Fetal Monitoring



Labor and Birth: What to ExpectFetal Monitoring Kathleen is in the hospital having her first baby. The rhythmic thump-thump of the external fetal monitor, which loudly projects the unborn baby's heartbeat into the birthing room, is reassuring to Kathleen and her husband. This type of monitoring is called Electronic Fetal Monitoring (EFM). It is commonly used to assess the fetal heart rate of a baby during labor. The fetal heart rate gives an indication of how the baby is tolerating labor and if he or she is receiving sufficient oxygen.During EFM, an ultrasound sensor is placed on the laboring mother's abdomen and is usually held in place by an elastic belt. It is commonly used in conjunction with a pressure-sensitive transducer to assess strength, duration, and frequency of uterine contractions. Together, they create a printout that shows a beat-to-beat reading of how the fetal heart rate changes during and between contractions.Hospital policies. Most hospitals have a rule that requires initial EFM for about 20 minutes. If the printout looks reassuring, some allow intermittent monitoring, either with the monitor strapped on or with a handheld ultrasound device called a Doppler. Some require monitoring during the entire labor, and some places want continuous EFM during labor to document any problem as a legal protection in case of a malpractice suit.For some women and their healthcare providers, continuous fetal monitoring provides reassurance of infant well-being during labor. Whether continuous or intermittent, electronic fetal monitoring provides information to healthcare providers on how the infant is tolerating labor. This information can lead to changes in the management of labor, for example, giving the mother oxygen, having her change position, stopping labor-inducing medication, and at times, quickly delivering the baby by forceps or by methods such as vacuum extraction or cesarean section.Continuous fetal monitoring for low-risk women. Continuous monitoring is beneficial to high-risk patients, including women induced with pitocin or women who have thick meconium (infant stool) in the amniotic fluid, but its benefits for low-risk mothers are unclear. Continuous EFM is used in the majority of births in the U.S., but studies have shown that continuous monitoring is not more effective than intermittent monitoring. Other studies have shown an increase in interventions such as vacuum extraction, cesarean sections, and the use of forceps for women who are monitored continuously, with limited benefit to the baby.According to Phyllis Rattey, CNM, of Special Beginnings Birth and Women's Center in Arnold, Maryland, the reason for the increase in interventions in the normal birth process for women who are continually monitored could be due to misinterpreting the monitor strip and jumping to intervene for a speedy delivery rather than looking for ways to help improve conditions for the baby. "Decreases in heartbeat are common during labor, especially during a contraction. By using a machine instead of midwives, nurses, and doctors to provide care, decisions might be made too quickly, instead of looking for simple ways to provide improved oxygenation for the baby," says Rattey. Both the American College of Obstetricians and Gynecologists and the U.S.Preventive Services Task Force say laboring women need some form of fetal monitoring, yet they reserve continuous fetal monitoring for high-risk cases. Continuous fetal monitoring for high-risk women. Many people think that continuous fetal monitoring should be used only when there are significant risk factors for complications. According to Connie Breece, CNM, of the Cambridge Birth Center/Cambridge Midwives, in Massachusetts: "EFM is useful when a baby is stressed, such as when there is thick meconium, the mother has a fever, or there is an obvious problem with the placenta, or when the baby isn't tolerating the stress of labor well. For healthy moms and babies in labor, intermittent auscultation of the fetal heart with a handheld monitor is sufficient."Most midwives and doctors would agree that high-risk patients should be closely monitored. "There is a role for this type of monitoring for women who are receiving labor inducing medication or for women who have not had reassuring fetal heart tones early in labor," Rattey says. She worries that this method of monitoring during labor places too much attention on a machine instead of taking cues from the mother. But for Kate Bauer, who delivered at New York Hospital in New York City, the fetal monitor strip "gave my husband, who is very scientific, something to focus on, and it helped him understand what was going on during labor and with the baby."According to Breece, "Many patients choose out-of hospital births to avoid monitoring and other interventions that might hinder labor."Intermittent fetal monitoring. In out-of-hospital births, and for many midwives and doctors, electronic fetal monitoring for low-risk women is used intermittently. The baby's heart rate is heard through a Doppler both during and after contractions, or for short-term periods with the fetal monitor attached to the mom. Some Dopplers can be used underwater, and this new technology frees the mother to use a tub or a shower to increase comfort."At the hospital and at the birth center, we carefully monitor the patients through intermittent monitoring during and after contractions, and we observe the amniotic fluid, the mother's temperature, and other signs," Breece comments.Karin Theophile of Takoma Park, Maryland, was induced during her first pregnancy because her baby was large. After a day of labor, the fetal monitor showed the heart rate decreasing during contractions, and she had a cesarean section. When she was attempting a VBAC (vaginal birth after cesarean) and being induced with her second child, she was very frustrated by all the "attachments"-the IV, the epidural and, worst of all, the tight straps of the monitor belts. Nevertheless, Theophile understands the importance of all of this technology and feels that it was necessary in her case. "The most important thing in labor is that you know the baby is okay and that you have a trusting support group," she says.Other forms of fetal monitoring. Internal monitoring is another form of electronic monitoring. It requires that the amniotic sac be broken spontaneously, or by the midwife or doctor, and that the women be at least 2 cm to 3 cm dilated. A scalp electrode is passed through the birth canal and attached directly to the baby's head. This type of monitoring provides a more accurate reading of the fetal heart, as you can pick up maternal heart rates or lose the signal during contractions or from the mother's movements.The newest type of monitoring uses telemetry and radio waves. A transmitter is connected to the mother's body, usually on the thigh, and fetal heart tones are transmitted to a remote area, usually at the nurses' station. Women in labor have more mobility and fewer wires and connections with this type of monitoring.Know your options. Each woman, birth, and healthcare facility have different needs and standards. It's most important for expectant parents to be familiar with the methods of fetal heart monitoring used by their healthcare provider and by the place where they will give birth. For example, a facility might be unwilling to conduct intermittent monitoring for a couple that wants it. Therefore, a couple's expectations for fetal monitoring during labor should be discussed during prenatal care, and if the facility or provider is unable to accommodate a low-risk patient, she might choose to give birth elsewhere. Women who are high risk, who are being induced, or who choose an epidural will be more likely to have continuous monitoring.