Place of birth
The place where you chose to give birth depends on many different factors. Some of these are: your health, how your pregnancy is going, who your prenatal care provider is, the position of your baby, and what it is you want from your birth.
If you have health problems like high blood presure or diabetes, or if you suspect that your baby will have birth defects, you will probably chose to give birth at a hospital that is equipped to give you and/or your baby the care needed.
If your baby is in breech position (buttocks first) or if you have previously had a ceserean section, you might also have to go to a hospital. In these cases it is important to determine how much experience your care provider has in delivering in your situation.
If you are in good health, if your baby is positioned head down, your pregnancy has been free of complications, and you've been exercising regulary and following a healthy diet, you might want to consider giving birth in a free standing birth center or at home.
Hospital staff are not evil. Most of the labor & delivery nurses are very nice people with good intentions. They are skilled professionals, trained to deal with all sorts of emergency situations. But what if it's not an emergency, but just normal labor? You are still on the clock, your "performance" tracked and measured on various statistical charts. You only have so much time to dialate, so much time to push, so much time to deliver the pacenta...
Some reasons healthy women might want to avoid hospital birth:
- Routine IV or hep. lock, can be distracting + allows hospital staff to administer drugs too easily
- Routine practice of putting the woman on her back for labor and delivery, making her work against gravity and possibly causing the more painful "back labor"
- Routine withholding of food and drink during labor, leaving the woman's body without "fuel" it needs to do its work
- Routine rupture of membranes to start and/or speed up labor, may cause cord prolapse or infection, leading to more interventions
- Routine use of Pitocin to start and/or speed up labor, may cause unusually strong and painful contractions, leading to pain relief medication, which leads to directed pushing, which in turn can lead to swelling, episiotomy, etc.
- Routine vaginal checks, can be distracting and/or painful and might slow down or stop labor
- Routine directed pushing before the woman feels the urge to push, can lead to complications and additional interventions
- Routine cord clamping immediately after the baby is born, forces baby to start breathing before it might be ready. Stops the baby from getting extra blood from the placenta
- Routine use of Pitocin to speed up delivery of placenta, may lead to postbirth hemorrhage
"Average" process of labor
Pre-Labor: Can occur one or two weeks before delivery, and continue on and off. Can vary from mild discomfort to strong contractions, but do not stay regular and go away after a while. It’s best to: increase your calcium/magnesium/iron/chlorophyll intake. Up your fluid intake to 3 liters a day. Eat two eggs every day. Up your carbohydrate intake (cereals, breads, bagels, pasta, potatoes, and rice). Also eat high-fiber foods (whole wheat, vegetables) to avoid constipation. Rest as much as possible, but also take regular short walks to avoid becoming sluggish. Do some light stretching every day. Spend time on your hands and knees to avoid back labor. Make sure you have all the baby items you’ll need.
First stage: Latent/Early Phase of Labor: This is by far the longest, lasting up to 10 or 14 hours. During this phase the contractions are mild to moderate, progressing from irregular and far apart to every 5 to 10 minutes, lasting 30-45 seconds. It’s best to: continue to stay hydrated, drinking frequently; continue eating plenty of carbohydrates; rest as much as possible during this time. Do a massive grocery shopping (get diapers for baby, maxi-pads & witch hazel for you). Schedule a massage/pedicure/facial/haircut for the third or fourth week after the birth. Have a movie/dinner date with your partner. Spend time on your hands and knees to avoid back labor.
First stage: Active Phase of Labor: Contractions are moderate to severe, often coming every 3 to 5 minutes apart and lasting up to 60 seconds. This phase can take anywhere from 3 to 7 hours or less. During this time it’s best to: try to empty your bladder at least every hour; relieve backache by spending a few contractions on your hands and knees; try to relax; change positions frequently (at least every 30 minutes), take a walk, shower and/or bath, and remember to keep hydrated (drink 5 to 12 ounces of fluid every 15 to 20 minutes) and eating (30 to 60 grams of carbohydrates every hour). See the list of suggested food and drinks.
First stage: Transition Phase of Labor: The contractions are very close together, very strong, long, regular and intense; often associated with pain, nausea, vomiting, leg cramps, uncontrollable shaking, despair, dependence, crying, sensitivity to touch, drowsiness, hiccups, burping, belching, cold feet, hot flashes and flushing of the face. The contractions average about 2 to 3 minutes apart and lasting 90-120 seconds. This phase takes anywhere up to 2 hours. This is the hardest and shortest part of labor. This is where it gets really intense. Many women will respond with phrases like "I can't do this." It’s best to: try to relax; change positions frequently; moan through each contraction; pee; take a shower or a bath; take it one contraction at a time; use the rest periods to relax; remember that you’re having a baby; remember that this is the shortest part of your labor; stay hydrated (take a drink after each contraction or every 15 minutes); keep the room warm, dark and quiet.
Rest and Be Thankful Phase: You might experience anywhere from a few minutes to two or three hours of practically no contractions, and no strong urge to push. Usually this is occurring to allow your cervix to efface fully, allow rotation of the baby to a preferable position, molding of baby's head to better fit through the birth canal, and/or the uterus contracting to a smaller size to better push out the baby. Use this time to pee, rehydrate and rest.
