Labor is Good for Babies

A nice concise summary of Why Labor is Good for Babies.

Science & Sensibility

A neat new blog from Lamaze International, Science & Sensibility, a "research blog about healthy pregnancy, birth & beyond". Looks wonderful already.

Thanks to Molly of Citizens for Midwifery for pointing it out.

More "news" we already knew: Don't lie on your back when you are in labor

Remaining active and mobile during labor can shorten the first stage and results in less discomfort for moms:

Women who walk, sit, kneel or otherwise avoid lying in bed during early labor can shorten the first stage of labor by about an hour, according to a new Cochrane evidence review.

Women who labored out of bed during the early stages were also 17 percent less likely to seek pain relief through epidural analgesia, the review found.

This is not only for physiological reasons, such as widening the pelvis and optimizing fetal position, but "[o]ther research has found that feeling in control and able to make choices reduces pain and psychological distress in general." If fact, lying on your back during labor can be dangerous:

[l]ying flat on one's back during labor can put a great deal of pressure on the blood vessels in the abdomen. "There is widely accepted physiological evidence that the supine position may be harmful in late pregnancy and labor," [lead review author Annemarie] Lawrence said.

According to the reviewers, the supine position puts the entire weight of the pregnant uterus on the blood vessels that supply oxygen to both mother and child, which could potentially lead to problems with heart functioning in the mother and reduced oxygen to the baby. These outcomes could be serious in extreme cases. Lying on one's side has no link with such problems, however.

So why do so many women labor in bed?

[Teri] Stone-Godena[, director of midwifery at the Yale School of Nursing,] said that despite all the attention given to empowering women to have the type of birth experience they prefer, medical professionals still pressure women into lying in bed during labor, because it is more convenient this way for nurses and doctors - and makes fetal monitoring easier.

"I think this research is very vindicating of women being allowed to assume positions of comfort," she said. "Listening to their bodies is what they need to do. Most of time when we limit people's activity, it isn't for reasons that are soundly based on evidence."

She added, "This clearly shows that there are no advantages in staying in bed unless that's where you want to be."

Generally speaking, if a particular labor position causes you increased pain or discomfort, it's not a good one to be in - for you or the baby. Pain is your body's way of letting you know you need to change what you are doing.

Link to article.

When doing nothing is the best course of action

Many C-Sections Can Be Avoided By Waiting Out Stalled Labor for an extra two hours, according to a new study:

"One third of all first-time cesareans are performed due to active-phase arrest during labor, which contributes to approximately 400,000 surgical births per year," said [study author Dr. Aaron] Caughey, who is affiliated with the UCSF National Center of Excellence in Women's Health. "In our study, we found that just by being patient, one third of those women could have avoided the more dangerous and costly surgical approach."

The cesarean delivery rate reached an all-time high in 2006 of 31.1 percent of all deliveries, according to the UCSF study. Arrest in the active phase of labor has been previously shown to raise the risk of cesarean delivery between four- and six-fold.

"Cesarean delivery is associated with significantly increased risk of maternal hemorrhage, requiring a blood transfusion, and postpartum infection," Caughey said. "After a cesarean, women also have a higher risk in future pregnancies of experiencing abnormal placental location, surgical complications, and uterine rupture."

The study also notes that ACOG already recommends waiting at least two hours before proceeding with a cesarean when adequate contractions in active labor produce no progress , but "it is routine practice in many clinical settings to proceed with a cesarean for 'lack of progress' before those ACOG criteria have been met", according to Caughey.

HT: Unnecessarian

But what if the test is wrong?

