“If you don’t know your options, you don’t have any.” ~Diana Korte and Roberta M. Scaer, A Good Birth, A Safe Birth

As a birth doula, woman & mother I would like to advocate awareness through education. I want to help you. Education is empowerment. Books are great and if you are in our military community, the short classes offered are great, but YOU need more–IF you want to be empowered and make informed decisions. Even if you plan to have an epidural. There are educational opportunities out there, but YOU need to look into them. You will want a well, rounded, childbirth, education class. Complement this class with pregnancy classes on base. Yes, these 6 to 12 week classes cost money. But really–it’s worth it. This is the birth of your child that you can never take back. These 6 to 12 week classes are ideal in order to truly learn, retain and practice what’s going to help you in the long run.

In this section, I am going to share some of my knowledge with you. I desire the birth of your child to be beautiful, pleasant and incredibly memorable and I’m sure you do too! It CAN be this! Understand that emergencies in birth are RARE. Birth does not have to be filled with fear, tears, time constraints, a sterile environment, people talking loudly, bright lights, confined to a bed, legs in stirrups, food & drink withheld, attached to a myraid of wires etc. Within the United States, giving birth at a hospital is what is “culturally acceptable”, “the norm” and “a learned way of having a baby”. Think about it. How did your sister birth? Mother? Maybe even grandmother? Births from home to hospital shifted in the 1930’s. In many countries around the world, birth is still in the home. Hospitals are for people that are sick. Therefore when you go to a hospital, you will–for the most part–be treated as if you are sick. You will be in bed, have an I.V , have devices that monitor you and your baby and have dietary restrictions. Some women prefer this “safe” aspect. That’s ok! Be informed.

I want you to understand that pregnancy is not an illness, unless you have a high-risk issue that needs to be monitored closely. Birth is a NATURAL process. Our bodies know how to birth babies. Childbirth pain is NORMAL and it is manageable with knowledge and the right support. Please understand that I am not advocating against hospital births. Where you choose to birth is your choice. But understand you have options i.e. waterbirth, homebirth, alternative birthing center etc. You may need to put out extra money if you are a spouse of an active-duty member and yes, this may be challenging depending on your location. However, you can achieve an “alternative birth”. Active-duty women:  it is even more essential that you be empowered since you must birth at a designated hospital/clinic. You CAN still have a good experience, but again, you must be empowered. Birthing your baby is a very, powerful, life-changing event. I challenge you to “step outside the box” and think about your “ideal birth experience”. Where? How? With who?

Please take a moment to visit CIMS (Coalition for Improving Maternity Care Services) at http://www.motherfriendly.org. They have some great information. Please review their “free documents/downloads”. See what’s important to you.

Common Hospital Medical Interventions–I am just going to briefly highlight as there is far too much to discuss. Please spend some time to look into these interventions yourself. **ANY medical interventions you receive INCREASES your risk for MORE medical interventions**  It’s a domino effect. I’ve seen it over and over again.

The following excerpts are from 4th Edition Pregnancy Childbirth and the Newborn The Complete Guide By authors: Simkin, Whalley, Keppler, Durham and Bolding

Induction (This word means to begin or start labor by artificial means.)

Common MEDICAL reasons for induction

  • post-date pregnancy (It is within normal limits to go up to 42 weeks! Your baby is not coming for a reason–they need more time in the womb! Let them come when they are ready to come. TRUST your body. Be PATIENT. Some caregivers, such as midwives, will typically monitor your baby closely after 42 weeks.)
  • rupture of membranes (Generally speaking, hospital providers would like labor to start within 24 hours after rupture. Once your membranes rupture you must call the hospital and come in, irregardless of absence of contractions. A positive Group B strep is a deciding factor too. Midwives will monitor you closely, but typically do not have a limit in hours but days.)  
  • lack of growth in the baby
  • genital herpes
  • illness in the mother
  • fear of macrosomia (big baby)

Elective Induction

  • convenience for the caregiver’s schedule
  • convenience for the family’s schedule, support needs, or circumstances
  • discomfort in late pregnancy
  • pregnancy reaches term–should not be done BEFORE 39 weeks, to allow babies lungs to mature fully

Reasons to think carefully BEFORE consenting to induction

  • induction leads to a more medicalized birth
  • depending on method of induction, the intervention may make contractions more painful
  • elective induction bypasses the baby’s ability to start labor at the optimal time
  • all methods of induction carry possible risks, especially uterine hyperstimulation (contractions that are too strong and too frequent) and the higher likelihood that the baby won’t tolerate labor
  • no guarantee that induction will get labor started. If induction fails, a cesarean section typically is performed.

Key questions for making an informed decision

  • benefits?
  • risks?
  • alternatives?
  • next steps?

