Timely Birth--the facts about induction

Here's an article from Midwifery Today with some well-presented info on the indications, reasons and risks for induction of labor, as well as some practical tips on how to avoid preterm labor.
http://www.midwiferytoday.com/articles/timely.asp

Labor is usually artificially induced in order to avoid "post-dates syndrome" in the baby, which includes growth retardation and a rise in the incidence of stillbirth in babies who have been in the womb longer than the normal gestation period (the average of which is, by the way, not 40 weeks, but 41 weeks and one day). But it is used far too commonly: modern research indicates that there is no significant rise in stillbirths between 40 and 42 weeks, and a very slight rise between 42 and 43 (all rates are below 1 in 1000). Also, determining a baby's development and gestational age by ultrasound is very imprecise and becomes more so as the pregnancy progresses, so it is very difficult to be certain that a "post-dates" baby is actually postmature.

The main risk with induction (there are many, including cesarean section, uterine rupture, cord prolapse, meconium aspiration, fetal distress, neonatal jaundice, maternal hemorrhage and even the rare but disastrous amniotic fluid embolism) is prematurity, which is the leading cause of death in newborns other than genetic anomaly. Premature babies are more likely to have serious breathing problems, hypoglycemia, trouble maintaining body temperature, colic, and trouble nursing and/or digesting.

Nutshell: Avoid induction if at all possible; it is very, very rarely necessary and, when it isn't, it causes far more problems than it solves. There is little reason to be concerned about an "overdue" baby and much more about prematurity. Even if your doctor or midwife schedules an induction (over one third of American women's labors are induced), you do not have to attend. Studies show that waiting for labor to begin spontaneously is associated with no greater occurrence of problems and fewer interventions in labor (and hence fewer problems for mama & baby).

The rest of the article is on avoiding premature labor, which is a very important topic in itself and deserves its own post.

Good Hands mei tai

Here's a picture of my mei tai design--I have more, but my camera cord is broken! This is my friend Grace, carrying her brand-new baby boy Rhys <3

The mei tai is a Chinese baby carrier, and this one is updated with some modern features, such as funky reversible design (you should see the fabric Grace picked for the other side--fancy!) and wide padded straps and headrest.

Does the Vaccine Matter? and how to stay healthy this season

This is an article from the Atlantic that addresses the issue of whether any flu vaccine, for either the seasonal or swine flu, is actually helpful. Not maternity-related, but pregnant & nursing women are being encouraged by some to get vaccinated, and to vaccinate their small children.

http://www.theatlantic.com/doc/200911/brownlee-h1n1

Nutshell:

• The composition of the seasonal vaccines is determined by an educated guess, based on previously-widespread strains. They may be pertinent to current strains, and they may be irrelevant.
• Flu vaccines do boost immune response to the virus in young, healthy people (who are not considered at risk), but not nearly as much or as reliably in the elderly, the sick, children and the immune-compromised (ie those undergoing chemotherapy, those with an autoimmune disease such as AIDS, lupus or rheumatoid arthritis, and pregnant women). Immune response is an imperfect measure of vaccine effectiveness, but this does suggest that the vaccine may not be effective for those for whom protection is necessary (or necessary for those on whom it is effective).
• The trials for vaccine efficacy have not been very rigorous; they have largely been based on "cohort studies," which are notoriously difficult to control, rather than placebo studies. Many in the medical community, convinced of the vaccine's helpfulness independently of scientific trials, say it would be unethical to provide some patients with the vaccine and others with a placebo.
  
• Anti-virus drugs like Tamiflu are also not well-supported by scientific research; the virus can become resistant to them in days. In otherwise-healthy people, Tamiflu cuts the duration of the disease by up to 24 hours, but as many as 1 in 5 will experience nausea and vomiting as a side effect; it produces neuropsychiatric effects in 1 out of 5 children, including suicidal behavior, and it has also been responsible for fatal cardiac arrest.

Here's how you can take care of yourself this flu season and boost your immune system:

• Drink lots of water and get plenty of sleep.
• Cut as much refined sugar and flour out of your diet as possible; these shut down immune response.
• Stay off antibiotics. They don't fight viruses and they weaken your immune system.
• Wash your hands frequently with a non-antibacterial soap; your skin has friendly bacteria that make up your body's first line of defense, and it won't kill viruses anyway.
• Get a good probiotic supplement, and/or consume probiotic foods (active yogurt, kombucha, kefir, there are many out there) every day.
• Vitamin C supports your immune system, and you need vitamin D as well.
  
