I have a client who had an initial early ultrasound and based on that test and her last menstrual period, giving her a due date of the 26th. When she had a second ultrasound a couple of months later, the technician said that the baby was measuring a week older due to length. So, the next person she saw in her care providers' office changed her due date- decreasing it by 6 days!
I discussed with her how important those six days may really be. In her practice they consider their patients late at 41 weeks and I knew she was shaving almost a week off of missing an induction! So, are six days really a big deal?
Showing posts with label Avoiding Interventions. Show all posts
Showing posts with label Avoiding Interventions. Show all posts
Tuesday, December 7, 2010
Thursday, November 18, 2010
Evidence Based Medicine Re: Your Membranes Releasing Prior to Labor Beginning
What does this mean? The internet offers these definitions:
Definitions of Evidence-based medicine on the Web:
Definitions of Evidence-based medicine on the Web:
- Evidence-based medicine (EBM) aims to apply the best available evidence gained from the scientific method to medical decision making. It seeks to assess the quality of evidence of the risks and benefits of treatments (including lack of treatment).
en.wikipedia.org/wiki/Evidence-based_medicine - Heath care whose policies and practices are derived from the systematic, scientific study of the effectiveness of various treatments
en.wiktionary.org/wiki/evidence-based_medicine - The practice of medicine or the use of healthcare interventions guided by or based on supportive scientific evidence. Also, the avoidance of those interventions shown by scientific evidence to be less efficacious or harmful.
www.qaproject.org/methods/resglossary.html - The practice of medicine with treatment recommendations that have their origin in objective tests of efficacy published in the scientific literature rather than anecdotal observations.
www.grg.org/resources/glossary.html - An approach to practicing medicine that involves consideration of results of clinical trials that are relevant to the disease or condition being treated when making decisions about how to treat patients.
www.ecri.org/patients/references/Pages/Clinical_Trials_Patient_Reference_Guide_Glossary.aspx - is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. ...
www.hse.ie/eng/about/Who/Population_Health/Health_Intelligence/Health_Intelligence_Work/Evidence_Based_Health_Care/Glossary_of_Terms/ - For many in the medical field, evidence-based medicine includes only those treatments that have been shown to be effective through a narrow lens, especially double-blind studies. ...
www.hyperbariccenter.org/glossary.html - Evidence-based medicine (EBM) is the integration of best research evidence with clinical expertise to aid in the diagnosis and management of patients.
www.azdoqit.com/LS4/Glossary%20of%20EHR%20Terms.doc
Monday, March 22, 2010
Watch the Language Around You!
Imagine you are driving down a road- it is not clear where you are going. The weather outside is beginning to be unpredictable. You turn on the radio and the commentator keeps saying he does not think the road is open ahead. In fact he says multiple times you may be able to drive down the road but that does not mean you will be able to get through this huge roadblock ahead. You may have the gas to get there- you may have a car that works to get you there- but it does not mean you will be able to get through the roadblock.
A passenger in the car may encourage you that you can do it. But all you can see ahead is a red flashing light saying STOP! TURN AROUND!
I want to share with you the language used in two births I attended recently. One was a mom attempting a VBAC (vaginal birth after a previous cesarean) and one was a first time mom having her labor augmented. I want you to consider the mind body connection and how this type of language can interfere with a mom's ability to believe in her body- her baby- and her birth.
The doctor came into the room and after suggesting that Pitocin was needed commented, "He can get anyone to dilate but that did not mean you could get the baby to be born vaginally."
Later he came in and said, "He was sure this baby was over 9.5 pounds and the baby’s head was molding a lot. But he was unsure if this baby really was going to fit." (the baby weighed 8# 14 oz)
He returned an hour later and said, "He hates pushing cause he knows the damage it can do. He has to do so much reconstructive surgery on women due to pushing out big babies."
After having to stay in the hospital all night since she was a VBAC, he made the comment, "That there was no financial viability in doing VBACs like this. It was not cost effective for him."
He later came in and shared how awful it was to have to bump a doctor out of the OR for his planned cesarean deliveries when a mom waited til just before 7am to have her cesarean called. He told her he would not impose that schedule change on another doctor as he hated it when it was done to him. He would be calling this before he had to do that.
He was certainly surprised when only an hour or so later when she pushed her daughter our vaginally into the hands of her supportive midwife. He even said, "You certainly surprised me!"
The next mom had a doctor who was very gentle and encouraging for the most part. He would come in and although she was not progressing he would offer that she could do nothing and keep going. But he would offer the caveat that she was an older mom- she was 34 years old. How our uterus was really meant to have babies in our 20's.
He then would return and say almost identical to the first doc, "I can get you fully dilated, but that does not mean this baby is going to fit out your vagina."
He would encourage her to keep doing what she was doing but would end each statement with, "I don't think this baby will fit."
He would also offer up that in Ireland they are doing active management of labor. "The active management of labor, first introduced by O'Driscoll et al in the 1960s at the National Maternity Hospital in Dublin, Ireland,5 is a group of interventions initially devised to ensure short labors in nulliparous (never having given birth before) women. In addition, active management of labor was noted to be associated with a lower cesarean section rate,6,7 which was thought to be due to a decrease in the number of cesarean deliveries performed for dystocia. Three randomized studies have been done to evaluate the efficacy of active management of labor.8,9,10 These studies have demonstrated significant decreases in the duration of labor and the incidence of infectious morbidity, as well as a trend toward lower cesarean section rates." What this really means is they gave moms huge amounts of Pitocin after breaking their water and pushed their labors into a short but frenzied labor. There was no discussion of how the Pitocin may effect the baby or mom. Nor was there any consideration for the type of birth experience this left the mom with. But he said it is catching momentum with doctors!
So after not progressing for several hours, this mom had her water broken and then active labor began. She did get fully dilated but after a little more than an hour with constant comments on how this baby, "was not going to fit." and a declaration that the baby had a capput- the swelling of the soft tissue on his head, a cesarean was strongly encouraged.
I am not sure if this doctor felt the same way as the first about having his surgery schedule messed with- since the call was made just before 6am and the scheduled cesareans begin at 7am. I am unsure if this doctor was just tired of waiting. I am unsure if this mom really could not fit this baby through her pelvis. (The baby was just under 8 pounds.) I am unsure we will ever know.
But what I do know is it is hard to keep driving forward when the red flashing lights are blaring at you. It is hard to keep moving ahead when those you feel are in authority are saying you can get there but you will never make it through the roadblock that they see.
The mind body connection is a strong one. But it is also so hard when you are feeling so vulnerable. When you are second guessing your ability, when the ones you believe can guide you best are not believing the dream you had planned, it is shaky ground. It is a highly emotionally charged time. You do not know the decisions that are right all the time- when you look back later you wonder... but you have to make the decisions that feel right in that instance. It is not black and white. There is no clarity. It is easy for those on the outside to second guess your choices. It is awful when someone says you made the wrong decision. They were not there! They did not feel what you felt!
And what about the baby? What about the mom's intuitive spirit? One mom hoped she would be able to birth her baby vaginally this time and she did. One mom had no idea she would be having a surgical birth. Some of her friends had opted to do so without labor. She had discussed this early in her labor with me. I thought it a curious conversation at the time. I wonder if her body was letting her know something. I wonder if she needed to know that laboring first before a planned cesarean had its benefits. When later she felt something just was not working, it makes me wonder if that came from her internal spirit or was it a seed this doctor had planted. We won't ever know for sure.
But when you are driving down a road- it is not always clear where you are going. The weather can be unpredictable. Those in authority may believe you will not be able to get through this huge roadblock ahead. You must believe what you have come to believe as truth. You must shut out the negative voices around you and give it your best try. Then you will either find out they did not speak the truth for you- you either do make it through the road block or indeed it is one that is insurmountable. But what you will know is this- you gave it your best. You did not quit due to non belief.
And with that I pray you will surround yourself with voices of affirmation. I pray you will surround yourself with support along the way so you can get the information you need to make your decisions. I hope you will face your roadblocks with courage.
A passenger in the car may encourage you that you can do it. But all you can see ahead is a red flashing light saying STOP! TURN AROUND!
I want to share with you the language used in two births I attended recently. One was a mom attempting a VBAC (vaginal birth after a previous cesarean) and one was a first time mom having her labor augmented. I want you to consider the mind body connection and how this type of language can interfere with a mom's ability to believe in her body- her baby- and her birth.
The doctor came into the room and after suggesting that Pitocin was needed commented, "He can get anyone to dilate but that did not mean you could get the baby to be born vaginally."
Later he came in and said, "He was sure this baby was over 9.5 pounds and the baby’s head was molding a lot. But he was unsure if this baby really was going to fit." (the baby weighed 8# 14 oz)
He returned an hour later and said, "He hates pushing cause he knows the damage it can do. He has to do so much reconstructive surgery on women due to pushing out big babies."
After having to stay in the hospital all night since she was a VBAC, he made the comment, "That there was no financial viability in doing VBACs like this. It was not cost effective for him."
He later came in and shared how awful it was to have to bump a doctor out of the OR for his planned cesarean deliveries when a mom waited til just before 7am to have her cesarean called. He told her he would not impose that schedule change on another doctor as he hated it when it was done to him. He would be calling this before he had to do that.
He was certainly surprised when only an hour or so later when she pushed her daughter our vaginally into the hands of her supportive midwife. He even said, "You certainly surprised me!"
The next mom had a doctor who was very gentle and encouraging for the most part. He would come in and although she was not progressing he would offer that she could do nothing and keep going. But he would offer the caveat that she was an older mom- she was 34 years old. How our uterus was really meant to have babies in our 20's.
He then would return and say almost identical to the first doc, "I can get you fully dilated, but that does not mean this baby is going to fit out your vagina."