Kathy at Woman to Woman Childbirth Education has posted several great articles recently, including What does natural birth sound like and C-sections and Mastectomies. But I really wanted to focus on "But what if the test is wrong?" which reminds women to get a second opinion,

One question to keep in mind with this sort of thing is always, “What’s the false positive rate?” Because if a recommendation is made to you to induce or perform a C-section or have some other intervention based on one thing alone, and that “thing” is wrong almost half the time, then how confident can you — and the doctor, for that matter — be in the diagnosis and subsequent intervention. If, however, there is a low false-positive rate, then you can be more confident that your diagnosis is indeed accurate.

and to be wise in evaluating the risks of their options:

It’s one thing for doctors to say that having some medical condition or refusing some intervention “doubles your risk” — which sounds very bad — but it’s another to find out that the “risk” is still only 1 in 50,000 (which is double the risk of 1/100,000). Sure, nobody wants to be that one, but that means that 99,999 mothers and babies are subjected to an intervention which also carries risk. It’s about perspective — a balance — a trade-off between two different courses of action. Nothing in life is guaranteed (except death and taxes); and there are risks and benefits for every course of action. It’s up to you to choose which risks are acceptable for the proposed benefit.

I could not have said it better myself.

Timing Contractions

This looks handy: Contraction Master. For those of you who like to live-blog labor.

Supporting Your Partner in Labor

The Talk Birth blog links to Transition to Parenthood's helpful handouts, including Ideas for Supporting Your Partner in Labor.

Oxytocin

Hathor's been doing some neat comics lately on Oxytocin - the "Love Hormone". She just came back from the Trust Birth Conference which I really wish I could have gone to. She heard Michel Odent speak, and he really rocked her world, as he did mine when I heard him speak a couple years ago at a local conference. Hathor came across this article, over a year old and just a rat study, but still important:

The massive surge in the maternal hormone oxytocin that occurs during delivery might help protect newborns against brain damage, a new study in rats suggests.

Researchers say the findings should encourage scientists to investigate whether elective caesarean sections, which lack this oxytocin surge, disrupt normal brain development.

Also, I found Hug the Monkey, a whole blog devoted to the subject of Oxytocin; and an article entitled 5 Ways Pitocin is Different than Oxytocin which, in honor of list month, I will include here:

1. Pitocin is released differently. Oxytocin is released into your body in a pulsing action. It comes intermittently to allow your body a break. Pitocin is given in an IV in a continuous manner. This can cause contractions to be longer and stronger than your baby or placenta can handle, depriving your baby of oxygen.
2. Pitocin prevents your body from offering endorphins. When you are in labor naturally, your body responds to the contractions and oxytocin with the release of endorphins, a morphine like substance that helps prevent and counteract pain. When you receive Pitocin, your body does not know to release the endorphins, despite the fact that you are in pain.
3. Pitocin isn't as effective at dilating the cervix. When the baby releases oxytocin it works really well on the uterine muscle, causing the cervix to dilate. Pitocin works much more slowly and with less effect, meaning it takes more Pitocin to work.
   
4. Pitocin lacks a peak at birth. In natural labor, the body provides a spike in oxytocin at the birth, stimulating the fetal ejection reflex, allowing for a faster and easier birth. Pitocin is regulated by a pump and not able to offer this boost at the end.
   
5. Pitocin can interfere with bonding. When the body releases oxytocin, also known as the love hormone, it promotes bonding with the baby after birth. Pitocin interferes with the internal release of oxytocin, which can disturb the bonding process.
   

I knew, like, three of those already. And for some really hair-raising stories, try Knitted in the Womb's Rant on Pitocin (with comments).

Six Practices for a Healthy Birth

If you haven't seen a copy of Lamaze International's new quarterly publication, Pregnancy, Birth & Beyond, I highly suggest you try to get a copy. I was mightily impressed by the inaugural issue.

Lamaze has identified six care practices that promote, support and protect normal birth. These are:

1. Labor should begin on its own.
2. Laboring women should be free to move throughout labor.
3. Laboring women should have continuous support from others throughout labor.
4. There should be no routine interventions during labor and birth.
5. Women should not give birth on their backs.
6. Mothers and babies should not be separated after birth and should have unlimited opportunity for breastfeeding.

Detailed information about each of these Care Practices are available here.

