Archive | July, 2016

Mother-Baby Dyad: Snuggle to Heal, Grow & Thrive

27 Jul

We’re on the home stretch in our “11 Ways to Prepare for Your Best Birth” series and only have 2 left!

#10 Keep mother and baby together, with lots of skin-to-skin – it’s best for mother, baby, and breastfeeding

To clarify the title of today’s post: Think of the mother and baby as one unit in the first 3 months of baby’s life; we call it the “mother-baby dyad”. They need almost all the same things in the postpartum period — lots of snuggling, nourishment, rest, support, love.

I previously wrote a blog post on this topic after attending an all-day class with renowned perinatal neuroscientist and neonatologist Nils Bergman, so will refer you to it here: Snuggle with Your Baby: Benefits of Skin-to-Skin. The focus of that post was mostly about the benefits to the baby of skin-to-skin (aka “kangaroo care”).

I want to also detail a few benefits of this closeness for the mom (or non-postpartum/breastfeeding parent or family member, for select bullets):

  • Helps parent to bond and connect with baby
  • Helps parent get to know and understand their unique baby and baby’s more subtle signs in an acute and helpful way
  • The closer baby can stay to breastfeeding mom, the more restful it is and therefore the more conducive to healing from giving birth
  • Thanks to oxytocin (the “love” hormone) produced by skin-to-skin and, in even greater amounts, through breastfeeding helps mom feel happier and more relaxed, thereby reducing the chance of suffering from postpartum depression
  • The oxytocin is also helping your uterus heal, helping shrink your uterus (called “involution”) toward its pre-pregnant size each time you feed your baby in the first few weeks
  • The more mom can hold your baby skin-to-skin, the more frequently baby will tend to breastfeed, which bodes well for a healthy milk supply

I want to acknowledge that there are instances in which mom is not available to hold baby skin-to-skin, and absolutely it’s still helpful from a physiological perspective for dad, partner, or another family member or friend to hold baby skin-to-skin. So boost those endorphins and have fun snuggling away on your sweet baby!

More reading

Snuggle with Your Baby: Benefits of Skin-to-Skin (Birth Matters NYC)
7 Reasons To Be Skin-To-Skin With Your Baby After Birth
 (Mommypotamus)
Skin-To-Skin Care After Birth: A Practical Guide (Mommypotamus)
Birthful podcast: Ep. 56, SylviaHouston, Skin-to-Skin
Video: Dr. Nils Bergman on Skin to Skin
http://ninobirth.org/
http://www.skintoskincontact.com/home.aspx
http://www.kangaroomothercare.com/
Giving Birth with Confidence (Lamaze) – The Wonder of Mothers: Skin-to-Skin Care
Video: Keep Your Baby with You After Birth
Birthful podcast: Ep. 56, SylviaHouston, Skin-to-Skin

 

Push it, Girl, Push It Real Good: 2nd Stage of Labor

20 Jul

Okay, so I totally just revealed that I was product of the 80s and cheese out on that era of music (she says, referring to the post title’s nod to the 1987 Salt n Pepa song)! We’re up to #9 on our 11 Ways to Prepare for Your Best Birth series:

#9 Avoid giving birth on your back, and follow your body’s urges to push

Today we’ll talk about the 2nd stage of labor, in which our uterus is pushing the baby down and out and we get to meet our sweet baby.

Avoid giving birth on your back

First: Avoid giving birth on your back (also known as “dorsal lithotomy”). I’ve never worked with nor heard of a laboring woman who, if left to follow her body’s instincts, would choose to lie down on her back. Isn’t it kind of bogus that we tell women in pregnancy to stay off their backs for so many weeks and then in labor we order them to get on their backs to push a baby out? A woman should be allowed to have full freedom of movement and choose whatever positions she finds most instinctive and least uncomfortable throughout her labor, including the pushing stage. This will virtually never mean lying on her back.

Here are a few reasons lithotomy (either flat on your back or semi-reclined) doesn’t feel right to a laboring woman at any point in labor—especially during pushing:

  • In labor, we often have discomfort in our backs, and lying on our back only increases that uncomfortable sensation
  • Lying on the back is the most closed position for the pelvis; our wise instincts lead us more often to sit, squat, or get on all fours — significantly more open positions for the pelvis.
  • The vast majority of us, at least in our adult lives, have never passed a bowel movement while lying on our backs in bed. A laboring woman often pushes with the contractions very effectively while upright or sitting on the toilet because that’s where she’s used to coordinating her abdominal muscles and releasing the pelvic floor ones. Then if a care provider comes in and disrupts that process by ordering her patient on the bed, suddenly when she’s out of the familiar territory she feels totally disoriented. This is normal and to be expected, so I’d say, “just say no!”