*taken from "Heart Beats" by Lois Wessel, Every Baby magazine, Issue Four.Caesarean Sections Women have always had to make a number of important decisions in preparation for labor and birth: Where will I have my baby?Who will be my healthcare provider? Who will be with me to support me during labor and delivery?How will I deal with the pain in labor? But choosing in advance whether you want a vaginal birth or a cesarean birth was not one of the options - until now.Previously, the decision to perform a cesarean section was made only at the recommendation of your healthcare provider, based on medical conditions and critical issues of safety for you and your baby.Some physicians now offer the new option of an "elective cesarean section" or a "cesarean on demand." This means that some doctors permit a mother with a healthy, full-term pregnancy to schedule a C-section rather than go into labor and have a vaginal birth-even if the mother has had no prior cesarean deliveries and has no current medical indications.What's the justification? Proponents of elective cesareans suggest that the operation is as safe for the mother and the baby as a vaginal birth. Furthermore, some proponents reason that vaginal birth damages a woman's pelvic-floor muscles, which could lead to incontinence later in life. By choosing surgery, the argument goes, a woman might avoid the problem in her future.Even the most informed mother-to-be could be confused. Isn't a C-section a major abdominal surgery reserved for urgent medical situations? Isn't giving birth vaginally nature's way-and therefore the safest method for both the mother and her baby? The problem is that most of what is being said about elective cesareans is speculative at best and inaccurate at worst.An appropriately performed C-section can be a life-saving procedure for both a woman and her baby. Vaginal births are the norm, but sometimes a cesarean is the best way to have the healthiest birth possible when medical issues are present.But cesareans on demand? Is that like movies on demand? Will this be the era of fast-food healthcare? Drive-through deliveries?What we don't know. Changes in standard medical practice should be made only after studying the results of well-planned, controlled research studies. When thinking about elective cesareans, it's important to understand that we just don't have the scientific studies on which to base an informed decision. Here's why:Until recently, C-sections were mainly performed for medical reasons, such as arrest in the progress of labor, serious medical conditions that would preclude starting labor, or medical problems that developed during labor or delivery. The current information we have is derived from studies of these types of cesareans. You can't just apply those findings about risks and outcomes to this new use of the surgery, in which none of those conditions are present. It's like comparing apples and oranges.Also, most of the information we have about vaginal birth is derived from a mix of different kinds of vaginal deliveries. Studies that evaluate the impact of vaginal birth on longterm bowel and bladder incontinence involve researching women who birthed 20 or more years ago, when medical practices such as forced pushing, episiotomies, and the use of forceps were common. All such practices have been shown to significantly increase the risks for damage to the pelvic floor muscles. To date, there are almost no studies of vaginal births done without these practices, making the existing data very limited in its usefulness. Again, it's a mixed-fruit basket.And here's a twist: There have been well-documented studies that show that a C-section doesn't protect women from these complications. In comparisons of women over age 50 who had cesareans (or had no children at all) to women who had vaginal births, the rates of incontinence problems were the same.What we do know. It's simplistic and misleading to just list the risks of a C-section compared with a vaginal birth, because the risks described below - although well documented - generally derive from studies of all types of cesareans and almost never from first-time, elective cesareans. What we can do is divide the risks into two categories: 1. Risks that are likely to be present regardless of the reason the cesarean was done. These risks are applicable, even in an elective cesarean.Risks that exist for all cesareans, including elective:Longer hospitalization than for vaginal births More pain than with vaginal birthInjury to the mother from surgery, such as accidental cuts to the bladder or the uterus Injury to the baby from the surgery, such as accidental cuts to the baby's head Higher risk of the baby developing asthma Unexplained stillbirth in subsequent pregnancies Catastrophic complications such as an ectopic pregnancy (tubal pregnancy) and uterine rupture in the next pregnancy Placental problems that can threaten both the mother's life and the baby's life in the next pregnancy Problems with getting pregnant again and possibly an increased risk of miscarriage 2. Risks that can be related to, or made worse by, the medical reasons for which the cesareans were performed. An elective cesarean done without medical reasons might have decreased risks for these factors, but the risks remain to an unknown degree.Known risks of medically indicated cesareans:Maternal death Excessive bleeding or hemorrhage The need for an emergency hysterectomy (surgical removal of the uterus) Infection after birth o Problems with blood clots such as stroke or pulmonary embolism, which can be life-threatening Hospital re-admission for problems Respiratory problems for the baby Premature babies Other concerns. When thinking about an elective cesarean, some women consider other factors, such as convenience, pain avoidance, and future sexual satisfaction. But again, the answers are not black and white. Convenience and satisfaction: Having a baby in any fashion is an interruption in a woman's life. Being able to choose the timing of your birth is likely to prove to be a small benefit in the larger scheme of things. Ultimately it is a trade-off. Are the risks of elective abdominal surgery versus a spontaneous nature-mediated event worth the convenience factor?In Childbirth Connection's landmark study of elective cesareans, mothers were surveyed regarding maternal satisfaction with their birthing experiences. Women who had undergone cesareans were less satisfied (both at the time of birth and later) than mothers who'd had vaginal births.Pain avoidance: Whether one has labor pain or postoperative pain, the fact remains that childbirth will most always involve some pain, even with the use of narcotics and anesthesia.The Childbirth Connection survey found that women with cesareans rate themselves as having more pain overall than do mothers with vaginal birth. The pain of labor is limited. The pain of abdominal surgery continues for weeks afterwards.Bonding and breastfeeding: Cesareans result in delayed contact with the baby in the critical first hours after birth, postponing mother-child bonding. They also can make breastfeeding more difficult to establish and more challenging. Sexual satisfaction: Some women worry about the impact of vaginal birth on their sex life. While birth certainly impacts intimacy on a temporary basis, no evidence exists to suggest that it is the cause of long-term problems, nor that women who have cesareans face any fewer challenges.Long-term impact: While not all cesareans are avoidable, it is important to remember that having one cesarean not only affects you and your baby in this pregnancy, but can impact your ability to both get and stay pregnant the next time. Having a C-section can also affect the health of your future children and your own health during your next pregnancy and birth.For the best and safest birth. While the times have changed, one thing has not: The safest birth is still a vaginal birth that does not include labor and birth practices known to damage your pelvic floor. There is not enough information at this time to ethically say that an elective C-section is as safe or safer than a vaginal birth. And there is no evidence that birth by abdominal surgery protects women against incontinence issues in later life.Take the time to discuss your questions, concerns, and preferences with your healthcare provider. Ask for what you need. It is, after all, your body, your baby, your birth.Reducing risks in vaginal births. Certain labor-management and birthing practices have been proven to increase the risk of damage to a woman's pelvic-floor muscles, which in turn could increase her risk of incontinence later in life - although that correlation has not been conclusively proven by current studies.Labor-management practices.Pushing: Early pushing, before the baby has descended to the pelvic floor and the woman has a strong urge to push, can increase stress on the pelvic floor muscles and is associated with potential damage to the bladder connective tissue."Purple pushing": So-called purple pushing - where the mother is told to hold her breath and push to the count of 10, three times with each contraction - can lead to the woman being too tired to continue pushing. This increases the need for mechanical assistance, such as forceps or a vacuum extractor, both of which are associated with damage to the pelvic floor. What you can do: The timing and method of pushing in the