Jan 12 2010
Choosing Where to Have Your Have
Today’s prospective mothers have many delivery options. These range from the traditional hospital birth to home birth. When considering birthing alternatives, parental values are important. Many couples, for instance, feel that the modern medical establishment has dehumanized the birth process; thus they choose to deliver at home or at a birthing center, a homelike setting outside a hospital where women can give birth and receive postdelivery care by a team of professional practitioners, including physicians and registered nurses. Financial considerations are also important, and a couple’s income and insurance coverage will often dictate its choice.
Transition The process during which the cervix becomes nearly fully dilated and the head of the fetus begins to move into the birth canal.
Episiotomy A straight incision in the mother’s perineum.
Perineum The area between the vulva and the anus.
Afterbirth The expelled placenta.
Birth Methods
Expectant parents have several options for their infant’s birth and their participation in it. Although several of these methods have decreased in popularity, all continue to be used.
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Lamaze Method This birth alternative is the most popular one in the United States. Prelabor education classes teach the mother to control her pain through special breathing patterns, focusing exercises, and relaxation. Lamaze births usually take place in a hospital or birthing center with a physician or midwife in attendance. The husband(or labor coach) assists by giving emotional support, physical comfort(massage and ice chips), and coaching for proper breath control during contractions. Lamaze proponents discourage the use of drugs.
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Harris Method Parents using this alternative are taught by registered nurses. Gentle touching and controlled breathing are stressed. Husbands(or other partners) provide emotional support while a physician-nurse team essentially controls the labor and delivery. Drugs are not prohibited.
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Childbirth without Fear Sometimes called the Read Method, this method advocates education for understanding of the birth process. Mothers are taught to recognize that anticipation of pain creates more pain. Relaxation is stressed.The husband or other partner provides emotional support. Drugs are not prohibited.
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Leboyer Method Leboyer proponents believe that birth in the standard delivery room is a traumatic experience for the baby. The Leboyer method allows the mother to deliver in a dark and quiet setting. Immediately after delivery, the infant placed in a warm bath to ease its transition to life outside the womb. Drug use is discouraged.
Tags:breathing patterns, expectant parents, financial considerations, hospital birth, medical establishment, parental values, perineum prelabor
Jul 23 2009
It outlines the situations in which cesarean is the delivery of choice. Vaginal delivery of a breech baby is considered safe only when the baby is in a favorable position for vaginal delivery. The buttocks, rather than the feet, present and the breech is low in the pelvis at the onset of labor. The baby is neither too small nor too big. The fetal head is well flexed, making its birth following the birth of the buttocks and body more likely to succeed without problems. The flexion of the head usually can be ascertained with ultrasound. If this is inadequate, a computerized tomography scan(C-T scan) often can tell whether the head is flexed. As a last resort, because it exposes the fetus to more radiation, or in the absence of C- T scan equipment, an X ray can be done. Even with X ray, the radiation exposure is small.
Anytime labor is tried when the baby is in the breech presentation, the labor must be monitored carefully for progress and signs of cord prolapse. Careful attention must be paid when the membranes rupture as this is the time the cord may come down or prolapse.
For a vaginal breech birth, the birth attendant should be experienced in delivering a breech. Some midwives deliver breech babies, usually with assistance of an obstetrician. An anesthesiologist or nurse-anesthetist should be available as should a physician or neonatal nurse practitioner who can provide immediate infant resuscitation, if that becomes necessary. There are three types of vaginal breech deliveries:
- In a spontaneous breech delivery, the fetus is born without assistance, except for support of its body .
- In an assisted breech delivery(or partial breech extraction), the fetus is born without assistance until the umbilicus, or navel. The rest of the fetus is born with assistance of the birth attendant .
- In a total breech extraction, the entire body of the fetus is taken out with assistance. Today, this is done rarely for a living fetus, except for a second twin .
Tags:anesthesiologist, breech baby, c t scan, cord prolapse, nurse anesthetist, umbilicus vaginal delivery
Jun 30 2009
Amnioinfusion is a technique introduced relatively recently into obstetrical care. In this technique, a physiologic fluid, usually saline(salt water) is infused into the uterus. It may be infused as a one-time dose, or continually throughout labor. Amnioinfusion is beneficial in three situations:
- When fetal heart rate decelerations indicate cord compression.
