Pregnancy, maternity, birth, and baby information » Childbirth

Pregnancy: Your Delivery Options

Jennifer — Thu, 22 Mar 2007 17:55:56 +0000

Some women understandably wish from time to time that a baby could be delivered by Fed Ex. After nine months of hormonal changes, carrying extra weight and reduced movement many will want to just get it over. But the race is won at the final leg and Lamaze, Bradley or other options can help carry you over the finish line in optimal shape.

Women, obviously, have been giving birth for hundreds of thousands of years. The basic process has changed little over that time. But medical knowledge has grown by leaps and bounds.

During the mid-19th century that knowledge consisted of a growing set of tools and drugs to minimize pain. By the mid-20th century, though, birth was almost something that happened to a woman and her baby, rather than something they did. Contemporary knowledge can help the expectant mother take more active control of her birth and deliver with the highest chances for her baby’s health.

The Bradley method was devised by Dr. Robert Bradley in the 1940s. The emphasis was, and is, on a set of techniques to deliver without the use of drugs. There are pros and cons to the approach, since anything a mother receives will affect the baby. With the drugs designed today, and the dosages low enough, the odds of harm are very low. Completely drug-free births are not entirely without risks either.

The uncontroversial aspect of the Bradley method is its use of breathing techniques that aid the woman during periods of non-contraction. Relaxation techniques are helpful at those moments to prepare for more active moments. The deep breathing taught in Bradley classes is a positive benefit.

Lamaze has its own proponents and detractors, and more similar reasons. Developed by a French physician and popularized in the 1960s, it too emphasizes ‘natural’ childbirth. It discourages use of pain control drugs, in favor of hot and cold packs, positioning and breath control.

The Lamaze breathing techniques, like Bradley, are helpful – more so during the more active parts of delivery. The rapid, in-out-in intake of air helps fully oxygenate tissues and control pain. The focus required to maintain that breathing, while also focusing on the need to push in the proper way helps keep the mother’s mind off the pain and onto the process.

Both Bradley and Lamaze classes emphasize the importance of having a birth partner to assist in delivery. That can be a friend, spouse or even a midwife. Having that person there is an emotional comfort. Either professionally, or thanks to the classes, they’ll have an (at least theoretical) understanding of delivery. They help maintain focus, provide physical assistance in positioning and offer a friendly face in what might be an emotionally cold environment.

Mothers should consider carefully all their options. There’s no need to rule out modern medical technology. Being aware of the risks and benefits of anesthetic and some of the common potential problems can help you prepare. The more information you have, the better you can rationally examine options ahead of time. That helps you make better decisions at a time when you have other things on your mind.

Pregnancy: What’s a Midwife?

Jennifer — Wed, 21 Mar 2007 17:55:15 +0000

For centuries giving birth was strictly an affair between the pregnant woman and a midwife. Though not always present, a mid-wife would frequently aid in the birthing process. The role was often performed by an older woman who had previously experienced birth herself. She gave comfort, medical knowledge based on real experience and a second pair of hands at a critical time.

With the rise of obstetrics in the 19th century, midwifery became much less common, almost disappearing from birthing practice in the U.S., except in circumstances of deep poverty or geographic isolation. In recent decades, it has risen again in a new form in which midwives are often licensed nurses with considerable traditional medical experience.

Though midwifing was historically carried out in the home, modern practitioners carry out their work in hospitals almost entirely today. Many women want to have the services of a midwife, but still avail themselves of the advantages of modern medicine in a traditional hospital setting.

In the overwhelming majority of births, the midwife has to take little active part in the process. She provides assurance, a hand to hold and ‘insurance’ in the form of letting the woman know that, should the need arise, an expert is at hand. But their presence and practice goes far beyond or rather before labor.

Midwives are available for pre-natal visits, and they offer one-on-one advice, much as an obstetrician will do – though frequently at lower rates. They are often there for much more of the time during the entire process, too, once labor starts. Many obstetricians have more patients than any single person can care for, even working 14 hour or longer days (as many of them do). A midwife can usually devote exclusive attention to a woman during labor.

They will be there at the beginning of the birthing process, continuously up to and after the completion of birth. Having a trusted and experienced medical expert at the bedside for the entire time is a great comfort to many. That’s especially true for first time mothers, for whom the experience can be naturally a bit scary.

Midwives have the medical knowledge and the available technology to handle any situation. Breech births, preclampsia and other potential complications are nothing new to a good midwife. They can carry out needed tests – for iron levels, blood pressure and the like. And they can seek additional help, acting as an expert liaison when a woman may have other things on her mind. All midwives have an active working relationship with an obstetrician.

Midwives can be found through recommendations from friends or you can seek one by contacting the American College of Nurse Midwives in Washington, DC. The ACNM website (http://www.acnm.org/) is a good place to start your search.