Second stage: Pushing Stage of Labor: Usually lasts up to 3 hours. The contractions will usually space out a bit, going back to as much as four minutes apart. It’s normal to see little bits of poop, since the woman bears down just like she would for a bowel movement. It’s best to: stay upright so you’re working with gravity not against it; squat or get on your hands and knees; do not hold your breath. Once the baby's head enters your vagina ("crowns"), you might feel "the rim of fire" - the head stretching your vaginal opening and your perineum. Give yourself a little time to stretch by coughing or blowing instead of pushing. This might keep you from tearing. Drink something sweet and hot to keep up your energy.
Third stage: Placenta Delivery: Contractions are few and relatively mild. Nursing your baby will help the uterus to contract and expel the placenta. This can take from few minutes to an hour. Continue to keep hydrated. You might want to keep the cord intact and the placenta level with the baby until the cord stops pulsating (about 5 to 10 minutes) or until Wharton’s Jelly solidifies (about 2 hours). Placenta resembles raw liver on the side detached from the uterine wall; the side that used to be toward the baby is covered by the shiny bag of waters and large blood vessels radiating out from the cord.
Recovery, physical healing, etc: During the time right after birth, you may experience trembling in your legs, pain as your uterus contracts, and swelling and discomfort in your perineum, anus and vagina. A warm blanket helps relieve trembling, and a couple of ice packs reduce discomfort and may help control swelling.
The uterus continues to contract, shutting off the open blood vessels at the site of the placenta, preventing excessive blood loss, and sloughing off the extra lining that built up during the pregnancy. You will begin menstrual-like bleeding and may wish to wear a sanitary pad.
Lying flat on your back, check your uterus to make sure that the top (fundus) remains firm by pressing several areas of your abdomen above your pubic bone. You should feel your uterus as firm as a grapefruit. If it is relaxed, try the following: with one hand slightly cupped, massage your lower abdomen firmly with small circular movements until you feel your uterus contract and become firm. It may be painful, but the uterus can bleed excessively if not firm. Nursing your baby or stroking your nipples will help your uterus contract.
If you lose more than 2 cups of blood, you may be hemorrhaging and may feel symptoms of shock: rapid pulse, heavy breathing, pale skin, weakness, faintness, excessive thirst, trembling, cold, and sweating. Follow the above instructions to get your uterus to contract. Also, elevate the lower half of your body. Drink one quart of water containing one level teaspoon of salt and (if available) one-half teaspoon of baking soda. If liquid Chlorophyll is available, drink some to replenish the lost blood. Follow this up with some sweet, hot coffee or tea.
Try to eat 50 to 100 grams of carbohydrate within 30 minutes after birth of the placenta. Example: 16 ounces (500 ml) of sports drink, 1 soft pretzel, 1 sports bar. Follow this up with about 50 grams of carbohydrate every 2 hours. The goal is to consume around 600 grams of carbohydrate within 24 hours. This should restore glycogen levels. Get a little protein right after, too, as research has shown that protein may speed glycogen rebuilding.
Menstrual-like bleeding and crump-like contractions might continue for the next few weeks. During the first week after birth you will lose the extra fluid (as much as five pounds) accumulated during pregnancy by urinating large quantities and perspiring heavily. Your bowels and bladder may be “traumatized” by the birth. Extreme fatigue and soreness are common in the first few weeks. It takes about four to eight weeks following an uncomplicated vaginal birth for the mother's body to complete the initial stage of recovery from childbirth.
It's best to: not lift anything heavier than your baby. Sleep when the baby sleeps. Get a lot of rest the first week - don't resume exercising yet and do as little as possible around the house. Drinking 2 to 3 liters of water a day will help your skin regain/maintain its elasticity. Also, if you are breastfeeding, consuming plenty of fluids will help you main your milk supply.
Your support team
If you are having an obstetrician at your birth, you need to remember that unlike a midwife, a doctor will not be there for the duration of your labor. In the best case scenario, she or he will stop by to see you at some point after you check into the hospital, then leave and show up again when you are pushing your baby out. The labor & delivery nurses work in shifts, so it is quite possible that you will pass through the hands of two or three nurses in the course of your labor. The only people who will be there with you the whole time are your support team.
Chose carefully the people you invite to your birth. How will they hold up under stress? How well will they deal with seeing you in a lot of pain? If screaming helps you deal with pain, will you be able to scream in front of these people? Will they try to stop you? Will they bring calm and assurance or worry and nervousness into your birthing space? Will they be helpful and patient no matter how long your birth lasts? Will they support your choices and make sure nothing is done without your informed concent? Or will they doubt your decisions, question your wishes and try to convince you to do whatever the medical staff suggests?
If you are hiring a birth doula, you need to remember that not all doulas are the same. They come from different training programs, have different beliefs and practices, as well as different cultural and spiritual roots. Make sure you have discussed what you want from your birth, as well as what you think you'll need from your support person. Make sure that she will not make you feel guilty about your choices, even if you change your mind mid-labor. If you want her to be your advocate to the medical staff, make sure she understands and agrees - not all doulas will do this.
What you'll need
If you're going to the hospital or birth center:
- phone numbers for your support team
- a watch with a second hand in case you want to time the contractions
- chapstick
- toiletries (tooth brush, tooth paste, mouthwash, deodorant and soap, comb, perfume...)
- clothes & underwear for you (2 nursing bras)
- robe and slippers
- socks in case your feet get cold
- change of clothes for your partner
- shower cap for you & your partner
- bathing suit for your partner
- car seat / capsule fitted to your car
- food & drinks for you and your partner
- several "instant" icepacks you can apply right after the birth to keep the swelling down
- a thermos of sweet hot coffee to drink during the pushing
- camera, film, etc
- who will care for other children?