He would encourage her to keep doing what she was doing but would end each statement with, "I don't think this baby will fit."
He would also offer up that in Ireland they are doing active management of labor. "The active management of labor, first introduced by O'Driscoll et al in the 1960s at the National Maternity Hospital in Dublin, Ireland,5 is a group of interventions initially devised to ensure short labors in nulliparous (never having given birth before) women. In addition, active management of labor was noted to be associated with a lower cesarean section rate,6,7 which was thought to be due to a decrease in the number of cesarean deliveries performed for dystocia. Three randomized studies have been done to evaluate the efficacy of active management of labor.8,9,10 These studies have demonstrated significant decreases in the duration of labor and the incidence of infectious morbidity, as well as a trend toward lower cesarean section rates." What this really means is they gave moms huge amounts of Pitocin after breaking their water and pushed their labors into a short but frenzied labor. There was no discussion of how the Pitocin may effect the baby or mom. Nor was there any consideration for the type of birth experience this left the mom with. But he said it is catching momentum with doctors!
So after not progressing for several hours, this mom had her water broken and then active labor began. She did get fully dilated but after a little more than an hour with constant comments on how this baby, "was not going to fit." and a declaration that the baby had a capput- the swelling of the soft tissue on his head, a cesarean was strongly encouraged.
I am not sure if this doctor felt the same way as the first about having his surgery schedule messed with- since the call was made just before 6am and the scheduled cesareans begin at 7am. I am unsure if this doctor was just tired of waiting. I am unsure if this mom really could not fit this baby through her pelvis. (The baby was just under 8 pounds.) I am unsure we will ever know.
But what I do know is it is hard to keep driving forward when the red flashing lights are blaring at you. It is hard to keep moving ahead when those you feel are in authority are saying you can get there but you will never make it through the roadblock that they see.
The mind body connection is a strong one. But it is also so hard when you are feeling so vulnerable. When you are second guessing your ability, when the ones you believe can guide you best are not believing the dream you had planned, it is shaky ground. It is a highly emotionally charged time. You do not know the decisions that are right all the time- when you look back later you wonder... but you have to make the decisions that feel right in that instance. It is not black and white. There is no clarity. It is easy for those on the outside to second guess your choices. It is awful when someone says you made the wrong decision. They were not there! They did not feel what you felt!
And what about the baby? What about the mom's intuitive spirit? One mom hoped she would be able to birth her baby vaginally this time and she did. One mom had no idea she would be having a surgical birth. Some of her friends had opted to do so without labor. She had discussed this early in her labor with me. I thought it a curious conversation at the time. I wonder if her body was letting her know something. I wonder if she needed to know that laboring first before a planned cesarean had its benefits. When later she felt something just was not working, it makes me wonder if that came from her internal spirit or was it a seed this doctor had planted. We won't ever know for sure.
But when you are driving down a road- it is not always clear where you are going. The weather can be unpredictable. Those in authority may believe you will not be able to get through this huge roadblock ahead. You must believe what you have come to believe as truth. You must shut out the negative voices around you and give it your best try. Then you will either find out they did not speak the truth for you- you either do make it through the road block or indeed it is one that is insurmountable. But what you will know is this- you gave it your best. You did not quit due to non belief.
And with that I pray you will surround yourself with voices of affirmation. I pray you will surround yourself with support along the way so you can get the information you need to make your decisions. I hope you will face your roadblocks with courage.
Monday, March 15, 2010
CIMS posting of Cesarean Guidelines
NEW from CIMS! “The Risks of Cesarean Section” and “A Checklist for Expectant Mothers”
CIMS’ newest fact sheet was released on Feb. 26 at the 2010 CIMS Forum
CIMS proudly announces the availability of a recently updated fact sheet “The Risks of Cesarean Section,” (PDF) which also includes “About the Risks of Cesarean Section: A Checklist for Expectant Mothers to Read During Pregnancy.”
Birth is a normal, natural, process and the vast majority of women can have safe, normal, vaginal births. While there are health conditions where a cesarean birth is necessary for the well-being of the mother or her baby, more and more mothers these days are giving birth by cesarean section for non-medical reasons. CIMS along with 20 endorsing organizations recommend that cesarean surgery be reserved for situations when potential benefits clearly outweigh potential harms. This educational material is provided by CIMS to help healthcare providers and expectant parents learn about the risks of cesarean section.
Take Action:
* Download the new Cesarean Section Fact Sheet & Mother’s Checklist (PDF)
* Purchase CDs of recorded sessions from the 2010 CIMS Forum through our A/V partner Network Communications
* Download slide presentations of select 2010 CIMS Forum sessions
CIMS’ newest fact sheet was released on Feb. 26 at the 2010 CIMS Forum
CIMS proudly announces the availability of a recently updated fact sheet “The Risks of Cesarean Section,” (PDF) which also includes “About the Risks of Cesarean Section: A Checklist for Expectant Mothers to Read During Pregnancy.”
Birth is a normal, natural, process and the vast majority of women can have safe, normal, vaginal births. While there are health conditions where a cesarean birth is necessary for the well-being of the mother or her baby, more and more mothers these days are giving birth by cesarean section for non-medical reasons. CIMS along with 20 endorsing organizations recommend that cesarean surgery be reserved for situations when potential benefits clearly outweigh potential harms. This educational material is provided by CIMS to help healthcare providers and expectant parents learn about the risks of cesarean section.
Take Action:
* Download the new Cesarean Section Fact Sheet & Mother’s Checklist (PDF)
* Purchase CDs of recorded sessions from the 2010 CIMS Forum through our A/V partner Network Communications
* Download slide presentations of select 2010 CIMS Forum sessions
Monday, November 30, 2009
Epidural consent form
There was recent conversations regarding informed consent. Often times if a mom chooses to get an epidural it will be after she has been in a situation where she is hurting and it is hard to make a decision much less read the form- so here is a form from http://www.gentlebirth.org/archives/epdrlrsk.html for you to read now so you understand the risks involved.
Epidural Consent Form
Here's the consent form I mentioned a while back. The only thing I'd like to see added is increased c-section rate, which seems to finally be proven.
CONSENT TO EPIDURAL FOR LABOR PAIN CONTROL AND/OR CESAREAN SECTION
1. I authorize the performance upon _________ of the following
procedure ______________ performed under the direction of
______(physician's name).
2. I consent to the administration of local anesthetics, narcotics,
and/or other medications into the epidural space.
3. I understand that the following, among others, are possible
complications or risks of the procedure and that while they are
uncommon, they have been reported in the medical literature:
-Failure to relieve pain.
-Hypotension (low blood pressure).
-Postdural puncture (spinal) headache which may require
medical therapy.
-Persistent area of numbness and/or weakness of the lower
extremities.
-Temporary nausea and vomiting.
-Breakage of needles, catheters, etc. possibly requiring
surgery.
-Hematoma (blood clot) possibly requiring surgery.
-Infection.
-Rapid absorption of local anesthetics causing dizziness
and seizures.
-Temporary total spinal anesthesia (requiring life
support systems).
-Respiratory and/or cardiac arrest (requiring life
support systems).
-Back pain.
-Fetal distress resulting from one of the above complications.
4. I consent to the performance of procedures in addition to or
different from those now contemplated, whether or not arising from
presently unforeseen conditions, which the above named doctor or his
associates or assistants including residents, may consider necessary or
advisable in the course of the procedure.
5. The nature and purpose of the procedure, possible alternative
methods of treatments, the risks involved and the possibility of
complications have been fully explained to me. I understand that no
guarantee or assurance has been given by anyone as to the results that
may be obtained.
Notes from Midwifery Today tape on epidurals
After 7 hours on an epidural, the woman's temp is up 2.1 deg. F, which is considered a maternal fever, which requires a neonate septic workup.
Of 96 first-time moms, 0 w/o epidural had a c-sect., 25 w/ had a c-sect. Of those getting epidurals < 3 cm, 33% had c-sects, 3-4 cm, 26%, > 5 cm, 0% MORAL - try to wait until 5 cm before epidural.
Problems with epidurals: 5% got no pain relief; 5% got inadequate pain relief, often had windows of sensation, which are just as annoying as all over pain.
Epidurals require catheters, which can require antibiotics, which may interfere with nursing.
Another study of 11,000 women having epidurals showed that 18% of women had chronic backache within 6 months of birth, lasting > 3 months. Of those with chronic backache, only 10% didn't have an epidural.
Lactation consultants say that nipples don't get erect for 24 hours after end of epidural. Newborns can't get a good latch. (Ref: Dr. Edie? Laurence, "Measuring Effects of Breastfeeding Success and Epidurals", U. Rochester.)
Rare complications of epidurals: cardiac arrest, respiratory paralysis, convulsions (most often from high spinals or intravascular injection). Other complications, 9 had spinal headache for 6 weeks, 5 for a full year.
Ways to minimize risks: Choose attendant w/low -sect. rate. One study showed that 46% of primips have epidurals. 1% of "clinic" patients have c-sects. 20% or private patients. If you get an epidural, make sure the facility has emergency c-sect. available and full resuscitation team. For a first baby, posterior or VBAC, delay epidural until after active labor is well established.
Robbie Davis-Floyd says "Women's satisfaction with the birth experience is directly related to her sense of having mastered it."
You lose endorphins and euphoria.
Epidural Consent Form
Here's the consent form I mentioned a while back. The only thing I'd like to see added is increased c-section rate, which seems to finally be proven.
CONSENT TO EPIDURAL FOR LABOR PAIN CONTROL AND/OR CESAREAN SECTION
1. I authorize the performance upon _________ of the following
procedure ______________ performed under the direction of
______(physician's name).
2. I consent to the administration of local anesthetics, narcotics,
and/or other medications into the epidural space.