Made for Birthing

Take a look at these neat hospital gowns made for birthing. Not only do they allow coverage for modesty while still providing access for medical procedures and breastfeeding, they also help support baby's immune system:

The risk of germs is one of the biggest risks in hospital birth. Hospitals and medical caregivers supposedly provide a "sterile field" but you and your baby are still exposed to a multitude of germs that your body has not built immunity to. Roll your gown around on your bed, couch, and hold the dog and cat before you bring it to the hospital. You'll be bringing YOUR "sterile field" from home for your baby to be born into and to be touched by first and covered by. Not harsh, potentially risky hospital towels and sheets.

Birth & Pregnancy Briefs

US among worst in world for infant death:

The United States ranks near the bottom for infant survival rates among modernized nations. A Save the Children report last year placed the United States ahead of only Latvia, and tied with Hungary, Malta, Poland and Slovakia.

The same report noted the United States had more neonatologists and newborn intensive care beds per person than Australia, Canada and the United Kingdom — but still had a higher rate of infant mortality than any of those nations.

And Memphis fights its infant mortality rate, nearly twice that of the national average.

The risks linked to caesarean births from a study published in the British Medical Journal:

They found that a woman having a caesarean delivery had twice the risk of illness and mortality (including death, hysterectomy, blood transfusion and admission to intensive care) as a woman having a vaginal delivery.

There was a five times higher risk of having to have antibiotic treatment after birth for women who had a caesarean delivery (elective or decided by clinicians) than those who had a vaginal delivery.

Risk of having to stay in a neonatal intensive care unit for newborn babies who were born head-first was doubled after a caesarean delivery compared to a vaginal birth.

The authors also found that the risk of neonatal death was also significantly increased (more than 70% higher) up to hospital discharge for babies who were born head first from both an elective and a clinician chosen caesarean delivery, compared to a vaginal delivery.

However, caesarean delivery had a large protective effect in preventing foetal deaths in cases of breech born babies and reduced overall risks in those cases.

Elective Caesareans put mums and babes at risk of death:

According to a new British study women who opt for non-emergency Caesareans double their risk of dying or developing severe complications following the procedure.

The study by researchers at the University of Oxford has also found that in some cases Caesareans increased the risk of death to newborn babies by as much as 70 per cent.

Common Drug For Stopping Preterm Labor May Be Harmful For Babies

Dozens of studies have been done, but none have had a large sample size or a definitive outcome on the effects of indomethacin. The new analysis of a collection of studies, or a metaanalysis, by University of Rochester Medical Center researchers pulls together enough data to conclude that there is an association between use of indomethacin and babies experiencing periventricular leukomalacia (white matter injury by decreasing blood flow in the brain, which may lead to cerebral palsy).

The analysis also showed an association between indomethacin and necrotizing entercolitis (a condition in which intestinal tissue dies, which can sometimes be successfully treated with antibiotics but can require surgery and even cause death), especially for those babies who were exposed to the drug within days of birth.

And, no surprise, Diet Affects Fertility.

Women given unwanted episiotomies

A CNN Health article, "5 operations you don't want to get -- and what to do instead", covers episiotomies:

It can sound so simple and efficient when an OB-GYN lays out all the reasons why she performs episiotomy before delivery. After all, it's logical that cutting or extending the vaginal opening along the perineum (between the vagina and anus) would reduce the risk of pelvic-tissue tears and ease childbirth. But studies show that severing muscles in and around the lower vaginal wall (it's more than just skin) causes as many or more problems than it prevents. Pain, irritation, muscle tears, and incontinence are all common aftereffects of episiotomy.

Last year the American College of Obstetricians and Gynecologists released new guidelines that said that episiotomy should no longer be performed routinely -- and the numbers have dropped. Many doctors now reserve episiotomy for cases when the baby is in distress. But the rates (about 25 percent in the United States) are still much too high, experts say, and some worry that it's because women aren't aware that they can decline the surgery.