- cloth diapers, if that's what you want to use (hospital will probably provide you with reg. diapers as well as maxi pads for you)
- reading and writing material for afterwards
- undershirt, receiving blanket, outside blanket, booties & cap for baby
- phone numbers for your support team
- chapstick
- waterproof protector on your bed mattress (shower curtains work)
- towels, warmed blanket for you immediately after the birth
- protection for floor and furniture (more shower curtains?)
- hot & cold packs
- 4X4 sterile gauze squares
- bulb syringe for suctioning (if necessary)
- a watch with a second hand in case you want to time the contractions
- exercise or birth ball, pillows
- music tapes/CDs, candles, oil burner (if you want)
- oil to massage or pour onto your perineum during birth
- evening primrose oil for reducing swelling
- plastic-lined pads
- witch hazel, rubbing alcohol & hydrogen peroxide
- baking soda
- ace bandages
- several "instant" icepacks you can apply right after the birth to keep the swelling down
- a thermos of sweet hot coffee to drink during the pushing
- flashlight
- large hand-held mirror for you to see the baby's head as it's coming out
- warmed wraps and towels for baby
- cotton newborn caps/hats
- maxi-pads for you
- diapers for baby
- portable room heater
- thermometer (not a rectal one)
- container for placenta
- special items such as birth pool
- food for you
- a cooler with drinks for your (water, milk, juice, iced tea, sports drinks)
- flexible straws
- drinks & food for your partner and team
- camera and film - who will take photos? What photos do you want?
- garbage bags for soiled items
- yogurt
- bananas
- sports bars
- miso soup
- fresh-squeezed fruit juices
- whole grain toast with fruit spread
- white grape juice (red may impede blood clotting)
- strong very sweet coffee
- ginseng extract, the kind you get in health food store with royal jelly and honey
- energy gels available at sporting goods and athletic stores (Power Gel, GU or Pocket Rocket)
- guava paste (available in ethnic food stores)
- sports drinks (like Recharge, Gatorade or Propel)
- protein drinks (like Ensure)
Labor complications
Abnormal Presentation: Presentation refers to the position the fetus takes as your body prepares for delivery, and it could be either vertex (head down) or breech (buttocks down). In the weeks before your due date, the fetus usually drops lower in the uterus. Ideally for labor, the baby is positioned head-down, facing the mother's back, with its chin tucked to its chest and the back of the head ready to enter the pelvis. That way, the smallest possible part of the baby's head leads the way through the cervix and into the birth canal.
Because the head is the largest and least flexible part of the baby, it's best for it to lead the way into the birth canal. That way there's little risk the body will make it through but the baby's head will get hung up. In cephalopelvic disproportion, the baby's head is often too large to fit through the mother's pelvis, either because of their relative sizes or because of poor positioning of the fetus.
Sometimes the baby is not facing the mother's back, but instead is turned toward her abdomen (occiput or cephalic posterior). This increases the chance of painful "back labor," a lengthy childbirth or tearing of the birth canal. In malpresentation of the head, the baby's head is positioned wrong, with the forehead, top of the head or face entering the birth canal, instead of the back of its head.
Some fetuses present with their buttocks or feet pointed down toward the birth canal (a frank, complete or incomplete/footling breech presentation). Breech presentations are normally seen far before the due date, but most babies will turn to the normal vertex (head-down) presentation as they get closer to the due date. In a frank breech, the baby's buttocks lead the way into the pelvis; the hips are flexed, the knee extended. In a complete breech, both knees and hips are flexed and the buttocks or feet may enter the birth canal first. In a footling or incomplete breech, one or both feet lead the way. A few babies lie horizontally (called transverse lie) in the uterus, which usually means the shoulder will lead the way into the birth canal rather than the head.
Abnormal presentations increase a woman's risk for injuries to the uterus or birth canal, and for abnormal labor. Breech babies are at risk of injury and a prolapsed umbilical cord. Transverse lie is the most serious abnormal presentation, and it can lead to injury of the uterus (ruptured uterus) as well as fetal injury. Click here for exercises that help preven abnormal presentation.
Failure to progress: Once a woman enters labor, she is on the clock. Her cervix is expected to dialate 1 to 1.5 centimeters per hour. Once the cervix is dialated to 10 centimeters, the baby is expected to start progressing down the birth canal at 1 to 2 centimeters per hour. If the labor slows or stops the obstetrician might suspect fetopelvic disproportion, a situation where the fetus is too large to fit through the mother’s pelvis.
Unless the mother is diabetic or has a malformed pelvis, it is unlikely that her baby won't fit though her pelvis. It is more likely that the baby's head is molding to better fit through the birth canal, or the baby is rotating to a better position, or that the baby is partially out of the uterus, and the uterus is contracting down to a smaller size. This would be the rest and be thankful phase of labor, of which it seems most doctors haven't heard.
As long as the fetal heart rate is normal, you might want to ask your care provider to just let you rest.
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Placenta previa:
When the placenta implants over or near the inner
opening of the cervix, the condition is called placenta previa.
The cervix is the opening of the uterus. As the cervix dilates
during labor, the abnormal location of the placenta may cause
heavy vaginal bleeding and keep the baby from traveling through
the birth canal.
Symptoms may include:
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Umbilical Cord Prolapse: The umbilical cord is your baby's lifeline. Oxygen and other nutrients are passed from your system to your baby, through the placenta and the umbilical cord. Sometimes before or during labor, the umbilical cord can slip through the cervix, preceding the baby into the birth canal. It may even protrude from the vagina. This is dangerous because the umbilical cord can get blocked and stop blood flow to the baby. You will probably feel the cord in the birth canal and may see it if it protrudes from your vagina. This is an emergency situation.