Actually, that’s a little late for the communication. I would recommend doing that if you must, but it would be better for you to have conversations with your care provider now, prenatally, about this point in labor and get a sense of how flexible your care provider is for the moments of baby’s head crowning and for baby’s birth. In a hospital setting, most OBs/midwives aren’t there with the laboring woman for the earlier stages of pushing until the baby is very close to crowning, at which time they’d come to stay with you until an hour or so after the baby’s birth. For the early stages of pushing, one or more nurses would be the continuous support, monitoring the descent of baby through the birth canal and getting your care provider when it’s time. So, in an unmedicated birth there’s usually a good deal of freedom of movement until the OB/midwife comes. This is assuming, of course, that you get a natural-friendly nurse (tip: request this if you’re hoping for an unmedicated birth upon arrival at the hospital in labor).

Follow your body’s urges to push

When a woman’s labor progresses to the degree that her cervix reaches 10 cm dilation (=openness of the cervix) and 100% effaced (no lip/edge of the cervix in the way of the baby’s head), which we also call “complete”, it signifies the end of Labor Stage 1 and entering Labor Stage 2 (Pushing).

For many unmedicated women, around the same time she’ll get an uncontrollable, overwhelmingly strong urge to bear down and push. This urge can be hugely helpful for women, particularly when it’s our first time to experience labor. It takes the insecure feeling of, “how in the world do I do this?” out of the equation entirely because the urge is SO strong and helpful.

It’s equally normal for other unmedicated women’s urge to take a while to be triggered. If you find yourself in this latter camp, here are my tips for you:

  1. If hospital staff are pressuring you to push immediately, ask if there’s any reason you can’t wait to actively push until the urge is triggered. (In the mean time, your uterus will continue to do lots of that work for you.) That is, there’s no rush to start actively pushing just because you are “complete”—contrary to what hospital staff might make you think due to their being stuck in their ways of regular all-too-impatient protocols.
  2. Change positions. Often the simple act of changing position can trigger the urge. (It’s a good general rule of thumb in labor, in fact: When in doubt, change positions to encourage progress.)

In a hospital setting, the nurses are accustomed to the majority of women getting the epidural and therefore not feeling this natural, instinctive urge to push. Therefore, they are trained to default to a highly coached, loud method of the “valsalva maneuver”, aka “purple pushing” because women are encouraged to bear down vigorously and hold their breaths for unnaturally long periods of time. With this method, nurses loudly and slowly count to 10 while yelling, “harder, harder!…that’s good!…go, go, go!” and often scold the laboring woman if she lets her breath go before they reach 10. For most women, this coached method will really only be needed if a) we’re rushing things and not waiting for the natural urge to push comes (as is standard in most hospital settings), or b) a woman has the epidural and most likely won’t feel the urge and therefore may welcome some guidance (particularly if it’s her first time to give birth). It is far from the most likely non-breath-holding method you’d use with the physiologically organic urge to push and tends to lead to greater likelihood of fetal distress due to oxygen deprivation.

I would add that, in the 2014 ACOG report on things hospitals can do to reduce the unnecessarily high cesarean rate in the U.S., they ask hospitals, “Why are you putting women on a deadline in this stage of labor?” — that is, most hospitals have set a fairly arbitrary time limit on the 2nd/pushing stage of labor. Usually it’s a generous 3-4 hours, but there’s really no reason to move to a c-section solely because “time’s up” if a mom and baby are doing fine and are up for pushing longer. With this, keep in mind here that studies have revealed that hospitals take 15-17 years to adopt new recommendations, no matter how evidence-based, wise, or urgent they are to incorporate.

Here is the BEST article I’ve ever read on the topic of instinctive pushing.

If you’ve given birth before, or if you are a birth professional, I invite you to chime in with your experiences and insights! What worked for you? What didn’t work?

Further reading

2014 ACOG report summary (Choices in Childbirth; full report link found on this page as well)
Second Stage of Labor: You Don’t Have to Push by Nancy Tatje-Broussard
Supporting Women’s Instinctive Pushing Behaviour During Birth (Midwife Thinking)
The Anterior Cervical Lip: How to Ruin a Perfectly Good Birth (Midwife Thinking)

Patience is key: On Spontaneous Labor & Avoiding Unnecessary Induction

10 Jul

Did you think I forgot to finish the “11 Ways to Prepare for Your Best Birth” series? I promise I didn’t! I just went on vacation and decided to take a pause and post some birth stories written by my students so I could truly vacation. Now I’m back from Lake George and feeling refreshed.

So, let’s finish these last few points on the list over the next few weeks!

#8 Allow labor to begin on its own & avoid interventions that are not medically necessary

I admit, the first part of this one is hard. It’s so incredibly common to have a sense of wanting the pregnancy to be over and meet your baby already—largely because baby is getting uncomfortably cozy in there as he grows and is kicking you in the ribs, making it hard to get enough rest and the like. It’s quite common for one of these things to happen around or soon after passing the (estimated) due date:

  • A pregnant woman requests induction
  • A care provider simply says, “it’s time” (insinuating there’s a need to synthetically initiate labor, even in the absence of an evidence-based reason to induce).
  • Or, a care provider uses the words “getting big” in referring to the baby’s size—which undoubtedly instills a good deal of fear in any woman who ever hears this!