"We asked women who'd delivered vaginally with episiotomy in 2005 whether they had a choice," says Eugene Declercq, Ph.D., main author of the leading national survey of childbirth in America, "Listening to Mothers II," and professor of maternal and child health at the Boston University School of Public Health. "We found that only 18 percent said they had a choice, while 73 percent said they didn't." In other words, about three of four women in childbirth were not asked about the surgery they would soon face in an urgent situation. "Women often were told, 'I can get the baby out quicker,'" Declercq says, as opposed to doctors actually asking them, 'Would you like an episiotomy?'"

Wow.

Caesarean risk higher when labor induced

A new Australian-based study shows that first-time moms are more likely to "need" a Cesarian when induced:

In a study of more than 37,700 women, Mary-Ann Davey, an epidemiologist at La Trobe University's Mother and Child Health Research, looked at all uncomplicated first births in Victoria between 2000 and 2005. The mothers were aged 20-to-34 when they were between 37 and 41 weeks' pregnant.

Of those, 9.4 per cent had their labour induced — 6.1 per cent of public patients and 14.1 per cent of private patients.

"These women had no medical indication recorded for induction of labour," Ms Davey said. "Common reasons given were 'social' or 'post dates' (but less than 41 weeks' gestation)."

She also found that more women who were induced had epidurals then those who weren't induced. Although her findings are still preliminary, Ms Davey said there was "a substantial and significant increase in the number of caesareans" following an induced labour.

Eating Durring Labor

A new study finds:

Women permitted to eat low-fat, low-residual foods during labor were no more likely than women who received only water to have labor, delivery, or neonatal complications in a randomized study conducted in the United Kingdom.

Moreover, women who ate rated their overall labor experience as significantly better than that of women who were only allowed to drink water, according to a study presented in poster form at the annual meeting of the Society for Gynecologic Investigation.

(link)

No Benefit to Fetal Oxygen Monitoring

This is an old article, but one that I think is important, and didn't get much press at the time:

New Childbirth Technology Tanks: A study finds no benefit from monitoring fetal oxygen during labor. The rate of Cesarean deliveries is not reduced.

Epidurals aren't for wimps

Epidurals aren't for wimps – labour can be different for every mother:

In everyday life, we respond in instinctive ways to pain. If you drop something on your foot, you automatically rub yourself because rubbing causes your body to make endorphins which are natural pain-killing substances. If you have a bad stomach ache, you would probably lie down and curl up in a ball with a heatpad because warmth and being in a particular position are very comforting. It would seem that pain tells us how to help ourselves recover from injury. In labour, there is no injury taking place, but the pain teaches the woman how to give birth. She is led by it to try a variety of positions to increase her comfort and by moving around and using different positions, she is also helping her baby's head to press down firmly all around the cervix so that it opens up evenly. Later in labour, her changes of position cause the baby to be shifted one way and then the other, helping him to find the easiest way down through the pelvis.

Oh, Yes I Can!

Molly at My Three Pennies Worth has a great piece on self-confidence and mothering. Basically, if we belive we were designed to be a mother, to give birth, etc., we will believe that we can do these things, even when they seem hard. She writes:

When I approach childbirth, I have to recondition my mind and make it accept the fact that I was MADE to bring forth life. My body is DESIGNED to do this--it is not something to hard for me to accomplish at all, but something I was destined for from the beginning. If I view birthing as something I doubt I can manage, than that's exactly what happens to me. Pain that is bearable becomes absolutely unendurable, all because I treat it as if it's more than I can handle, rather than a sensation that women have successfully born since time began. More is in the head than anywhere else, and the way my head decides to view things makes a big difference in the outcome (disclaimer: this doesn't apply to difficult childbirth experiences, obviously, etc!).

A recent British study found that "lack of privacy and uncomfortable surroundings are making birth more difficult for thousands of women." I have also read that some hospitals over there are so dirty, women take there own cleaning supplies with them when they go into labor. Ugh.