Evansville Birthnetwork

The Evansville Birthnetwork has received a grant from Birthnetwork National to have an online survey asking local women about their maternity care experiences.  The survey is open to any woman who has given birth in the last three years within a 50 mile radius of Evansville, IN.  We hope to use the responses to help other women make informed decisions about their maternity care.  If you would like to take the survey, click here-

https://www.surveymonkey.com/s/EvansvilleAreaBirthSurvey

All questions, except the first, are optional.

By Megan Newhouse-Bailey, CHES, CLD, CD(DONA), CCCE, HCHD, BAIPPD

It is important for a woman to feel safe and comfortable while laboring and birthing. What mama chooses to wear can have an affect on her labor. While some prefer them, hospital gowns tend to be itchy and uncomfortable. They also can put mama in the mindset that she is a sick patient instead of a normal, healthy, birthing woman- especially when it says “Property of X Hospital” on the front of it. Unless you are going in for a cesarean, a mama has every right to wear what she wants, even at the hospital.  Hospital staff will probably warn you about how messy your clothes might get, so of course, plan to wear something you aren’t too attached to.

When thinking about what to wear for labor and birth ask yourself a few questions- will it be comfortable? Will it come off easily? Can I take it off if I have an IV? Do I have easy access to my breasts for breastfeeding?

I found quite a few things that meet that criteria, so I thought I would share them with you!

Tube dresses fit that requirement the best. In the summertime, there are lots of great swim cover ups that fit the bill. This one from Target  is a jersey knit maxi dress.

Another dress option is from the folks at Pretty Pushers. They make really cute “disposable” dresses made specially for birthing mamas. The have ties that open in the front to accommodate monitors, etc. I had a doula client wear one of these in hot pink.  She was really comfortable and looked great walking the halls of L&D.

If you don’t want to wear a dress, there are several skirt options. I love the combination of a simple jersey knit skirt and a nursing bra or tank.

The Old Navy  fold over maternity skirt is a classic to me. They are perfect for birth!

A skirt paired with a simple tank or a sleep bra (like these ones from Target) are great for labor and birth.

I am so glad we live in a time where woman have so many options and they can choose what they wear to give birth.

Megan is a childbirth educator and lactation educator, a birth doula and postpartum doula.  More information about her services can be found at Crazy Love Support.

If a mom has had a cesarean and is planning another birth, she has two options.  She can have a repeat cesarean or a vaginal birth after cesarean (VBAC).  There are risks and benefits of both options.  The main risk of having a VBAC is uterine rupture.  Uterine rupture happens about .8% of the time during a VBAC.  Most uterine rupures are not dangerous- many aren't even noticed until a cesarean or other abdominal surgery is done.  But occasionally, a rupture can cause serious consequences- the death of the baby or mother. 

On the other hand, having multiple cesareans poses risks too.  Cesareans increase the risk of placenta problems in future pregnancies such as placenta previa and placenta accreta.  The chances of these occuring increase with each cesarean.  These conditions are serious and can be life threatening.  Cesareans also increase risks such as breathing problems for the baby and NICU admissions.

In 2010, the National Institutes of Health held a conference on VBACs.  You can read their Consensus Statement, which includes information on the risks and benefits of VBACs and repeat cesareans. 

Another helpful resource is A Woman's Guide to VBAC, which explains the NIH Statement. 

The Internation Cesarean Awareness Network (ICAN) has lots of great resources about cesareans and VBACs.  The website includes information to help moms make the decision between repeat cesarean and VBAC, webinars, forums, and a listing of hospitals' VBAC policies.  Recently, a chapter of ICAN was formed in Evansville.  You can find information about meetings on their https://www.facebook.com/ICANofEvansville?ref=ts&fref=ts" target="_blank">Facebook page or on ICAN's website.

You can also watch vol. 4 of More Business of Being Born:  The VBAC Delimma.  The video is available on demand for $4.  The video includes information about risks, benefits, issues that keep many doctors and hospitals from offering VBAC, and stories of moms who have VBACs. 

If you are a mom considering VBAC, please contact us at evansvillebirthnetwork@gmail.com.  We can provide information on local options for VBAC and give you tips for having a VBAC.  Several moms in the Birthnetwork have had VBACs and are willing to talk about their experiences.  EBN also has a yahoo group where you can post questions and get input from other local moms. 