Not good reasons to induce, my friend.

I encourage you to resist the temptation to request or agree to an induction (solely based on dates or size) as you approach or pass your due date.

Here’s why. Did you know that baby initiates labor when she is done “cooking”, so to speak? There is a protein that is sent out from baby’s lungs when they are finished developing and ready to breathe the ex-uterine air (throughout the pregnancy, baby gets her oxygen through the umbilical cord). This triggers an inflammatory response in the pregnant parent that triggers labor. Additionally, March of Dimes says babies aren’t fully developed until at least 39 weeks, and also points out that important in-utero brain development happens between 35-40 weeks. Therefore, in the absence of any unusual medical indication to start labor, it seems logical and optimal to wait for baby to trigger labor rather than getting unnecessarily involved in ways that could put baby at risk.

Keep in mind a couple of other things:

  • The estimated due date is just that—an estimate. There is a 5-week window (37 weeks-42+ weeks) that falls within the (large) range of normal for baby being ready to be born. Dating is often inaccurate, unless you know exactly when you conceived.
  • Even if you have the accurate date of conception, also remember that both baby and mom are organic, unique beings who weren’t created according to nor behave in line strictly with textbook-rigid timing. Therefore, everyone’s optimal timing is different.
  • We live in a litigious environment, so care providers will often intervene (induction + many other interventions) because that is their best defense in the event of lawsuit from a bad outcome. There’s also just an unfortunate general sense of impatience in a clinical/hospital setting. It is therefore up to us to move through the perinatal period as informed consumers so as to know the difference between this scenario and legitimately wise uses of interventions.

So, the bottom line in a healthy pregnancy is: it’s best to wait for baby to initiate labor.

A bit more on the “avoid interventions that are not medically necessary”. Your best strategic tools along these lines are:

  • Labor at home as long as possible
  • Buying yourself time as many times as needed if/when interventions are suggested (assuming the suggestions are not emergencies; and never assume an urgent tone in your care provider’s voice equals emergency as it rarely does. Probe, ask questions!). In case you could use some clarity on what your rights are in childbirth, check out the Rights of Childbearing Women from Childbirth Connection.
  • Take birth classes in order to learn about the good vs. questionable reasons for the many interventions as well as the current state of your local birth environment and facilities. This way, you’ll know the questions to ask and how to make informed decisions

A little bit of patience goes a long way. You can then use that time, while waiting for baby, to study up or simply rest and enjoy the quiet in your last few pre-newborn weeks and days.

Further Reading

March of Dimes

 

Ned’s Birth Story

3 Jul

Another birth story for you today, this one told from a dad’s perspective and with my students’ permission. This one is VERY new, hot off the birth presses!


Our first sign that something was up was a little “bloody show” on Sunday night. About an hour later, a little more came out (we were at a Tony viewing party). An hour after that, D felt like we needed to go home as she was leaking more. At this point we were unsure if it was just mucus or if it was some of the bag of waters.

We Uber’d home and about 15 minutes after arriving home (thank goodness not in the Uber!) her water broke, an obvious “gush”. Fortunately she had put a pad in (since she was leaking) and we were able to clearly see that the fluid was yellow/green, obviously a warning sign. Still no contractions at this point.

We called our doctor and she asked us to come to the hospital to be checked. We arrived about 1:30am and after being examined (2 cm dilated estimated at that time) they admitted us and started a pitocin drip.

Thanks to our Birth Matters class we felt pretty informed about everything going on and understood the concerns with meconium (which is also why we were glad to go right to the hospital rather than trying to start laboring at home).

Contractions started in the next couple of hours and by 10:30am they were strong enough that D asked for her epidural (which was part of the plan all along).

We had a couple of hours of respite with contractions around 5 min apart on average but the epidural helping the pain a lot. By 1:30pm we were 5 cm dilated and 90% effaced. The next couple of hours were pretty difficult as D was feeling a lot of pressure and pain even after a “top off” on the epidural. At 4pm we were just about to explore some additional pain management when our attending doctor examined D again and determined she was fully dilated and it was time to push. D had had the urge to push with her last contraction. I don’t think we ever consistently had contractions closer than 4-5 min apart.

Pushing was about an hour (?) though of course it felt like forever. Our doctor did an amazing job and apart from the drugs there were no interventions, and the baby had a vaginal birth. D had no tearing, which was a delightful and welcome surprise! She was a real trooper during the birth, especially considering she hadn’t slept at all the previous night. She really kicked into another gear during the pushing, when it didn’t seem like she had another gear left!

Baby Ned
Born June 13, 2016 at 5:27pm (38 weeks)
6 pounds 6 ounces

ned.JPG

 

 

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