3. I understand that the following, among others, are possible
complications or risks of the procedure and that while they are
uncommon, they have been reported in the medical literature:
-Failure to relieve pain.
-Hypotension (low blood pressure).
-Postdural puncture (spinal) headache which may require
medical therapy.
-Persistent area of numbness and/or weakness of the lower
extremities.
-Temporary nausea and vomiting.
-Breakage of needles, catheters, etc. possibly requiring
surgery.
-Hematoma (blood clot) possibly requiring surgery.
-Infection.
-Rapid absorption of local anesthetics causing dizziness
and seizures.
-Temporary total spinal anesthesia (requiring life
support systems).
-Respiratory and/or cardiac arrest (requiring life
support systems).
-Back pain.
-Fetal distress resulting from one of the above complications.
4. I consent to the performance of procedures in addition to or
different from those now contemplated, whether or not arising from
presently unforeseen conditions, which the above named doctor or his
associates or assistants including residents, may consider necessary or
advisable in the course of the procedure.
5. The nature and purpose of the procedure, possible alternative
methods of treatments, the risks involved and the possibility of
complications have been fully explained to me. I understand that no
guarantee or assurance has been given by anyone as to the results that
may be obtained.
Notes from Midwifery Today tape on epidurals
After 7 hours on an epidural, the woman's temp is up 2.1 deg. F, which is considered a maternal fever, which requires a neonate septic workup.
Of 96 first-time moms, 0 w/o epidural had a c-sect., 25 w/ had a c-sect. Of those getting epidurals < 3 cm, 33% had c-sects, 3-4 cm, 26%, > 5 cm, 0% MORAL - try to wait until 5 cm before epidural.
Problems with epidurals: 5% got no pain relief; 5% got inadequate pain relief, often had windows of sensation, which are just as annoying as all over pain.
Epidurals require catheters, which can require antibiotics, which may interfere with nursing.
Another study of 11,000 women having epidurals showed that 18% of women had chronic backache within 6 months of birth, lasting > 3 months. Of those with chronic backache, only 10% didn't have an epidural.
Lactation consultants say that nipples don't get erect for 24 hours after end of epidural. Newborns can't get a good latch. (Ref: Dr. Edie? Laurence, "Measuring Effects of Breastfeeding Success and Epidurals", U. Rochester.)
Rare complications of epidurals: cardiac arrest, respiratory paralysis, convulsions (most often from high spinals or intravascular injection). Other complications, 9 had spinal headache for 6 weeks, 5 for a full year.
Ways to minimize risks: Choose attendant w/low -sect. rate. One study showed that 46% of primips have epidurals. 1% of "clinic" patients have c-sects. 20% or private patients. If you get an epidural, make sure the facility has emergency c-sect. available and full resuscitation team. For a first baby, posterior or VBAC, delay epidural until after active labor is well established.
Robbie Davis-Floyd says "Women's satisfaction with the birth experience is directly related to her sense of having mastered it."
You lose endorphins and euphoria.
Friday, May 15, 2009
Can You Afford To NOT HIRE A Doula?
Recently I gathered some information regarding the costs of an intervention filled birth and received this, "my epidural was $1500 and when it turned c/s there was an additional $600 bill for the anesthesiologist who was present during surgery. between the c/s (which there were bills from 2 different surgeons on top of my $3000 maternity care), the pediatrician bill who was present during the surgery, the 48 hour after birth stay in the hospital, etc, etc, etc....it was about $10,000 in Montana in 2007. i remember looking at the hospital bill (from the stay, not including birth "meds") and seeing over $200 of "drugs" on the bill...which included a few pain pills, some Colace, and i think a calcium supplement."
And a midwife in another area sent me this, "Trying to find "proof" but asking my hospital MW and nurse friends around the country, the average vaginal birth looks to be about $10,000 - without an epidural and with a 2 day hospital stay. This does NOT include the doc's fees. A cesarean seems to be about $18,000 or so, again, not including OB or anesthesiologist's fees (another $2000-$5000 dollars). Epidurals look to be about $2000, not including the anesthesiologist's fees. Hope this helps!"
$17,843 was the amount of the bill from one of my students who ended up with an induction- an epidural- a cesarean and a baby who ended up in the NICU for twelve hours since she was having trouble keeping her temperature up...I do not see on the bill that she sent me that this includes the obstetrician or the anesthesiologist either.
This made me think about how when economic times are difficult a few things happen...
Folks decide that childbirth education is optional. They decide they can not afford to do the preparation for their birth experience. Childbirth preparation is not an item I would consider optional unless you are fine with a birth full of interventions. You can not expect to show up for the Olympics to race purely because you were able to obtain a uniform. It take training to get the birth you desire. It takes preparation to know the questions to ask to determine if a procedure is the one you feel informed enough to make. If you do not prepare, be prepared to hand your birth over to the medical team to make the decisions for you. Now some of you may think that is not a bad option. Just remember if your birth turns out differently than you desired- you gave up any ability to shove the blame elsewhere- it is yours to acknowledge. Kinda like complaining about the government if you don't vote.
Some folks decide that they do not need a doula after all. But the studies show that having a doula not only enhances the mom's view of her birth experience- but the studies show having a doula
* results in shorter labors with fewer complications
* reduces negative feelings about one’s childbirth experience
* reduces the need for Pitocin (a labor-inducing drug),
* reduces the use of forceps or vacuum extraction
* reduces cesareans
* reduces the mother’s request for pain medication and/or epidurals
* mothers who feel better about their birth experience and therefore have less postpartum depression
A study by Klaus and Kennel showed that using a doula as part of the birth team decreases the overall cesarean rate by 50%, the length of labor by 25%, the use of Oxytocin (Pitocin) by 40% and the request for an epidural by 60%.
So, how does this speak to your wallet during these times of trying to save money? Well due to insurance costs, many folks now have a deductible and then have to pay 20%- 30% of the final costs of their hospitalization. So keep in mind if the average birth in the metro area has an epidural- with the cost of an epidural being around $1500- then the cost to a couple could be $300 to $450. If a cesarean occurs the cost to a couple could be an additional $120 to $180 or more for anesthesiology alone. A complicated birth ending in a cesarean could be as much as $17,000 or more. There is an additional day stay in the hospital if not even two extra days. Now your cost could be $3400 - $5100 or more.
Now a doula can not promise you a natural, easy, non surgical birth- but certainly the studies show if that is what you desire- you have a greater chance of getting it if you hire a doula. Now the cost you saved by having a doula may have saved you a lot of money in comparison to her fee which is usually between $500 and $1000 in most areas. And you also can possibly be more assured that if you ended up with a cesarean you did what you could to avoid it by having a great support system in place.
So whether your insurance plan has a percentage you have to pay or not add the cost of a good childbirth class $250 and a doula for the cost of $600 for a doula- the total is $850 which is a far cry less than the upwards of $5000 you could pay for not having the preparation and support. A great class and a fabulous doula may not keep you out of the OR but again- these two things can certainly help do so!
Remember there are other pieces to the pie- care providers and choice of birth location play into this as well.
Keep in mind more and more insurance companies are trying to decrease costs- so some are actually reimbursing doula costs. Some even reimburse childbirth class costs. And I know that most any pretax plan often times does pay for both of these items. Often times if you ask the insurance plan if they cover doula services prior to having the baby, they will say no. But if you end up saving them money by leaving a day earlier- not having an epidural and such- they will consider paying for your doula. So, can you afford to not hire a doula?
And a midwife in another area sent me this, "Trying to find "proof" but asking my hospital MW and nurse friends around the country, the average vaginal birth looks to be about $10,000 - without an epidural and with a 2 day hospital stay. This does NOT include the doc's fees. A cesarean seems to be about $18,000 or so, again, not including OB or anesthesiologist's fees (another $2000-$5000 dollars). Epidurals look to be about $2000, not including the anesthesiologist's fees. Hope this helps!"
$17,843 was the amount of the bill from one of my students who ended up with an induction- an epidural- a cesarean and a baby who ended up in the NICU for twelve hours since she was having trouble keeping her temperature up...I do not see on the bill that she sent me that this includes the obstetrician or the anesthesiologist either.
This made me think about how when economic times are difficult a few things happen...
Folks decide that childbirth education is optional. They decide they can not afford to do the preparation for their birth experience. Childbirth preparation is not an item I would consider optional unless you are fine with a birth full of interventions. You can not expect to show up for the Olympics to race purely because you were able to obtain a uniform. It take training to get the birth you desire. It takes preparation to know the questions to ask to determine if a procedure is the one you feel informed enough to make. If you do not prepare, be prepared to hand your birth over to the medical team to make the decisions for you. Now some of you may think that is not a bad option. Just remember if your birth turns out differently than you desired- you gave up any ability to shove the blame elsewhere- it is yours to acknowledge. Kinda like complaining about the government if you don't vote.
Some folks decide that they do not need a doula after all. But the studies show that having a doula not only enhances the mom's view of her birth experience- but the studies show having a doula
* results in shorter labors with fewer complications
* reduces negative feelings about one’s childbirth experience
* reduces the need for Pitocin (a labor-inducing drug),
* reduces the use of forceps or vacuum extraction
* reduces cesareans
* reduces the mother’s request for pain medication and/or epidurals
* mothers who feel better about their birth experience and therefore have less postpartum depression
A study by Klaus and Kennel showed that using a doula as part of the birth team decreases the overall cesarean rate by 50%, the length of labor by 25%, the use of Oxytocin (Pitocin) by 40% and the request for an epidural by 60%.
