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Friday, August 15, 2014

The Pregnant Woman’s Guide to Preventing C-Section

We live in a day and age where planned cesarean sections are routine, and are even recommended for all women. However, this is not a desirable procedure for many women today. There has been a push in recent years for a return to the natural methods of childbirth. This is indicated by the growing popularity of midwives, the burgeoning relatively new field of birth and post-partum doulas, as well as an overall general shift towards being healthy and living a natural life.
There are many reasons to prevent a C-section. There are financial reasons, since the cost of a C-section coupled with the hospital stay required afterwards can cost a new mother and father out of pocket in the tens of thousands of dollars, especially if they have a not-so-great health insurance policy. When compared to the cost of a natural birth (which is more in the area of one to two thousand in deductible or out of pocket), there is a big difference.

A natural birth requires a shorter hospital stay, often only a couple of days. A C-section can cause a woman to be in the hospital for a week or more afterward, especially if there were complications to the woman or the newborn. This can create a significant increase in cost, and for some women it can become a real financial burden.

Another reason to prevent a C-section has to do with the possible long term consequences to the mother in future pregnancies. As mentioned in a previous article, improper placental implantation has been positively linked to previous C-section. A Wikipedia entry about cesarean sections (linked to here ) speaks about several complications that are higher with C-sections, and apply to later births. “Women who delivered their first child by Caesarean delivery had increased risks for malpresentation, placenta previa, antepartum hemorrhage, placenta accreta, prolonged labor, uterine rupture, preterm birth, low birth weight, and stillbirth in their second deliveries.” These same risks were echoed by GynoGab (linked to here )

Some of these risks can lead to maternal mortality, especially placenta accreta. In most cases placenta accreta will lead to hemorrhage since the placenta must detach from the uterus and be expelled after the birth. This is a fact of every birth. With placenta accreta, the placenta is essentially tied to the body through the previous C-section scar, so it cannot be expelled. The article states that women who plan to have larger families should not have elective C-sections. An elective C-section is performed for the convenience of the mother and the hospital staff, rather than in an emergency situation where the mother or baby is at risk.

It should also be noted that in Ina May‘s Guide to Childbirth, she states that these placental implantation problems have become an issue in recent years because surgeons have elected to use a single layer stitch when closing the wound in the uterus, whereas in the past the stitching was done in multiple layers. These multiple layers did not lead to such an increased risk of placental mal-implantation. Women who know they are at high risk can discuss the type of stitching they would prefer if they have a C-section with their surgeon to reduce their risk of these problems.

When placenta accreta occurs, the surgeon attending the birth will often have to perform a complete hysterectomy in order to save the mother’s life. This should indicate how serious of a problem this can become. When this happens, the mother can have no more children.
In addition to these types of complications, there is also a three times higher rate of maternal mortality with a C-section in general over having a natural birth. While natural births can sometimes result in death, the rate of death from a C-section is higher than that in a normal birth. Considering that birth is a natural part of life, and that the female body was designed to give birth, this makes sense.

So, how can the pregnant woman prevent a C-section? Possibly one of the best ways to prevent this would be to have a midwife for your prenatal care provider. A midwife is experienced in taking care of many of the problems that would otherwise lead to a C-section. For example, nuchal cord births (where the umbilical cord is wrapped around the neck), breech births, and twins, can often be naturally delivered by an experienced midwife. For this reason, having a midwife with experience is very important.

Another way to help prevent C-section is to hire a birth doula. This person is knowledgeable about childbirth and can help to calm you if you feel that the labor is lasting too long or that there is a problem. She will likely be able to tell you if there is an actual problem, or if there is actually no reason to panic.

Another way to help prevent C-section is to have frequent pre-natal massages. Multiple studies have shown that prenatal massage can help to prevent complications, interventions, prematurity, and other problems. When complications are reduced, so is the rate of C-section since emergency C-sections are performed due to complications. While the reasons massage helps in this way are not understood, it is worthwhile to try prenatal massage while you are pregnant. For more information on prenatal massage, please click here.

Prenatal chiropractic can also help in similar ways, and you can find a chiropractor trained in prenatal care by clicking here. Prenatal yoga has also been shown to have similar benefits. You can do prenatal yoga in a classroom setting, or by purchasing one of the many DVDs available. Prenatal yoga has become very popular in recent years, as many midwives and even OBs have been recommending it. Consequently, it is likely that you can find a yoga studio offering prenatal yoga in your area. Low impact exercise during pregnancy, such as walking, has also been shown to help prevent complications.