second stage of labor are critical components to preserving the strength of a woman's pelvic-floor muscles. Don't push until you feel a strong urge to do so. In the case of an epidural, wait until the baby's head is very low (called laboring down). This will decrease the time needed for pushing, reduce stress on the pelvic floor, and increase effectiveness.Birthing practices.Episiotomy: Cutting the perineum has been proven to create short-term and long-term damage to the woman's pelvic support structure. Episiotomies often lead to "extension" tears that occur after the initial cut is made as the baby is born. These tears often lead to more serious injury.What you can do: Discuss your strong preference for no episiotomy with your healthcare provider. It is usually necessary to do one only in an emergency.Forceps and vacuum extractors: The use of forceps for vaginal birth significantly increases the risk for damage to the pelvic-floor muscles. The use of forceps and vacuum extractors are associated with the use of episiotomies, which also increases the risk of pelvic-floor injury.What you can do: The best way to avoid the use of forceps and vacuum extractors is to work with care providers who rarely use them. Birthing positions: Supine positions, where the mother lies on her back, put more stress on the pelvic-floor structure than other positions and can increase the potential for damage from the birth. What you can do: Try semi-sitting, squatting, side-lying, using a birth stool, hands and knees, or even standing while birthingWhat the experts say about elective cesareans The American College of Nurse-Midwives"The list of reasons women must not think surgical birth is as safe as a vaginal birth is long and ranges from increased incidence of drug-resistant infections, to the potential for life-threatening complications from blood transfusions. Women risk permanent damage to abdominal and urinary tract organs, longer recovery times, little to no chance for a subsequent vaginal birth, and a premature end to their ability to safely bear children."Childbirth Connection What Every Pregnant Woman Needs to Know About Cesarean Section provides the most complete review of what is known about the risks of elective cesarean section and proven techniques for avoiding unnecessary surgery. The American College of Obstetricians and Gynecologists"ACOG cautions that 'both sides to this debate' must recognize that evidence to support the benefit of elective cesarean is still incomplete and that there are not yet extensive morbidity and mortality data to compare elective cesarean delivery with vaginal birth in healthy women."The Society of Obstetricians and Gynaecologists of Canada"The Society of Obstetricians and Gynaecologists of Canada does not promote Caesarean sections on demand. The Society has always promoted natural childbirth and believes that the decision to perform a caesarean section during labor and delivery should be based on medical indications. At this time, there is no indication that a caesarean section carries less risk than a vaginal delivery for mother and baby. The Society is concerned that a natural process would be transformed into a surgical one, and that elective procedures would create added pressure on healthcare resources that are already overextended."Preventing and Detecting Preterm Labor The womb is the best place for babies to grow until they reach full term, which is usually between 37 and 40 weeks from the mom's last menstrual period. However, preterm births - those under 37 weeks gestation - have been increasing in the United States. In 1990, 10.6 percent of all births were preterm deliveries. This figure jumped to 11.6 percent in 2000 and 12.6 percent in 2005; far from reaching the March of Dimes goal of 7.6 percent by 2010. Some preemies suffer short-term problems that go away, while others have lifelong problems including respiratory difficulties, mental retardation, physical impairments, or blindness. Causes of Preterm Labor. While the cause of preterm labor and delivery is often unknown, many controllable lifestyle habits can be the cause, including smoking, alcohol and drug abuse, poor nutrition, and lack of prenatal care. Carrying twins, or problems such as uterine fibroids, cervical abnormalities, obesity, and infections, can also cause premature delivery. New studies indicate that moms with serious gum disease have a greater risk of giving birth to a preterm baby.However, Phyllis Rattey, CNM, points out that "moms often blame themselves for preterm labor, but in more than two-thirds of the cases, there is no obvious cause, and the mother did nothing wrong." The best ways to prevent the complications of an early delivery and a low-birthweight baby are to recognize the signs of preterm labor and to seek care from your midwife or doctor if the following signs occur between 20 and 37 weeks gestation:Regular contractions or tightening (even if not particularly painful) of your uterus every 10 minutes or more often Any spotting or bleeding from the vagina Menstrual-type or abdominal cramps Low, dull back pain Clear, pink, or brown vaginal discharge Pelvic pressure, as if baby is pressing down Slowing Preterm Labor. If you suspect you are in preterm labor, drink two to three big glasses of water, lie down on your left side, and call your midwife or doctor. If detected early, preterm labor can often be slowed; and every additional day that the baby is in the womb can be important. There are medicines to give the mother that can help the baby's lungs mature, and once born, a treatment containing the substance surfactant can be given to the baby. Testing for Preterm Labor. There are new tests available to help determine the risk of a preterm delivery. The fetal fibronectin exam tests the cervical secretions for a protein that attaches the amniotic membrane to the uterus; when this is present, it indicates that labor could start within two weeks. The salivary estriol test looks for a type of estrogen in the saliva which surges in the weeks before labor. These tests may help determine if a woman is at risk of a premature delivery. While not used routinely in all settings, these tests are more and more likely to be offered to women, especially those with a history of preterm delivery or those carrying twins or more. For women with a history of preterm delivery, additional good news might be on the horizon. The results of a new study presented at the last meeting of the Society for Maternal Fetal Medicine showed that women with a history of delivering a premature baby could reduce the risk of having another preemie with weekly progesterone injections.Guide to Emergency ChildbirthGiving Birth "In Place"A Guide to Emergency Preparedness for ChildbirthWhile most women do not go into labor during emergencies and most of those who do can get to a hospital or birth center, women and their families should know what to do if travel is not possible. Being prepared can help. The information here includes a list of supplies and directions for managing a normal labor and delivery while taking shelter in place.This is not a "do-it-yourself" guide for a planned home birth, nor is it all the information you need for every emergency. It is not meant to replace the knowledge and skills of a doctor or midwife. The information is a basic guide for parents-to-be who wish to be ready in case they have to give birth before they can get to a hospital or birth center.Call for help. If you think you are in labor, try to get to a hospital, birth center or clinic. If you are alone or travel seems unwise, call the emergency number in your community and ask for help. After you have called for help, keep your front door unlocked so that rescue workers can get in if you are unable to come to the door. Call a neighbor to come and help the family. If the phones are working, keep talking to emergency services or your health care provider who can "talk you through" a labor and birth.If your labor is going fast and birth seems near, stay at home and have your baby in a safe place rather than the back seat of the car. Fast labors are usually very normal, and the mothers and babies can both do well. Slow labors will give you time to get to a hospital or birth center, or for a health care provider to get to you. Get out your supply kit and put the supplies where you can easily reach them. As the helper, your job is to:Keep mom comfortable. It is good for her to walk, take a shower, get a massage, and move even if she is in bed Be sure she drinks lots of fluids. Water, tea, and juice are the best Be sure she goes to the bathroom