Eating in Labor

Posted on May 3, 2011 by Heidi Thaden-Pierce

From the doula guide again:

When you are in labor, whether to eat is ultimately your personal choice, even though the hospital staff may strongly discourage or wish to prohibit it. Do your best to avoid a heated confrontation about this provocative issue, while knowing that you have the right to choose to eat normally.

I remember 24 years ago watching my mother pack her bag for the hospital when she was expecting my youngest sister. She had Smarties and I asked why was she taking candy to the hospital? She explained that the hospital policy was you could not eat in labor and she needed something to give her energy. I remembered this as I packed my hospital bags for my first birth and thought I felt sneaky about it, I had Kit give me food to eat when I was laboring. In hindsight that's silly - it's my body, I was hungry, and it was appropriate for me to eat. You can look up the research for how safe it is to eat in labor and how unlikely you are to need general anesthesia (and in case you did need it, how unlikely it is that you would aspirate and it not be treatable. Plus some argue that aspirating stomach acid is more dangerous than aspirating your lunch.)

While you don't want to get into an argument with your nurse while you are laboring (not conducive to calm labor environment) you should realize that you have hired the hospital to help you with your birth, not the other way around. They may have policies designed to minimize their liability and potential risks to you but they cannot kick you out for eating. Legally they cannot deny you care, to include a c-section if it was warranted, because you ate. (Elective surgery can be postponed if you ate and the anesthesiologist refuses to provide care to you, but that's another issue.)

Anyhoo, when I did need general anesthesia for my stat c-section I had just finished my yummy pie and waffle cut fries and that didn't stop them from knocking me out. 😀 And after that I decided my chance of getting struck by lightening twice, so to speak, was unlikely and I wasn't going to go hungry in labor again. Though my next delivery was at the birth center and they encourage you to eat and drink so it wasn't an issue.

Do your research. Talk to your care provider. If you have a fast labor then chances are you aren't going to be pausing to ask someone to run to Chipotle for you. But if you have a long labor and you are feeling hungry then listen to your body. Know the risks, decide for yourself, and do what feels best to you. Laboring without nourishment has risks of its own and an IV isn't going to cut it when you're starving and need all of your strength to push out your baby. Here's the World Health Organization labor report, check out Category D #1.

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The Benefits of Touch

Posted on May 3, 2011 by Heidi Thaden-Pierce

"Benefits of touch include increased levels of the hormone oxytocin, which speeds labor and promotoes a sense of well-being. (Synthetic Pitocin does not produce the effect of well-being because it is delivered through the bloodstream by IV, rather than being manufactured in the brain like natural oxytocin.) Studies from the Tourch Research Institute at the University of Miami show that women receiving massage in labor report less pain, less anxiety, and have shorter births. According to doula researchers Dr. Kennell and the Klauses, fathers-to-be touch their partners about 20 percent of the time in labor, while doulas touch mothers up to 95 percent of the time. However, the exception to this is when both the father and the doula are present; in these cases the amount of time fathers touch their partners is increased." - The Doula Guide to Birth

So again, it doesn't have to be a professional level massage, it can be as simple as wiping your face with a cool cloth or holding your hand while you get the IV or resting their hand on your leg, but TOUCH HELPS. I read in another text (sorry, no direct quote) that when laboring in a hospital if medical professionals enter the room that the father steps farther away from his wife. One presumes it's because they want to get out of the way of any exams needed? But as a result the mother is losing a source of comfort and reassurance. When a doula is present and demonstrating ways to touch and help the mother then the father is MORE likely to touch his partner. I think that's fantastic!

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Ina May’s Guide to Childbirth

Posted on May 3, 2011 by Heidi Thaden-Pierce

"Endorphins are nature's opiates. When we expend a lot of physical effort, endorphin levels rise correspondingly, especially when we are warm enough, feeling loved and supported, and, above all, when we are not frightened. Endorphins are a blessing, because they actually block the reception of pain. Endorphins give us that feeling of pleasure that comes with a job well done or a work-in-progress."

"We need to always remember that mothers who are afraid tend to secrete the hormones that delay or inhibit birth. This is true of all mammals and is part of nature's design. Those who are not terrified are more likely to secrete in abundance the hormones that make labor and birth easier and less painful - sometimes even pleasurable."