It is commonly acknowledged that cord prolapse is a concern specific to the breech baby. Cord prolapse is more specific to pre term babies who are less likely to have a good sized buttocks to cover the cervical opening. It is also these pre term babies who are more likely to present as footling breeches - again a factor that predisposes to cord prolapse. Breaking of waters also facilitates cord prolapse.
Anterior lip: An anterior cervical lip seems to be the side effect of the mother starting to push before she feels a strong urge to do so. Anterior lip occurs when the presenting part (of the baby) is not positioned correctly upon the cervix, causing unequal pressure that results in unequal dilation. Think of a square peg trying to come through a round hole. If there is unequal pressure, and the fetal head is not given enough time to accommodate (mold), then the narrowest diameter of the fetal head cannot come through the widest diameter of the inlet.
The temptation is to treat the symptom--the lip--by pushing it back out of the way, without considering why it is there in the first place (the malpresentation) and correcting that. But if instead you allow the fetal head to back off the cervix, even just a bit, it will often allow the baby to tuck its chin and approach the pelvis at a better angle.
A good thing for the mother to do is to stop pushing, empty her bladder, and try two contractions on her left side, two contractions on her right side, two contractions on her hands and knees, and two in a knee-chest position. Pull up on your top leg as you are side lying, which will open that side of the pelvis a little more. Blow through the contractions, and refrain from pushing. Give it at least 15-30 minutes. Remember, you are trying to allow the baby a little room to back off the cervix so it can reposition and/or mold its head correctly.
In this particular situation, an upright sitting position is not as helpful, and in fact the 45 degree angle pushing position which is de rigeur in the hospital actually compounds the situation because the pushing urge becomes so strong, and the angle so acute, that the baby has no room to back up and cannot reposition itself.
Remember that the uterus is extremely competent at working the head down into the pelvis at the appropriate speed and angle if given the opportunity to do so.
Shoulder dystocia is often diagnosed when the shoulders are "stuck" after the head is born. Your obstetrician or midwife might encourage you to try and push the shoulders out immediately after the head is born. She or he can also tell you that a large episiotomy will be necessary, or even a cesarean.
As long as your baby's head looks good, and the heart rate is good, there is no need to panic, start pushing between contractions, have your perineum cut, your baby pulled out of you by force, or to have major surgery performed.
Your baby's shoulders are rotating and will be born with the next contraction or two. You might try lying on your back, lifting up and wiggling your hips, then turning over and getting on all fours and arching your back for the next contraction. If that doesn't work, try squatting for the next contraction. You can also try side-lying.
If your doctor or midwife do end up having to try various maneuvers to deliver the shoulders, offer to be on your hands and knees. This will give her/him a lot more room than if you were on your back, and will probably make an episiotomy unnecessary.
Labor interventions
"Whenever women are allocated a risk label there will be an accompanying pathology that is anticipated. Care will be organized around the 'risk factor'. All the woman's uniqueness will merge into the background as her care centers around the fear entrenched and litigation driven principle of 'just in case'."
Maggie Banks, Reclaiming Midwifery Care
"Obstetricians have inflexible ideas of how labor ought to go. If your labor doesn’t conform to that pattern, typical doctors 'do something' to you to make you fit. There are, as you may gather, a number of drawbacks to this myopic approach. "
Henci Goer, The Thinking Woman's Guide to a Better Birth
Whatever the intervention, the only person qualified to decide if it is "safe" is the laboring woman. Therefore, the obstetrician should not assure her that such and such procedure is "safe" - but instead she or he should inform her of the risks involved in performing the procedure as opposed to the risks of not performing it. The woman should also be told about alternative treatments.
Labor induction /augmentation: There can be several reasons your doctor might advice you to "be induced" (start your labor artificially). Some of them include pregnancy-induced hypertension that threatens the mother's and baby's health and diabetes where the doctor suspects your baby is growing too large. Another reason your doctor might have for inducing you is suspected postmaturity. Any pregnancy that's still going 2 or more weeks after the "due date" is considered "postmature". The problem with "postmaturity" is that your due date is an estimation and the length of your pregnancy is individual to you - not necessarily the same as the length of an "average" pregnancy.
There can also be different reasons your doctor might suggest augmenting (speeding up) your labor by rupturing your membranes or administering Pitocin (or other drugs). The most common one is "failure to progress", when your labor is going slower than "average".
As long as your baby's heart rate is good, you might want to let your body labor at its own pace. Your labor slowing down is not a problem in itself, but a sign that there is something else going on. For instance, your cervix might not be completely effaced yet, or the baby might be rotating into a better position, or the baby's head might be molding to better fit through the birth canal. Fear and anxiety can also slow down labor. Since the strength of your contractions is not a problem, speeding up and/or strengthening your contractions is not a solution.
Rupture of the membranes (amniotomy): the woman's bag of waters is ruptured to start or speed up labor. While in some cases this procedure accomplishes it's goal, it is not without possible complications. One of them is that the baby's progress is no longer cushioned by the waters. Another is the increased possibility of infection and umbilical cord prolapse. Once your doctor has ruptured your bag of waters, she or he will give you roughly 24 hours to give birth. This might or might not be enough time if you are already in active labor (having regular contractions every 5 to 10 minutes, lasting 30 to 45 seconds each). However if your waters are broken in order to start labor, and your labor still doesn't start, you will be on a very tight clock, with a cesarean section looming ahead.