- raman amplifierWhen there is reduced amniotic fluid(oligohydramnios).
- When there is thick meconium.
In the first two instances, the purpose of the amnioinfusion is to provide cushioning for the umbilical cord for optimal blood flow through it. Reduced fluid may occur when the membranes have been ruptured for a long time before labor and sometimes in pregnancies that are 2 weeks or more past the due date. In the third situation, the purpose of the infusion is to dilute the meconium(the often thick and sticky contents of the fetal bowel). This is an attempt to prevent meconium aspiration syndrome, in which the fetus breathes in some of this thick substance and subsequently develops pneumonia and breathing difficulties.
The research on amnioinfusion has shown conflicting results. Although researchers have documented fewer variable decelerations after amnioinfusion, studies have not always shown that this has reduced the need for cesarean delivery or improved the condition of the newborn. The same can be said for research on the effect of amnioinfusion on meconium aspiration syndrome. Studies have shown beneficial effects and no effects.
Amnioinfusion is not without risks. It can cause an increase in pressure inside the uterus, leading to abnormalities in fetal heart rate patterns. It also has been associated rarely with infection, rupture of the uterus, heart or respiratory problems in the mother, placenta abruptio(the tearing away of the placenta from the uterine wall), and, most rarely, a fatal problem called amniotic fluid embolism in the mother.
Amniotic fluid embolism(or clot) is an extremely rare occurrence, usually believed to be unavoidable in obstetrics-a true “act of God.” It occurs in 1 out of 8,000 to 1 out of 30,000 pregnancies. Although only two case reports have appeared of this fatal complication with amnioinfusion, this is a relatively large number of women having an amniotic fluid embolism for the number of amnioinfusions that are performed. Amniotic fluid embolism has been considered to be the result of solid material in the fluid, such as fetal cells, somehow getting into the maternal pulmonary(lung) circulation. Today, an alternative explanation is that the embolism is a result of a type of maternal allergic reaction to the fluid. Although it is thought that the maternal and fetal tissues are separate, it is possible for fluid to get into the mother’s circulation during procedures, in this case amnioinfusion, and even during normal labor and delivery as tiny tears occur in the lower part of the uterus or the cervix.
Tags:amnioinfusion, embolism, oligohydramnios, placenta abruptio, respiratory problems, thick meconium umbilical cord
May 12 2009
While perhaps not technically an intervention, women need to realize that if they choose a birthing center or home birth, the possibility always exists that they may need to be moved to a hospital. The reasons for this are varied. You may want more pain relief than is safe in an outof-hospital setting. Your labor may fail to progress and you may need augmentation. You may have thick, meconium-stained fluid. Your baby may not rotate into a good position for birth or there may be nonreassuring signs in the fetal heart rate patterns.
Moving to a hospital does not necessarily mean that you will have an intervention for the rest of labor or for birth. Sometimes, a labor that progresses slowly starts to move more quickly after transfer. Sometime, a little pain medication is all you need for the rest of the labor to go smoothly.
Transfer is included in this section on interventions because it can be traumatic for the mother. The actual physical reality of transfer can be stressful. The emotional disappointment can be great, if you have not adequately prepared yourself for the possibility that your labor and birth plan has to change.
Every birthing center and midwife or physician who practices home birth has policies for transferring the mother, or the baby after birth. You should become familiar with these. Everything you want for birth-a healthy baby and a healthy mother-are independent of the birth site. With this in mind, your experience can be satisfying and happy after transfer.
A Bit of Advice
Labor might be easier to handle, and certainly more convenient, if it could be planned. Child care arrangements or work-related activities would be more manageable if you knew exactly when labor would start. Pain might be more tolerable if you knew exactly when it would end. You might have more energy for pushing if you were certain it would last no more than 47 minutes. Women today are used to being in control of their lives, scheduling things well in advance, living by their weekly, even monthly, calendars.
The process of labor, fortunately or unfortunately, was not designed for convenience. Predictability is not a word that can be used in its description. Most pregnancies classified as at-risk or even highrisk actually need few interventions. An occasional pregnancy considered perfectly normal may require several interventions, even a cesarean delivery. Since you cannot plan or predict, all you can do is be prepared. Be aware that an intervention may become necessary even one you assumed you would never need.