"When avoidance of pain becomes the major emphasis of childbirth care, the paradoxical effect is that more women have to deal with pain after their babies are born." (Referring to surgical recovery, forceps, episiotomies, etc.)

And you have to try this! While standing or kneeling put one hand on the bottom of your tailbone and one hand on your pubic bone. Feel about how far apart your hands are, then keep them there while you lean back and then lean forward and notice the difference in how close & far apart your hands become. I knew leaning forward in labor could be helpful but I was stunned at the difference in my pelvis when I leaned forward.

Really liking this book, fascinating stuff about how our bodies relax and our sphincter muscles and the connection between relaxing your throat/mouth and your cervix/vaginal muscles. If you are feeling tense or if you feel like your privacy is being invaded then you'll have a totally different experience because your body is reacting to your stress! She talks about the connection between relaxing during sex & orgasm and relaxing so you can give birth and how our minds have such connection to our body's ability to let those things happen. If we aren't in a place we feel safe and comfortable and protected and private then our bodies aren't going to cooperate! Fascinating...

Referring to the incredibly low transfer, c-section and intervention rates:

Anyone with a scientific bent should find it fascinating that three midwifery practices in the world produced outcomes so similar. There are certain obvious common elements that the three practices share:

- careful psychological preparation during pregnancy
- births attended by midwives able to be constantly with the laboring woman
- obstetrical backup provided by physicians able to recognize the abilities of midwives and women
- a philosophy that women are beautifully and admirably designed to give birth

I agree, we are beautifully and admirably made. 🙂

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The Doula Guide to Birth

Posted on May 2, 2011 by Heidi Thaden-Pierce

From The Doula Guide to Birth:

Warm water promotes relaxation by increasing circulation and lowering blood pressure, by stimulating the skin on your entire body (like a water "massage"), and in the case of baths, by providing buoyancy which takes strain off of the heavy uterus and belly. To reap the full effects, make your showers and baths in labor long, especially at the hospital, where there is plenty of hot water. For the most pain releif, it is recommended that you stay in for up to ninety minutes at a time!"

Ideally in a tub you want it deep enough that your entire belly is submerged but that can be tricky in a standard home or hospital tub. Labor tubs can be rented (as inexpensively as $50) that are deep enough to allow this and big enough to let your partner throw on some swim trunks and hop in with you. (While I did not think I would want this option, when the time come I really wanted my husband's arms around me and I LOVED giving birth then pulling our baby up into my arms, with m husband's arms around us both.) If you aren't comfortable birthing in the tub then laboring in the time is still fantastic and I've done this at the hospital and birth center. Though in both cases the water made me relax so much that I dilated from 5 cms to almost full dilated/pushing very quickly and it was intense. In those cases I did feel more comfortable hopping out of the water, so do whatever feels best to YOU, of course. And it's up to you and your care provider if you deliver the placenta in the tub or not - I got out for that part. Discuss the tub with your care provider because sometimes in very early labor the tub can slow things down, though in active labor it can speed things up.

I did not know until just now that when your uterus contracts it naturally leans forward so if you are laying back then it's fighting gravity. If you are laboring upright, leaning forward on a birth ball or on all fours then your uterus is already leaning forward and it may be less painful. That helps explain to me why I was naturally leaning like that in labor! And in the tub you can get on all fours or kneel and lean forward into the water for some relief.

Both hospitals in Denton have the option of laboring in tubs, depending on your care provider. Denton Regional has some in the rooms, though they are not deep and last I heard their policy is no water births. Denton Presby has a designated tub room (though they did admit it's mostly used as a storage closet!) and they also say no birthing in the tub, though I'm aware of exceptions being made if you ask a specific OB. 🙂

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The Benefits of Water

Posted on May 2, 2011 by Heidi Thaden-Pierce

From The Doula Guide to Birth:

Warm water promotes relaxation by increasing circulation and lowering blood pressure, by stimulating the skin on your entire body (like a water "massage"), and in the case of baths, by providing buoyancy which takes strain off of the heavy uterus and belly. To reap the full effects, make your showers and baths in labor long, especially at the hospital, where there is plenty of hot water. For the most pain releif, it is recommended that you stay in for up to ninety minutes at a time!"