every hour Say and do things that create a calm feeling, even if you are very nervous Wear gloves if you are going to be touching blood Wash your hands or gloves often Do not let pets into the labor and birth room. Talk to mom about the sounds of childbirth. Making groaning or crying noise during labor is okay and can help the mom-to-be. It can scare the helpers. So mom has to try to not scream and lose control and the helpers have to let mom make the noise that helps her cope Decide how to help other members of the family. Will they be present for the birth? What do they need to feel safe? Prepare the bed. To keep the mattress from getting wet, cover it and the sheets with a shower curtain and then cover the shower curtain with another clean sheet, plastic-backed under pads and lots of pillows for comfort. The mother may want to spend a lot of time in bed, or she may prefer to be on her feet or in a chair. Whatever feels best is okay.When the baby's head comes first. If you know your baby has been head down during the last weeks of pregnancy, chances are good that the baby will be head first at birth. This is the most common position for a baby. First labors can last for 12 hours or more while the next babies can come much faster. The urge to push. The longest part of labor is the time it takes for the cervix to open wide enough for the baby to pass into the birth canal or vagina (first stage). You can tell the cervix has opened all the way (fully dilated) when the mother has a very strong need to push (second stage). She cannot hold back that urge and may make sounds like she is going to the bathroom. Once she starts pushing, the baby can be born in a few minutes or a couple of hours. As birth gets closer, the area around the vagina begins to bulge out until the top of the baby's head can be seen at the vaginal opening. The mother should be encouraged to push the baby's head out gently in any position that is comfortable for her. She does not have to lie on her back in bed; but, you will feel safer if she is lying down or squatting so the baby can slip gently onto a soft surface.Put on your gloves and get in a place where you can see the baby come out. Remind mom to push gently even when she wants to push hard. As the baby comes out, mom will feel a lot of burning around the vagina and this is when she may make a lot of noise. After the head is born, look and feel with your fingers to find out if the cord is around the baby's neck. If you find a cord around the neck, this is not an emergency! Gently lift the cord over the baby's head, or loosen it so there is room for the body to slip through the loop of cord. The baby's head will turn to one side and with the next contraction the mother should push to deliver the body. If the body does not come out, push on the side of the baby's head to move the head toward the mother's back. The shoulder will be born. The rest of the body slips out easily followed by a lot of blood-colored water. If the head is born but the body does not come out after 3 pushes, the mom must lie down on her back, put two pillows under her bottom, bring her knees up to her chest, grab her knees and push hard with each contraction. After the baby is born, place her or him on the mother's chest and tummy, skin to skin, and cover both with towels. If the baby is not crying, rub her back firmly. If she still does not cry, lay her down so that she is looking up at the ceiling, tilt her head back to straighten her airway and keep rubbing. Not every baby has to cry, but this is the best way to be sure the baby is getting the air she needs. If the baby is gagging on fluids in her mouth and turning blue, use the baby blanket to wipe the fluids out of her mouth and nose. If this does not help, use the bulb syringe to help clear things out. Just squeeze the bulb, place the tip in the nose or mouth and release the squeeze. This will suck fluid into the bulb. Move the bulb away from the baby and squeeze again to empty the bulb. Repeat until the fluid is removed. If the baby is still not breathing, follow the CPR directions.The umbilical cord. There is no rush to cut the cord. All you have to do is keep the baby close to the mom so the cord is not pulled tight. If you pick the cord up between your fingers you can feel the baby's pulse. Within about 10 minutes the pulse will stop. At that time you can tie and cut the cord. Remember the cord is connected to the placenta (afterbirth) which is still inside the mother.The baby. At the time of birth, most babies are blue or dusky. Some cry right away and others do not. Do not spank the baby, but rub up and down her back until you know she is taking deep breathes. Once the baby starts to cry, her color will be more like her mom; but, her hands and feet will still be blue. Now is the time to keep the baby warm. Remove the wet towel that is over the baby and put another dry towel and blanket over the mother and baby. Put a hat on the baby. The mother can help keep the baby warm with her body heat. Put the baby to breast. Even if you did not plan to breastfeed, one of the safest things you can do for mom and baby is put the baby to breast. A breastfeeding baby helps keep the mother from bleeding too much and gets the food it needs right away. If the cord is too short to allow the baby to reach the breast, it is ok to wait until you cut the cord. Cutting the cord. There are no nerve endings in the cord so it does not hurt either the baby or the mother when it is cut. It is very slippery so take your time as there is no rush. Wash your hands, put on gloves then get the container with the scissors and shoe lace. Tie one of the laces around the cord very tightly with a double knot about three inches from the baby's tummy. The baby will cry when she is uncovered because she is cold, not because it hurts. Tie the other shoelace around the cord about two inches from the first knot. Pick up the scissors by the handle without touching the blades. Cut between the knots you have tied. It is rubbery and tough to cut, especially if you have dull scissors. After it is cut, place the end of the cord that is still connected to the mother's placenta into the mixing bowl. Cover the baby again to keep her warm. The placenta or afterbirth (third stage). The placenta looks like a big piece of raw meat with a shiny film on one side. On the other side it has membranes that are attached to the placenta (the membranes look like skin that has been peeled off). When the placenta is ready to come you will see a gush of blood from the vagina and the cord will get a little longer. Put the bowl close to the mother's vagina and put more waterproof pads under her bottom. Ask the mother to sit up and push out the placenta into the bowl.There will be a lot of blood and water coming after the placenta. Firmly rub the mother's stomach below her belly button until most of the bleeding stops. This will hurt but needs to be done. The heaviest bleeding should stop in a minute and then the bleeding will be more like a heavy period. If the bleeding increases again, very firmly rub the mother's lower belly until the bleeding slows. When it is firm, you will be able to feel the uterus (womb), which is the size of a large grapefruit, in the lower belly. A firm uterus is a good thing as it will stop the mom from bleeding too much.Mom's bottom and her uterus may be sore. You may see places where the mother's skin has torn around her vagina. Most of these tears will heal without any problems. Mom will feel better when you put an ice pack on her bottom where the baby came out then put the sanitary pad on top of the ice pack. She may want to take a couple of pain pills at this time. Put the placenta in a medium-sized trash bag and wipe off any blood on the outside of the bag. Put this bag into a second trash bag. Take the placenta with you to the hospital or birth center. If you cannot leave the house for over 4 hours, put the bagged placenta in a container with a lid and put it in the freezer. Clean up. After the mother has delivered the placenta and the bleeding has slowed down, give her a drink of juice, soup, or milk and something to eat like crackers and cheese or a peanut butter and jelly sandwich. Put on gloves to clean up the bed. Roll up the sheet and pads inside the shower curtain and put in a large plastic bag. Have clean under pads ready to cover the sheets and a sanitary pad for the mother. The dirty sheets and towels can be washed in cold water with bleach or ammonia added. Wear gloves when touching items that are bloody. Put a diaper on the baby or you will be sorry!Breastfeeding. It