Know your physician’s or midwife’s practices in advance. Be sure you are comfortable with their answers to the following questions:
Will they induce at 42 weeks with a cervical ripening agent if your cervix is not ready, or continue fetal surveillance?
Do they use prophylactic forceps?
Do they prefer forceps or a vacuum extractor?
Will you be admitted to a hospital if your membranes rupture before labor or will you stay at home, taking your own temperature?
Will they induce labor within a set period of time if your membranes rupture, or will they practice watchful waiting?
Do they do a cesarean for all babies in the breech presentation? If not, what is their experience delivering vaginal breeches?
Remember, many of these questions have no absolute right or wrong answers. What is right is that you and your physician or midwife have similar feelings and attitudes. In the final analysis, your care provider should be someone you are comfortable trusting.
Tags:birth plan, child care arrangements, fetal heart rate, interventions, pain relief physical reality
Apr 16 2009
The Condom The condom is a strong sheath of latex rubber or other material designed to fit over an erect penis. The condom catches the ejaculate, thereby preventing sperm migration toward the egg. The condom is the only temporary means of birth control available for men and the only barrier that effectively prevents the spread of STDs and AIDS. They may also slow or reduce the development of cervical abnormalities in women that can lead to cancer. Regardless of your preferred method of birth control, you should always use a condom. Condoms come in a wide variety of styles: colored, ribbed for “extra sensation,” lubricated, nonlubricated, and with or without reservoirs at the tip. All may be purchased with or without spermicide in pharmacies, in some supermarkets, in some public bathrooms, and in many health clinics. A new condom must be used for each act of intercourse or oral sex.
Condoms must be rolled on the penis before the penis touches the vagina, and held in place when the penis is removed from the vagina after ejaculation. For greatest efficacy, they should be used with a spermicide containing nonoxynol9, the same agent found in many of the contraceptive foams and creams that women use. If necessary or desired, users can lubricate their own condoms with contraceptive foams, creams, and jellies or other water-based lubricants, such as K-Y jelly, For Play Lubricants, Astroglide, Wet or Aqua Lube, to name just a few. However, products such as baby oil, cold creams, petroleum jelly, vaginal yeast infection medications, or hand and body lotions should never be used. These products contain mineral oil and will begin to disintegate the latex condom within 60 seconds.
The efficacy of condoms can be compromised and the likelihood of their breaking during intercourse is increased when they are old or poorly stored. To maintain effectiveness, condoms should be stored in a cool place(not wallet or hip pocket) and they should be inspected for small tears before use.
For some people, a condom ruins the spontaneity of sex. Stopping to put it on breaks the mood for them. Others report that the condom decreases sensation. These inconveniences contribute to improper use of the device. Couples who learn to put the condom on together as part of foreplay are generally more successful with this form of birth control.
Tags:ejaculate, erect penis, latex condom, petroleum jelly, spermicide vaginal yeast infection
Apr 10 2009
Induction of labor means bringing on labor before it has begun on its own. Labor may be induced for reasons related to the mother’s health, the baby’s health, or the health of both. Although inductions have been performed for the convenience of either mother or physician, the medical ethics of this practice are questionable, at best.
Maternal Reasons for Induction of Labor
A common maternal reason to induce labor is preeclampsia or pregnancyinduced hypertension. Mild cases of this disease of pregnancy may be treated prior to term with bed rest and observation alone, but severe disease usually requires delivery. An induction is considered safer than a cesarean birth, although if the induction is not successful, a cesarean may become necessary.
When the membranes rupture prematurely, the risk or presence of infection may be a reason for induction. Premature rupture of the membranes(PROM) is defined as rupture that occurs before the onset of labor. If it also occurs before the fetus is at term, it is called preterm premature rupture of the membranes(PPROM). Labor almost always ensues within a few days to a week after rupture, with its onset more rapid the closer to term the rupture. At term, more than 60 percent of women will be in labor within 24 hours and more than 95 percent within-2 hours.