Ideally in a tub you want it deep enough that your entire belly is submerged but that can be tricky in a standard home or hospital time. Labor tubs can be rented (as inexpensively as $50) that are deep enough to allow this and big enough to let your partner throw on some swim trunks and hop in with you. (While I did not think I would want this option, when the time come I really wanted my husband's arms around me and I LOVED giving birth then pulling our baby up into my arms, with m husband's arms around us both.) If you aren't comfortable birthing in the tub then laboring in the time is still fantastic and I've done this at the hospital and birth center. Though in both cases the water made me relax so much that I dilated from 5 cms to almost full dilated/pushing very quickly and it was intense. In those cases I did feel more comfortable hopping out of the water, so do whatever feels best to YOU, of course. And it's up to you and your care provider if you deliver the placenta in the tub or not - I hopped out for that part.

I did not know until just now that when your uterus contracts it naturally leans forward so if you are laying back then it's fighting gravity. If you are laboring upright, leaning forward on a birth ball or on all fours then your uterus is already leaning forward and it may be less painful. That helps explain to me why I was naturally leaning like that in labor! And in the tub you can get on all fours or kneel and lean forward into the water for some relief.

Both hospitals in Denton have the option of laboring in tubs, depending on your care provider. Denton Regional has some in the rooms, though they are not deep and last I heard their policy is no water births. Denton Presby has a designated tub room (though they did admit it's mostly used as a storage closet!) and they also say no birthing in the tub, though I'm aware of exceptions being made if you ask a specific OB. 🙂

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Observations in Labor

Posted on May 1, 2011 by Heidi Thaden-Pierce

Some of the things your care team is observing about you (and you can read about these in your labor progress notes in your medical chart, which is worth getting a copy of for a fun birth timeline!)

- Your behavior, activity level, and emotional state during and between contractions.
- The frequency, intensity, and duration of your contractions.
- How you assess your pain (most hospitals use a 0 to 10 pain scale.)
- Vagina secretions.
- Labor progress (combo of above.)
- Vital signs: pulse, temperature, respiration, blood pressure.
- Fetal heart tones (using doppler or external fetal monitoring strips.)
- Tone of uterus and amount of bleeding postpartum.
- APGAR, baby's temperature, respiration, pulse.
- Baby's general behavior, physical appearance, and state of alertness.

Specific to your amniotic sac breaking:
- color: brown or green indicates meconium
- amount: leak or gush
- odor: smell can indicate infection

(Notes paraphrased from The Birth Partner by Penny Simkin.)

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Belly Dancing

Posted on April 29, 2011 by Heidi Thaden-Pierce

"British anthropologist Sheila Kitzinger says belly dancing originated as a ritual of childbirth as well as seduction... the idea is that the pelvic gyrations help dispere the pain of contractions, orient the fetus, and propel the baby into the world. In early labor, when contractions are mild, the expectant mother may find comfort in dancing slowly and hypnotically, using hip circles, crescents, and figure eights. As labor gets more intense, the movements may progress to a rapid rocking of the pelvis from side to side - a technique known as the shimmy - to help position the baby correctly and relax the pelvic floor. In the final phase of pushing, a full body undulation known as the camel roll can help the baby move into the birth canal." - The Doula Guide to Birth

That is why I hula hooped in early labor. 😀 It really did provide relief from the intensity, was a fun distraction, and helps get the baby into a good position. If how we are birthed influences us, maybe Miss O will be a beautiful dancer, or at least a good hula hooper? A good swimmer for sure!

Cam

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Questions for your Hospital

Posted on April 29, 2011 by Heidi Thaden-Pierce

While you are discussing your birth plans/hopes with your care provider, it's also a good idea to tour the hospital and ask about their policies. When you arrive at the hospital in labor your doctor will likely NOT be there. You'll be triaged to confirm you are in labor, they'll call your doctor or midwife to discuss if they should keep you or send you home, and your doctor can give orders over the phone. If you want anything outside the norm as far as hospital policy, generally your doctor will have to explicitly state that's okay - to including getting in the shower or tub, eating or drinking anything, declining the IV/heplock, doing intermittent monitoring instead of being kept on the straps in bed, etc. You need to discuss all of these things with your doctor/midwife in advance and include them in your birth plan, but ultimately it's the doctor giving permission while you are in labor that makes it possible. If they cannot reach your doctor to get the go ahead, be prepared to have any of those wishes denied! (I had to wait for the okay from my former midwife to even get into the tub while laboring with my second birth. Not amusing.)

