Friday, April 09, 2010

Are You A Veteran Too????

I had to laugh at myself this morning as I was setting up for Day 2 of the ICEA Professional Childbirth Educator Workshop.

We are starting the day with teaching comfort measures and I took out my mini-speakers and I-Pod.

I remembered the first childbirth class I ever taught in Lompoc, California in August of 1980. I had a cassette tape of relaxation music.

Some years later, I was teaching childbirth classes at a community college south of Melbourne, Florida and I had a boom box.

Now a set of speakers and COUNTLESS tunes on my I-Pod. Including my favorite to teach relaxation and breathing ~ "Mexican Memories" by Michael Jones from his Seascapes CD.

We've come a long way baby! A very long way. ROFLOL!

Wednesday, April 07, 2010

Why We MUST Teach Breathing if We Teach Relaxation

As I prepare to teach my next ICEA Professional Childbirth Educator Workshop, I am reminded why it is imperative that we teach breathing techniques if we want those in our childbirth classes to know how to really relax.

First, we should teach nasal breathing on the inward breath and outward breath as the nose provides a much more direct route for air to fully inflate the lungs than does the mouth.

Second, when the nasal breath is slow, meticulous and full, the lungs fully inflate and stimulate the nerves which signal "Ok, no stress, relax!" Within seconds of doing this, the amount of stress hormones in the body (catecolamines) is reduced, the blood pressure drops slightly as does the pulse.

Third, without the fight/flight stress hormones, the person is free to relax completely, do some positive relaxation techniques, or just coast.

Let's face it...Lamaze made breathing famous and many of those attending childbirth classes have heard about breathing techniques for labor and birth. But more than being famous, slow breathing techniques help all of us live more stress free lives..

...and isn't that what we would all like to have? Less stress?

Monday, April 05, 2010

Top 10 Myths about Birth & Breastfeeding

In no particular order, here they are:

1. You have to give birth unmedicated to have a healthy baby.

FALSE. While all medications do cross the placenta (the placenta is not a barrier and is not selective), judicious use of medication as a coping tool can lead to a wonderful birthing experience. Mothers do not have to have high thresholds of pain to give birth. Rather, education and some great coping tools can really help!

2. You have to have big breasts like Dolly Parton to breastfeed your baby.

FALSE. It is not about the size of the breasts but that you have ample and unobstructed milk ducts, a supportive environment, good nutrition and hydration, and the internal desire to breastfeed that is important!

3. It is my due date. This baby should come out NOW!

FALSE. Each woman gestates their babies at differing lengths of time. That is to say, one woman may be "at term" at 38 weeks and another be "at term" at 42 weeks. Both are normal for both women. So, if you gestate your babies to 42 weeks and that is term for you, an elective induction at 38 or 39 weeks might result in a 3-4 week premature baby. Remember that Due Dates are merely estimates!

4. I am scared to try a water labor or water birth. I am afraid the baby will drown.

FALSE. No need to worry here. The baby will not take a breath until air pressure changes are registered by the trigeminal nerves on the face. The baby will be oxygenated by the blood in the umbilical cord from the placenta. The baby cannot stay submerged for a long time, though. Once the baby has been born, a hormonal shift takes place and the placenta will begin to detach from the wall of the uterus, interfering with the blood flow.

5. I don't need to take childbirth education classes. My doctor and the nurses will be with me all of the time to coach and help me.

FALSE. Only in RARE situations will this occur. Physicians and even midwives have office hours with patients to see, plus other actively laboring patients. Nurses, given the nursing shortage and tight hospital budgets, often have 2-4 actively laboring patients to care for. Attending childbirth education classes should address the fear factor of labor and educate you so labor isn't as scary, give you comfort measures to reduce your tension and pain, and give you information so you can make informed decisions!

6. If I have a cesarean, I won't be in as much pain as if I had labor.

FALSE. Remember that a "cesarean" is really major abdominal surgery. You will have an incision not only on your outer skin but also on your uterus. Recovery with a cesarean is much, much slower than with a vaginal birth. Please research this thoroughly if you are considering an elective cesarean birth.

