6/25/09

Avoiding Induced Labor


I have been trying to find clear, informative information on induction as I see so many moms opting for early or unwarranted inductions because they are impatient or uncomfortable.

It makes it that much harder for moms when we live in this "fast food nation" where doctors are suggesting inductions for convenience, not properly informing of the risks and insurance companies are also to blame for still paying for voluntary inductions. If insurance companies stopped paying for them that would only be half the battle, because you'd still have some doctors who would say "baby is too big" or "your past due" to get the induction funded. I loathe the ways our maternity system mis-educates by fear mongering.

I do think that Inductions DO save lives when used in high risk situations.

Below are very informative quotes and excepts on the FACTS of induction from an article published by Medical News Today. You can find the original here.

Throughout pregnancy, many women eagerly anticipate the day they finally will meet their new baby. This is especially true in the last few weeks of pregnancy when, as a baby grows larger, an expectant mother becomes increasingly uncomfortable and impatient to finish out her pregnancy.

Despite the anticipation, research shows that allowing labor to start naturally, rather than induce, is more beneficial to both mom and baby. Labor induction, or artificially initiating labor through the use of medicine, is performed for a variety of reasons. Today, one of the more common reasons for induction is "convenience." Hospitals can staff extra nurses, physicians can schedule births for times that are most convenient for them, and expectant parents can make work and family arrangements in advance according to their scheduled induction date. At first glance, labor induction may seem more convenient; however, it's important to recognize that induction may lead to a longer labor and overall hospital stay, more medical interventions, higher costs, risk of potential for litigation, and adverse outcome for a mother or baby.

In the last weeks of pregnancy, a woman's body and her baby perform crucial functions to prepare for birth. The baby's lungs mature and he or she develops a protective layer of fat. In addition, the baby drops down into the pelvis, the cervix tilts forward and softens, and irregular contractions help the cervix thin and begin to dilate. In most cases, a woman's body goes into labor only when her body and her baby are ready.


"Research at The University of Texas Southwestern Medical School suggests that it is a signal from the baby that starts the process of labor," says Debby Amis, RN, BSN, CD(DONA), LCCE, FACCE.

"The best way for a mother to know that her baby is fully mature and ready to be born is to allow labor to begin on its own."

"By avoiding induction, women are less likely to encounter other medical interventions," says Lamaze International President Allison J. Walsh, IBCLC, LCCE, FACCE.

"Experiencing natural contractions and laboring without unnecessary medical interventions increases a woman's freedom to respond to contractions by moving and changing positions, both of which facilitate the process of labor and birth."

Lamaze International recommends that a woman allows her body to go into labor on its own, unless there is a true medical reason to induce. Allowing labor to start on its own reduces the possibility of complications, including a vacuum or forceps-assisted birth, fetal heart rate changes, babies with low birth weight or jaundice, and cesarean surgery. Studies consistently show that inducing labor almost doubles a woman's chance of having cesarean surgery.

Avoiding induction also decreases the likelihood of a premature birth. Because neither doctors nor mothers can determine a baby's due date with 100 percent accuracy, babies may be induced accidentally before they reach full term (at least 37 completed weeks). A scheduled induction at 39 weeks could result in giving birth to a preterm baby who is only 36 weeks gestation. Preterm babies miss critical stages of development that take place during the last weeks of pregnancy and are at risk are for several postnatal complications. A study published in The Journal of the American Medical Association examined 4.5 million births in the United States and Canada and concluded that babies born only a few weeks early-at 34 weeks through 36 weeks-were nearly 3 times more likely to die in their first year of life than full-term infants. When medically necessary, inducing labor can be a life saving procedure.

The American College of Obstetricians and Gynecologists states that labor may be induced if it is more risky for a woman's baby to remain inside her body than to be born. Medical reasons for induction include, a woman's water has broken and labor has not begun for several hours; her pregnancy is post term (more than 42 weeks); she has pregnancy-induced high blood pressure; she has health problems that could affect her baby, like diabetes; there is an infection in her uterus; or her baby is growing too slowly.