is important for the mother to breastfeed the baby in the first hour after birth and at least every two hours until her milk comes in. Breastfeeding will keep the uterus firm and decrease bleeding Colostrum, the liquid in the breasts right after birth until the milk comes in will give the baby all of the food she needs and it will help prevent infection Even if the emergency situation continues for days, weeks or months, there will always be a ready supply of safe and perfect food for the baby Getting started with breastfeeding. A newborn will nurse best in the first hour after birth when she is awake and alert. The mother may be more comfortable if she lies on her side with pillows under her head. The mother and baby should be face-to-face and belly-to-belly. The baby will also nurse better if they are skin-to-skin.The mother should place her nipple and breast against the baby's lips. The baby will lick and try to nurse. The mother needs to help out by placing her nipple into the baby's open mouth. It may take a few tries before the baby can start sucking. If the baby is sleepy, rub her belly and back firmly to wake her up. If the baby is too sleepy, try uncovering her for a short time and rubbing the mother's nipple against the baby's lips. If the mother gets tired, take short breaks and start again. Once the baby nurses for the first time it gets easier.If the baby sucks a few times then lets go and the mom has large breasts, mom may need to help the baby breathe by using her finger to hold some breast tissue away from the baby's nose What to avoid.Don't use a pacifier or a bottle to start the baby sucking. It confuses some babies because they do not suck the same on the mother's breast as on a bottle or pacifier. Do not separate the mother and baby for very long. The more they stay together, including when they sleep; the sooner breastfeeding will be well-established. Care of the mother. If you still cannot get to the hospital or birth center to be checked, the mother should go to the bathroom within an hour after the baby is born.If the room is cold, you can use the hot water bottle to help keep the baby warm. Just wrap the warm bottle in a blanket and place it next to the babies back. After birth in a hospital, women are usually offered Tylenol? or Advil? for pain every three to four hours as needed. This would be a good choice at home if the mother does not have an allergy to this medication. When a new mother gets out of bed for the first time, she may feel dizzy. It is important to have her leave the baby on the center of the bed and get up slowly:Sit up on the side of the bed to see how she feels Have an adult take her to the bathroom and wait to be sure that she is not feeling faint If she says she is going to faint BELIEVE HER and have her lie down on the floor. Do not attempt to walk her back to bed. You have about 10 seconds to get her down on the floor before she passes out and bangs her head on the way down! Once she is down flat she will wake up and feel better. Just wait a few minutes and then carefully help her back to bed. In a couple of hours the mom may want to take a shower. Be sure she has had something to eat and is not dizzy when she gets up. It is good to have someone close by as dizziness can return quickly. What to do for the mother and baby in the first two to three days. If you still are unable to get professional health care for several days, you can take care of yourself and your baby during this time by remembering the basic needs: eat, drink fluids, rest, and feed and care for the baby.Keep someone with you as a helper so you can rest most of the time. The helper should see that you always have plenty of fluids at your bedside and something to eat each time you breastfeed the baby. Keep ice on the vagina where the baby came out for the first 24 hours. To keep the area extra clean, pour warm water over the vagina every time you go to the bathroom.Check the uterus for firmness every few hours until the gushes of blood and/or clots stop and the baby is breastfeeding every two to three hours. Change the baby's diaper every few hours. The baby's first bowel movements will be a black and sticky (meconium) so be sure that diaper is on snug! The baby needs to wet at least once every 24 hours until the mother's milk comes in. After the milk is in, the baby will wet six to eight diapers a day. If the baby is not wetting, nurse the baby more often. Each time you change the diaper clean off the umbilical cord with cotton balls soaked with alcohol. The diaper should be placed below the umbilical cord to help keep it clean and dry (it turns dark as it dries). If the cord has a bad smell, a sign of infection, clean it with alcohol until the smell is gone.What if?The baby is coming bottom firstA few babies are born bottom first. You will probably not know this is the case until mom pushes and you see a bottom or feet and not a head coming out. At that time you must: Bring the mom's bottom to the edge of the bed and have her legs pulled up to her chest. Prepare a soft landing spot for the baby on the floor. Let the baby's body (arms too) come out without touching the baby. You will be looking at the baby's back. Yes, you have to let her little bottom hang down toward the floor even if you are afraid she will fall. If you have to touch something, grab another pillow for the landing zone. When the head slips out grab the baby under the arms and bring her up to the mom. If the baby's arms are out but the head does not come with the next contraction, you should have the mother get out of bed, squat and push. Key pointsAll parents-to-be should go toChildbirth education classes Infant/child CPR (cardiopulmonary resuscitation) classes Breastfeeding classes Parents-to-be should keep the family carIn good repair Filled with gas If you have to labor at home during a terrorist attack or other emergencyCall your midwife or physician Call for an ambulance Call a neighbor to help you Unlock the front door Keep these instructions and the birth supplies handy! Women in labor need lots of encouragement and need helpers who are calm, positive and caring. No matter what is happening in the rest of the world, it is important to keep the room peaceful and to focus on the mother's needs. She needs support and reassurance to do the hard work of labor. Be there for her and her baby.DisclaimerThe information provided in this document is not a do-it-yourself guide for a planned home birth, nor is it all the information you need for every emergency. Following these directions will not replace the knowledge and skills of a doctor or midwife and cannot assure a safe outcome. The information is a basic guide for parents-to-be who wish to be ready in case they have to give birth before they can get to a hospital or birth center. In all cases, it is critical that you attempt to make contact with a trained health care professional. Cope with Labor Pains, Naturally An unmedicated labor doesn't mean a labor without pain relief. ? Barbara had an epidural for her first birth. It was a good birth, but not quite what she'd wanted. For her second baby, Barbara chose a midwife. When the midwife met her at the hospital, Barbara was deep into her labor, walking, holding her husband with each contraction, working hard, but coping. About an hour later, she asked for an epidural. "You may not need one," the midwife suggested, remembering that Barbara had wanted an unmedicated labor. Barbara insisted. But before the epidural was placed, the midwife examined her again and determined Barbara was ready to push.Sure enough, Barbara was fully dilated, and agreed to bypass the epidural so that she would feel the sensations to help her push her baby out. She expressed great satisfaction afterward. "I did it," she proudly told her midwife, as she nursed her newborn son. A few years later, Barbara had a third child. With this labor, she never asked for an epidural. "For my second birth," she explained, "it was important to know the epidural was available. But once I knew I could do it, I didn't need that."Many women feel like Barbara. They may want to avoid exposing their babies to drugs, however small the dosage. They may want to be fully present in the labor and delivery experience--to feel all its sensations. They may want the challenge, similar to the way a marathon runner wants to run the race. Experiencing an unmedicated labor and birth can give a woman the same feelings of accomplishment and exhilaration as crossing the finish line. But an unmedicated labor does not mean a labor without pain relief. There are many ways to