7. Home birth is dangerous and only fringey people do it. There are no emergency precautions!

FALSE. There is much literature showing the safety of home birth when an well-educated, low risk expectant couple and a qualified birth attendant (such as a Certified Professional Midwife) are working together. In fact, there is literature showing that homebirth, in certain situations, is safer than hospital birth. Again, this is a topic that deserves more research if you are considering it.

8. The hospital nurses know the latest in breastfeeding techniques.

Generally false. For continuing education, some nurses elect to take advance breastfeeding courses or become Certified Lactation Consultants. Many nurses do not, or opt for more technological courses for continuing education such as reading fetal heart monitoring. If you have questions about breastfeeding, it is generally best to consult a Lactation Consultant for the most up-to-date and accurate information about breastfeeding.

9. My grandmother doesn't think my breastmilk is enough to fill up the baby's belly. She wants me to use formula supplements.

FALSE. If the baby is gaining weight, producing wet and soiled diapers, and is content, the baby is getting enough to eat. Breastmilk might look thin and weak, but it packs a punch in the nutrition department! Formula has additives that the baby cannot digest and can contribute to childhood obesity.

10. My doctor (and my hospital) won't do a VBAC: they say it is unsafe.

FALSE. According to the recent (March 2010) National Institute of Health Consensus on VBAC, VBAC is a plausible option for most women with a previous cesarean with low transverse uterine incision.

Thursday, April 01, 2010

The Evidence Says: Delayed Umbilical Cord Clamping is Safe

Last year, I wrote a series of blogs titled “The Evidence Says”. This series of evidence-based maternity care blogs were very popular and I have had many requests to do another series this year. So for the first in the 2010 series, the topic is….delayed cord clamping.

Back in the time when we were living in caves and wearing fig leaves, we didn’t have the technology, sanitary conditions or even perhaps the knowledge to clamp and cut the umbilical cord on a newborn. For that reason, and perhaps others, Mother Nature covered the umbilical cord with a protective and insulating mucous tissue called Wharton’s Jelly. Wharton's jelly, when exposed to temperature and moisture differences, collapses structures within the umbilical cord and thus will provide a physiological clamping of the cord, approximately 5 minutes after birth. One wonders if early clamping of the cord in today’s maternity care setting results in lesser blood volume that was intended for the baby?

Lotus birth is the practice of leaving the umbilical cord unclamped and attached to the placenta after birth of both the baby and the placenta. In a Lotus Birth, the placenta is typically wrapped and carried with the baby until the cord naturally dries and detaches a few days after birth. Often, the placenta is treated with salts and herbs to preserve the meat and prevent spoiling and odor. Cultural disposal of the placenta varies from planting under a tree (the tree then becomes the child’s tree), to making a very nourishing placental soup, to dehydration and encapsulation for the mother to take by mouth. Studies are being done as to the impact of ingestion of the placenta on the postpartum period.

A review of current medical literature (2005-2010) finds overwhelming recommendations that late cord clamping can be advantageous for newborns by improving iron status and does not increase the risk of postpartum hemorrhage (Cochrane Database Syst Review. 2008 Apr 16;(2):CD004074.). A 2007 article in the Journal of the American Medical Association found that delay clamping in full term babies is beneficial to the newborn and the increase in polycythemia was benign. (Journal of the American Medical Association 2007 Mar 21;297(11):1241-52. Hutton EK, Hassan ES “Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials”.)

When looking at the effect of placentofetal transfusion on cerebral oxygenation in preterm infants, delayed clamping of the umbilical cord actually improved cerebral oxygenation in these infants in the first 24 hours. (Pediatrics. 2007 Mar;119(3):455-9).

Finally, an article in the British Medical Journal addressed concerns that delayed cord clamping could not only increase polycythemia but also cause hyperbilirubinaemia (abnormally high levels of red blood cells and bile pigments in the bloodstream, often leading to jaundice). However, trials show this is not the case. (British Medical Journal 2007, August 17 18;335(7615):312-3. Weeks, A. “Umbilical Cord Clamping After Birth”).

Obviously, if the newborn was compromised during labor or birth and needs specific and emergent care, the possibility of delayed cord clamping may also be compromised.