First-time mothers are most vulnerable to the risks of inductions. Contrary to what many believe, suspecting a large baby is not a medical reason for induction. It is very difficult for a doctor or midwife to determine the size of a woman's baby before birth with accuracy, even with the use of ultrasound. Studies consistently show that inducing for a suspected large baby increases, rather than decreases, the incidence of cesarean birth.

Lamaze International has developed a care practice paper entitled "Labor Begins on its Own," which presents the research surrounding labor induction and tips for avoiding induced labor .

Childbirth education classes, such as Lamaze, provide women with the tools and information they need to make educated choices during labor and birth. To find a Lamaze class in your area, visit http://www.lamaze.org/.

6/18/09

Beautiful Home Birth

Click here to view a incredible slide show of a great home birth!

I wish more moms knew how wonderful birth could be!

6/16/09

TENS for labor



Medical News Today recently published a press release citing a 2009 review by the Cochrane Collaboration that concluded that women should have the option of using transcutaneous electrical nerve stimulation (TENS) as a non-pharmacological method of pain management in labor.

The full report can be found on the Cochrane Collaboration’s website. The summary reads:


“TENS is a device which emits low voltage currents which has been used for pain relief in labour. The way that TENS acts to relieve pain is not well understood. The electrical pulses are thought to stimulate nerve pathways in the spinal cord which block the transmission of pain. In labour, the electrodes from the TENS machine are usually attached to the lower back (and women themselves control the electrical currents using a hand-held device) but TENS can also be applied to acupuncture points or directly to the head. The purpose of the review was to see whether TENS is effective in relieving pain in labour. The review includes 19 studies with a total of 1671 women. Fifteen studies examined TENS applied to the back, two to acupuncture points and two to the cranium (head). Results show that pain scores were similar in women using TENS and in control groups. There was some evidence that women using TENS were less likely to rate their pain as severe but results were not consistent. Many women said they would be willing to use TENS again in a future labour. TENS did not seem have an effect on the length of labour, interventions in labour, or the wellbeing of mothers and babies. It is not known whether TENS would help women to manage pain at home in early labour. Although it is not clear that it reduces pain, women should have the choice of using TENS in labour if they think it will be helpful.”

I like that the TENS unit can increase a mother’s feeling of control during her labor, it doesn't have any risks of harming mom and baby, and its non-pharmacological! It's win win!

How it works:

  • TENS is a small battery-operated electrical current generator that provides input to your central nervous system. The TENS unit is small and portable-the size of a pager-so you can walk around or be up with it while using it in labor. TENS is a safe method of pain control. It has no side effects and is controlled by you. And, while TENS does not eliminate pain, many women have found it to be extremely effective in helping them work with their contractions and feel more in control.
  • The TENS unit sends an electrical "signal" through your skin to the nerves. This signal feels like a warm, comfortable tingling sensation which helps block out some of the other pain stimuli that is also reaching your central nervous system.
  • Four electrode pads are placed along your spine.
  • Electrode wires are inserted into the pads and plugged into the TENS unit. The unit is turned on to the level of feeling a mild sensation.
  • With each contraction you dial up the intensity of the current with the contraction and turn it down to a mild sensation in between.
I am trained on using the TENS in labor and I am offering my unit to doula clients as requested. If you are interested in using a TENS unit for pain management in labor please contact me.

Advanced Doula Training


Last weekend I had the pleasure of attending a workshop taught by Penny Simkin, PT. Penny is a internationally revered physical therapist who has specialized in childbirth education and doula work since 1968. She is one of DONA’s founders and has written several books on birth and labor support. I just had to have Penny sign my doula bible (Labor Progess Handbook). Yay!

I was so grateful to attend this workshop! I learned so much! Below is an outline of what we learned.

Day 1
  • When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women
Day 2
  • Non-Pharmacological Methods of Pain Relief in Labor
  • When pain becomes suffering
  • TENS Training (transcutaneous electrical nerve stimulation)
  • The OP (Occiput Posterior) fetus: How little we know
  • Postpartum: The Neglected Phase of Childbearing.

I am looking forward to using the knowledge I learned to better support moms in labor!

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