• Echinacea also bolsters immune response, and tincture of osha kills both families of seasonal flu. Alfalfa is also a great immune and energy booster.
  
• If you feel ill or fatigued, stay home! Rest is good and you expose fewer others to whatever you have.
• Don't go to the hospital or emergency room unless you absolutely must; it is the best place to catch a virus.
  
• Chicken (or turkey) soup is really proven to help! Add cayenne to break up congestion and lots of garlic to fight the secondary bacterial infections that cause many flu complications.

Breastfeeding Basics

This is an online course I'm taking for my doula certification, and it has a lot of great information on the most important choice you can make in your baby's first year--breastfeeding. The modules are in pretty bite-size pieces, but I'll nutshell them for you and provide a link so you can read more if you're interested or if you're looking for documentation. You may have to register, not sure, but it is free, they don't send spam and you can hop around to the pages that interest you if you don't want to read the whole thing.

Link: http://www.breastfeedingbasics.org/cgi-bin/deliver.cgi/content/Introduction/history.html

We start with a short (or long, depending how you think of it) History of Breastfeeding (in a Nutshell): Breastfeeding started when humans started. Routinely using alternatives like cows' milk- or soy-based artificial baby milk (ABM) began in the 20th century.


Next time: Benefits & Barriers: Nutritional Advantages

Cord Blood Banking

Cord blood banking is marketed as either blood donation on a higher scale (can be used to save someone else) or biological health insurance (stem cells to treat future diseases in your child). This article highlights the reasons why one family decided against it.


http://alternativebirthservices.blogspot.com/2009/10/why-cord-blood-banking-was-not-right.html

Nutshell:

• 75% of donated cord blood samples are too small for a transfusion and are sold for research into such things as cloning and biological weapons, and the donor's family has no say in this.
• Any genetic disease the child has which might be treated with stem cells will be present in the cord blood; thus, while it could be used for a sibling, it is ineffective for that child.
• Early clamping of the umbilical cord, which is required for banking, is harmful to the newborn baby, depriving him/her of up to half his/her total blood volume, taking up to six months to regenerate. Babies need that blood at birth - it isn't waste, it's there for a reason.

My OB Said What?!

Oh, it's funny but it's sad. Real comments made by birth professionals in earshot of their clients.

http://myobsaidwhat.com/

If you think you might want an epidural

[My apologies to anyone who has read this post in its horribly-formattedness...hope this is better]

then you should know the risks. An anaesthesiologist will probably not list and discuss these with you before letting you decide whether or not to have it - and the middle of labor is not a time to process information well. Whatever choice you make, it's better to understand the benefits (it hurts less), consider the risks (some are listed below), discuss it with your doctor or midwife, make a decision and then discuss it with your practitioner again :) so everyone is clear, before you go into labor.

The following chart lists only the possible complications to the progress of the labor, not for either the mother or the baby; those may be found at Seattle-area doula Kim James' site at http://www.kimjames.net/epidural_risks_and_side_effects.htm, from which this chart is taken (and at which you may find her sources of information).