So, how does this speak to your wallet during these times of trying to save money? Well due to insurance costs, many folks now have a deductible and then have to pay 20%- 30% of the final costs of their hospitalization. So keep in mind if the average birth in the metro area has an epidural- with the cost of an epidural being around $1500- then the cost to a couple could be $300 to $450. If a cesarean occurs the cost to a couple could be an additional $120 to $180 or more for anesthesiology alone. A complicated birth ending in a cesarean could be as much as $17,000 or more. There is an additional day stay in the hospital if not even two extra days. Now your cost could be $3400 - $5100 or more.
Now a doula can not promise you a natural, easy, non surgical birth- but certainly the studies show if that is what you desire- you have a greater chance of getting it if you hire a doula. Now the cost you saved by having a doula may have saved you a lot of money in comparison to her fee which is usually between $500 and $1000 in most areas. And you also can possibly be more assured that if you ended up with a cesarean you did what you could to avoid it by having a great support system in place.
So whether your insurance plan has a percentage you have to pay or not add the cost of a good childbirth class $250 and a doula for the cost of $600 for a doula- the total is $850 which is a far cry less than the upwards of $5000 you could pay for not having the preparation and support. A great class and a fabulous doula may not keep you out of the OR but again- these two things can certainly help do so!
Remember there are other pieces to the pie- care providers and choice of birth location play into this as well.
Keep in mind more and more insurance companies are trying to decrease costs- so some are actually reimbursing doula costs. Some even reimburse childbirth class costs. And I know that most any pretax plan often times does pay for both of these items. Often times if you ask the insurance plan if they cover doula services prior to having the baby, they will say no. But if you end up saving them money by leaving a day earlier- not having an epidural and such- they will consider paying for your doula. So, can you afford to not hire a doula?
Tuesday, April 28, 2009
Are You Doing Your Kegels?
At the ICAN conference this past weekend, we had the pleasure of meeting the Kegel Queen. She has a wonderful book out on how to make sure you are doing your kegel exercises the right way and the benefits of doing so. She interviewed us and put her video up on the site. It is a must see for sure!
http://kegelqueen.com/videos/video_ICAN_bocce_balls.html
Want to know more about doing kegels - the why, the when, the how, and the how often- check out her site!
Friday, April 17, 2009
Nuchal Cords
"Nuchal Cord: A nuchal cord is an umbilical cord that is wrapped around the fetus's neck. A nuchal cord occurs in about one fourth of deliveries. Normally, the baby is not harmed.
Before birth, a nuchal cord can sometimes be detected by ultrasonography, but no action is required. Doctors routinely check for it as they deliver the baby. If they feel it, they can slip the cord over the baby's head. Sometimes if the cord is tightly wrapped, it is clamped and cut before the shoulders are delivered."
Recently I have heard about several women who had to have a cesarean birth due to the baby having the cord around the neck. But it happens according to this research a fourth of the time. So why does it cause issues for some and not others? In fact my grandson was born with the cord around his neck four times- without any issues at all.
What happens is if the baby is not allowed to maneuver and stretch the cord- making his or her way down the birth canal on his or her own time. But what happens is a mom gets an epidural and then is limited in her ability to move- helping the baby move. If we want to move the baby we move the mom. But if she is immobile then that is limited at best. Then the epidural slows labor down, especially if given too early. And the need for pitocin is increased. And since she is medicated now to not feel the pain, the use of pitocin is usually much more accelerated than it is when a woman does not have an epidural and needs to be able to manage the augmentation.
Pitocin can sometimes slam a baby down into the birth canal and there is no time for the cord to be able to stretch or the baby to move to accommodate having the cord around his or her neck. So the very interventions that are selected can end with an unnecessary surgical birth due to a baby going into distress.
So, just having the cord around the neck of the baby is not a reason for a cesarean birth. I know for me as a doula, I have seen nuchal cords at least 20% of the time. It is easily slipped over the head of the baby or the baby easily slides through the loop as he or she is being born. How often are cesareans performed that could have been avoided if the laboring mom was not induced or augmented during her labor- therefore causing the very problem that would not have been a problem otherwise. Sad.
Before birth, a nuchal cord can sometimes be detected by ultrasonography, but no action is required. Doctors routinely check for it as they deliver the baby. If they feel it, they can slip the cord over the baby's head. Sometimes if the cord is tightly wrapped, it is clamped and cut before the shoulders are delivered."
Recently I have heard about several women who had to have a cesarean birth due to the baby having the cord around the neck. But it happens according to this research a fourth of the time. So why does it cause issues for some and not others? In fact my grandson was born with the cord around his neck four times- without any issues at all.
What happens is if the baby is not allowed to maneuver and stretch the cord- making his or her way down the birth canal on his or her own time. But what happens is a mom gets an epidural and then is limited in her ability to move- helping the baby move. If we want to move the baby we move the mom. But if she is immobile then that is limited at best. Then the epidural slows labor down, especially if given too early. And the need for pitocin is increased. And since she is medicated now to not feel the pain, the use of pitocin is usually much more accelerated than it is when a woman does not have an epidural and needs to be able to manage the augmentation.
Pitocin can sometimes slam a baby down into the birth canal and there is no time for the cord to be able to stretch or the baby to move to accommodate having the cord around his or her neck. So the very interventions that are selected can end with an unnecessary surgical birth due to a baby going into distress.
So, just having the cord around the neck of the baby is not a reason for a cesarean birth. I know for me as a doula, I have seen nuchal cords at least 20% of the time. It is easily slipped over the head of the baby or the baby easily slides through the loop as he or she is being born. How often are cesareans performed that could have been avoided if the laboring mom was not induced or augmented during her labor- therefore causing the very problem that would not have been a problem otherwise. Sad.
Tuesday, March 24, 2009
Induction methods
Many women feel if they go past their due date- they are late. Many times providers will put pressure on a mom when she goes past her due date... please before you read this read my article on due dates- so you totally understand you are due within a four week period- week 38 to week 42... so going past the magical date is not being late at all.
Today I received a text from a mom who is 10 days past her magical date assigned to her by her doctor as her due date. She sees her doctor tomorrow and she wanted to review some induction methods prior to going to the doctor. So I thought I would share them in this blog and hope others will chime in with more.
I think there are several methods- so I will start with the least invasive first... Relaxation- just realizing that the pressure needs to be lifted will help some moms relax enough to begin labor on their own. I sell a cd from Earth Mama Angel Baby called "Getting Labor Started." The relaxation methods on it along with the guided imagery will help many moms begin to let go and begin to release what it may be that is holding them back. The mind body connection is a strong one. It can cause labor dystocia if you are not able to allow your body to begin the work that it needs to do.
When one sees herself as normal- and relaxed... letting go of the preconceived notion that she is no longer beautiful or sexual- she may be able to also have some great sex. The prostaglandins in semen help to ripen the cervix and nipple stimulation in foreplay along with the orgasm that hopefully follows or accompanies the sex releases oxytocin. Pitocin is the synthetic form of oxytocin- but one that does not pass through the blood brain barrier. Trust me oxytocin is much nicer than Pitocin!
Making sure the baby is lined up properly will also help. This is especially important if you have been having lots of "false starts" to your labor. If the baby is not quite lined up right it could cause your labor to not only begin but could also cause a longer labor. We offer a class based on Gail Tully's knowledge (www.spinningbabies.com). So make sure the baby is lined up great.
Evening Primrose Oil is taken by some women orally - first day with breakfast- then day two with breakfast and lunch- then day three with each meal and then on day four adding it vaginally from week 37 on. This is considered a natural prostaglandin and certainly could help to ripen your cervix. If you already have a diet rich in good oils- Vit E, Fish Oil. Omega 3 oils- this may make little difference. Some say it increases the chance of meconium with the baby- but that is still undetermined.
Getting your membranes "stripped" may be a good way once you go past your due date. Some care providers do this without really even talking to you about it first. You must be at least one centimeter dilated to help make this make a difference. But they insert their finger in your cervix- no this is not a comfortable event. It is also not without risks- infection, breaking your water by mistake, causing contractions that do not produce anything if your uterus is sensitive, etc.. but it can also help to release some prostaglandins to help get labor started. But keep in mind if you take your panties off and get up on the exam table this could happen if you don't have a conversation prior to taking your panties off.
Getting the party started by having your colon begin the party is another way that some women resort to in order to avoid a medical induction. You may take castor oil- it is done in numerous ways- in root beer- in the blender with orange juice and ice- spread on toast with nutella, in the pan when you cook eggs, etc- or you may take borage oil instead. This is also why an enema may cause your labor to begin. What it does is start your colon contracting and thus the party begins and your uterus jumps in as well. Ask a mom who has been up all night with diarrhea if this is a good way to begin labor. If you are going to do this- I would suggest at least having a ripe cervix and beginning it early in the day so it kicks in before the middle of the night. (See my article on fatigue being an issue with the need for medication in labor to understand why a lack of sleep is never a good way to begin labor.)
Some natural prostaglandins can be found in foods as well. Fresh pineapple- rich in bromelain, eggplant, flaxseed, nuts and seeds...foods rich in Omega 3 Oils are great for this. We have always known that a great diet does effect pregnancy and certainly can effect labors.
Acupuncture and acupressure can be useful in helping to get labor started. As doulas we have some areas we may use to help get labor to kick in if your water is broken and you are on a time crunch. There are several places that can help to align your body rhythms to help your body ready for labor to begin. A good acupuncturist is imperative- www.grdhealth.com, dr khalsa is my personal acupuncturist. A good massage therapist can also massage certain areas that will help to get your labor going as well. If you insist on seeing a female massage therapist I can recommend Regina Elvis at themiracleofmassage.com and if you want an active KMI type massage I can recommend Harry Kramer at www.kmiatlanta.com.
There are several herbal things that can be taken. Since I am not an herbalist, I will encourage you to seek one out if you need guidance with the use of herbs.