Pitocin: The most common way for a woman to be induced is to begin her labor with pitocin. Pitocin is an artificial form of the body’s own hormone, oxytocin. Pitocin is supposed to be used to induce labor or increase the strength or duration of contractions for the health of mother or baby.
Oxytocin, the body's natural hormone, is secreted in bursts. However, when you are given pitocin you are placed on a regulated intravenous pump, to regulate the amount of pitocin to a steady flow. Therefore, pitocin induced contractions are different from your body's natural contractions, in strength and effect. With pitocin, the induced force of the contraction may decrease uterine blood flow (this also happens during a natural contraction, but not for as long and not as close together), reducing the oxygen to the baby. With pitocin you will also receive continuous electronic fetal monitoring. This is because fetal distress is more common with pitocin use and needs to be detected if it occurs.
Pitocin can also be the beginning of a domino effect of interventions. The IV, the infusion pump, and the continuous monitoring will confine most mothers to bed, decreasing her ability to deal with the contractions naturally. With the more painful contractions, a mother is more likely to need pain medication, such as epidural anesthesia. Pitocin can present other hazards. For the mother these include: tumultuous labor and tetanic contractions, which may cause premature separation of the placenta, rupture of the uterus, laceration of the cervix or postbirth hemorrhage. Fetal hazards include: fetal asphyxia and neonatal hypoxia from too frequent and prolonged uterine contractions, physical injury and prematurity if the due date is not accurate.
About 80% of women who have had pitocin say that there is more pain with pitocin than without. Unlike natural contractions, you do not get the slow build up, rather the contractions may began at a harder and faster rate than most normal natural labors.
Prostoglandins: Other types of synthetic induction agents being used more commonly are: cytotek, misoprostal and prostoglandin gel. These are all synthetic forms of prostoglandins, which are found naturally in a pregnant woman and in semen. These are used in two ways: to ripen a cervix that is unfavorable, and to induce labor. The procedure is to put the gel or tablet on the woman’s cervix, or to take the tablet orally. It is less invasive than using pitocin, as it can be done without the use of IVs. However, it can have side effects.
The most common problems are: uncontrollable and rapid contractions, may not induce labor, not approved by the FDA, overstimulation of the uterus, nausea, vomiting, diarrhea and shivering. It can also have an affect on blood pressure.
Vaginal Exams: The frequency of these exams vary from hospital to hospital, but they are performed to determine the progress of labor. In other words, the doctor or nurse is checking to see how much the cervix has dilated and has become effaced. Frequent vaginal exams can increase the risk of infection and slow down labor.
Intravenous Solution (I.V.): Some doctors will start an I.V. in order to have a vein open, usually with a glucose solution.
Denial of Food and Water: This is routine in most hospital births because of the potential for surgery. It deprives the mother (and baby!) of needed nourishment during a process that is taxing her stamina. This can certainly lead to dehydration as well.
Episiotomy: an incision in the perineal tissue between the vagina and the anus. It is done to prevent tearing and speed up labor. However, tearing during delivery is not inevitable, and perineal massage can reduce to risk or it happening. Also, making a cut may lead to a more serious tear. Not to mention that there is a possibily that your doctor might cut you more than you would have torn on your own.
Epidural: "An astounding 96% of all women who get a fever in labor have had an epidural. A tragic 86% of newborns who are put on full-spectrum antibiotics, and have full septic workups while in the ICU have been born to mothers who had epidurals in labor." -Suzanne Arms
The administration process is complex. Briefly, a local anesthetic is injected into the lumbar region of the woman's back, and then a long needle is inserted into the epidural space (outside the last of the three membranes that cover the spinal cord, just inside the bone and ligament of the vertebral column). This needle makes a hole into the epidural space, and through it a soft catheter is threaded. The needle is then removed, the point of entry sealed, and the catheter is taped to the skin. At its end a small filter and stopper are attached, through which doses of anesthetic can periodically be administered. The whole process, during which the mother must hold herself as still as possible, takes about 20 minutes to complete, and up to 90 minutes to take effect.
An epidural block either relieves the pain or simply numbs you from waist down. Partial block can happen, where you still feel everything on one side of your body. Either way, you will now have to stay in bed. You will also have a catheter incerted into your urethra. There is a danger of the mother developing a fever, which may cause the baby to also have a fever at birth, which in turn will have the medical staff taking your baby to the nursery for various tests.
There are several other potential disadvantages of epidural anesthesia to the mother. These include lowering of the blood pressure and paralysis of the breathing muscles if there is an accidental lumbar puncture, as well as long-term backache, headache or even temporary or permanent paralysis.
Dangers to the baby include oxygen deprivation, slowing of the heart rate, an increase in the acidity of its blood, and poor muscle tone. If an epidural is administered before the woman enters active labor, marked slowing of labor can result. During second stage labor, epidurals are likely to decrease a mother's ability to push, leading to delay of the birth or "failure of descent", which in turn may result in further interventions, including a cesarean section.
Continuous Fetal Monitoring: An external fetal monitor involves straps around the mother's abdomen and uses ultrasound. An internal fetal monitor involves rupturing the mother's membranes, an electrode being screwed into the baby's head and a catheter being inserted in the mother. Either monitor restricts movement (including position changes). Needless to say, the internal fetal monitor can cause fetal distress, possibly leading to a cesarean section. Studies have shown that auscultation of the fetal heart tones every 5 minutes during the second stage of labor is sufficient
Forceps, Vacuum Extraction: Mechanical ways of pulling the baby out. Can cause shoulder dystocia as well as tearing of the birth canal, and other mild to permanent damage to mother and baby.