NON-MEDICAL methods for induction ALWAYS TRY THESE FIRST!

  • take a brisk walk
  • intercourse or orgasm (*Best to wait until 41 weeks, in order to give your body the best chance to go into labor naturally.)
  • nipple stimulation (*Best to wait until 41 weeks, in order to give your body the best chance to go into labor naturally.)
  • acupressure (*Best to wait until 41 weeks, in order to give your body the best chance to go into labor naturally.)
  • chiropractic care to achieve balance in your body so that baby may get into optimal fetal position. Massage therapy is also a great way to achieve this.

Complementary Medicine Methods Because of their potential side effects, these methods require the supervision of a trained professional

  • herbal tea and tinctures
  • homeopathic remedies
  • acupuncture

MEDICAL methods of induction

  • balloon dilators
  • stripping (or sweeping) the membranes
  • artificial rupture of membranes (AROM)

Medications to induce or augment labor

Pitocin is a liquid medication that is a synthetic form of the naturally occurring hormone, oxytocin. Pitocin is diluted with a standard saline solution an introduced into your body by IV drip.  The medication is regulated on a medication pump.  This is an attempt to minimize complications and to help your doctor or midwife mimic normal labor as much as possible.

This IV drip will be set to deliver a certain amount of Pitocin per hour.  Depending on the orders written by your practitioner, the Pitocin drip will normally be turned up every hour until you have reached the contraction pattern that they are looking for you to have.  This may be different for each woman.  Some practitioners turn the Pitocin up really quickly and others go more slowly.  Some of this will depend on how you respond to the Pitocin and how well your baby responds to Pitocin.

When you have Pitocin you will also normally have:

There are increased risks with using Pitocin including:

(Again, Pitocin INCREASES medical interventions as stated above!).

Medication to ripen the cervix

  • synthetic prostaglandins

Being told you have “low amniotic fluid” and wouldn’t you know you’re a week past your due date? Yup. Provider’s are a bit itchy. Are they playing the scare card with you too? Be educated. Be empowered. Ask for a second opinion. Ask questions. Seriousness? Risks? Additionally, it’s ok to collect the data and check out to research and discuss your options! Really, it is! Don’t feel you have to be “admitted” on the spot. I’ve seen too many women fall victim. If you have that motherly instinct that everything is ok, then it probably is!  https://evidencebasedbirth.com/what-is-the-evidence-for-induction-for-low-fluid-at-term-in-a-healthy-pregnancy/ or http://www.perinatology.com/Reference/glossary/A/Amniotic%20Fluid.htm  

A word on Epidurals

As I’ve been working in the hospital setting, most women request epidurals. This is every woman’s choice. But I would like you to be fully informed of your choice and the risks associated. If you want to receive an epidural, it is best you wait until you are in active labor. It is also important, prior to the epidural, that if you are experiencing severe back pain–an indication of a possible malpositioned baby–that efforts are made through various positioning techniques–speak with your doula–to reposition the baby. Gravity (an upright position) and movement of the pelvis, are VERY important during labor. Getting an epidural restricts these actions. Epidurals often require you to labor on your back, which is the WORST position for laboring. Finally, keep in mind that epidurals don’t always work. You need to ask yourself, do the benefits outweigh the risks?

Text below from “The Birth Partner A Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions” Third Edition by Penny Simkin

Neuraxial Analgesia/Standard Lumbar Epidural

How and Where Given

  • Injected into a catheter placed in the epidural space outside the spinal canal; given as a continuous drip
  • Given before 8 cm dilation, or later if labor is slow or arrested

Desired Effects

  • Loss of pain sensation from abdomen to toes, adequate for cesarean
  • Relaxation as pain is relieved
  • Sleep for an exhausted mother

Other Possible Effects

Mother: Inability to move the lower half of her body; toxic reaction (rare); after four hours, fever that increases with the duration of the epidural; decrease in blood pressure; slowing of labor; reduced urge and ability to push; spinal headache if the drug is inadvertently injected into the dural space; prolonged birthing state; increased chance of malpositioned baby.

Fetus: Heart-rate changes and lack of oxygen, caused by low maternal blood pressure and fever.

Baby: Subtle changes in reflexes, including suckling and breathing; fussiness

Precautions And Procedures For Safe Use

Mother: Restriction to bed, frequent checks of blood pressure and blood oxygenation, withholding of food, limits on drinking, intravenous fluids, bladder catheter, oxygen mask, possible antibiotics for fever, continuous electronic fetal monitoring, Pitocin to augment contractions, forceps or vacuum extractor, episiotomy, possible increased chance of cesarean.

Baby: Blood or urine cultures to detect infection, antibiotics, and 48 hours in a special-care nursery for observation if the mother has had a fever in labor (to rule out infection).

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