Now if these things don't work- and your care provider begins to look at the need for medical inductions there are several methods. One is to break your water to help begin labor. My suggestion is to ask the questions- What are the risks? What is the time frame they require before they begin the next intervention? Often labor when it starts by having your water break on it's own- will begin within 8-12 hours- but when it is broken artificially that is not always the case.
You may ask about ripening a cervix by having a foley catheter inserted to help to stretch your cervix or having cervidil- tampon type method that is embedded with prostaglandins- inserted may be the next step prior to any other intervention. This increases your bishop score and therefore allows for a more favorable chance for an induction to end with a vaginal birth. If either of these cause a problem they can be immediately removed. Some believe that cervidil does cause your cervix to be irritated, causing vaginal exams afterwards to be possibly more painful.
There are some care providers who still use the very controversial Cytotec or misoptrostil. Although the manufacturers of the gastro medication warn severely of using it with pregnant women for induction- and 60 minutes and 20/20 have both done exposes against it's use... it is still be done. The small pill is inserted vaginally or orally and once in your blood stream could possibly cause problems that could be very dangerous. Once it is in your blood stream the removal is virtually non existent. I will encourage you to do a google search and read about it for yourselves.
Pitocin is a most used method for induction. It requires constant monitoring. Whenever constant monitoring is involved- keep in mind it is because there are inherent dangers. This is given intravenously and can be closely monitored. But some care providers use it gently and increase it very slowly- therefore mimicking natural labor often. But often times it is given very actively since the care provider does not feel you need to be going without an epidural and senses that rapid infusion will help you get that epidural sooner than later. If Pitocin causes problems, it can be discontinued.
Remember that inductions are not without risks. Certainly there is a risk to going more than 42 weeks as well since it does increase the risk of stillborn births. One of the best ways to determine how your baby is doing is to do agree to a non stress test and biophysical. This test is one that is able to let you know how your baby is really doing- how the environment of the womb is doing. Often I have been at inductions for postdates to see a baby born with tons of vernix and showing signs of not being late at all. Due dates are subjective. Your normal gestation is also subjective.
I walked around 70% effaced and 3 centimeters dilated for over three weeks with my first two babies. You may wonder about my third pregnancy. I did not allow anyone to check my cervix since I did not value the findings as being information that was needed. I was ten days "late" with each of my babies. My first grandson was born to my youngest ten days past her magical date. My oldest daughter gave birth to her first two babies four days early and her last baby on her magical date. So... what does that all mean... that labors are all individual. That you are an individual and so is your baby.
Enjoy the last weeks or days of your pregnancy. Change your phone message to "No baby yet, we will update this message when He/She is born with the details. Don't leave a message unless it is urgent as we are nesting." And then don't answer your phone. When sharing your due date- share a due month instead. Don't let others determine how you feel about the last weeks of growing your baby.
Please feel free to comment to this entry. I would love to hear what worked or what did not work for you personally. Thanks!
Today I received a text from a mom who is 10 days past her magical date assigned to her by her doctor as her due date. She sees her doctor tomorrow and she wanted to review some induction methods prior to going to the doctor. So I thought I would share them in this blog and hope others will chime in with more.
I think there are several methods- so I will start with the least invasive first... Relaxation- just realizing that the pressure needs to be lifted will help some moms relax enough to begin labor on their own. I sell a cd from Earth Mama Angel Baby called "Getting Labor Started." The relaxation methods on it along with the guided imagery will help many moms begin to let go and begin to release what it may be that is holding them back. The mind body connection is a strong one. It can cause labor dystocia if you are not able to allow your body to begin the work that it needs to do.
When one sees herself as normal- and relaxed... letting go of the preconceived notion that she is no longer beautiful or sexual- she may be able to also have some great sex. The prostaglandins in semen help to ripen the cervix and nipple stimulation in foreplay along with the orgasm that hopefully follows or accompanies the sex releases oxytocin. Pitocin is the synthetic form of oxytocin- but one that does not pass through the blood brain barrier. Trust me oxytocin is much nicer than Pitocin!
Making sure the baby is lined up properly will also help. This is especially important if you have been having lots of "false starts" to your labor. If the baby is not quite lined up right it could cause your labor to not only begin but could also cause a longer labor. We offer a class based on Gail Tully's knowledge (www.spinningbabies.com). So make sure the baby is lined up great.
Evening Primrose Oil is taken by some women orally - first day with breakfast- then day two with breakfast and lunch- then day three with each meal and then on day four adding it vaginally from week 37 on. This is considered a natural prostaglandin and certainly could help to ripen your cervix. If you already have a diet rich in good oils- Vit E, Fish Oil. Omega 3 oils- this may make little difference. Some say it increases the chance of meconium with the baby- but that is still undetermined.
Getting your membranes "stripped" may be a good way once you go past your due date. Some care providers do this without really even talking to you about it first. You must be at least one centimeter dilated to help make this make a difference. But they insert their finger in your cervix- no this is not a comfortable event. It is also not without risks- infection, breaking your water by mistake, causing contractions that do not produce anything if your uterus is sensitive, etc.. but it can also help to release some prostaglandins to help get labor started. But keep in mind if you take your panties off and get up on the exam table this could happen if you don't have a conversation prior to taking your panties off.
Getting the party started by having your colon begin the party is another way that some women resort to in order to avoid a medical induction. You may take castor oil- it is done in numerous ways- in root beer- in the blender with orange juice and ice- spread on toast with nutella, in the pan when you cook eggs, etc- or you may take borage oil instead. This is also why an enema may cause your labor to begin. What it does is start your colon contracting and thus the party begins and your uterus jumps in as well. Ask a mom who has been up all night with diarrhea if this is a good way to begin labor. If you are going to do this- I would suggest at least having a ripe cervix and beginning it early in the day so it kicks in before the middle of the night. (See my article on fatigue being an issue with the need for medication in labor to understand why a lack of sleep is never a good way to begin labor.)
Some natural prostaglandins can be found in foods as well. Fresh pineapple- rich in bromelain, eggplant, flaxseed, nuts and seeds...foods rich in Omega 3 Oils are great for this. We have always known that a great diet does effect pregnancy and certainly can effect labors.
Acupuncture and acupressure can be useful in helping to get labor started. As doulas we have some areas we may use to help get labor to kick in if your water is broken and you are on a time crunch. There are several places that can help to align your body rhythms to help your body ready for labor to begin. A good acupuncturist is imperative- www.grdhealth.com, dr khalsa is my personal acupuncturist. A good massage therapist can also massage certain areas that will help to get your labor going as well. If you insist on seeing a female massage therapist I can recommend Regina Elvis at themiracleofmassage.com and if you want an active KMI type massage I can recommend Harry Kramer at www.kmiatlanta.com.
There are several herbal things that can be taken. Since I am not an herbalist, I will encourage you to seek one out if you need guidance with the use of herbs.
Now if these things don't work- and your care provider begins to look at the need for medical inductions there are several methods. One is to break your water to help begin labor. My suggestion is to ask the questions- What are the risks? What is the time frame they require before they begin the next intervention? Often labor when it starts by having your water break on it's own- will begin within 8-12 hours- but when it is broken artificially that is not always the case.
You may ask about ripening a cervix by having a foley catheter inserted to help to stretch your cervix or having cervidil- tampon type method that is embedded with prostaglandins- inserted may be the next step prior to any other intervention. This increases your bishop score and therefore allows for a more favorable chance for an induction to end with a vaginal birth. If either of these cause a problem they can be immediately removed. Some believe that cervidil does cause your cervix to be irritated, causing vaginal exams afterwards to be possibly more painful.
There are some care providers who still use the very controversial Cytotec or misoptrostil. Although the manufacturers of the gastro medication warn severely of using it with pregnant women for induction- and 60 minutes and 20/20 have both done exposes against it's use... it is still be done. The small pill is inserted vaginally or orally and once in your blood stream could possibly cause problems that could be very dangerous. Once it is in your blood stream the removal is virtually non existent. I will encourage you to do a google search and read about it for yourselves.
Pitocin is a most used method for induction. It requires constant monitoring. Whenever constant monitoring is involved- keep in mind it is because there are inherent dangers. This is given intravenously and can be closely monitored. But some care providers use it gently and increase it very slowly- therefore mimicking natural labor often. But often times it is given very actively since the care provider does not feel you need to be going without an epidural and senses that rapid infusion will help you get that epidural sooner than later. If Pitocin causes problems, it can be discontinued.
Remember that inductions are not without risks. Certainly there is a risk to going more than 42 weeks as well since it does increase the risk of stillborn births. One of the best ways to determine how your baby is doing is to do agree to a non stress test and biophysical. This test is one that is able to let you know how your baby is really doing- how the environment of the womb is doing. Often I have been at inductions for postdates to see a baby born with tons of vernix and showing signs of not being late at all. Due dates are subjective. Your normal gestation is also subjective.
I walked around 70% effaced and 3 centimeters dilated for over three weeks with my first two babies. You may wonder about my third pregnancy. I did not allow anyone to check my cervix since I did not value the findings as being information that was needed. I was ten days "late" with each of my babies. My first grandson was born to my youngest ten days past her magical date. My oldest daughter gave birth to her first two babies four days early and her last baby on her magical date. So... what does that all mean... that labors are all individual. That you are an individual and so is your baby.
Enjoy the last weeks or days of your pregnancy. Change your phone message to "No baby yet, we will update this message when He/She is born with the details. Don't leave a message unless it is urgent as we are nesting." And then don't answer your phone. When sharing your due date- share a due month instead. Don't let others determine how you feel about the last weeks of growing your baby.
Please feel free to comment to this entry. I would love to hear what worked or what did not work for you personally. Thanks!
