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Last night we had a lovely meeting! In addition to having an almost full room of adults, we had six delightful babies, and a sweet little girl.
We were able to meet the owner and founder of the new cloth diaper service in the CSRA – Busy Bee Diaper Service! We are so very excited to have a cloth diaper service in the area 🙂 From what I understand, there used to be one quite some time ago, but there hasn’t been one since I moved to the area over 3.5 years ago. This is definitely a niche that needed to be filled! If you already have a stash of cloth diapers, they will even clean your own diapers each week for a small fee.
After our introductions, Christine Wieberdink, a local Certified Professional Midwife and Licensed Midwife, talked about several common interventions during childbirth. All of these interventions have a time and a place when the benefits outweigh the risks. However, none of these interventions have been proven to be beneficial when done to all laboring women regardless of their health history and situation.
We learned about Continuous Fetal Monitoring (CFM) and about how it can be beneficial for women who have a high risk situation, as well as being necessary for women who have gotten an epidural or are getting pitocin to speed things up. Babies can more easily and more quickly go into distress after an epidural is placed or after pitocin is started. The continuous monitoring is advantageous to the hospital staff because they get a continuous strip of your baby’s heart rate and they don’t have to send a nurse in periodically to listen by hand.
The downsides of CFM are that the belt is rather uncomfortable and tight, you cannot move around as easily, CFM hasn’t actually been shown to make a statistically significant difference in fetal outcome, and studies have shown that CFM increases your risk of having a c-section. When you move around, the belt can slip and the monitor can sometimes lose the baby’s heartbeat. This can lead to some panicking if the heartbeat cannot easily be found again.
If you are healthy and your baby is healthy, you can always request intermittent fetal monitoring. Sometimes the hospital staff can use a hand-held doppler device or hold the monitor to your belly for a couple of minutes instead of strapping on the belt. They can also simply unplug the belt monitor from the machine to let you have 20 minutes off the monitor and 10 minutes on the monitor, if you agree to that.
Here is the American Congress of Obstetricians and Gynecologists (ACOG) most recent revised position statement about Continuous Fetal Monitoring. There was also a New York Times article about the changes in 2009.
We also learned about cord clamping and about the routine intervention of immediate cord clamping. At the time of a fully-term, healthy baby’s birth, about 1/3 of the baby’s blood is contained in the placenta and cord at any given time. Cutting off 1/3 of a baby’s blood supply is probably not the best way to welcome them into the world, no matter how you look at it.
The American Academy of Pediatrics has, on their website, an abstract of a study that shows some of the benefits of delaying that cord clamping, such as increased iron stores in newborns and the lack of any evidence to show that delayed cord clamping is harmful.
There’s also an excellent talk from the Academic OBGYN about Delayed Cord Clamping. If you have a spare 50 minutes, I strongly recommend that you listen to what he has to say. He has handy graphs and discusses quite a few studies about cord clamping.
This is definitely an issue to be informed about before you go in to talk to your doctor about your preferences because it often takes a while for practiced medicine to catch up to the newer evidence and this issue is not an exception. Doctors are busy people and they only know what they’ve learned on their own or were taught in school and continuing education programs.
Most Doctors are open to learning if you are willing to bring in the evidence from legitimate studies and professional organizations. Your work in bringing this information to your doctor could have a ripple effect on your doctor’s future clients who might be encouraged to look into this issue by the doctor him or herself!
Breaking your water, or Artificial Rupture of Membranes (AROM), is another intervention that we talked about . AROM is necessary if you need to have an internal fetal monitor and is generally preferable to having a c-section due to external fetal monitoring not finding the heartbeat. Studies have also shown that, if done early in labor, AROM can reduce the length of labor by about an hour.
However, in the grand scheme of things, one hour is really not very long, and that benefit really needs to be weighed against the sobering potential risks that AROM introduces into your labor. AROM drastically increases your risk of infection because the protective amniotic sac around the baby is no longer intact to protect your baby from outside germs. If you are still at home after a Spontaneous Rupture of Membranes (SROM), you need to be scrupulous about hygiene and put NOTHING in your vagina.
Once your water has broken you are on a clock and most doctors like to see the baby born within about 18 hours of the water breaking. Most midwives like to see women in good, strong active labor by 24 hours after their water breaks. Not only is the baby’s protection against infection gone, but the cushion around the baby is gone once the water is broken as well. If the baby’s head is in a less than optimal position, it could get stuck there. If the baby’s head is not down in the pelvis then the cord could slip between the head and the pelvis, cutting off the baby’s oxygen supply; or prolapse, which necessitates a c-section in most cases.
The next intervention we talked about seems less like an intervention to most people because it doesn’t seem like something that’s done to a laboring woman – it’s something that she’s not allowed to do. However, not allowing a woman to eat and drink during labor is most definitely an intervention.
There is really only one benefit to not allowing food or drink to a woman in labor. If a woman had to have an emergency c-section and be put under general anesthesia she could vomit and aspirate her stomach contents and she could get pneumonia or asphyxiate, IF she is not intubated properly. Now, the situation where a woman would need general anesthesia for a c-section is extremely rare to begin with. It is even more rare for a woman to be intubated improperly and not everyone who aspirates their stomach contents gets sick in the first place, but it is a small risk of eating and drinking during labor.
The downsides of not eating and drinking during labor are that women are working extremely hard during labor and birth – many people liken labor and birth to a marathon or climbing a mountain – and their bodies need fuel. When a woman’s body is exhausted and no longer has any reserves of fuel, her uterus doesn’t work as effectively and she starts having ketones in her urine. The baby can become acidic and can go into distress.
The answer to not eating during labor, for most women in the hospital, is to be hooked up to an IV, which is the last intervention we discussed. The benefits of an IV are very clear, if you’re not being allowed to eat or drink during labor. IV’s prevent dehydration and can help preserve electrolyte balance. They can also keep a woman’s blood sugar levels up so that she has energy. For women who are nauseous and cannot keep any food or drink down during their labors, IV’s can be lifesaving.
The downsides and risks of getting an IV range from the minor annoyance of having a painful port in your arm or hand, which can make it difficult to move around or hold your baby after the birth, all the way to the more serious risk of the baby’s blood sugar levels getting too high and then crashing after he or she is born. You can also get too many fluids and swell up, which is rather uncomfortable and can cause issues with breastfeeding. If the baby gets swollen with fluids then he or she can end up losing more weight than the doctor or hospital is comfortable with and you might end up being encouraged to supplement or being told that you aren’t producing enough colostrum or milk.
There are benefits and risks to every intervention. It is up to every individual family to weigh those benefits and risks, with the help of their care provider, before deciding what to do routinely during their labor and birth. As long as the baby’s doing well and the mom’s doing well, you can decide to refuse any of these interventions. Sometimes the benefits of complying with a more minor intervention can include the goodwill of the hospital staff, but be very careful about making decisions during your pregnancy, labor, and birth solely for the benefit of the people who are working for you, and think things through carefully before making that decision.
If you missed this month’s 1st Monday meeting we hope to see you at next month’s! We will be talking about the first hour after a baby’s birth. It is a very special time for both mother and baby and if you join us for our meeting you will find out why 🙂