Is Underwater Childbirth Safe? Some Doctors Say No.

Compliments of Health Day News

Compliments of Health Day News

Most women look forward to having a baby but no one wants to feel pain. In recent years, having a baby in a pool of water has become a popular trend because it allegedly reduces the need for pain meds and anesthesia however not so fast, says both obstetricians and pediatricians. The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) have issued a formal opinion (Committee Opinion #594 April 2014) that does not support “immersion” (aka underwater) births because of its associated complications while a mother is pushing to deliver her baby. The “pushing” part of childbirth is also known as “second stage labor.”
Why is this important? Because there are presently 143 birthing centers in the U.S. that offer underwater births to pregnant women. In fact, 1% of all births in the United Kingdom are immersion. While some research claims that these births are safe, experts think otherwise and state that the number of women studied was too small to detect rare but potentially harmful outcomes.
While some women may experience a feeling of well being and control, decreased stress and less vaginal tears during an immersion birth, according to the Committee Opinion, there is no scientific evidence that an underwater or immersion birth helps the baby. In fact, there is evidence of increased complications such as
• increased infections to both the mother and newborn, especially after the membranes are ruptured (aka “water broke”)
• difficulty in regulated the newborn’s temperature
• increased risk of the umbilical cord tearing from the placenta
• infant drowning and near drowning
• infant seizures and suffocation
• severe infant breathing problems
Should women give up immersion births completely? Probably not. The experts think that a woman may stay in these tubs during labor but should NOT push or deliver the baby underwater. They also recommend stricter protocols, patient selection and infection control.
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New Guidelines say Give First-Time Pregnant Women More Time in Labor

Courtesy of Virginiawomen'sbirthcenter.com

Courtesy of Virginiawomen’sbirthcenter.com

The American College of Obstetricians and Gynecologists and The Society for Maternal Fetal Medicine (aka high-risk obstetricians) have issued a new recommendation that is a game-changer in the manner that obstetrics is practiced: allow low-risk first-time pregnant moms more time in labor. This is assuming that the fetal tracing is normal and the mother does not have a fever, high blood pressure or a condition that could compromise her life or the life of her unborn baby. This recommendation is based on new evidence that demonstrates contradicts the old school Friedman Curve theory that active labor begins at 4 centimeters. It actually begins at 6 centimeters. This would be especially helpful to first-time teenage moms who might be forced to have future cesarean sections based on hospital rules and physician opinions if their first delivery was a cesarean section. The “once a C-section, always a C-Section” culture hits this particular group the hardest.
According to the new recommendations:
• Women should be allowed to push for at least two hours if they’ve given birth before, three hours if they are first-time mothers, and even longer in certain cases, such as when an epidural is used for pain relief.
• Vaginal delivery is the preferred option whenever possible and doctors should use techniques — forceps, for example — to assist with natural birth.
• Women should be advised to avoid excessive weight gain during pregnancy.
A word of caution should be offered about these recommendations: forceps deliveries are becoming a lost art and can cause more damage than good in the hands of an inexperienced provider and the “avoid excessive weight gain during pregnancy” is easier said than done for most women.
That being said, these new recommendations gives first-time pregnant women the right to step on the proverbial brakes, the next time someone wants to rush their delivery via a C-section.
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Could You Pass This Pregnancy Quiz?

Pregnant moms, are you ready to take a Smart Mother’s quiz? Here’s one that taken from The Smart Mothers Guide to a Better Pregnancy. All rights reserved.

You have been which might be considered fluid for the past two days. You call your provider, who advises you to go to the hospital for further evaluation. Upon your arrival at the hospital, the nurse does something called a nitrogen test.  Nitrogen is a substance that turns blue when exposed to amniotic fluid, mucus or blood. Your nitrogen test proves negative. Should you be discharged home? Yes or No.

The answer is no, you should not be discharged home. You first need to have an ultrasound to make certain you have adequate fluid. You could have legitimately been leaking fluid for several days and now have no fluid. Without fluid, an infection called chorioamnionitis could easily develop. Or if your fluid is extremely low (also known as oligohydramnios), you might need to be delivered.

Did you learn something? Well here’s another quiz also taken from the book:

You have had a dull headache all day. For the past two weeks you have received nonstress tests because you complained of decreased fetal movement. You had a two-hour wait before a bed became available in the triage unit. The nurse takes your vital signs, and your blood pressure is 140/90. After twenty-five minutes, your nonstress test is reactive, the triage unit is becoming busy, and the nurse calls your physician with a report of your NST results but omits your blood pressure result and complaint of a headache. However, she does advise your physician that the labor is busy and they need your bed. Your physician’s midwife is on call and sends you home. Is this correct?

No. Although the nurse was correct to report a reactive nonstress test, she did not mention your elevated blood pressure or your complaint of a headache. In this clinical situation, other tests would be necessary to make certain that you are not developing pre-eclampsia.

In pregnancy, the unexpected things, if not managed properly could get you in trouble. Sadly, many healthcare providers do not discuss potential problems with patients until they are smack in the midst of a crisis.

Want to be prepared? Then order a copy of The Smart Mother’s Guide at www.smartmothersguide.com. Remember a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.

 

Can Uterine Rupture in VBACs be Avoided?