Monday, February 2, 2009
Gail J. Dahl, "Pregnancy & Childbirth Secrets”
Well I figured I write about this all of the time- maybe it would be good to share another professional's view of induction. Here is a link to her blog as well http://gaildahl.wordpress.com/
10 Reasons to Avoid Induction
A common decision today's parents will face during childbirth is birth induction. A birth induction happens when the labor of a pregnant woman is artificially started. Today's parents need to know why it is important to avoid birth induction and why it is important to allow labor to begin normally and naturally without any interference. Here are the reasons you would want to avoid induction in childbirth:
1. If you induce the birth of your baby you will be at risk of delivering a premature baby. New studies are showing that babies who are even slightly premature have more problems at birth and beyond. There is no proven health benefit to forcing your baby from the womb before your baby has had enough time to properly develop. Even in the last few days before the birth of your baby, last minute finishing touches are ongoing. The final layers of fat are placed, the lungs are receiving the finishing touches even as you are going through labor. All of this will help your baby to be comfortable in a change of environment. Your baby will most likely be ready ten days after your estimated due date, especially if you are a first time mother. There are no studies showing any benefit whatsoever to artificially starting labor and there are many studies showing the risk of premature birth to every baby. Wait for your labor to begin normally and naturally.
2. If you induce your labor, your labor will become more painful and prolonged. Your contractions will be too long, too strong and too close together causing your baby to have difficulty breathing and your contractions to be less effective.
3. If you induce your labor you may not be ready physiologically or emotionally to give birth without your baby signaling to your body the exact time it is ready and able to labor. Inducing labor, by any means, will cause unnecessary stress on your body and your baby.
4. If you induce your labor, your baby may experience harm caused by the mechanical force of the artificial contractions that can damage your baby’s brain and affect your baby’s ability to breathe.
5. If you induce your labor you may be at risk of secondary infertility due to the increase of the risk of damage to your uterus caused by uterine rupture.
6. If you induce your labor you may be at risk of bleeding throughout your labor and after childbirth because of the damage caused to your uterus by the induction drugs creating a greater difficulty in caring for the new baby along with the increased possibility of prolonged postnatal depression caused by the induction drugs.
7. If you induce your labor you will not be able to experience a natural birth due to the increased pain during labor. The narcotics used in a epidural cross the placenta and cause increased stress on your baby as the narcotics hit your baby’s immature liver and brain causing a decrease in the cardiac and brain function. Your baby will find it hard to breathe because of this. Your baby will have great difficulty breastfeeding because of the afterlife of the narcotics. Very few women are able to have an induced birth without additional drugs to handle the increased pain from the artificial contractions.
8. If you induce your labor you will unknowingly trigger a cascade of medical interventions like, strong medications to force your cervix open, multiple narcotic drugs for increased pain, continuous fetal monitoring, forceps delivery or the use of a vacuum extractor; when the attempt at the induction fails.
9. If you induce your labor you will become a high risk for emergency cesarean delivery, (as high as 50%) as many induced labors fail and leave both mom and baby in medical distress. In the case of an extreme medical emergency, for either mom or baby, consider bypassing induction and going right to a cesarean section. Adding induction drugs to an already stressed mother and baby may cause additional damages to both. Allowing a woman to labor naturally before a cesarean section will help to further develop the baby’s lungs.
10. If you don’t induce your labor, and allow your labor to begin normally; your labor will be less painful, your labor will be shorter and more productive, (your body will be ready for it), your baby will be able to breathe, you will reduce your risk of cesarean section, you will reduce the health costs associated with your birth, you will have less need for pain medication, you will have a shorter delivery, you will have a faster recovery and you and your baby will be healthier as a result. Your baby will breastfeed more easily and you will find it easier to bond and attach to your new baby. If you are anxious about your baby’s arrival, make sure everything is ready for the baby’s arrival, the house is clean, groceries are purchased, banking done, extra food prepared, official registration papers for your baby and the myriad of other things you will need to take care of at this time. Avoiding a labor induction is one of the best secrets to having a safe and gentle labor and delivery for both mother and baby.
Secrets Newsletter 2008. Gail J. Dahl, "Pregnancy & Childbirth Secrets”.
10 Reasons to Avoid Induction
A common decision today's parents will face during childbirth is birth induction. A birth induction happens when the labor of a pregnant woman is artificially started. Today's parents need to know why it is important to avoid birth induction and why it is important to allow labor to begin normally and naturally without any interference. Here are the reasons you would want to avoid induction in childbirth:
1. If you induce the birth of your baby you will be at risk of delivering a premature baby. New studies are showing that babies who are even slightly premature have more problems at birth and beyond. There is no proven health benefit to forcing your baby from the womb before your baby has had enough time to properly develop. Even in the last few days before the birth of your baby, last minute finishing touches are ongoing. The final layers of fat are placed, the lungs are receiving the finishing touches even as you are going through labor. All of this will help your baby to be comfortable in a change of environment. Your baby will most likely be ready ten days after your estimated due date, especially if you are a first time mother. There are no studies showing any benefit whatsoever to artificially starting labor and there are many studies showing the risk of premature birth to every baby. Wait for your labor to begin normally and naturally.
2. If you induce your labor, your labor will become more painful and prolonged. Your contractions will be too long, too strong and too close together causing your baby to have difficulty breathing and your contractions to be less effective.
3. If you induce your labor you may not be ready physiologically or emotionally to give birth without your baby signaling to your body the exact time it is ready and able to labor. Inducing labor, by any means, will cause unnecessary stress on your body and your baby.
4. If you induce your labor, your baby may experience harm caused by the mechanical force of the artificial contractions that can damage your baby’s brain and affect your baby’s ability to breathe.
5. If you induce your labor you may be at risk of secondary infertility due to the increase of the risk of damage to your uterus caused by uterine rupture.
6. If you induce your labor you may be at risk of bleeding throughout your labor and after childbirth because of the damage caused to your uterus by the induction drugs creating a greater difficulty in caring for the new baby along with the increased possibility of prolonged postnatal depression caused by the induction drugs.
7. If you induce your labor you will not be able to experience a natural birth due to the increased pain during labor. The narcotics used in a epidural cross the placenta and cause increased stress on your baby as the narcotics hit your baby’s immature liver and brain causing a decrease in the cardiac and brain function. Your baby will find it hard to breathe because of this. Your baby will have great difficulty breastfeeding because of the afterlife of the narcotics. Very few women are able to have an induced birth without additional drugs to handle the increased pain from the artificial contractions.
8. If you induce your labor you will unknowingly trigger a cascade of medical interventions like, strong medications to force your cervix open, multiple narcotic drugs for increased pain, continuous fetal monitoring, forceps delivery or the use of a vacuum extractor; when the attempt at the induction fails.
9. If you induce your labor you will become a high risk for emergency cesarean delivery, (as high as 50%) as many induced labors fail and leave both mom and baby in medical distress. In the case of an extreme medical emergency, for either mom or baby, consider bypassing induction and going right to a cesarean section. Adding induction drugs to an already stressed mother and baby may cause additional damages to both. Allowing a woman to labor naturally before a cesarean section will help to further develop the baby’s lungs.
10. If you don’t induce your labor, and allow your labor to begin normally; your labor will be less painful, your labor will be shorter and more productive, (your body will be ready for it), your baby will be able to breathe, you will reduce your risk of cesarean section, you will reduce the health costs associated with your birth, you will have less need for pain medication, you will have a shorter delivery, you will have a faster recovery and you and your baby will be healthier as a result. Your baby will breastfeed more easily and you will find it easier to bond and attach to your new baby. If you are anxious about your baby’s arrival, make sure everything is ready for the baby’s arrival, the house is clean, groceries are purchased, banking done, extra food prepared, official registration papers for your baby and the myriad of other things you will need to take care of at this time. Avoiding a labor induction is one of the best secrets to having a safe and gentle labor and delivery for both mother and baby.
Secrets Newsletter 2008. Gail J. Dahl, "Pregnancy & Childbirth Secrets”.
Thursday, January 29, 2009
Local News Show about Inductions...
There was a neonatal physician on the local 5 o'clock news this week who made this statement, "Having a baby as few as four days early increases the newborn complications risk by 20%!" and the statement was made that, "Northside Hospital the nations busiest labor and delivery center with over 18,000 births per year supposedly issued a new rule that women can not schedule an elective c-section or be induced before their 39th week of pregnancy." But my experience working with moms who give birth in the Atlanta metro area- and yes even at Northside is that is not being done. Doctors seem to be able to find a medical reason for an induction even when the birth later shows the risks were not there.
Who is doing all of these inductions? What is causing this to happen? I believe it is not only the doctors who schedule inductions and cesareans for factors that include convenience as well as malpractice concerns, but it is women who are demanding it. The doctor in this interview eludes to moms getting tired during their pregnancy and wanting to have the baby born. So, do no harm should mean that the doctor advises a mom that this is risky. That not only will an induction lead to more of a chance of a surgical birth, but more risks that she will not be bringing her baby home when she is discharged.
I can tell you that I have conversations almost weekly from moms who were induced or told to have a surgical birth due to their baby being too big. Then the baby is born and is well within the normal range of size. She then goes on to have a vaginal birth with a subsequent child who is much larger than the first. What happened? Did her pelvis get larger the next pregnancy?
This is a link to the original newscast:
http://www.myfoxatlanta.com/myfox/pages/News/Detail?contentId=8311537&version=2&locale=EN-US&layoutCode=TSTY&pageId=3.5.1
The news story went on to state, "The number of Cesarean sections has skyrocketed in recent years. One out of every three babies is now delivered surgically. New research shows women may want to think twice about scheduling an early delivery."