Cesarean Section: "major abdominal surgery which poses "documented medical risks to the mother's health, including infections, hemorrhage, transfusion, injury to other organs, anesthesia complications, psychological complications, and a maternal mortality two to four times greater than that for a vaginal birth. [..] An elective cesarean section increases the risk to the infant of premature birth and respiratory distress syndrome, both of which are associated with multiple complications, intensive care and burdensome financial costs. Even with mature babies, the absences of labor increases the risk of breathing problems and other complications." -International Childbirth Education Association (ICEA)
Researchers found that the incidence of pulmonary hypertension among newborns delivered by cesarean section is almost five times higher than the rate for babies delivered vaginally.
The most common reasons for a c-section are breech position, placenta previa, and failure to progress.
Cutting a Pulsing Cord: Doctors will often cut the umbilical cord immediately after birth. The baby can receive up to a third of his or her blood supply at birth through the umbilical cord. Additionally, cutting the cord before it stops pulsing forces the newborn to rely entirely on new lungs just as they are inflating. It only takes about five minutes for the cord to stop pulsing and the baby to transition from receiving oxygen through the cord to breathing it in.
Routine suctioning: Right after the baby's head is born, the doctor or nurse will probably want to suction out the baby's nose and mouth. After the birth, this procedure will probably be repeated. However, with healthy, vigorous babies these procedures are often unnecessary.
Suctioning just after the head is born may interfere with the normal flow of labor, causing the delay in the birth of the shoulders, which may be mistaken for shoulder dystocia, causing more dangerous interventions.
Deep suctioning may induce a vagal response, including apnea (cessation of breathing) and/or bradycardia (dropping of heart rate).
International Guidelines for Neonatal Resuscitation state that deep (tracheal) "suctioning of the vigorous infant with meconium-stained fluid does not improve outcome and may cause complications".
Separation of Mother and Baby: Routinely, the newborn will be taken away from the mother immediately to be cleaned, weighed, and measured. These procedures may even be done in another room. This is done purely for the convinience of the hospital staff. These procedures can wait for as long as few hours in order to give mother and baby a chance to spend the first hours of baby's life together.
Pitocin Shot After Delivery: A shot of pitocin is routinely administered to facilitate the delivery of the placenta. Nursing immediately will have the same effect by causing the uterus to contract. Unless the mother is bleading profusely, there is no need to hurry the delivery of the placenta.
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Labor positions
If for medical reasons you must lay in bed for your labor, at least try staying on your left side, instead of flat on your back. This will decrease the possibility of fetal distress. Lying flat on your back creates the most stress on the perineum, making a tear or episiotomy almost impossible to avoid. Upright positions like kneeling or squatting allow for even distribution of pressure on vagina and perineum and may prevent tearing. Another reason not to be laying down, and to change positions is that it will help you deal with the pain of your contractions. As long as your labor is progressing normally, you might want to try any or all of the following positions: |
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Walk around. This helps work with gravity; contractions less painful
and more productive;
helps backache; may speed labor; aligns the baby with the pelvic angle; may
encourage baby's descent.
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| Stand and lean forward or sway. You can lean against your partner, a high counter, or a bed. Same benefits as walking, but less tiring. |
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Kneel on all fours or with your arms and head against some pillows on an
upraised bed. You could also try this on the floor, leaning on a cushion
placed on the seat of a chair; this helps relieve back pain; may rotate posterior baby;
may prevent shoulder dystocia; may be used when other positions cause a drop in
fetal heart rate; may improve chances of an intact perineum.
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| Half-kneel, half-squat, with one knee up and one knee down, in bed or on the floor. This is easier than squatting, described below. If it feels good to you, rock back and forth toward your raised knee during the contractions. Change legs as needed. | |||
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Squat on the toilet, floor or on the bed. You can use the furnuture or your
partner for support; takes advantage of gravity; widens pelvic outlet;
requires less bearing-down effort during second stage;
may enhance rotation and descent in a difficult birth;
contractions may be stronger and more effective.
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Supported squat enhances descent in a difficult birth;
permits relaxation of pelvis, allowing baby to spread pelvic bones;
may improve chances of an intact perineum;
eliminates external pressure on pelvis from bed, chair, stretched muscles, etc;
takes advantage of gravity.
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Side-lying, with legs together or with the top leg flexed a little
more than the bottom leg; or with upper leg propped up with an under-inflated beach
ball between the legs; very good resting position; useful to slow a very rapid
second stage; takes pressure off hemorrhoids; helps lower elevated blood
pressure; may reduce backache; may improve chances of an intact perineum;
safe if pain medications have been used;
contractions may be less
affective and longer; best if alternated with walking.
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Sit upright or straddle a chair, leaning on a pillow on the back of
the chair. Sitting cross-legged may open pelvic outlet.
A review of labor positions by the International Childbirth Education
Association (ICEA) concluded that labor contractions were least efficient in sitting
and supine positions. But sitting may still afford you a needed rest.
Don't use this position if you are experiencing anterior cervical lip.
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A note on moaning:
it may help you get through the pain of your contractions.
Listen to yourself as each contraction subsides. Try to remember
the way you sound at the end of the contraction, and try to
mimic that sound throughout each contraction. It might really
make things easier on you.