Some practitioners believe that inducing labor within 12 to 24 hours after rupture will prevent or reduce the risk of infection for the mother and the fetus. Many practitioners will induce routinely when the fetus is at term or near term, but only induce when there is evidence of infection if the fetus is preterm. In fact, in a small number of women whose membranes rupture before term, there is only a small leak rather than a large rupture. In these cases, the membranes may reseal themselves and the fluid will stop leaking.
Usually, fever in the mother is the symptom that indicates infection. When the membranes rupture, your temperature must be taken frequently-at least once a day if you are not in labor. If you are admitted to the hospital, as some women are whenever the membranes rupture, your temperature will be taken every 4 or 8 hours. If you are at home you must take your temperature and call your physician or midwife if there is a rise or if you have chills or feel feverish.
Whether to induce or not when membranes rupture without labor is an area of some controversy within obstetrics. Studies are not entirely consistent, but seem to show that while there are more infections when the woman is not induced, the newborn is infected in less than 20 percent of maternal infections. There also may be more cesarean deliveries when induction is used routinely. The most important preventive measure against infection once the membranes rupture is to avoid vaginal examinations.
You may have feelings regarding induction or watchful waiting in the situation of ruptured membranes at term. This is a topic to discuss with your physician or midwife. Find out his or her beliefs and practices. You should feel comfortable with them.
Induction of labor means bringing on labor before it has begun on its own. Labor may be induced for reasons related to the mother’s health, the baby’s health, or the health of both. Although inductions have been performed for the convenience of either mother or physician, the medical ethics of this practice are questionable, at best.
Maternal Reasons for Induction of Labor
A common maternal reason to induce labor is preeclampsia or pregnancyinduced hypertension. Mild cases of this disease of pregnancy may be treated prior to term with bed rest and observation alone, but severe disease usually requires delivery. An induction is considered safer than a cesarean birth, although if the induction is not successful, a cesarean may become necessary.
When the membranes rupture prematurely, the risk or presence of infection may be a reason for induction. Premature rupture of the membranes(PROM) is defined as rupture that occurs before the onset of labor. If it also occurs before the fetus is at term, it is called preterm premature rupture of the membranes(PPROM). Labor almost always ensues within a few days to a week after rupture, with its onset more rapid the closer to term the rupture. At term, more than 60 percent of women will be in labor within 24 hours and more than 95 percent within-2 hours.
Some practitioners believe that inducing labor within 12 to 24 hours after rupture will prevent or reduce the risk of infection for the mother and the fetus. Many practitioners will induce routinely when the fetus is at term or near term, but only induce when there is evidence of infection if the fetus is preterm. In fact, in a small number of women whose membranes rupture before term, there is only a small leak rather than a large rupture. In these cases, the membranes may reseal themselves and the fluid will stop leaking.
Usually, fever in the mother is the symptom that indicates infection. When the membranes rupture, your temperature must be taken frequently-at least once a day if you are not in labor. If you are admitted to the hospital, as some women are whenever the membranes rupture, your temperature will be taken every 4 or 8 hours. If you are at home you must take your temperature and call your physician or midwife if there is a rise or if you have chills or feel feverish.
Whether to induce or not when membranes rupture without labor is an area of some controversy within obstetrics. Studies are not entirely consistent, but seem to show that while there are more infections when the woman is not induced, the newborn is infected in less than 20 percent of maternal infections. There also may be more cesarean deliveries when induction is used routinely. The most important preventive measure against infection once the membranes rupture is to avoid vaginal examinations.
You may have feelings regarding induction or watchful waiting in the situation of ruptured membranes at term. This is a topic to discuss with your physician or midwife. Find out his or her beliefs and practices. You should feel comfortable with them.
Tags:induction, preeclampsia or pregnancyinduced, Premature rupture of the membranes preterm
Mar 27 2009
All women should be screened for colonization with GBS from the vagina and rectum at 35 to 37 weeks gestation. A swab from the vagina and rectum is sent to the laboratory for culture. The only exceptions to this are women who have already demonstrated GBS in their urine during the current pregnancy or women who had a previous infant with invasive GBS disease.
Prophylaxis During Labor(preventive treatment with an antibiotic) is recommended in the following situations:
- Previous child with invasive GBS disease.