The news reporter, Beth Glavin states that "a pregnancy is considered full term at 37 weeks." But since often a woman does not know exactly when she conceived or when she actually ovulated it is difficult to know for sure if she is 37 weeks or 36 weeks and three days for example.
One OB online states "A normal pregnancy should last 38 weeks if you count from the day of conception. However, the day of conception is not always easy to determine, especially in the ancient past. Therefore, people then have used 40 weeks from the first day of the last menstrual period, on the assumption that women have 28 day cycles and they conceive 14 days after the start of their menses.This traditional way of counting has been in use till now.
Therefore, when we say you are 10 weeks pregnant, you have actually conceived 8 weeks ago. Based on this type of calculation, a pregnancy will have the expected date of delivery at 40 completed weeks but a pregnancy that has completed 37 weeks is considered full term already.
Beth states that "the recommendation is that a woman wait until she is 39 weeks to consider having a planned cesarean." But since inductions can lead to a cesarean = then shouldn't a woman wait until 39 weeks to consider even being induced? The doctor on the news report says every week of early birth due to inductions can cause the risks to the newborn escalate. It is due to lung and brain development. "Before 39 weeks the baby is just not ready."
This is another story - more reseach showing the risks of early inductions and cesarean births:
http://www.foxnews.com/story/0,2933,477687,00.html?sPage=fnc/health/pregnancy
The study showed, "More than a third of the C-sections were performed before 39 weeks, the researchers found. Those delivered at 37 weeks were twice as likely to have health problems, including breathing troubles, infections, low blood sugar or the need for intensive care. Fifteen percent of those born at 37 weeks and 11 percent born at 38 weeks had complications, compared to 8 percent of the babies delivered at 39 weeks."
A dream of mine would be for women to trust their bodies. For babies to select their day to be born. If a mom is more high risks, sure do non stress tests and biophysicals to insure that the baby is doing great. But the stress of going "late" and having a baby "on time" needs to end. We need to embrace that nature did not make a mistake. That MD does not stand for minor deity. That we can decide if we are going to get on that induction train or not. That the induction police don't come and pick us up to drag us to have our babies. We must begin to take responsibility for our health and the health of our babies.
It begins with trusting our bodies. And it also goes to trusting our care providers. So if a care provider says an induction or cesarean is needed- ask more questions. Know the risks. Weigh their guestimations with knowledge and with what the studies show- wait if you can.
Who is doing all of these inductions? What is causing this to happen? I believe it is not only the doctors who schedule inductions and cesareans for factors that include convenience as well as malpractice concerns, but it is women who are demanding it. The doctor in this interview eludes to moms getting tired during their pregnancy and wanting to have the baby born. So, do no harm should mean that the doctor advises a mom that this is risky. That not only will an induction lead to more of a chance of a surgical birth, but more risks that she will not be bringing her baby home when she is discharged.
I can tell you that I have conversations almost weekly from moms who were induced or told to have a surgical birth due to their baby being too big. Then the baby is born and is well within the normal range of size. She then goes on to have a vaginal birth with a subsequent child who is much larger than the first. What happened? Did her pelvis get larger the next pregnancy?
This is a link to the original newscast:
http://www.myfoxatlanta.com/myfox/pages/News/Detail?contentId=8311537&version=2&locale=EN-US&layoutCode=TSTY&pageId=3.5.1
The news story went on to state, "The number of Cesarean sections has skyrocketed in recent years. One out of every three babies is now delivered surgically. New research shows women may want to think twice about scheduling an early delivery."
The news reporter, Beth Glavin states that "a pregnancy is considered full term at 37 weeks." But since often a woman does not know exactly when she conceived or when she actually ovulated it is difficult to know for sure if she is 37 weeks or 36 weeks and three days for example.
One OB online states "A normal pregnancy should last 38 weeks if you count from the day of conception. However, the day of conception is not always easy to determine, especially in the ancient past. Therefore, people then have used 40 weeks from the first day of the last menstrual period, on the assumption that women have 28 day cycles and they conceive 14 days after the start of their menses.This traditional way of counting has been in use till now.
Therefore, when we say you are 10 weeks pregnant, you have actually conceived 8 weeks ago. Based on this type of calculation, a pregnancy will have the expected date of delivery at 40 completed weeks but a pregnancy that has completed 37 weeks is considered full term already.
Beth states that "the recommendation is that a woman wait until she is 39 weeks to consider having a planned cesarean." But since inductions can lead to a cesarean = then shouldn't a woman wait until 39 weeks to consider even being induced? The doctor on the news report says every week of early birth due to inductions can cause the risks to the newborn escalate. It is due to lung and brain development. "Before 39 weeks the baby is just not ready."
This is another story - more reseach showing the risks of early inductions and cesarean births:
http://www.foxnews.com/story/0,2933,477687,00.html?sPage=fnc/health/pregnancy
The study showed, "More than a third of the C-sections were performed before 39 weeks, the researchers found. Those delivered at 37 weeks were twice as likely to have health problems, including breathing troubles, infections, low blood sugar or the need for intensive care. Fifteen percent of those born at 37 weeks and 11 percent born at 38 weeks had complications, compared to 8 percent of the babies delivered at 39 weeks."
A dream of mine would be for women to trust their bodies. For babies to select their day to be born. If a mom is more high risks, sure do non stress tests and biophysicals to insure that the baby is doing great. But the stress of going "late" and having a baby "on time" needs to end. We need to embrace that nature did not make a mistake. That MD does not stand for minor deity. That we can decide if we are going to get on that induction train or not. That the induction police don't come and pick us up to drag us to have our babies. We must begin to take responsibility for our health and the health of our babies.
It begins with trusting our bodies. And it also goes to trusting our care providers. So if a care provider says an induction or cesarean is needed- ask more questions. Know the risks. Weigh their guestimations with knowledge and with what the studies show- wait if you can.
Friday, January 16, 2009
Estimating Due Dates
Due Dates
How accurate is your Due Date?
How are due dates calculated?
In the 1850's, a Dr. Naegele determined the average length of human gestation was 266 days from conception, or 280 days (40 weeks) from last menstrual period. He assumed that the average woman had cycles that lasted 28 days and that she ovulated on Day 14 of her cycle. He used his data to come up with a mathematical calculation for due dates:
((1st day of your last menstrural period -LMP + 7 days) - 3 months) = Due Date. EX: ((January 1, 1996 + 7 days) - 3 months) = October 8, 1996
This is still the standard method used to calculate due date, despite the fact that it doesn't take into account: that many women are uncertain of the date of their last menstrual period and not all women ovulate on day 14. Other factors which affect term are: mother's age, ethnicity, prenatal care, prenatal nutrition, number of prior pregnancies.
Another Calculation
A more recent study (Mittendorf, 1990) indicates that term for uncomplicated pregnancies in first-time, Caucasian mothers, averages 274 days from ovulation. It averages 269 days for mothers who've given birth before. The abstract says non-Caucasian pregnancies are shorter than Caucasian, but doesn't give statistics.
*To calculate a due date: Take starting date of last menstrual period. Subtract 3 months. Add 15 days. (10 days if you're non-white, or this is not your first baby.)
What else can be done to determine fetal age?
If ultrasound is performed in the first half of pregnancy, it can indicate fetal age within a range of 7 - 10 days.
Fetal heart tones can be heard through Doppler starting at 9-12 weeks and by stethoscope at 18-20 weeks.
Some believe the baby will come five months after quickening, the first time the mother feels the baby move. This is hard to evaluate, as women can be more or less sensitive to these sensations, and may notice them at different times in their pregnancies. (First time mothers typically notice movement around 18-20 weeks. Mothers who have been pregnant before notice it as early as 16 weeks.)
Fundal height, the measurement of the uterus done throughout pregnancy, can indicate the size of the baby, which can give insight about fetal age.
When will my baby be born?
Only 4% of babies are actually born on their "due dates". 6-10% of babies are born early - prior to 37 weeks; 4-14% of pregnancies last more then 42 weeks.
If this leaves you very confused, just realize that predicting due dates is a very inexact science, and it's probably best to plan ahead of time for the baby to come anywhere between 2 weeks before and 2 weeks after your due date.
For more on due dates, read: Calculating Due Dates and the Impact of Mistaken Estimates of Gestational Age
Sources: "How long is too long?" by Penny Simkin, Childbirth Forum, Spring 1993. Abstract for "The Length of Uncomplicated Human Gestation" by Mittendorf et al
Obstetrics & Gynecology, V.75, N.6, June 1990. "When will my baby be born?" found at http://pregnancy.about.com/library/weekly/aa042197.htm "Pregnancy past your due date" by Terri Isidro-Cloudas on www.americanbaby.com
How accurate is your Due Date?
How are due dates calculated?
In the 1850's, a Dr. Naegele determined the average length of human gestation was 266 days from conception, or 280 days (40 weeks) from last menstrual period. He assumed that the average woman had cycles that lasted 28 days and that she ovulated on Day 14 of her cycle. He used his data to come up with a mathematical calculation for due dates:
((1st day of your last menstrural period -LMP + 7 days) - 3 months) = Due Date. EX: ((January 1, 1996 + 7 days) - 3 months) = October 8, 1996
This is still the standard method used to calculate due date, despite the fact that it doesn't take into account: that many women are uncertain of the date of their last menstrual period and not all women ovulate on day 14. Other factors which affect term are: mother's age, ethnicity, prenatal care, prenatal nutrition, number of prior pregnancies.
Another Calculation
A more recent study (Mittendorf, 1990) indicates that term for uncomplicated pregnancies in first-time, Caucasian mothers, averages 274 days from ovulation. It averages 269 days for mothers who've given birth before. The abstract says non-Caucasian pregnancies are shorter than Caucasian, but doesn't give statistics.