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Making choices for you & your baby:
"We are led to believe our birth, infancy and early mothering
experiences have no lasting significance on the rest
of our lives. Current scientific research and mounting clinical
evidence show the opposite -- our earliest experiences, from womb to
toddlerhood, create patterns in our nervous system and brain that
become the physiological foundation for life-long thinking, feeling and
behavior."
-Suzanne Arms
Induction: there are viable medical reasons to have your labor started artificially. However, if you are healthy, having a "low-risk" pregnancy, and are anticipating a healthy baby, your doctor might still suggest induction. His reasons might be as simple as going on vacation and not wanting to miss your birth.
Since inducing labor can lead to a slew of other interventions, you might want to avoid putting yourself at risk for your doctor's convinience. Remember that he is only there for a very small part of your labor, and that he might get stuck in traffick on his way to the hospital and miss your birth anyway.
If you decide to go ahead with the induction, at least consider keeping your bag of waters intact - that's the only cushioning your baby's head gets.
Scheduled ceserean section: like with induction, there are good medical reasons and then there are reasons of convinience. Remember that this is major surgery and can be risky for you, but also that having a c-section before you go into labor carries the risk of your baby being premature. Premature babies are more susceptible to infections as well as respiratory, heart and liver problems.
Cutting the cord: Unless you are collecting your baby's cord blood for cord blood banking, you have several options:
- letting the cord be clamped and cut when it is convinient to the hospital staff
- waiting until the cord stops pulsating (approx. 5 to 10 minutes) and then clamping and cutting it
- waiting until Wharton's Jelly solidifies (approx. 2 hrs) before cutting the cord
- leaving the cord & placenta attached to the baby to dry and fall off on it's own in 2-7 days (Lotus birth)
For Lotus birth, you can then cover the placenta with sea salt and/or dry rosemary, and wrap it in a diaper. Change diaper as needed, resalting the placenta.
Potential benefits of late cord clamping:
- lower incidence of anemia due to higher iron stores in infants
- less respiratory distress syndrome (RDS), especially in premature infants - this can be life saving
- less chance of infant brain damage due to oxygen depravation
- more maternal antibodies received by infant
- higher infant blood pressure
- less need for blood transfusion for premature infants
- less chance of organ damage from ischemia in premature babies
- improved infant kidney function
- more nutrients, vitamins, minerals, etc. received by infant
- increased hormone levels
- reported lower incidence of jaundice in infants
- increased quantity of stem cells
- improved breastfeeding success rate
The use of eye drops and ointment has no full guarantee an eye infection won't occur. This medication may cause temporary redness and swelling. This may also cause temporary (few weeks) loss of eyesight. Also, administering antibiotics may cause candida diaper rash, thrush, digestive problems, swelling or blockage of tear ducts, and antibiotic resistance.
If you know you don't have gonorrhea or chlamydia, and you wish to refuse the eye treatment, you'll need to discuss this with your doctor and with the hospital staff. You will probably have to sign a waver proir to being admitted for the birth. If you do decide you want eye treatment for your baby, make sure that erythromycin or tetracycline ointment is used - not silver nitrate drops.
Vitamin K: It is normal for newborns to have a low level of vitamin K. Breast milk is also very low in Vitamin K. Therefore (to correct nature's mistake) U.S. hospitals routinely administer to all newborns a synthetic, fat-soluble vitamin K injection (generic name phytonadione) that exceeds an infant’s recommended daily dietary intake of the vitamin by 100 times.
Peer reviewed journals have linked large doses of vitamin K to childhood cancers and leukemia. Animal studies have linked large doses of vitamin K to a variety of conditions that include anemia, liver damage, kidney damage and death.
On the other hand, vitamin K promotes blood clotting and can prevent Hemorrhagic Disease of the Newborn (HDN), a rare newborn bleeding disorder.
Parents who wish to refuse the shot must do so in writing prior to the birth of their baby.
Hepatitis B vaccination: Symptoms of hepatitis B disease include nausea, vomiting, fatigue, low grade fever, pain and swelling in joints, headache and cough that may occur one to two weeks before the onset of jaundice (yellowing of the skin) and enlargement and tenderness of the liver, which can last for three to four weeks. Fatigue can last up to a year. According to Harrison's Principles of Internal Medicine (1994), in cases of acute hepatitis B "most patients do not require hospital care" and "95 percent of patients have a favorable course and recover completely" with the case-fatality ratio being "very low (approximately 0.1 percent)."
The National Vaccine Information Center (NVIC) maintains that federal and state public health officials are promoting forced vaccination with hepatitis B vaccine without truthfully informing the public about the risks of hepatitis B disease in America or the known and unknown risks of hepatitis B vaccine. Without being provided with accurate and complete information about disease and vaccine risks, citizens cannot exercise informed consent, which becomes a human right when an individual considers undergoing a medical procedure that could cause injury or death.
Unlike other infectious diseases for which vaccines have been developed and mandated in the U.S., hepatitis B is not common in childhood and is not highly contagious.
Although Centers for Disease Control (CDC) officials have made statements that hepatitis B is easy to catch through sharing toothbrushes or razors, Eric Mast, M.D., Chief of the Surveillance Section, Hepatitis Branch of the CDC, stated in a 1997 public hearing that: "although [the hepatitis B virus] is present in moderate concentrations in saliva, it's not transmitted commonly by casual contact."