help you cope with labor pains that do not involve drugs.Emotional Support. Research shows that having someone to support you during labor can shorten labor and reduce the use of pain medication. Labor and delivery nurses are one source of support. A loved one can provide more emotional support by coaching or even kissing and caressing. Your physician or midwife, of course, will be another source of support. Midwives are particularly known for providing attentive and comforting labor care.A doula (or monitrice) is another option. The doula's job is to be on call to provide support and comfort. They meet patients before labor, so they are familiar and comfortable with them before labor starts.Relaxation. Practicing relaxation before labor pains begin will help you stay calm during the throes of contractions. To practice, lie down in a comfortable position with pillows under all joints. Have a partner "talk you" through relaxing each muscle. Tense, and then relax, all body parts. Your helper can test your relaxation by lifting each limb, one at a time. If you are truly relaxed, the limb will drop as soon as your helper lets go.To prepare for labor, practice tensing one body part, such as an arm or leg, while the rest of the body relaxes. Include not just the muscles of the arms and legs, but the smaller muscles in your face, hands and feet. In labor, your support team can watch out for tension. During the prenatal practice sessions, you can try responding to a gentle touch or a reassuring word. In labor, if your partner sees your toes curl, for instance, he or she can whisper in your ear and touch your feet and you will immediately uncurl them.Breathing is integral to relaxation. Deep breathing provides the best oxygenation for the fetus, and it calms the body. Some women attend yoga classes, or practice yoga with the aid of books, tapes or videos. Vocalizing is a good release, too. Chant, hum, or moan.Soothing Atmosphere. Make your environment comforting. Choose soothing music and become used to relaxing to it, then bring the music to the hospital or birthing center. Have the center dim the lights and adjust the temperature to suit you. Wear comfortable clothing. Ask your support team, birthing-center staff, or hospital staff to be quiet, especially during contractions.Movement. Unless you need continuous electronic fetal monitoring, you should be able to move around. Avoid lying flat on your back--it interferes with blood flow to the fetus and constricts the pelvis, making labor more painful. Use pillows to support your joints. Find out in advance if you can bring extra pillows for labor. Use the bed or your partner as a leaning post. Try the hands-and-knees position (as if you were going to crawl), but on the bed. Experiment with walking, rocking back and forth, or swaying during contractions. Change positions frequently.Birthing balls. Birthing balls are large, inflatable rubber balls that are used in exercise classes or children's play groups. In labor, you can sit and relax your back against the ball (with the ball supported by the wall or your partner) or lean your belly over the curve of the ball from a hands-and-knees position. Find out if you can bring a birthing ball to labor, or if one will be available.Visualization and affirmations. Visualization involves creating mental images of the body letting go, the cervix thinning and opening, the baby moving down in the pelvis. There are visualization tapes available, but you can make your own tape, or have your partner or somebody with a soothing voice make one for you. Talk to your body as part of the visualization, and talk to the baby. Use familiar pictures of openings--a flower, a butterfly emerging from a cocoon. You might include relaxing images other than labor. Imagine the baby's smell, its softness, the noises your baby boy or baby girl will make.Play your visualization tape during the final weeks of pregnancy. Incorporate it into relaxation sessions, use it to help you unwind at day's end, or fall asleep listening to it. Bring the tape to labor. Some people include affirmations in their tapes or simply repeat them before and during labor. "I will birth my baby." "My body is uniquely adapted for birth." "Labor will bring my baby to me." Create your own affirmations, using phrases with personal meaning.Heat and Cold. Some women prefer applications of heat, others prefer cold. Sometimes alternating between the two works best. You might try placing an ice pack on your lower back or a heating pad on your lower abdomen. However, don't apply heat to skin that is covered with lotion or ointment--it might burn.Massage. Effluerage is a gentle massage, used during or between contractions. You or your partner can glide the tips of the fingers in an up-and-down or circular motion on the uterus. Late in labor, however, even effluerage may be too much pressure for the uterus. Back massage is good for back labor and general relaxation. Your partner, midwife, or doula can be the massage therapist. You will need to guide them on whether you prefer light or deep strokes, or both. Deep pressure can be applied with the palms, the thumbs, or the fist. Muscles can be kneaded between the thumb and fingers. Massage strokes should be continuous, rhythmic, and definite, going from up to down and down to up without lifting the hands. Hands may slide more easily over a thin T-shirt or nightgown than over bare skin. Lotion, powder, oil, or witch hazel can help the hands move on skin. Don't forget the neck, head, face, feet, and hands. They can tense during labor.Water Immersion. A warm bath, a Jacuzzi or a shower is comforting. Recent research has shown that water immersion does not increase the chances of infection. But don't try getting in or out of a tub without assistance! In bed, a sponge bath may be soothing. Soaking your feet may be relaxing, even if you only sit at the bedside and immerse them in a basin.Hypnosis. The goal of labor hypnosis is to reduce anxiety, facilitate labor, and relieve pain. No form of hypnosis works for everybody. Certain individuals are more susceptible to hypnosis than others. The technique should be tried before labor. Books are available to help you with self-hypnosis.Aromatherapy. Aromatherapy uses the soothing scents of essential oils, extracted from flowers, plants, trees, roots, and fruit. Health-food stores and many pharmacies sell these oils. Lavender, sandalwood, chamomile, melissa, geranium, rose, and orange oil may be relaxing or refreshing. You may not be able to bring candles to a hospital, but you can use the oils in a tub for massage or as a compress. Dilute the oils; some women (and partners) get headaches from too strong a scent. Six drops in a bathtub is sufficient, and half that makes a good compress. Try the oils before labor to make sure you don't have a reaction to them.Acupuncture and Acupressure. Acupuncture is a Chinese healing technique utilizing the placement of needles to stimulate and heal. Acupressure or shiatsu is a massage technique in which the body is stimulated by touch. The Ho-ku and Spleen 6 points correspond to the uterus and cervix. Stimulating these points may relieve labor pains. The Ho-ku point is on the back of the hand, at the V formed by the thumb and the index finger. The Spleen 6 point is about the width of four fingers above the inner ankle on the shin. You press with the tip of the thumb from behind your leg, in and towards the front of the leg. Pressure is advised for ten to 15 seconds, three times, with a brief rest between each application.Transcutaneous electrical nerve stimulation (TENs). TENS is the application of small doses of electrical stimulation to nerve fibers. This is believed to cause the body to produce its own pain-relieving substances. Electrodes through which the current travels are taped to the lower back. TENS is most effective in early labor. Some hospitals have TENS machines and some childbirth centers rent them.Sterile Water Papules. Sterile water papules are used for the relief of back labor. A midwife, a nurse, or a physician will inject a small amount of sterile water into four areas just under the skin of the lower back. This is thought to provide nerve stimulation that distracts you from pain. The injections sting a bit. They can provide relief for two to three hours and can be repeated.Most women find they need a variety of techniques to help relive labor pain. Ask your support team in advance to remind you to move around, to breathe, and to ask you how they can help. If one technique doesn't work, try something else. With confidence, a little practice, and support, the pain of labor becomes quite bearable.