In most births, the baby's umbilical cord is clamped within seconds of being born.  Recently, this practice has been called into question.  There have been several studies that show benefits to waiting  even just a minute before clamping the cord.  More moms are beginning to ask for delayed cord clamping, and sometimes their doctors are not familiar with the benefits of it.

Nicholas Fogelson, an OB/GYN, has this blog post which summarizes the research on delayed cord clamping.   Much of the research he looks at focuses on preterm babies.  Some of the benefits seen in preterm babies include fewer cases of intraventricular hemorrhage and late-onset sepsis, higher red blood cell volumes and hematocrits and less need for mechanical ventilation and surfactant.  In term babies, there were higher iron stores at 6 months.

There is this study in the Journal of the American Medical Association which Dr. Fogelson doesn't discuss that looks at term babies:

Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials.  Hutton EK, Hassan ES.  Source: Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario.

In that study, babies had better iron status and less anemia. 

Dr. Folgelson also has this video of a Grand Rounds presentation he did looking at delayed cord clamping.  The video is 50 minutes long and divided into four parts.  In the video, he compares immediate cord clamping to robbing the baby of 40% of its normal blood volume.

Some local moms have talked to their doctors about delayed cord clamping.  One objection the doctors have had is that they believe if they put the baby on the mother's belly after birth and do not clamp the cord, the baby's blood will drain back into the placenta, or the blood in the placenta will not be able to get to the baby.  Dr. Fogelson addresses that issue in Part 2 of the video, starting around minute 6:30.  He discusses a study that says that babys who are placed on their mother's stomachs after birth get the same amount of blood from the placenta as babies held even with the birth canal or as babies held slightly lower than the birth canal. 

So if you are interested in having delayed cord clamping at your birth, look at these resources and share them with your doctor or midwife.  We would love to hear from you about your experience of asking for and receiving or not receiving delayed cord clamping.  Feel free to post a comment below or email evansvillebirthnetwork@gmail.com.

Eating and drinking during labor can give a mother energy and keep her hydrated.  It also helps her avoid feelings of hunger and thirst, which keeps her more comfortable.  Many birth locations restrict moms from having anything more than ice chips.  But are these restrictions necessary?

Not allowing moms anything to eat or drink started in the days when most moms gave birth while unconscious- under twilight sleep.  When someone is unconscious, they can vomit and the contents of their stomach can enter their lungs, causing a serious and sometimes fatal condition called aspiration pneumonia.  Today, it is rare for moms to give birth under general anesthesia.  And even when it happens, precautions are taken to help prevent aspiration.  A breathing tube is inserted into the mom's trachea to help prevent stomach contents from entering the lungs.  An antacid is given to help neutralize the acid in the mother's stomach. 

In 2010, the Cochrane Collaboration looked at policies restricting moms from eating and drinking in labor.  They found that, for low risk mothers, policies that restrict eating and drinking are not justified.  The review is available here-

Singata M, Tranmer J, Gyte GML. Restricting oral fluid and food intake during labour. Cochrane Database of Systematic Reviews 2010, Issue1. Art. No.: CD003930. DOI: 10.1002/14651858.CD003930.pub2

Available at: http://www2.cochrane.org/reviews/en/ab003930.html

The American College of Obstetricians and Gynecologists has this to say about drinking in labor:

“According to ACOG, women with a normal, uncomplicated labor may drink modest amounts of clear liquids such as water, fruit juice without pulp, carbonated beverages, clear tea, black coffee, and sports drinks. Fluids with solid particles, such as soup, should be avoided, however. Women who have uncomplicated pregnancies and are scheduled for a cesarean delivery may also drink these clear liquids upto two hours before anesthesia is administered.”          - from the ACOG press release “Recommendations Relax on Liquid Intake during Labor.” Available at http://www.acog.org/from_home/publications/press_releases/nr08-21-09-2.cfm

The American Society of Anesthesiologists has this statement:

“The oral intake of modest amounts of clear liquids may be allowed for uncomplicated laboring patients. The uncomplicated patient undergoing elective cesarean delivery may have modest amounts of clear liquids up to 2 h before induction of anesthesia. Examples of clear liquids include, but are not limited to, water,fruit juices without pulp, carbonated beverages, clear tea, black coffee, and sports drinks.”   - from the statement Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia available at: http://www.guideline.gov/content.aspx?id=10807