Other important questions to ask on the hospital tour are do they have an anesthesiologist in house? They will say they have one "available" 24 hours a day but as I learned in my second birth, available sometimes means they are at home asleep in bed and have 30 minutes to report to the hospital from the time they are called. Most hospitals do NOT have someone physically in the hospital around the clock, generally just the larger university medical centers (like downtown Dallas & Fort Worth.) Hospitals may have a nurse anesthetist available, but not an anesthesiologist (an MD.) Both can provide epidurals, both do surgeries, but it's something to learn more about as this is a person sticking a needle into your spine. 🙂 And once you are in labor and have decided you want that epidural then you're going to be feeling desperate and not wanting to ask questions. Better to ask BEFORE you're otherwise occupied!

Ask about their nursery, as more hospitals are claiming they have NICUs when really they have well baby nurseries with oxygen on hand for emergencies. That does not make a NICU! You don't want to discover this when you go into labor prematurely and learn your hospital is not equipped to care for a baby born before 36 weeks so your infant is being put into a helicopter and flown an hour away. (And yes, I've heard of this happening in our town.) It is better to transport a mom than a premature baby, and you don't want to be hospitalized in one city with your preemie in another location! Explore what options your hospital provides for premature babies and if a premature arrival is possible, determine where you would feel the most comfortable giving birth. (As 1 in 8 babies is now born premature, often with no warning signs, this is important for all parents to discuss.)

Ask about their c-section rate, as it varies widely from hospital to hospital in our area. If it's higher than the national average, why? And what does this say about the staff's feelings towards c-sections and how quickly they will jump to that option during your labor? For at least one downtown hospital I know their c-section rate is higher than average because high risk pregnancies are often transported to them, to include a floor of women living at the hospital on bedrest. In their case the c-section rate can be easily explained as it's special cases. If the hospital is NOT a major university medical center with high risk cases and yet they have a high c-section rate, why? Are they elective, repeat, or emergencies? (Ask the staff all these questions when you tour!)

Ask about their VBAC policy. Some hospitals are now banning VBACs, stating they do not have the staffing available to offer that option. ACOG guidelines state VBACs should take place in hospitals that can handle an emergency, specified as having an OB and anesthesiologist in house in case of an immediate cesarean birth being needed. However, if a hospital bans VBACs because they cannot handle an emergency c-section, then the hospital is not prepared to handle ANY emergency in labor. I know I was surprised to birth in a hospital and discover that little bit of information, that if I were to have an emergency the staff had 30 minutes to even show up? And then start the surgery? And I know many other parents have been surprised to hear that as well. If you are birthing in a hospital because you are concerned about having immediate medical access for the rare case of emergency, then make sure you are in a hospital that is actually prepared!

More to come. 🙂

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Doulas & Support Partners

Posted on April 29, 2011 by Heidi Thaden-Pierce

"A 2007 analysis funded by the National Institutes of Health found that fathers who were more involved throughout pregnancy, including participating in prenatal care, childbirth classes, and being present at the birth, were more likely to participate in child-rearing and engaged in a higher level of cognitively stimulating activities with their young children. These fathers also showed more warmth and nurturing behaviors toward their children and provided more hands-on physical care, such as changing diapers and giving baths."

"Studies show fathers participate more when a doula is present. Moreover, with doctors, nurses, and possibly several others in the room, birth is usually not a quiet, low-key affair. In fact, in order to help protect the couple's intimacy and shield them from chatter, background noise, and other intrusions, a priority for the doula is to make the room as calm and peaceful as possible."

"Studies have documented fathers' stress levels surging at various points throughout labor. That's not surprising, since apart from the intensity of the experience, fathers sometimes feel torn between different roles. They want to support their partners, which takes a good deal of focus, but they also feel responsible for taking on other jobs, like negotiating with hospital staff and advocating for their partners' needs. Studies show that dads feel less pressure to advocate when doulas are present."