*To calculate a due date: Take starting date of last menstrual period. Subtract 3 months. Add 15 days. (10 days if you're non-white, or this is not your first baby.)
What else can be done to determine fetal age?
If ultrasound is performed in the first half of pregnancy, it can indicate fetal age within a range of 7 - 10 days.
Fetal heart tones can be heard through Doppler starting at 9-12 weeks and by stethoscope at 18-20 weeks.
Some believe the baby will come five months after quickening, the first time the mother feels the baby move. This is hard to evaluate, as women can be more or less sensitive to these sensations, and may notice them at different times in their pregnancies. (First time mothers typically notice movement around 18-20 weeks. Mothers who have been pregnant before notice it as early as 16 weeks.)
Fundal height, the measurement of the uterus done throughout pregnancy, can indicate the size of the baby, which can give insight about fetal age.
When will my baby be born?
Only 4% of babies are actually born on their "due dates". 6-10% of babies are born early - prior to 37 weeks; 4-14% of pregnancies last more then 42 weeks.
If this leaves you very confused, just realize that predicting due dates is a very inexact science, and it's probably best to plan ahead of time for the baby to come anywhere between 2 weeks before and 2 weeks after your due date.
For more on due dates, read: Calculating Due Dates and the Impact of Mistaken Estimates of Gestational Age
Sources: "How long is too long?" by Penny Simkin, Childbirth Forum, Spring 1993. Abstract for "The Length of Uncomplicated Human Gestation" by Mittendorf et al
Obstetrics & Gynecology, V.75, N.6, June 1990. "When will my baby be born?" found at http://pregnancy.about.com/library/weekly/aa042197.htm "Pregnancy past your due date" by Terri Isidro-Cloudas on www.americanbaby.com
Sunday, November 30, 2008
Due Dates How accurate is your Due Date?
How are due dates calculated?
In the 1850's, a Dr. Naegele determined the average length of human gestation was 266 days from conception, or 280 days (40 weeks) from last menstrual period. He assumed that the average woman had cycles that lasted 28 days and that she ovulated on Day 14 of her cycle. He used his data to come up with a mathematical calculation for due dates:
((1st day of your last menstrural period -LMP + 7 days) - 3 months) = Due Date. EX: ((January 1, 1996 + 7 days) - 3 months) = October 8, 1996
This is still the standard method used to calculate due date, despite the fact that it doesn't take into account: that many women are uncertain of the date of their last menstrual period and not all women ovulate on day 14. Other factors which affect term are: mother's age, ethnicity, prenatal care, prenatal nutrition, number of prior pregnancies.
Another Calculation
A more recent study (Mittendorf, 1990) indicates that term for uncomplicated pregnancies in first-time, Caucasian mothers, averages 274 days from ovulation. It averages 269 days for mothers who've given birth before. The abstract says non-Caucasian pregnancies are shorter than Caucasian, but doesn't give statistics.
*To calculate a due date: Take starting date of last menstrual period. Subtract 3 months. Add 15 days. (10 days if you're non-white, or this is not your first baby.)
What else can be done to determine fetal age?
If ultrasound is performed in the first half of pregnancy, it can indicate fetal age within a range of 7 - 10 days.
Fetal heart tones can be heard through Doppler starting at 9-12 weeks and by stethoscope at 18-20 weeks.
Some believe the baby will come five months after quickening, the first time the mother feels the baby move. This is hard to evaluate, as women can be more or less sensitive to these sensations, and may notice them at different times in their pregnancies. (First time mothers typically notice movement around 18-20 weeks. Mothers who have been pregnant before notice it as early as 16 weeks.)
Fundal height, the measurement of the uterus done throughout pregnancy, can indicate the size of the baby, which can give insight about fetal age.
When will my baby be born?
Only 4% of babies are actually born on their "due dates". 6-10% of babies are born early - prior to 37 weeks; 4-14% of pregnancies last more then 42 weeks.
If this leaves you very confused, just realize that predicting due dates is a very inexact science, and it's probably best to plan ahead of time for the baby to come anywhere between 2 weeks before and 2 weeks after your due date.
For more on due dates, read: Calculating Due Dates and the Impact of Mistaken Estimates of Gestational Age
Sources: "How long is too long?" by Penny Simkin, Childbirth Forum, Spring 1993. Abstract for "The Length of Uncomplicated Human Gestation" by Mittendorf et al
Obstetrics & Gynecology, V.75, N.6, June 1990. "When will my baby be born?" found at http://pregnancy.about.com/library/weekly/aa042197.htm "Pregnancy past your due date" by Terri Isidro-Cloudas on www.americanbaby.com
Benefit of labor- even for planned cesareans
Babies born by cesarean section before labor are more likely to have breathing problems and to need special care in the early days of life,compared to babies born after labor. Sometimes the obstetrician thinks the baby is older than he or she actually is, perhaps even ignoring the mother's opinion of when she conceived. Other cases seem to reflect the normal human variation which leads some babies to mature sooner than others, just as they roll over, sit and walk at different times. None of the tests are 100% accurate in dating a pregnancy or in assuring fetal maturity. However, even when the baby is definitely mature, a certain number of born before labor suffer from lung disease, particularly complications from excess fluid in the lungs.
A recent article in Scientific American documents why labor benefits,including their lung functioning. ("The 'Stress' of Being Born," Hugo Lagercrantz and Theodore A. Slotkin, Scientific American, April 1986, pp.100-107). Hormones called catecholamines are released in the baby in response to the stress of experiencing contractions, being pushed through the birth canal, and the intermittent oxygen deprivation which occurs in normal labor. Twenty years of research indicates that these hormones not only protect the baby from a lack of oxygen, but also prepare him or her to adapt to life outside the womb.
Adults also produce catecholamines in response to physical or emotional stress. The heart rate increases, while blood is redirected away from many organs and sent to the heart, brain, arms, and legs, all needed for the so-called "flight or flight" response. This is the reason for a mother's fear and anxiety can lead to prolonged labor and fetal distress. (See C/SEC Newsletter, Vol.12(2), 1986). With the immature nervous system of the fetus, however, catecholamines work somewhat differently. Blood is kept in the brain and heart rather than the limbs, and the heart rate shows rather than rises. This allows the brain to survive without damage at much lower oxygen levels, similar to the way people can survive for hours in very cold temperatures under ice or buried in snow. The discovery of this different response to stress in the fetus means two things: 1) Babies are well protected from reduced oxygen in labor; and 2) When the fetal heart rate slows in labor, rather than meaning the baby is in danger, it may mean the baby is being protected from damage. This process explains why over 50% of babies delivered by emergency cesarean after monitor tracings indicate fetal distress are in fact not short of oxygen at birth. The authors recommend that only when fetal scalp blood sampling shows the baby is truly short of oxygen should he or she be delivered quickly.
Catecholamines appear to help the baby adapt to life outside the womb in several ways. First, a surge of catecholamines in labor facilitates breathing by causing fluid to be absorbed from the lungs and surfactant to be released. (Surfactant allows the lungs to remain open once they are expanded with the first breaths.) Lung compliance, the ability of the lung to stretch and fill with air, is partially dependant on lung liquid absorption. In research at the Karolinska Institute in Sweden, lung compliance was correlated with catecholamine levels at birth. Two hours after birth, vaginally delivered babies had significantly better lung compliance compared to cesarean babies. This helps explain why even mature babies born by elective cesarean are more likely to have breathing problems.
A second benefit of catecholamine surge at birth is to speed up the baby's metabolism, so energy stores in the liver and fat cells are made available until the baby begins to nurse. Cesarean stored fuel, and were more likely to have low blood-sugar levels. The burning of stored fuel also helps the newborn maintain body temperature.
A third effect of catecholamines is to alter blood flow so more blood is sent to the vital organs. Blood flow in vaginally delivered babies was lower in the legs and higher through the lungs during the first two hours of life. This effect is particularly important for babies experiencing breathing difficulties right after birth. In general, the higher the catecholamine surge, the better the baby can withstand oxygen deprivation. Babies who were moderately deprived of oxygen during birth had good Apgar scores if they had high catecholamine levels and lower Apgar scores if they had low catecholamine levels.
Another effect of high catecholamine concentrations is to produce a state of alert arousal. It is possible that the catecholamine surge leads to the extended quite alert state which usually occurs in a healthy baby in the first hour of life, and which may contribute to the beginning of parent-infant bonding right after birth.
The Karolinjska Institute studies also found that babies born by elective cesarean without labor had markedly lower catecholamine levels compared to those born vaginally, while those born by cesarean after labor had begun had only slightly lower levels. The message seems clear: A mother who wants a VBAC is not putting her own experience ahead of her baby's well-being. Babies benefit from a vaginal birth whenever possible. When it is not possible, they benefit from experiencing labor before a cesarean birth. The authors conclude, "Taken together, the weight of the evidence indicates that the elevation of 'stress' hormones in the normally delivered newborn reflects not only a response to acute stress but also an attempt by the body to enhance the chances for survival at birth. Such findings suggest that infants delivered by elective cesarean section before the mother begins labor may be at some disadvantage."
How Labor Benefits Babies:
Adaptational Effects of a Catecholamine Surge
Improves Breathing
Increases lung surfactant
Increases lung-liquid absorption
Improves lung compliance
Dilates bronchioles
Protects Heart and Brain
Increases blood flow to vital organs
Mobilizes Fuel
Breaks down normal fat into fatty acids
Breaks down glycogen (in liver) to glucose
Stimulates new production of glucose by liver
Activates heart-producing brown fat in response to cold
Facilitates Bonding
Dilates pupils
Appears to increase alertness
(From "The 'Stress' of Being Born," by H. Lagercrantz and T.A. Slotkin, Scientific American, Apr.'86, p.106.)
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