:

  • Higher spontaneous vaginal delivery rate (69% vs 56%, P=.041)
  • Shorter induction-to-delivery interval (mean 14 vs 19 hours, P=.003)
  • Fewer requirements for oxytocin (46% vs 59%, P=.037)
  • Shorter duration of oxytocin infuson (mean 2.6 vs 4.3 hours, P=.001)
  • Greater satisfaction with the birth process

Source: http://www.obgmanagement.com/home/article/membrane-sweeping-and-gbs-a-litigious-combination/08f78b0aa97dff9559c698c2bc0658ba.html#1809OBGM_Article2-box1
 
*CONS

  • Possible discomfort during procedure
  • Possible discomfort after procedure
  • Possible abdominal cramping after procedure
  • Possible spotting after procedure
  • The cramping that may occur in the 24 hours after your membranes are stripped can make it hard to rest or sleep; this means that you might lose some sleep before actually going into labor. 


  • Some people worry that membrane stripping may cause the bag of water to break or cause mothers or babies to become sick. Studies have found that membrane stripping does not make them more likely.
  • Possible risk of spreading infection for mothers that are GBS positive

Source: http://www.medscape.com/viewarticle/703499
 
*Links with other options to explore



Was this intervention part of your birth story? What is your insight? 
Please leave us a comment - it will be moderated and posted. 
 
Disclaimer:  
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, PaysonThe 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: External Cephalic Version

Posted on March 14, 2014 at 5:26 AM Comments comments (314)
External Cephalic Version for Breech Position
 
*Definition of the procedure/test
External cephalic version, or version, is a procedure used to turn a fetus from a breech position or side-lying (transverse) position into a head-down (vertex) position before labor begins. Your [practitioner] will use his or her hands on the outside of your abdomen to try to turn the baby
Source ~ Quoted from: 
http://www.webmd.com/baby/external-cephalic-version-version-for-breech-position
           
Image Source: 
Scott & White Healthcare http://bit.ly/1eyZCgI
 
*History
External version has apparently been practiced since the time of Aristotle (384 to 322 B.C.), who stated that many of his fellow authors advised midwives who were confronted with a breech presentation to “change the figure and place the head so that it may present at birth.” However, external version eventually fell out of favor as a result of several concerns: its high rate of spontaneous reversion (turning back to breech presentation) if performed before 36 weeks of gestation, possible fetal complications, and the assumption that an external version converts only those fetuses to vertex that would have converted spontaneously anyway.
 
Studies have documented the success and safety of external version. The authors of a recent literature review of 25 studies on the efficacy of external cephalic version calculated an overall success rate of 63.3 percent, with a range of 48 to 77 percent. Most of these studies used the currently accepted protocol that is discussed in this article. These studies documented minimal risks, including umbilical cord entanglement, abruptio placentae, preterm labor, premature rupture of the membranes (PROM) and severe maternal discomfort. Overall complication rates have ranged from about 1 to 2 percent since 1979. In another study, fetal heart rate changes occurred in 39 percent of fetuses during external version attempts, but these changes were transient and had no relationship to the final outcome. Importantly, the literature provides overwhelmingly reassuring evidence regarding the risk of fetal death. Before 1980, four fetal deaths from external cephalic version had been reported. All of these deaths occurred in association with attempts at external version using general anesthesia. Since 1980, only two fetal deaths have been reported with external version. Both occurred without the use of fetal heart rate monitoring or ultrasonography in preterm infants in Zimbabwe.

A recent study reported a success rate for external cephalic version of 69.5 percent. Noteworthy was the fact that among fetuses undergoing successful version, the incidence of intrapartum cesarean section was 16.9 percent, a figure that was 2.25 times higher than that in the control group. The high rate of cesarean delivery resulted from a significantly higher incidence of fetal distress and labor dystocia in the group receiving external version. Results of this study demonstrate that even after successful version, a higher rate of intrapartum abnormalities may occur.
Source: Quoted from American Academy of Family Physicians 


Image Source:
WHO Health Education To Villages http://bit.ly/1eyZWfv
 
*PROS
  • External version success rate is 63% at term (37 weeks or more gestation)
  • Researchers have found that having an external cephalic version decreased the risk of breech birth by 54% and decreased the risk of C-section by 33%
  • If a baby is in the “complete breech” position (buttocks down, with the legs folded at the knees and the feet near the buttocks) this increases the chance that the version will be successful.
  • Version is also more likely to be successful if the placenta is posterior (on the back side of the uterus) and if there are normal levels of amniotic fluid (an Amniotic Fluid Index >10)
  • The most common risk is a temporary change in the infant’s heart rate (4.7%); serious complications are rare (0.24%)
Sources ~ Quoted from: 
 
 
*CONS
Potential Risks include:
  • Twisting or squeezing of the umbilical cord, reducing blood flow and oxygen to the fetus.
  • The beginning of labor, which can be caused by rupture of the amniotic sac around the fetus (premature rupture of the membranes, or PROM).
  • Placentae abruptio, rupture of the uterus, or damage to the umbilical cord. The potential exists for such complications, but they are very rare.
  • 1 urgent C-section for every 286 versions. Recommended that a version should take place in a setting where an urgent C-section could be performed if necessary.
Sources ~ Quoted from:
  

Links with other options to explore 
 

Alternatives for turning breech babies

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