Pregnancy: What To Do When Labor Arrives

Jennifer — Tue, 20 Mar 2007 17:30:23 +0000

It can be difficult to know exactly when labor begins in earnest. But some signs are unmistakable. One such occurs when your new baby’s head exerts pressure on the amniotic sac and it breaks. When your ‘water breaks’ (the liquid isn’t just water, but amniotic fluid), labor is imminent.

Unfortunately, ‘imminent’ doesn’t mean ‘will occur within 10.5 hours’ or any exact amount of time. The time to the beginning of regular contractions and actual delivery, can vary enormously from woman to woman and even child to child.

Nevertheless, when you feel that trickle or gush of colorless fluid flow down your leg, it’s time to get ready. On average, labor will begin within 12 to 24 hours later. For some, the time is much sooner.

Note the time, wipe away the fluid and clean the vagina to minimize the risk of infection. Don’t bathe. Look for any green or brownish fluid, the meconium, which is from your baby’s bowel movement. That’s an indicator of fetal stress and should be reported to your physician immediately.

Contractions will follow shortly.

The uterus is a muscle and one of its roles is to force the baby out into the world through the birth canal. The contractions you feel are that muscle tensing. They will usually be preceded by dull cramps in the lower back or pelvis. When they happen regularly for an hour, lasting at least 30 seconds each, gaining in intensity, actual labor has started.

Since they can vary from woman to woman, try to verify that the contractions are labor by varying your position. Move around and sit. See if they still occur. Remember to keep a close eye on the clock or your watch. Timing the events is important.

First pregnancies will often take a little longer, so try to avoid any sense of panic. When contractions are coming five minutes apart for an hour, it’s time to head to the hospital. Err on the side of caution, though. The number is just an average and it’s best to avoid complications by being too early, rather than too late.

Severe pain, rather than regular (even if uncomfortable) contractions can be a sign of placenta previa. This is a condition in which the placenta can block the exit from the uterus. Or, the pain can be the result of placental abruption, where the placenta separates but limits the baby’s oxygen supply. Call your doctor.

Almost all labors proceed without incident. Stay calm, execute your plan and get ready for a healthy baby.

Pregnancy & Childbirth: Pain Control Options

Jennifer — Fri, 16 Mar 2007 17:26:09 +0000

Mothers report that few things are as painful, or as rewarding, as giving birth. How much pain, for how long and when varies enormously among individual women. But expectant women, especially when giving birth the first time, may want less pain in order to better enjoy the reward. For them, there are many choices.

Most experts and women agree that the less medication taken or anesthesia given the better, both for mother and child. When used the amounts are so low that problems are very rare, but anything that enters a woman’s bloodstream will affect the child during delivery. Training can help minimize the need.

Preparation well before the onset of labor is the first step. Lamaze or Bradley training is helpful, in order to learn good breathing and relaxation techniques. It’s difficult to focus on the process rather than the pain when you’re in the moment, but training can get her part way there. Attending with a partner is particularly helpful.

Some training involves learning focusing techniques – zeroing in on the need to push or the progress, rather than the discomfort. Others may emphasize distraction – counting, remembering a specific event clearly and so on. Those who have practiced yoga may find many of the ideas familiar. Several weeks practice before labor begins is a minimum, but there should be no substantial gap in time. Train up to the day.

Physical comfort can be enhanced by a variety of methods. Hot or cold packs can ease cramping. Sipping warm tea or ice water is sometimes helpful. That will need to be kept to a minimum, though. If general anesthesia has to be given, doctors will require minimal liquid intake beforehand. Anesthesia can produce nausea and vomiting. Disgorging under anesthetic is potentially dangerous, since it can lead to choking.

Some hospitals will use tubs of water or even showers to maximize physical and mental comfort during labor. A good soak can ease back tension and aid a sense of well being. Techniques like these don’t require any training or practice, just the ability to remember to use them when needed. A partner can help here, too.

Adjust your body as needed during the process. Talk over with your physician in advance his or her working needs and your options. Working together during the process is less stressful if things have been talked out ahead of time.

Still, there are women who experience great pain during birth, and it can vary from one delivery to the next. For those women, a range of medical options are available.

A general pain medication can range from over-the-counter remedies to mild narcotics. It’s important to be able to focus and participate during the process, so doctors keep the dosage to a minimum whenever possible. Stronger narcotics to ease pain can be used if necessary.

Local anesthetic is no longer an automatic choice. Studies revolving around the neurological effects on the baby have made doctors and mothers very conservative. But the types and dosages used very rarely present a problem. There’s no such thing as zero risk, but the odds are so low that this is a valid option.

