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Monthly Archives: November 2011

HAPPY THANKSGIVING !!!

To all of the families who give me the opportunity to share in their wonderful birth journey…a heart felt thank you!!!

Premature Rupture of Membranes & Repeated Pelvic Examines

Jacqueline Levine, a sister doula and occasional writer for  Lamaze research blog Science and Sensibility, gracefully gave me permission to post her comments about premature rupture of membranes… or PROM.

Very eye opening!!!

Hello all…There are some studies that point to the fact that repeated pelvic exams in the last month can irritate the membranes and lead to PROM at term (premature rupture of membranes), meaning labor is immanent, and mothers are close to their “due date”, but pelvic exams insert an artificial factor into the circumstances that lead to the healthy beginning of effective labor. Onset of labor may be just a few weeks or days away, but if waters break and labor doesn’t ensue, although mom is almost-but-not-quite ready, they must induce. Pelvic exams are not predictive or probative and unless there is compelling medical reason, should not be done week after week at the end of the last month. Being able to say to a mom that her cervix is softening but still not opening is nice, or to tell her that she is 50% and 1 cm is interesting indeed, but what really does it do for the process? Does it tell her when she’ll go into labor? Not bloody likely! If enough acid in the vagina is pushed to migrate upwards, or mother’s flora (or yikes! foreign germs from the glove covering the inserted hand) are forced up towards, and finally permeate the mucous plug to irritate and eventually disturb the integrity of membranes, they will respond by breaking. Now we have put another whole category of mothers onto the c-section express.

Here are some studies:
* Obstet Gynecol. 1984 Jan;63(1):33-7. Relationship of antepartum pelvic examinations to premature rupture of the membranes.

Lenihan JP Jr*
* Obstet Gynecol. 1987 Dec;70(6):856-60. Histologic chorioamnionitis in pregnancies of various gestational ages: implications in rupture of membranes.Perkins RP, Zhou SM, Butler C, Skipper BJ. SourceDepartment of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque.

* vaginosis and its implication in preterm labor and premature rupture of membranes. A review of the literature. Reynolds HD. Source Yale University School of Nursing, New Haven, CT

There are more studies. This knowledge has been around for a while. When, d’ya suppose, will caregivers heed some evidence-based stuff? Here’s the answer, I guess:

* Do the Medical Policymakers of Maternity Care Resist Changing Their Protocols to Reflect Best-Evidence Scientific Practices for Childbearing Women?

Olatunbosun OA, Eduoard L, Pierson RA. Physicians’ attitudes toward evidence based obstetric practice: a questionnaire survey. Br. Med. J. 316, 365–366 (1998).*
Abstract: In 1998, a questionnaire mailed to family physicians and obstetricians found that only 40% felt that evidence-based medicine was “very applicable to obstetric practice”. Concerning comments from this survey included “obstetrics requires manual dexterity more than science”, “evidence-based medicine ignores clinical experience”, and that following guidelines could result in “erosion of physician autonomy”. These views were described as obstacles to the adoption of evidence-based practices, and the authors recommended emphasis of critical analysis of the literature as part of medical education.”

Let’s let our mothers know about this and Bishop scores and give them the facts so that they can refuse pelvic exams and other procedures except for compelling medical necessity, and wait to get exams until they are well into labor and need to know whether they should be admitted!! There…I’ve said it!!!

Thank you, Jacqueline!!!

If you wish to weigh in….send your comments to

KennyShulman@aol.com

ARE YOU HAVING A HOLIDAY BABY?

 

My friends at “Preparing For Birth” posted the following…

“Induction is serious business — the holiday season is upon us — be wary of convenience labor induction to avoid a holiday birth day — knowing your bishop score can help you make this decision.”

This really got me thinking as I have several holiday babies scheduled in the next few weeks.

I started really looking at the Bishop Score to see how all of my mommies are faring at this point. And then I began to consider how care providers look at this and make their determinations.

If in the next few weeks, as these women have their next round of appointments, and their care providers start talking induction, what is my appropriate behavior as a certified DONA doula? I know it is not appropriate for me to contradict the medical professional or give any kind of advice at all. After all…I am not medically trained.

But it is within the scope of my profession to supply information so that informed decisions may be made by these future mommies.

And so…..I choose to post the Bishop Score.

Parameter/Score      0                       1                             2                       3

Position                Posterior      Intermediate       Anterior

 

Consistency         Firm              Intermediate       Soft

 

Effacement           0-30%           31-50%                   51-80%           >80%

 

Dilation                 0 cm                 1-2 cm                   3-4 cm             >5 cm

 

Fetal Station         -3                      -2                            -1,0                   +1, +2

Here’s how it works… Next time you have a vaginal examine  (at 40 weeks plus unless you really want to consider induction before full term)  you might ask your provider the following: uterine position, cervical consistency, cervical effacement, dilation, and the station of your baby.                                            You can find definitions of these terms in a good reference book such as Pregnancy, Childbirth and the Newborn by Simkin et al., or TheThinking Woman’s Guide to a Better Birth by Henci Goer.

“A score of 5 or less suggests that labour is unlikely to start without induction.  A score of 9 or more indicates that labour will most likely commence spontaneously.                                                                                                                                          A low Bishop’s score often indicates that induction is unlikely to be successful. Some sources indicate that only a score of 8 or greater is reliably predictive of a successful induction.”                                                                                                                   From Wikipedia

Wait a minute……I ask you to consider these two paragraphs  again. Hmmm…

Modified Bishop score

“According to the Modified Bishop’s pre-induction cervical scoring system, effacement has been replaced by cervical length in cm, with scores as follows- 0>3 cm, 1>2 cm, 2>1 cm, 3>0 cm.”

“Another modification for the Bishop’s score is the modifiers. Points are added or subtracted according to special circumstances as follows:

One point is added for:

1. Existence of pre-eclampsia

2. Every previous vaginal delivery

One point is subtracted for:

1. Postdate pregnancy

2. Nulliparity (no previous vaginal deliveries)

3. PPROM; preterm premature (prelabor) rupture of membranes

From Wikipedia

Just some things to consider.

As I always say……your body, your baby, your birth!

And Happy Holidays!!!

ARE YOU TOTALLY COMFORTABLE TALKING WITH YOUR CARE PROVIDER ???

ARE you totally comfortable talking with your care provider? Asking all those  questions you might be too embarrassed to ask someone else?

DOES this person give you the time to talk about whatever you want to talk about?

 

DOES your care provider validate your concerns? Make you feel like your question is the most single important question?

 

DOES s/he allow you to feel like an intelligent and caring parent to be?

 

DO you leave the office feeling like an adult who is worthy of this professional’s time? Do you leave feeling no shame?


 

 

If you answer NO to ANY of these questions……

it may be time to find yourself a different care provider!!!!


 

And it is never too late in your pregnancy to do so!!!

What we (and it isn’t just us women) tend to forget in the presence of    medical persons is that WE ARE THE CUSTOMER!!!! This is true of facilities, too.

This does not mean that we have the right to be rude and/or arrogant. But it does mean that we have the right to feel comfortable, to have the respect of the medical person, and to be given the time to address the topics that are important to us.


You are sharing probably the most important, and intimate, time/event   of your life. You have every right to feel good about whom you are sharing this with. Baby professionals should feel honored that you have chosen them for this time. I know I do in my capacity!

And after all……..you are the one paying this person’s salary!!!

Without you…they will not be in business!!!