All fromThe Doula Guide to Birth.

I absolutely agree that when a doula is there to help support BOTH parents, the partner is able to focus on the much more crucial task of providing support for the mother.

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Amniotomy

Posted on April 28, 2011 by Heidi Thaden-Pierce

An amniotomy is when a small hook is used to rupture your amniotic sac (break your water) and it's done frequently on laboring women. From my course manual with my own notes, an amniotomy is done to:

* To induce or augment labor.
* To check for meconium (baby's first stool).
* To place the internal fetal monitor the infant’s scalp. (OUCH! They actually screw a little wire probe into the baby's scalp to get a reading if they aren't happy with the external fetal monitoring.)

Potential complications:
* The amniotic sac is designed to act as a cushion for the baby's head during labor. The increased pressure around the fetal head may lead to deformities of the skull.
* The reduction in the amount of amniotic fluid may increase compression of the umbilical
cord which would show as fetal distress during labor, baby's not getting enough oxygen.
* Increases the possibility of a cord prolapse, when the umbilical cord comes out through the cervix. This generally necessitates a stat c-section as it can be life threatening to the baby. If the baby's head is not fully engaged in the pelvis and your amniotic sac is broken the cord can prolapse and the infant's head can then drop and compress the cord, cutting off oxygen to the baby.
* Having your water broken increases the likelihood of infection from vaginal exams and probes placed into the vagina. (Still need to find study that showed infection risk increases not 24 hours after your water breaks, but 24 hours after your first vaginal exam after your water breaks.) It's when people start sticking things in there that you introduce the increased risk of infection! The amniotic sac is protecting the baby from outside bacteria.
* Some practitioners will start the cesarean clock once the amniotomy is performed, some say 24 hours after water breaks it's c-section time. I've heard even shorter time frames, too, but again - the risk isn't your water breaking, the risk is vaginal exams after your water breaks.
* This may cause your practitioner to restrict you to bed.
* This may cause the practitioner to restrict your use of the tub or bath. (To which I say, show me the study that says my risk of infection is increased using a tub after my water breaks and I'll show you a study that says you sticking your hand up my vagina increases my risk of infection.* OH, sorry, tired and snarky today. I wouldn't really say that to my care provider because she's the one that lets me labor in the tub anyhoo.)

And not listed in this text but I also read that breaking your water prematurely makes it harder for the baby to move around and get into a better laboring position. If there is still water the baby will shift even in labor and move about to get into an optimal position (ideally - sometimes those sweet little things don't want to cooperate and come up with all sorts of acrobatic antics in there.) Letting your water break on its own instead of popping it prematurely gives your baby time to do their little labor dance, but once your water breaks the baby loses their mobility aid and they are more stuck.

In my personal experience, I delivered one baby "in the caul" when the sac was emerging unbroken around the baby. The cushion that it provided made for a more gentle arrival - I could feel the difference between my labor with the water sack in tact and my births when my water broke.

There are situations in which an amniotomy is recommended, but that's up to you and your care provider to determine. It's good to know that there ARE risk associated with the procedure, it does not necessarily speed things along, and it does start the timer for how long you can labor before the pressure increases for a c-section.

And if your water breaks on its own before active labor begins (which it does in about 10 to 15% of births depending on which website you read) then there's nothing you can do about that except minimize vaginal exams (YES, you can just say no to vaginal exams!) Laboring without your water in tact will still be okay! 🙂

*I cannot get the full study online but here explains more:

Although many questions regarding ruptured membranes, vaginal examinations and infection risk remain unanswered, one concept is clearly identified: avoid vaginal examinations whenever possible.

If you have medical journal access, here's the full info: Seaward, P. G., Hannah, M. E., Myhr, T. L., Farine, D., Ohlsson, A., Wang, E. E., et al. (1997). International multicentre term prelabor rupture of membranes study: Evaluation of predictors of clinical chorioamnionitis and postpartum fever in patients with prelabor rupture of membranes at term. Am J Obstet Gynecol, 177(5), 1024-1029.

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