If you have a high risk pregnancy, there may be no way for you to prevent having a C-section when the time comes for your child to be born. In such a case, it is better for you to be informed about all of your options. If you have tried all of the above measures, including massage, chiropractic, yoga, etc., and you must have a C-section, you can still ask your obstetrician to stitch your uterus in multiple layers to prevent future implantation problems. That way, you may be able to have a vaginal birth after your C-section, and continue having more children naturally if that is what you choose. However, as with everything, going into this procedure informed will be the best way to have a successful outcome for you and your children.

10 Reasons to Have a Midwife-Led or Midwife-Assisted Childbirth

When you are considering your options for labor and birth, you might wish to consider having a midwife lead or assist at your birth. This article details ten reasons for having a midwife at your birth. There are certain medical conditions, described below the list, that may prevent you from having a midwife led birth, but some of the benefits below will also apply to a midwife assisted birth (where you have a midwife work with your obstetrician at your labor and birth).

So, if you are interested in having a midwife but are unsure of the benefits to you, here are the top 10 reasons to have a midwife led or assisted labor and birth.

1) Lower maternity care costs. This may not apply if your deductible is very low or waived for pregnancy. However, you are likely to still pay about $2-3,000 for your co-pay or deductible depending on your insurance if you have a natural birth in a hospital. If you have an elective or necessary C-section, your co-pay is likely to be closer to $7,000.

2) Reduced mortality and morbidity rates due to a lower rate of cesaereans and other interventions.

3) Lower rate of interventions, including forceps and vacuum assisted delivery rates.

4) Fewer recovery complications

5) Flat rate pricing, which will often include gynecological exams, preconception care, labor and delivery support, newborn care, as well as birth and labor education and breastfeeding education. This flat rate is often lower than your co-pay or deductible out of pocket expenses for a hospital birth. Those co-pays do not include the cost of your hospital stay.

6) Provides hands on assistance and support during labor and birth. The midwife will also monitor the physical, emotional, and overall wellness of the mother throughout labor and birth.

7) The midwife will provide post-partum support, such as counseling and breastfeeding education.

8) The midwife can help reduce pain in the laboring mother by making suggestions for non-pharmacological interventions such as a warm bath, chaning positions, certain herbs and juices, etc.

9) A midwife led birth held out of a hospital will not be subjected to the same time limits as a hospital birth often is. In many hospitals, labors have a set time limit, after which interventions will begin. Such interventions can include induction of labor (where certain of the induction medications can cause their own complications including uterine rupture and fetal distress), forceps and vacuum extractor deliveries, as well as C-sections. As indicated above, C-sections can lead to complications in later births, and may be best avoided in situations where they are not medically necessary.

10) A midwife is also likely to suggest certain pre and post birth activities that will reduce later pain during labor as well as pregnancy itself. Such suggestions are likely to include pre-natal massage, pre-natal yoga, as well as post-natal massage. Post-natal massage has been known in other countries such as India to speed recovery time, enhance milk production, as well as enhance the bonding of the newborn with its mother. Pre-natal massage and yoga have both been shown to reduce complications and interventions.

The medical conditions that generally require obstetric assistance or intervention are the following: preeclampsia (which means high blood pressure in the mother); epilepsy, heart disease, and non-gestational diabetes are also conditions which will make your pregnancy be considered high risk; placenta accreta, percreta, and increta (where the placenta implants too deeply into the uterine wall), and placenta previa where the placenta covers the opening of the cervix.

While placenta previa is not necessarily a complication requiring a surgical delivery (as many midwives have attended these births), the former three types of placental implantation require surgical intervention and have been positively linked to one or more previous C-sections. See the page about placental problems on the American Pregnancy website here . In addition, most obstetricians will tell you that the presence of multiples (i.e. twins) is also a reason to have a cesarean section. However, the latest Summer issue of Midwifery Today is centered on the topic of twins, with many stories of twins being successfully delivered by midwives.

The decision to have a midwife or an obstetrician be responsible for your childbirth and prenatal care is a very personal one. However, there are also medical and physical reasons to consider having a midwife involved in your birth. A future article will discuss the benefits of a doula, so that if a midwife is out of your price range, you can also have a doula, who is a birth assistant there to help you.

This article referenced several websites that speak about the benefits of having a midwife for your birth. American Pregnancy’s article can be viewed here, the BabyCenter webpage can be found here, and Pregnancy Corner’s website can be found here.