* taken from "Sweet Relief," by Ronnie Lichtman, CNM, Every Baby magazine, Issue Four.Don't Just Lay There, Move! As many women have learned to their advantage, labor is not something to take lying down. Jenn Riedy of Allentown, Pennsylvania, would agree. After many hours of slowly progressing labor, Jenn's doula (a woman trained and experienced in labor-support techniques) persuaded her to get on her hands and knees. Soon Jenn's cervix was fully dilated, and she was feeling the urge to push. Jenn eventually became a doula herself and returned the favor to her very first client. The woman had been laboring for many hours. Pitocin, a medication used to stimulate stronger contractions, hadn't helped much. But once Jenn talked her into trying hands-and-knees, her client rapidly completed dilation.Speeding up labor. A variety of positions and related activities promote labor progress. According to The Labor Progress Handbook by Penny Simkin and Ruth Ancheta, positions and activities can correct a poorly positioned baby--almost certainly Jenn's and her client's problem--as well as line up the baby, the cervix, and the pelvic outlet so that the forces of labor work more effectively, make more room in the pelvis, and improve contraction quality. In most cases, they also ease pain. What's more, adds Saraswathi Vedam, CNM, an assistant professor of nurse-midwifery at Yale's School of Nursing, free mobility helps women feel in control and increases confidence. Finally, positioning and activity can avert the need for riskier interventions such as Pitocin, vaginal instrument delivery, or cesarean section. So, if you're not going to lie down on the job, what should you do? Here are some guidelines:Take advantage of gravity. Forward-leaning positions or positions like hands-and-knees that put your back parallel to the floor can swing a posterior baby (the back of the baby's head lies toward the back of the mother's pelvis) into the more favorable anterior position (the baby's face lies toward the back of the mother's pelvis). An upright torso can bring the baby's head down to help open the cervix during the dilation phase and help the baby move down and out during the pushing phase. (To see why you want gravity working for you, heft a gallon of milk or water--about the weight of the average newborn--to see how much force this exerts.) A vertical torso can be achieved standing, sitting, kneeling, or squatting. Sometimes you might need to get gravity out of the way as, for example, when pressure on the cervix causes a premature urge to push. Hands-and-knees, side-lying, and knee-chest (rump in the air) positions are all good for this.Rock and roll. To get a cork out of a bottle, you wiggle it. The same principle applies to babies. On hands and knees, you can rock your pelvis by tucking your tail under like a bad dog or rock your body forward and back. Standing, you can slow-dance with your partner, sway from foot to foot, circle your hips, or climb stairs. Ancheta adds that repetitive movement also soothes pain.Use your legs as leverage. Vedam notes that open-leg positions open the pelvic outlet by as much as an additional 30%. Vedam studied squatting to push and found that the combination of upright torso and wider pelvic outlet shortened the pushing phase by more than 20 minutes for first-time mothers compared with the conventional semisitting posture. Other open-leg options include lunging to one side, sitting with one leg over the arm of a chair, or kneeling with one leg up, one down.Avoid lying flat or nearly flat on your back. In this position, the weight of your body and baby compresses the major blood vessels serving the baby, diminishing oxygen supply. On your back, gravity holds the baby in the unfavorable posterior position, and the weight of your body against the bed prevents your sacrum, the flat plate at the base of your spine, from flexing open. Pushing while on your back means you're pushing your baby uphill.Use variety. Shifting from position to position might be the best method. What feels best almost always is best. Exception: if the labor isn't progressing, it might be necessary to stir things up--and occasionally, what is effective might be uncomfortable. If so, try it for a limited time-say, five contractions. If it hasn't helped by then, move to something else.With long labors, alternate activity with rest. Vedam likens long labors to a marathon--pace yourself. Rest positions include lying on your left side in bed, sitting in a comfy chair, or reclining into your partner's arms. In a long labor, remember that most problems with progress will resolve. Time is your friend.When factors limit mobility, be creative. The need for electronic fetal monitoring needn't keep you in bed. You can sit or stand. An IV can be hung on poles with wheels. If you must be in bed, you might be able to sit, kneel, get on hands and knees, or squat. At least lie on your left side, not on your back. With an epidural, sit up or lie on your side. Few women walk with the so-called walking epidural, but a light epidural can permit you to sit in a chair, get on hands and knees, or even squat with safeguards against falling.Do what comes naturally. As Vedam observes: "The most important thing is to listen to your body. When you're uncomfortable or the labor is not progressing well, the first thing to try is a position change. The evidence is clear that activity and upright position promote both comfort and progress."A Supportive EnvironmentYou're in good company in insisting on freedom to move about. Care in Normal Birth, a World Health Organization publication, states: “For both the [dilation] and [pushing] stage, women should be encouraged to experiment with what feels most comfortable and should be supported in their choice.” The Coalition for Improving Maternity Services’ Mother-Friendly Childbirth Initiative says that a mother-friendly hospital, birth center, or home birth service “provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor, unless restriction is specifically required to correct a complication.” When Labor Slows There I was: six days past my due date and feeling as bloated as a whale. So when my first labor pains began at 3 A.M., it was a relief. A recent exam had been encouraging; I was 2 centimeters dilated and the baby was in "take-off" position, head down and engaged. The contractions came about 20 minutes apart throughout the early morning but then abruptly stopped at 9 A.M., just as I was about to call my midwife. By afternoon I was desperate, so my midwife suggested I try taking castor oil. It was disgusting. It gave me a brief bout of diarrhea, but lo and behold, labor started quickly at 8 P.M. I soon delivered a healthy baby girl. If pregnancy sometimes feels like your own personal odyssey, then the start of labor signals the last leg of the journey. With the end in sight, it becomes even more frustrating when labor doesn't follow a progressive course. "Slowing down happens most often in early labor," says Sylvia Blaustein, a certified nurse-midwife who practices in New York City. "It also is more likely to happen to first-time moms." During early labor (also called the latent phase) the cervix becomes fully effaced and dilates to 4 centimeters or so. Contractions can be irregular and are usually mild. "You hear people say, 'I've been in labor for five days,'" says Allen Toles, an obstetrician-gynecologist at Long Island Jewish Hospital in New York, "but they really haven't started active labor."Active labor is when contractions increase in frequency and intensity and the cervix dilates from 4 centimeters to 10 centimeters. Toles says that women who are nearing or past their delivery dates sometimes mistake strong Braxton-Hicks contractions for the real thing. Others might notice labor sooner, staying awake with five-second contractions that are 20 minutes apart, for example. When the pains stop or slow down, it seems like labor has halted. Although early labor may stall, women should be assured that it is helping the body prepare for birth. During these fits and starts, the uterus is contracting and the baby is moving into a good position for birth. But if early labor stalls after the 41st week, practitioners suggest some techniques to start it again.The simplest one is to relax; have a warm bath and get some rest. Now is the time to pamper the mom. She deserves a back rub, a foot massage, a comfortable bed, and relaxing music. Disconnect the phone and, if possible, send the other children to a friend's house. "I've seen it work