- GBS in the urine culture during this pregnancy.
- Positive GBS screening culture during the current pregnancy, unless a planned cesarean delivery is performed, before the woman goes into labor and before her membranes have ruptured.
- If the GBS status is not known because the culture wasn’t done or is incomplete(was done too recently for the colonization to be documented) or if the results are unknown for any other reason and any of the following circumstances exist:
- Delivery before 37 weeks gestation.
- The membranes have been ruptured for 18 hours or longer(even at greater than 37 weeks gestation).
- A temperature develops in labor of 100.4° F or greater(38.0° C or greater) (this may require a different antibiotic therapy).
Prophylaxis During Labor(preventive treatment with an antibiotic) is not recommended in the following situations:
- Previous pregnancy with a positive GBS screening culture(unless a culture was also positive during this pregnancy).
- Planned cesarean delivery performed in the absence of labor or rupture of membranes(regardless of whether the GBS culture is positive or negative).
- Negative vaginal and rectal GBS screening culture in late pregnancy during the current pregnancy.
Antibiotics are given during labor through an intravenous line. A usual dosage schedule is penicillin G 5 million units for the first dose, then 2.5 million units every 4 hours until delivery. If a woman is known to be penicillin allergic, Cefazolin may be given if she is not considered to be at high risk for serious reaction(anaphylaxis). If she is at high risk for an anaphylactic reaction, then clindamycin or erythromycin may be used. All medications are given intravenously.
If the culture shows the organism to be resistant to these medications, then a very strong antibiotic is used, called vancomycin.
Two risks exist with this treatment:
- some women may have a potentially dangerous allergic reaction to penicillin, and
- the development of resistant organisms is possible with widespread treatment.
Tags:cefazolin, cesarean delivery, circumstances, late pregnancy, prophylaxis, rupture of membranes swab
Mar 23 2009
A cesarean delivery is the birth of a baby via surgery performed through the abdominal and uterine walls. Cesarean is the most common operation in the United States. Since the latter half of the twentieth century, the operation has increased in safety, in part because of the availability of trained anesthesiologists and obstetricians, and capable pediatricians to care for the newborn after the operation. The use of better surgical techniques, blood transfusion, and antibiotics also have helped.
Rates of Cesarean Birth
In 1965, approximately 4.5 percent of births were cesarean births. By 1988, this had risen spectacularly to almost 25 percent of all births . A small but steady decline followed, persisting through 1997. In 1998, the cesarean rate in the U.S. was 21.1 percent, rising to 22 percent in 1999. The recent rise in rate is mostly among women who had not had a previous cesarean, although there also has been a decline in the rate of vaginal birth after cesarean(VBAC).
The reasons for the upward, downward, and again upward trends in cesarean births are varied. Specific changes that took place in both society and obstetrical practices in the second part of the twentieth century were responsible for the increase in cesarean rates, in addition, of course, to the continuing increased safety of the surgery itself.
One societal change was that women began to have fewer babies, meaning a higher percentage of births occurred to nulliparas-women who’d never had a child before. These pregnancies tend to have more complications, or to be treated as more at risk by physicians. In addition, women are having babies at older ages than previously. This does not necessarily incur increased risk, but some of these women have medical problems such as diabetes and high blood pressure that are less common in younger women.
A major change in obstetrical practice has been the use of electronic fetal monitoring. This has led to the performance of more cesarean deliveries for fetal problems, although it has not improved newborn outcomes. In addition, babies in the breech presentation have been delivered more and more frequently by cesarean. In 1990, 83 percent of all breech babies were born by cesarean. During this same time, the use of forceps has decreased. High forceps, are no longer practiced. Some babies that would have been delivered by forceps are now delivered by cesarean.
In looking at whether the rate of cesarean birth is appropriate, one must consider the fact that the surgery does incur significantly increased risks to the mother: discomfort, due to an abdominal operation and an increased likelihood of infection, the need for more extensive anesthesia, hemorrhage from unavoidable surgical accidents, and the increased need for a repeat cesarean in subsequent pregnancies.