Monday, August 4, 2014

Informing Yourself About the Dangers of Induction Of Labor in Pregnant Women

When you are pregnant, you have a great many decisions to make. You need to think about a birth plan for yourself, you need to find the best midwife or obstetrician for your birth, and you need to consider where you want to have your baby. You also need to think a lot about your pre- and post-natal care, for example, will you have a midwife and a doula, an obstetrician and a doula, an OB only?

Will you have prenatal massages, or will you have a series of post-natal massage sessions after the baby is born to help you recover? Or will you have both? Do you understand why these decisions are important, and are you clear as to why you have made the choices you have?

In the midst of all of these decisions, you may be neglecting informing yourself about a very important decision that can have consequences for your and your baby: the decision of whether to induce labor or to let nature take its course.

It is helpful to understand that obstetricians working in hospitals are generally quick to try to get a pregnant woman to induce labor. They have a view that the pregnant woman’s body is somehow defective and will not induce labor when it is ready, on its own. However, this view is not borne out in the research, which has shown that women will labor when the time is right. (see midwifethinking for a more holistic view of birth and labor)(Also see the article on Clinic Advisor located here )

Many times when a woman has an induced labor, there are unintended consequences. The rates of caesarean sections after an induction are twice those of non-induced women. For many women today, this type of birth is undesirable. Additionally, for conditions like gestational diabetes where the baby is assumed to be very large based on ultrasounds and other monitoring, when born the baby is often underweight or premature.

Thus, many inductions were unnecessary. The problem here seems to be one of a missing feedback loop. In other words, a feedback loop would mean that: a hospital performs a certain number of inductions, many of those inductions turned out to be unnecessary or even dangerous for the baby or mother, thus fewer inductions would be performed in the future. However, this feedback loop is actually missing in most hospitals since most of them continue to perform just as many inductions, and the number is on the rise.

All of these facts are aside from the actual dangers to mothers and babies from inductions. When a woman is induced to have labor, it is an unnatural event. Thus, there is an actual risk of rupturing or tearing the uterine wall because the contractions are unnaturally strong. This leads to a higher rate of C-sections, and can also cause long term incontinence. (See this website for more information) A higher risk of post-partum bleeding has also been observed with the use of these drugs. (Belghiti J, Kayem G, Dupont C, et al. Oxytocin during labour and risk of severe postpartum haemorrhage: a population-based cohort-nested case-control study. BMJ Open 2011;1:)

With regard to the infant, brain damage, increased fetal heart rate (leading to a C-section), permanent CNS, as well as fetal death have all been reported. The rates for these conditions in the infant are higher than in those born to mothers who are not induced. In addition to these issues with newborns, they have been generally underweight or premature when born through induction, even though their ultrasounds had indicated a larger than appropriate for gestational age baby. See the pages here and here for more information.

It should also be remembered that a due date is a guess at best, since most women do not know the exact date on which they conceived. They may know the date of their last period, from which the due date is estimated. These possibilities have actually caused the American College of Obstetricians and Gynecologists to state on their own website that caution should be used when inducing labor, as quoted in the bellybelly webpage above. However, hospitals and obstetricians continue to use these procedures regularly.
In addition to the reasons mentioned, it is also helpful to note that when a woman is admitted to a hospital as being in labor, there is a time limit for that labor, regardless of what her body believes is the time limit. When that time limit has passed, the OB will generally insist on induction. When the induction occurs, if the fetal heart rate drops, or the fetus appears to be in distress, an emergency C-section will be performed. For further reading on this topic, see Ina May’s Guide to Childbirth by Ina May Gaskin, a midwife practicing since the 1970s.

It is also useful to remember that most independent midwives do not perform labor inductions. They prefer to consider the woman’s body as wise enough to know when the baby is ready to be born. The normal labor of a pregnant woman releases small amounts of induction hormones into her blood, so spontaneous uterine rupture is rare. A midwife will generally allow a woman to labor until the baby is born. Many midwives have the experience to know when a fetus is in distress, and have a hospital birth contingency plan in place before the birth takes place. (See Ina May’s book above, as well as current and past issues of Midwifery Today for further details)

Massage therapy in the prenatal period has also been shown to reduce the incidence of prematurity, as well as the incidence of complications during labor. This is another factor to consider when creating your prenatal care team. A doula is also helpful to have with you at birth, as they are another educated care provider, who can help you to be informed about the decisions you are making with your body and your baby.

The best time to learn about labor induction, using chemical or mechanical methods (such as breaking waters, which often leads to chemical induction if ineffective), is before you are scheduled to deliver your baby. Researching the possibilities will give you the best chance of having the birth experience that is best for you and your baby.