And the American College of Nurse Midwives has this to say:

 “The newest Clinical Bulletinfrom the American College of Nurse-Midwives reviews evidence relevant to providing oral nutrition to women in labor and concludes that drinking and eating during labor can provide women with the energy they need and should notbe routinely restricted.”  -from an ACNM press release “AMERICAN COLLEGE OF NURSE-MIDWIVES PUBLISHES CLINICAL GUIDELINES FOR ORALNUTRITION DURING LABOR” available at http://www.midwife.org/siteFiles/news/ACNM_Clinical_Guidelines_on_Nutrition_in_Labor.pdf

So if your doctor, midwife or hospital routinely restricts moms from eating and drinking in labor, you can ask if those restrictions are justified, or consider switching to a different provider or birth location.

Many women experience problems with their pelvic floor- leaking urine and, occasionally, feces.  In the past, some people have blamed having a vaginal birth for pelvic floor problems.  Childbirth Connection has a resource separating fact from fiction- what causes pelvic floor problems and what can be done to help prevent them. 

Vaginal birth has been blamed, and some suggest that enlarging the opening of the vagina by cutting it at the time of birth (episiotomy) or even having a surgical birth when there is no medical complication (elective c-section)will prevent weakened pelvic floor muscles and injury. Unfortunately,there is a lot of false, unproven, and incomplete information on this topic.

A few women plan a cesarean section in hopes of avoiding pelvic floor problems.  But will a cesarean prevent those problems?

Planning cesarean surgery simply to avoid the possibility of pelvic floor problems is unlikely to be in your self-interest. Cesarean surgery involves numerous extra risks to you and your baby. By contrast, the likelihood of continuing to experience bothersome symptoms after the postpartum recovery period with a vaginal birth is small. Moreover,some women with continuing problems can obtain relief or cure and avoid a corrective operation by an intensive regimen of pelvic floor exercises (kegels). It makes much better sense to avoid the procedures and practices that are known to cause problems in the first place.

Some of the interventions that may cause pelvic floor problems include: lying on the back, episiotomy, vacumm and forceps, directed pushing and fundal pressure.  Epidurals increase the chance of needing a vacuum or forceps delivery and the risk of having a tear into the anal muscle.  Those two things, in turn, increase the risk of pelvic floor problems.  Many of these interventions are overused in maternity care.  By choosing a caregiver that supports normal birth, you may be able to avoid having interventions that increase your risk of pelvic floor problems. 

I really like the midwife who blogs at Birth Sense.  Her latest posts talk about the "Cult of More."  If a little of something is good, a whole lot must be better, right?  Probably not when it comes to labor and interventions used during labor. 

She talks about how a straight-forward birth can be ruined by the Cult of More.  We're doing more of many things- more tests, earlier inductions for postdates, lower thresholds for Gestational Diabetes.  And often, the things we're doing more of aren't supported by evidence.  Maybe the "more" is leading to worse outcomes.  She says what we should be doing more of is simple things- more watchful waiting, more one on one care, being more supportive of normal birth.

She ends Part 1 of the Cult of More with this advice:

When your provider suggests doing more, make sure that what your provider is already doing is right.

In Part 2 of her post, she suggests that so many hospitals have opened high level NICU's that there aren't enough sick babies to fill them.  So, some babies who aren't all that sick are being sent to NICUs to bring in more money.

The New England Journal of Medicine contends that having more NICU resources than are needed to serve a region is not only expensive, but potentially dangerous for babies.  Researchers found no decrease in infant mortality rates in areas with more services, and suggest that too many expensive facilities may mean that “infants with less serious illness might be more likely to be admitted to the NICU”.  Admission to NICU could lead to overtreatment of babies who are not seriously ill, subjecting them to “more intensive diagnostic and therapeutic measures, with the attendant risks of errors and iatrogenesic complications [hospital-caused complications], as well as impaired family-infant bonding (emphasis mine).²

There has to be a balance in maternity care- finding a way to have the resources needed without over-using interventions.  Right now, it seems we're quite off balance.