Wednesday, November 18, 2015

Natural Induction?

I am going to go straight to the point. There is no such thing as a natural induction. There I said it. Non pharmacological inductions,certainly. To actively bring on labor is induction no matter what method is being used. In cases of healthy full term mothers carrying healthy babies,the body simply will not go into labor before it's ready. No method of induction is without risk. There are times when potential benefits will outweigh potential risks and that is when induction is the ideal choice for a mother and her baby.
Here are some of the claimed methods of natural induction:

Castor Oil: This is a laxative. The logic behind using this as a method of induction is that it triggers contractions of smooth muscles in the intestines which will trigger the tightening of uterine muscles. Research shows this is successful in about 50% of women. Realistically would you want diarrhea on top of contractions? Or just end up suffering stomach cramps and excessive pooping without bringing on labor!?

Membrane Stripping: A care provider will often do this during a cervical exam. They use a gloved finger to make a sweeping motion inside the cervix to detach the membranes from the cervix. This is thought to bring on labor in the next 48 hours. Side effects of this procedure are usually some spotting and cramping. On occasion premature rupture of membranes can occur (PROM).

Evening Primrose Oil: EPO is used to ripen the cervix, but there is little proof that it induces labor. The only studies regarding EPO are about consuming it orally. There are no studies about the safety of EPO used vaginally. It has not been found to shorten pregnancy or labor.

Black Cohosh: Black cohosh is an herb that is thought to bring on contractions. There are no reliable studies with evidence supporting this. Women with issues with estrogen should avoid black cohosh as it behaves similarly to estrogen.

Red Raspberry Leaf Tea: This tea, not to be mistaken for raspberry flavored tea is used as a uterine tonic. Some women drink it throught pregnancy and some wait until closer to full term. Red raspberry leaf tea may cause Braxton Hicks contractions in some women, while harmless this can be uncomfortable.

Pineapple: Pineapple is a prostaglandin, which will soften the cervix. For this to work large amounts of the pineapple and core must be eaten. Canned pineapple and store bought pineapple juice will not work. The jury is out on whether or not labor will start soon after doing this. If you love pineapple, maybe it's not the worst idea out there.

Sex: Semen is a prostaglandin and may help soften the cervix  Good sex, I know a full term pregnant woman can have trouble with this, with an orgasm for the woman can help move things along. Orgasms trigger uterine contractions,so maybe an orgasm could bring on labor contractions.

Spicy Food: Spicy foods trigger prostaglandins in the digestive process,which is thought to encourage labor. Extremely spicy foods can cause an endorphin rush. There is little evidence to back this claim up,but if heartburn isn't an issue in your pregnancy, why not hit up the Indian buffet?

I made this list starting with the most aggressive and risky methods of induction and ended with things that are harmless and even fun. Relax and enjoy your pregnancy. If the need to induce comes up bring these up with your doctor if you want to skip the Pitocin. You are in charge of your body and birth, there is no expiration date for pregnancy. No one has stayed pregnant forever. 

Wednesday, November 11, 2015

As Your Doula

I work for you.  I will give you all kinds of information about your birth options.  I will talk to you about your goals for your birth.  I will do research about anything I do not know, and come back to you with all the evidence I can find.  I will be there for you if you need to ask any questions during your pregnancy.  I will be almost as excited about your impending labor as you are.  I will wait anxiously by the phone for the call that might come in the middle of the night to come and join you while you are in labor.  I will come to your house, if you want to keep laboring at home.  I will follow you to the hospital or meet you as you arrive. I will hold your hand and tell you that everything is going normally, if it is.  I will decode any medical-speak you don’t understand and make sure that you are making informed decisions about your care.  I will squeeze your hips and try all my tricks to help you stay as comfortable as possible during your labor. If you ask me a third time, I will run to get the anesthesiologist to give you your epidural.  I’ll suggest position changes and help you move into them.  I will make you go to the bathroom every hour during labor. I will be there with you the entire time.  I will help guide you through the entire process, and I will love every minute of it.

I want for you to have the birth that you want to have.  I don’t care if you get an epidural; I still have ways that I can help you. If you don’t want an epidural, I know how to get you there too.  I want you to leave your birth feeling fulfilled.  I want you to feel like you accomplished something, because having a baby is a MAJOR accomplishment no matter how it happens.  I want you to feel like you were supported in every decision you made along the way, and that you had all the information to make each one.   I want for you to be happy with your birth, exactly how it happened, no matter if it was to plan or not.  I want so much for you to completely exhilarated and excited about your birth, so much so that you can’t wait to tell the story to anyone that will listen. 

I believe that birth is amazing.  There is nothing more exciting than getting to watch a new baby come earthside.  Getting to be a part of that process is what makes the job of a doula so rewarding.  I believe in this work and its value.  I believe that this job makes a difference not only in the lives of the women we serve, but also in all those that we touch through our service: the nurses and other hospital staff, the physicians, the midwives, the family members, and the friends. I believe that one birth at a time, I am making a difference in the way that birth is viewed and approached.  Most of all, I believe that this work is my passion.

Doulas make a difference.  Doulas everywhere want to change birth one mother at a time. Doulas are evidence-based. 

Wednesday, November 4, 2015

What's Gravity Got to Do with It? Delayed Cord-Clamping Evidence

I was recently at a birth where the mom didn’t even request delayed cord-clamping, but the OB did it anyway.  I asked him why he waited, and his response was, “Why not? There’s great evidence that it is beneficial.” I almost hugged him, but stopped short when I realized that he was wearing a sterile gown and covered in birth goo. 

Delayed cord-clamping is a BIG issue that many parents don’t even talk to their provider about or even put into their birth plan.  There have been numerous studies published on the benefits of delayed cord-clamping, so much so that it really doesn’t make sense that it isn’t common practice.  Though, as we know, there is a lag of YEARS between research and policy change. 

Most recently, we have been hearing about moms who are being forced to choose between immediate skin-to-skin contact with their baby and delayed cord-clamping, based on the misguided theory that a baby must be lower than the placenta in order to get the blood from it.  We find this extremely interesting considering so many facts and research that states that this is NOT the case at all. 

A long time ago (1969), this gravity interference theory was a commonly held misconception.  So much so, that there was a real dearth of research even looking into the idea.  But, that really is no longer the case at all.  There has been a Cochrane Review out since 2010 that discusses the ridiculousness of thinking that a baby must be lower than a placenta to receive the 25-40% of the baby’s blood that could be left in it.  Even older than that is Mercer & Skovgaard’s publication analyzing the physiology of cord clamping and blood transference.  More recently (2012)Mercer & Erickson-Owens published an article calling for a change in practice with regards to umbilical cord clamping.

What is our take on the issue:
1.      There is ample evidence to support the fact that delayed cord-clamping is a GREAT idea.
2.      Gravity is NOT an issue, and thinking so means you are misinformed.

3.      We need to DEMAND delayed cord-clamping and specifically discuss it not only in the office setting before birth, but also during labor, and immediately following the birth!