During the past decade, there have been many reports in the medical literature (primarily in international medical journals rather than U.S. medical journals) that hepatitis B vaccination is causing chronic immune and neurological disease in children and adults, including lupus: Tudela & Bonal (1992); Mamoux & Dumont (1994); Guiserix (1996); arthritis, including polyarthritis and rheumatoid arthritis: Christan & Helin (1987); Hachulla et al (1990); Rogerson & Nye (1990); Biasi et al (1993),(1994); Vautier & Carty (1994); Hassan & Oldham (1994); Rheumatic Review (1994); Gross et al (1995); Pope et al (1995); Cathebras et al (1996); Soubrier et al (1997); Guillain Barre Syndrome GBS): Shaw et al (1988), Tuohy (1989); demyelinating disorders such as optic neuritis, Bell's Palsy, demyelinating neuropathy, transverse myelitis and multiple sclerosis: Shaw et al (1988); WHO (1990); Reutens et al (1990); Herroelen et al (1991); Nadler (1993); Brezin et al (1993); Mahassin et al (1993); Kaplanski et al (1995); Baglivo et al (1996); Marsaudon & Barrault (1996); Berkman et al (1996); Waisbren (1997); diabetes mellitus: Poutasi (1996); Classen (1996); chronic fatigue: Salit (1993); Delage et al (1993); vascular disorders: Fried et al (1987); Goolsby (1989); Cockwell et al (1990); Poullin & Gabriel (1994); Mathieu et al (1996); Graniel et al (1997); and others.
Breastfeeding: It is well known that breast milk is superior to formula.
- Formula feeding accounts for up to 26% of insulin dependent diabetes mellitus in children.
- Otitis media (middle ear infection) is up to 3-4 times as prevalent in formula-fed infants.
- US Formula fed infants have a 10 fold risk of being hospitalized for any bacterial infection.
- Scores on the Bayley Mental Development Index were lower in formula-fed children at 1-2 years of age. Scores appeared to be directly correlated with the duration of breastfeeding.
- Formula fed preterm infants had lower IQ scores (8 points) at age 7-8 years than breastfed premies, even after adjustment for mother's education and social class.
- Due to an excessive phosphate load in formula, formula fed infants face a 30 fold risk of neonatal hypocalcemic tetany (convulsions, seizures, twitching) during the first 10 days of life.
- Formula fed infants are at a high risk of exposure to life-threatening bacterial contamination. Enterobacter sakazakii is a frequent contaminant in powdered formula and can cause sepsis and meningitis in newborns.
It takes up to 6 weeks for the new mother and baby to correct the bad sucking habits baby may have aquired and to establish good breastfeeding habits. During this time it is essential to have a good support system in place - experienced mothers you can talk to and ask questions.
It might be helpful to you to start going to your local La Leche League meetings even before your baby is born. There, you will see other mothers breastfeeding, discuss proper techniques as well as how to prevent various problems, and establish contact with experienced breastfeeding experts who will gladly take your calls and answer your questions.
Infant circumcision: There are good arguments pro and against this procedure. The list of pros goes something like this:
- infants don't experience pain the way adults do
- infants won't remember this being done
- lets just do this and get it over with
- we want our son to look like everybody else
- we want our son to look like daddy
- foreskin is unatractive
- foreskin is uncleanly
- foreskin might develop problems later on such as adhesions, phimosis, frenulum breve or skin bridges
- my people have a covenant with G-d to circumcise all our males on the 8th day after birth
- foreskin is attached to the head of baby's penis, and has to be ripped off the head before it can be cut
- I heard other newborns scream bloody murder during this procedure so I know it must hurt alot
- there is a chance of too much skin being cut off, resulting in unattractive appearance as well as painful erections later in life
- there is a chance that too little skin being cut off, resulting in skin bridges and unattractive appearance
- my son might resent me later for making this decision without him
- by removing the foreskin, the head of the penis will get desensitized, resulting in less pleasure during sex
- foreskin has many nerve endings and removing it will rob my son of extra pleasure
- G-d created my son with foreskin
Newborn blood screening: In this procedure blood is either drawn with a needle or milked out of the opening sliced in the baby's heel or leg. Blood is then used to screen the baby for various metabolic and/or genetic disorders like PKU or Galactosemia.
On one hand, if both parents have a rare genetic disorder, it is probably a good idea to screen your baby for that disorder, as there can be dire consecuences. For instance, PKU can be held in check by a change in diet, but if undetected, it can cause mental retardation.
On the other hand, these diseases are very rare, both parents have to be carriers, and many strands of each disease exist that will not be detected by the test. Having your baby scream in agony for up to 20 minutes as the nurse or the lab technician milks his foot for blood is an excruciating experience.
Your provider is only required to offer you a few select tests, which vary from state to state. Since the reason you are allowing these tests in the first place is that they may save your child's health and life, you might want to do your own research. Tests are available for about 30 inhereted diseases. In addition, new tests and new methods of testing might be available, that might be more beneficial to your baby. Also, there are several methods by which blood can be drawn from your baby. Some of these methods are less dangerous, more humane, and require less blood to be drawn.
Last, if you do decide to go through with the "PKU", make sure that the nurse or the lab technician is experienced in the procedure, and warms the baby's foot for a few minutes before cutting.
Books
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| Emergency Childbirth : A Manual (Spiral Wire Binding) by Gregory J. White | Gentle Birth Choices : A Guide to Making Informed Decisions by Barbara Harper | Birth Reborn by Michel Odent | Birth Without Violence by Frederick Leboyer | Active Birth : The New Approach to Giving Birth Naturally by Janet Balaskas |