Risks and/or side effects	How often this happens	Why is this a problem?	What you can do
Prolonged 1st stage of labor (while your cervix is dilating; usually the longest stage by far)	Common[30]	The anesthetic in epidurals weakens all the muscles below the epidural site. This can dampen the strength of uterine contractions. · Can be exhausting, boring, or otherwise discouraging for both mother and father. · Greater use of Pitocin needed to strengthen contractions can be stressful on baby and/or uterus, which may lead to cesarean section. · Greater incidence of maternal fever.	·Give labor time to happen. The risks increase the longer Pitocin and epidural anesthesia are in your system. However, as long as mother and baby are doing well, allow time for labor to work. Do not accept arbitrary time limits. There is no “magic amount of time” for labor to be finished. · Ask your nurse and care provider for reassurances that you and the baby are well. · Negotiate with your care provider, before labor happens, how long you’ll be able to labor. Find out when your care provider will begin suggesting cesarean section for failure to progress
Increase of malpresentation of baby’s head (the baby's head doesn't come into the pelvis at the best angle; lengthens the pushing stage)	20%-26%[31]	· Relaxation of the pelvic diaphragm predisposes malpresentations, as does lack of mobility and switching positions.	· Choose a CSE or intrathecal epidural. · Wait until baby is very low in pelvis (at least +1 or +2 station) before requesting epidural. · Wait until at least 5 cms dilation before requesting epidural
Increases the need for Pitocin augmentation.	Almost always, especially if epidural is given before 5 cms.[32]	· Some babies simply do not tolerate pitocin-induced contractions, the result being abnormal fetal heart rate after administration of pitocin. · Abnormal fetal heart rate may necessitate an emergency c-section. · Pitocin has a myriad of side effects. Please see Epidurals and pitocin below.	· Refuse an induction and wait to go into labor on your own unless the risks of continuing the pregnancy outweigh the risks of induction. · Wait until 5 cms dilation before requesting an epidural. Give your body a change to establish labor on its own and you’re less likely to need augmentation. · Ask your care provider to wait at least 2 hours before Pitocin is started to give your body a chance to adjust to the epidural. · Your body must also process the IV fluids that were administered before the epidural. That much fluid very often dilutes the oxytocin in your body, resulting in weaker, spaced out contractions. Give your body a chance to process the excess IV fluid and catch up. · You may want to practice active visualizations in an effort to speed up your own oxytocin production.
Prolonged 2nd stage of labor (pushing stage)	Especially true for first time mothers [33]	· May go against some care providers’ philosophy (ex: 2nd stage must be finished in 2 hours).	· Wait to start pushing until the baby’s head is visible on the perineum. · Negotiate with your care provider, before labor begins, how long you’ll be allowed to push. Find out when your care provider will being considering forceps or vacuum extraction or cesarean section for failure to progress. · Change positions and use downward gravity to help push your baby out. · Again, stay off your back.
Decrease in the ability to push effectively	Common[34]	· The build up of anesthetic simply weakens muscles to the point of ineffectiveness. · Mother may be able to push a little, but may not be able to effectively help the baby to rotate and descend. · Leads to increase in operative delivery.· The build up of anesthetic simply weakens muscles to the point of ineffectiveness. ·· Leads to increase in operative delivery.	· See above.
Increased likelihood of forceps or vacuum extraction delivery	Five-times greater likelihood.[35]	· Less efficient uterine contractions may keep baby from rotating naturally, and the diminished urge to push may keep baby from coming down. · Muscle weakness may not allow mother to push effectively.	· Consider letting the epidural wear off for pushing. · Don’t request an epidural until at least 5 cms. The fewer hours the epidural anesthesia is in your system, the less muscle weakness you’ll have to contend with.
Increases the likelihood of needing an episiotomy[36]	Depends on care provider philosophy	· Goes hand-in-hand with increased use of forceps and vacuum extraction. · Episiotomies are far more likely to tear beyond the original incision. · Take longer to heal, with greater scar tissue, than natural tears. · More postpartum pain for the mother.	· Talk to your care provider about their philosophy towards episiotomies. Find out when they are most likely to cut an episiotomy and how often this happens in their practice. · Strengthen your pelvic floor muscles before labor.
Increase in cesarean section	50% if you get the epidural when your cervix is dilated to 2 cm; 33% 3 cm; 26% 4 cm; After 5 cm, no difference in non-epidural group.[37] [38] Often depends on care provider philosophy	· Cesarean section deliveries carry far more risk to both the mother and baby than vaginal births do. · Mother may feel cheated out of a vaginal birth experience. · Postpartum recovery time is significantly longer than a vaginal birth.	· Don’t request an epidural until at least 5 cms. dilation. This will give you the greatest opportunity to get labor established on your own and to be upright and active.

Nutshell: The epidural is almost never medically necessary, BUT if you must have one, here's what you can do to minimize negative side effects:

• Keep changing positions and stay off your back.
• Labor at home as long as you can before heading into the hospital; this makes Pitocin augmentation, which causes unnaturally strong pain, less likely.
  
• Wait till your cervix is dilated to 5cm.
• Let it wear off during pushing (2nd stage of labor). This also helps avoid side effects to the baby.
  

A basic principle for all labor pain-relief techniques is that, in general, what makes it hurt less (i.e. epidural, horizontal positions) slows it down and what makes it hurt more (i.e. upright positions, Pitocin) speeds it up. The main exception to this is the fear-tension-pain cycle - if you reduce fear/tension, you will experience less pain and your labor will also be faster. More on that later, it's important...