really well; a woman rests and things suddenly pick up," says Blaustein. Once a woman is rested, she can try to get labor going by taking walks, climbing stairs, or even having sex. If a woman's labor is slow or stalled but she has already started dilating and the baby is in a good position for birth, some midwives recommend taking castor oil. This unpleasant oil can cause diarrhea, but it doesn't hurt the baby and can be effective at starting up contractions.A more pressing reason (than being overdue) to get labor going is that a woman's membranes have ruptured. Most hospitals set time limits once this happens. At Virginia Mason Medical Center in Seattle, where nurse-midwife Judy Lazarus practices, the policy is that women need to begin active labor-either by medical induction or on their own-24 hours after membranes rupture. In some practices, routine management of ruptured membranes includes the expectation that women will deliver within 24 hours. The reasoning behind this decision is that the risk of infection rises once the amniotic sac is broken. This is especially true for women with certain medical conditions, or if the woman has had several pelvic exams to check the cervix.Lazarus had a patient whose membranes ruptured at 8:30 A.M. on a Tuesday. An exam showed no problems, so the woman returned home, where she spent the night having mild contractions. By the time Lazarus saw her again, 30 hours had passed and they began to discuss using Pitocin, a drug that is used intravenously to induce or augment labor. The woman was set against using Pitocin, worried that it could lead to other medical interventions. Instead Lazarus did an internal exam where she stretched the cervix. She told her patient that she'd let her go another nine hours, then she'd have to start Pitocin. The woman walked for several hours, rested, then she and her husband did nipple stimulation for an hour and a half-it's a natural way to get the body to release oxytocin, the active ingredient in Pitocin. It worked: Four hours later, Lazarus' patient delivered a healthy baby girl.Jennifer Hammer, 32, also of Seattle, had planned to have her baby at home. Then her labor failed to speed up 48 hours after her water broke, she used acupuncture treatments and also took black cohosh, an herb believed to induce labor. "It was by far the easiest labor I had," says Hammer, mother of three. If labor slows or stops altogether during its active phase, it can signal a problem; the pelvis might be too small to accommodate a large baby or the baby might be in the wrong position to descend further. There is clinical evidence that epidurals, given to relieve pain, can also stall labor, says Toles. Sometimes dehydration can prevent labor from progressing, so simply supplying fluids can get labor going again. Obviously, if labor fails to progress and the mother or baby begins experiencing problems, it is imperative to get labor going as quickly as possible, usually by augmenting with Pitocin.In the end, labor is an individual experience. Some women progress quickly through every stage and deliver after just six hours of contractions. Others poke along in early labor for several days or go back and forth to the hospital while contractions begin and then stop. Just as every labor is slightly different, so too are practitioners' attitudes. Talk to your midwife or doctor beforehand about issues such as how long to wait for delivery after your water breaks or what techniques they might use to augment labor.Induction. The rate of induction more than doubled between 1989 and 1998, the most recent date the figure was actually calculated. When a woman is induced, she has technically not begun labor. If labor has begun and a woman receives Pitocin, that is called augmentation. According to Richard Henderson, an obstetrician/gynecologist at St. Francis Hospital in Wilmington, Delaware, the reason for this increase in the number of women being induced is that "we have much better antenatal testing, so we are able to identify fetuses in trouble before a woman goes into labor."More precise and detailed ultrasound exams are able to show if a baby is not growing or moving adequately. There are other reasons for inductions. In Lazarus' practice, post-date pregnancies and ruptured membranes are the most common reasons for induction.Although a mother and baby can be doing well after the delivery date, careful monitoring is necessary to be sure the placenta is still nourishing the fetus and that there is adequate amniotic fluid to cushion the baby. Practitioners will also check the mother's blood pressure and other vital signs. In some cases, practitioners are now less willing, in these circumstances, to wait for a woman to go into labor on her own. Part of that is worry about lawsuits, says Toles, and part of it is that induction techniques have improved so that the risks of waiting outweigh the risk of inducing.Elective inductions. A final reason for increased inductions is the rise in elective inductions-cases in which either the prospective parents or a practitioner choose the procedure for nonmedical reasons. Examples include a woman who lives far from the hospital and is worried she won't make it in time once labor begins, or another woman who is feeling a lot of discomfort late in her pregnancy or may have a partner who is available only at certain times. Jodi Brumble, a home-healthcare marketer in Scottsdale, rizona, found out that her doctor was going to be away at the time she was due to deliver. She decided she wanted to have him induce her before he went away because she feared delivering with a stranger. Elective induction is not risk-free. Studies show that it leads to more cesarean deliveries in women who are having their first babies and significantly increases the length and costs of hospital stays.The chances of a successful induction increase greatly when a woman is already somewhat dilated, the baby's head is engaged, and the woman has already had one previous vaginal birth. In some cases, practitioners will use creams or suppositories that contain prostaglandin-hormone-like substances that "ripen" the cervix, causing it to thin and dilate. The cervical-ripening agents alone can sometimes start contractions, but more often Pitocin is needed to get active labor going. Because Pitocin can cause more intense contractions, most women choose to have pain relief-either Demerol or an epidural-while they are being induced.Induction can also cause a cascade effect of unintended interventions, especially in first births. A Pitocin-induced labor is more painful, and the mothers often request pain relief earlier in labor. When epidurals and narcotic-like drugs are used, it can slow the progress of labor, and higher doses of Pitocin are needed to move the labor forward. Pitocin can cause enough distress in the baby that additional interventions, such as forceps, vacuums or a cesarean section are needed for the baby's safety. That is why elective induction in a first-time mother should be carefully evaluated.Meeting Your Baby: What to Expect Let’s be honest: The first newborn picture seldom makes it into the baby album. The birth process is messy. Most babies are dusky at birth, and their first reaction to the world outside the womb communicates just how startling it must feel, even with the most gentle birth. A newborn’s crying is a very normal reaction to going from night to day, from a warm cocoon to what must feel like a free fall, and from sounds that are muffled by layers of skin and fluid to direct human contact with voices that are, undoubtedly, very excited.His umbilical cord is still attached and his skin looks gooey and messy. But he’s covered with a natural protector called vernix, and he has picked up some naturally occurring blood from the birth canal. His eyes and genitals are swollen. His natural instinct to cry can be just the right thing during this period; he needs to take deep breaths to help bring out his natural color. Amazingly, within 30 minutes, this baby is ready to pose for the heartwarming picture we all expect. Much of his vernix is absorbed while he has his first feeding. The blood is easily wiped off and the swelling starts to decrease immediately. His umbilical cord has been cut and clamped, he obviously feels very secure in his new surroundings, and he is ready for a nap. His little legs are still used to being cramped close to his body, and he has even begun to peel a layer of skin off of his feet. Look closely, because in another 30 minutes he will change again. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download