A regional block, epidural or spinal, refers not to specific medication but simply the way it’s administered. The drug is injected into a space at the base of the spinal column. The purpose is the same: to numb pain in the vaginal and back areas where the pain is most intense. Here again, doctors are cautious but the option is still used safely in thousands of cases every year.

Explore your options well in advance so that on that golden day you can put your mind where it needs to be: delivering a healthy baby.

Labor, Signs, and Actions

Jennifer — Fri, 16 Mar 2007 17:25:31 +0000

Expectant mothers, especially those pregnant for the first time, often have doubts about when labor begins and what it feels like. That’s natural. Only experience can inform a woman exactly what it is, and even then one childbirth will vary from another. But being prepared by acquiring guidance can help ease concerns.

False labor is one of the trickiest issues pregnant women have to deal with. Packing the car, rushing to the hospital, disrupting a mate at work and more are all normal parts of delivery. Not generating false alarms is going to be high on anyone’s wish list.

The first step is simply to accept an inescapable fact: no one can predict with certainty when labor begins (yet). A due date is nothing more than a best estimate. Those estimates have improved with the greater accuracy of early pregnancy tests, but they are still not 100% reliable.

Only about 5% of women who carry their babies to term actually deliver on the estimated date. Dates vary from a few days to a few weeks before or after. That doesn’t mean that delivering early is necessarily delivering prematurely. There is simply a natural variation in how long pregnancy lasts. Due dates are specified for the average, that’s all.

There are some signs to look for that labor has begun, however.

During a first pregnancy, babies will often move slightly into the birth canal two to three weeks before the onset of labor. An attentive mother can detect that movement. It may be easier to breathe, due to the shift away from the diaphragm. At the same time, pressure on the bladder may increase, leading to more frequent urination.

Past the first child, this movement may be less pronounced, and will tend to occur much later, sometimes only a few hours before labor begins.

Throughout pregnancy, it’s normal to experience contractions. The baby moves, your muscles react. Hormonal changes induce neural events that lead to contraction. These random events don’t indicate much. But as the third trimester advances, they can increase in frequency and intensity.

As they come more often and stronger, mothers report they experience heightened energy and may feel compelled to take on projects around the house. Working off some of that energy is a healthy thing, particularly since (as the day approaches) they often just ‘want it to be over’.

A small mucus plug that sealed the cervix during pregnancy can stretch and break apart, even before ‘water breaks’. This pinkish mucus is a normal discharge. Deep red fluid or blood should be investigated at once as a possible sign of tearing of the placenta from the uterus.

Now is the time to get prepared for the final stages.

Childbirth: Delivery, What to Expect

Jennifer — Fri, 09 Mar 2007 17:24:53 +0000

Once the first stage of labor is passed, the placental sac has broken, the cervix has dilated and contractions are regular and frequent, the second stage of labor – actual delivery – begins. Of course, there’s no bright line dividing the first from the second. Where one leaves off and the other begins will vary from woman to woman and birth to birth.

There’s a wide variation among women in many aspects of the process. The length of time is different for everyone and from child to child. The amount of pain differs. And the post-birth consequences will vary for each individual person and baby. In 75% of women who carry to term, delivery is within 12 hours. Only 2% will be in labor for more than 24 hours.

During the active delivery phase contractions are frequent, though there are breaks in between. Here that training you spent so many hours to practice kicks in. Proper breathing technique differs between the resting phase and the contraction and pushing phase. Use both.

Drugs are an option but both mothers and physicians try to keep them to a minimum. Anything the mother receives still makes its way into the child. Pain medication crosses the placenta and can slow the baby’s heart rate and make breathing sluggish.

Analgesics are enough for most women, but they can produce side effects such as rapid heartbeat or nausea. A regional block may be appropriate for some women. This can offer pain relief without interfering with the ability to push, but it’s not for everyone. Hot pads, ice packs and a hand to hold can often substitute for the time needed to get through the toughest phases.

Develop a plan with your physician well in advance to cover all the possibilities.

Transition is the interval during which the cervix dilates the final two centimeters (about an inch). It produces the most intense and frequent contractions, but may last only a few minutes. Rarely is it longer than an hour. Here again, breathing techniques and a good partner are great aids to staying focused and minimizing pain.

Deep breaths are best for those resting periods, short and sharp ones for the period of active pushing. Shallow chest breathing is best for the most intense contractions. This helps keep the blood well oxygenated and the mother focused as well as possible on something other than the pain.

When the widest part of the baby’s head has moved into the birth canal, the second stage has begun in earnest. Contractions slow to four or five minutes apart. When the head is even with the lower pelvic bones, it’s said to be at ‘0′ station. It will progress through 1, 2, 3, and so on, measured by the baby’s exit.

The excitement rises as the baby becomes clearly visible. Tiring by this time is normal, but adrenaline helps keep most mothers at it during this final stage. Then, success!