The risk of maternal death from cesarean is several times that of vaginal birth. Still, it is extremely small-about 1 in 10,000 births. If this is weighed against the chance of fetal injury from a delay in delivery or a difficult birth-both events avoidable by cesarean-the decision in equivocal situations is likely to be in favor of cesarean.
Yet, once the cesarean rate reached one-quarter of all births, there was a public outcry against so many surgeries performed for what is usually a normal body function. In the publication Healthy People 2000, the federal government called for a lowering of the cesarean rate. The rate of cesarean birth in the United States is much higher than in a number of developed countries in Europe, especially for cesareans attributed to previous cesarean and dystocia-difficult labor. Dystocia is often a somewhat subjective diagnosis and how quickly a physician or midwife intervenes in the case of slow progress of labor can vary greatly among practitioners.
Reasons for Cesarean Birth
There are four reasons cited most commonly today for the performance of a cesarean delivery:
- Repeat cesarean.
- Dystocia or failure to progress in labor.
- Breech presentation.
- Fetal distress, or the desire to avoid fetal distress.
Tags:birth of a baby, blood transfusion, cesarean deliveries, increased safety, obstetrical, societal change, steady decline vaginal birth after cesarean
Mar 12 2009
Although the new mother’s milk will not begin to flow for two or more days, her breasts secrete a thick yellow substance called colostrum. Because this fluid contains vital antibodies to help fight infection, the newborn baby should be allowed to suckle.
As a result of recent scientific findings, the American Academy of Pediatrics has strongly recommended that full-term newborns be breast-fed. This recommendation does not mean that breast milk is the only adequate method of nourishing a baby. Prepared formulas can provide nourishment that allows a baby to grow and thrive.
Still, there are many advantages to breast-feeding. Breast milk is perfectly suited to a baby’s nutritional needs. Breastfed babies have fewer illnesses and a much lower hospitalization rate because breast milk contains maternal antibodies and immunological cells that stimulate the infant’s immune system. When breast-fed babies do get sick, they recover more quickly. They are also less likely to be obese than babies fed on formulas, and they have fewer allergies.
When deciding whether to breast-or bottle-feed, mothers need to consider their own desires and preferences. Both feedings methods can supply the physical and emotional closeness so essential to the parent-child relationship.
The postpartum period lasts from four to six weeks after delivery. During this time, the mother’s reproductive organs revert to a nonpregnant state. Many women experience energy depletion, anxiety, mood swings, and depression during this period. This experience, known as postpartum depression, appears to be a normal end-product of the birth process. For most women, the symptoms gradually disappear as their bodies return to normal. For others, the symptoms, coupled with the stresses of managing a new family, can cause more severe depression that lasts for several months.
Tags:breast milk, emotional closeness, energy depletion, new mother, parent child relationship, postpartum period term newborns
Feb 26 2009
>online casino netve management of labor is a term used to described a specific approach to labor. The goal of this approach is to make labor as efficient as possible, in an effort to reduce the number of cesarean deliveries performed. Whether or not active management actually reduces the number of cesarean deliveries is unclear, as different studies have reported different findings. What seems to be true of this approach, however, is that it does shorten labor.
In a large study funded by the National Institute of Child Health and Human Development, the length of labor was decreased with active management, fewer women experienced labor longer than 12 hours, and fewer women developed fever in labor. However, active management did not reduce the number of cesarean operations performed.
In active management, once active labor is diagnosed, the woman is examined vaginally every hour for the first 3 hours of labor, and then every 2 hours. At each hourly examination, the cervix is expected to dilate at least 1 centimeter. If it does not, first amniotomy is performed, and then high-dose oxytocin started. A nurse or midwife must be in constant attendance.
Some medical centers use a variation of this management, also calling it active management of labor. The key point is that the woman is given a limited time from the onset of active labor to delivery. Labor is monitored frequently by vaginal examination-every 1 to 2 hours. If labor does not progress within a specified time frame, intervention is begun.
You should ask your physician or midwife whether they use active management of labor as a routine procedure. If they do, you must decide whether or not you wish this type of management. While detrimental effects have not been shown, many women prefer to allow nature to take its course. Hastening labor is not the goal of every woman.
Tags:attendance, cesarean deliveries, limited time, midwife, national institute of child health and human development oxytocin