ImageThe topic of vaginal birth after cesarean section (aka VBAC), is in the news again. According to OB-GYN News, a recent medical study has shed some light on the dreaded VBAC complication, uterine rupture.  A uterine rupture is the opening of a previous uterine scar or incision that occurs while the uterus is contracting in labor. Although rare, occurring 1 in every 5,000 to 8,000 pregnancies, its results are life-threatening and can result in significant bleeding and shock. Traditionally, a uterine rupture was difficult to diagnose with signs and symptoms presenting only after a catastrophe such as fetal death or significant bleeding.  However, there is new hope in sight.

According to Dr. Lori Harper of Washington University in St. Louis, slow progression of labor after reaching 7 centimeters in women who are attempting a trial of labor after c. section (TOLAC ) may signal signs of uterine rupture. Women who have never had children dilate 1.2 centimeters per hour while women who have had previous children progress at 1.5 centimeters per hour. If a woman with a previous c. section makes progress to 7 centimeter and then her labor pattern slows down, this is a cause for concern. Labor progress is determined by how quickly the cervix dilates each hour. According to Harper, once a patient has reached 7 centimeters and the cervix is taking 10 to 13 minutes longer than expected, there is a possibility that the uterine incision might be separating, especially for patients who are being induced with a medication called Pitocin.  Harper emphasizes that slow progress before 7 centimeters during (TOLAC) does not necessarily suggest a uterine rupture, but slow progress after 7 centimeters does.

Harper suggests that patients should be examined every hour as opposed to two, if their labor slows down after reaching 7 centimeters. The adoption of this protocol might improve the safety of VBACs significantly; therefore if you’re pregnant and contemplating a VBAC, please consider discussing this with your healthcare provider.

Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.

http://youtu.be/rySO6jqj0ik

You’re Pregnant and Your Local Hospital Closed. Now What?

Today will be a day of mourning for pregnant women who are uninsured and receiving Medicaid in Houma, Louisiana. Their local hospital closed its maternity and neonatal units because of a $2.9 million dollar budget cut. Over 100 employees will lose their jobs, many whom have held their positions for over 20 years.  This closing will have a ripple effect and is an increasing phenomenon that has besieged many hospitals across our nation. Over thirteen hospitals in Philadelphia closed their labor and delivery departments and in my own backyard, South Seminole Hospital in Florida did the same. What’s going on? Hospitals claim they’re losing money and government insured and non-insured pregnant women are feeling the aftermath. These are some very scary times.

The options for Houma’s uninsured pregnant women or women who receive Medicaid are quite limited. A few years ago, they could have gone to Lafayette Hospital in Lafayette; or Earl K. Long in Baton Rouge or Charity Hospital in New Orleans. Sadly, all of those hospitals have closed their labor and delivery department. I know those hospitals well, having worked and lived in Louisiana for almost four years as a community health physician.

Although Houma is a small, close-knit community, its hospital provided hundreds of prenatal visits for pregnant women in nearby parishes. They interacted like family. The nurses at Leonard J. Chabert Medical Center are devastated and apprehensive about the future of the pregnant women knowing that most cannot afford to go to private physicians and many have high risk problems. Consequently, many of these patients will be forced to travel over 300 miles on a 5-hour trip to Shreveport, Louisiana to receive prenatal care at its charity hospital.

I strongly encourage the State of Louisiana to brace itself for an increase in infant and perhaps even maternal deaths. Many high risk patients are simply not going to be able to make that 300-mile trek to Shreveport without adverse consequences. Any perceived benefit from that $2.5 million dollar budget cut will quickly dissipate based on the spike of NICU admissions that are sure to come.

The women and their unborn babies deserve better. Shame on the State of Louisiana.

Questions Every Pregnant Woman Should Answer

To be forewarned is to be forearmed. That is the mantra that should be adopted by all potential patients who are engaged in our present healthcare system and especially pregnant women. Information is power and you can never have too much regarding your health. There is a trend for pregnant women to write a birth plan regarding their delivery but there should also be an action plan during the third trimester.

Listed below are questions taken from Harvard Medical School’s Family Health Guide. I strongly encourage you to become familiar with these questions because they could inevitably save your life or the life of your baby. Many of them address the warning signs of pre-eclampsia (swelling of the hands and face) and preterm labor (leaking fluid).

 

  • Do you have adequate support at home from family or friends?
  • How do you feel? Have you had any problems since your last visit?
  • Have you had any vaginal bleeding or spotting?
  • Have you had any pain or uterine cramping?
  • Have you had any discharge or leakage of fluid from your vagina?
  • Have you noticed swelling of your face or ankles?
  • Have you had any problems with your vision?
  • Are you getting frequent headaches?
  • Have you noticed a change in the frequency or intensity of fetal movement?
  • Are you planning to breast-feed or bottle-feed?
  • Have you selected a pediatrician for your baby?
  • Are you taking classes on labor and delivery?
  • Have you made arrangements for your family’s health insurance to cover your baby when the baby is born?
  • Have you purchased a special car seat to hold your baby when riding in your car?
  • Have you decided on whether the baby will have a circumcision, if a boy?
  • Have you talked with your doctor about the length of your stay in the hospital?
  • Do you know the signs of going into labor so that you can call your doctor when labor begins? (These include uterine contractions and rupture of the membranes).

A good defense begins with a good offense. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.