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Active Management of Third Stage of Labor & Birth

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Jacqueline Levine, Childbirth Educator/Lactation Consultant, has taken a hard look at the Third Stage of Labor and Birth.
If this stage is “managed” or not may have an impact on your breastfeeding.
Take a look at what this long time professional has to say…..

Prophylactic pit is just  part of that package of “Active Management of Thirds  Stage of Labor” (AMTSL) and there’s  a really great analysis of that concept  and its consequences  in “Optimal Care in Childbirth” Romano and Goer’s  great book.  They contend, and studies agree,  that the medical model of birth…induction and pit to augment labor and other protocols…are modifiable causes of PPH (Post Partum Hemorrhage),  and all woman do not just bleed to death after birthing their babies.   

We know that docs think that medical intervention is always the answer to a problem… never the cause.   I quote from the Goer/Romano book “…research fails to provide ANY evidence that universal application of AMTSL   results in clinically important improvements in maternal outcomes in developed countries, while documenting that it introduces harms”  (p379).     

 In 2010, Cochrane reviewers raised many issues about the trade-offs between the benefits and harms of managing third stage, including worries about prophylactic pit for all women regardless of their risk profile. The key phrase for looking at PPH is, I think, “developed” countries.   99% of deaths due to hemorrhage are in undeveloped and developing countries (says the WHO) , and pit has had  great success in the prevention and treatment of PPH in low-resource countries.

 But here in the US and  in other  high-resource settings, AMTSL “ conferred no benefit other than a small absolute reduction in transfusion rates, but findings show that transfusion rates are not an objective measure”, (Goer/Romano p379), because of the biases found in decisions about  the administration of transfusion and the lack of standardization as to when to treat.   Here, where we have the best medical resources (badly used and badly distributed, no doubt), a pit shot for every woman is overkill, unnecessary for the healthy mother, takes the place of her own highest-ever levels of natural oxytocin, upsets the beneficent cocktail of post birth hormones  the high levels  that nature provides for the most successful and joyous first minutes and hours with her newborn.  

During a c-section,  the mother may lose as much as 1000ml of blood, and that’s not enough to make docs call for a transfusion, but the standard for vaginal birth is only 500ml, and one wonders how they can tell how much blood loss there really is, when much of what a woman loses may be absorbed in the chux pads under and around her.

The Cochrane  says” Women should be given information on the benefits and harms of both methods to support informed choice. Given the concerns about early cord clamping and the potential adverse effects of some uterotonics, it is critical now to look at the individual components of third-stage management.”

Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev. 2011; 11:CD007412 (ISSN: 1469-493X) Begley CM ; Gyte GM ; Devane D ; McGuire W ; Weeks A
School of Nursing and Midwifery, Trinity College Dublin, 24, D’Olier Street, Dublin, Ireland, Dublin 2.

 

They Get It…Why Can’t We?

 

As some of you may know, I have just returned from an awesome vacation in Belize.S6304091 While visiting a friend in Corozal Town, we passed a park at the water edge called Mother’s Park.
In the center of this park, for all to see, every single day, S6304087in color no less, is a statue of a mother breastfeeding her baby.
PERFECT! JUST PERFECT!

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As my picture was being taken, this little girl wanted to stand with me. With her mother’s permission, we posed.
In the second picture, she S6304090wanted us to say “cheese”. Who am I to deny such an adorable child?
Our country is so advanced compared S6304088to this small country. How can we be so delinquent in something that is so very natural?

 

The Squat Bar

The squat bar can be an awesome tool to use when you are pushing your baby into this world. But it can be very confusing as to how to use it…and feel strange. I will try to give you a feel for it with the pictures and comments below. Unfortunately, it is rare to have an opportunity to actually practice with a bar.

3cbd034e9e27cd1efe410ff6801cc37b.wix_mp_1024 This is how the bar and the bed are positioned. You sit right on edge of raised portion until a contraction comes. Then with a contraction, you squat so your bottom is not touching bed, and you push.

khkhjymjjkujPushing like this at first can feel a little insecure because all of your weight is on that lowered portion of the bed. It will help you to know that your support person is right there with you.
It may also help to have entire bed lower to the ground so you do not feel like you might fall off a cliff.

hNote how the bar is tilted towards the foot of the bed and all of your weight is on lowered portion.

 

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Between contractions, you can try to rest the weight of your body back onto the higher portion of the bed.

 

index (2)Then, with a contraction go into a deep squat, supporting yourself with the bar.

squatting bar on hospital bedRemember, your support people are right there for you and will help steady you. And having the entire bed lower to the floor will also help you to feel more secure in this position. Everyone else will accommodate your position.

a4128bd43637fbfa63d5aa40946a1e19.wix_mp_1024This is an awesome way to use the squat bar and “tug-of-war” position. Please note how she is not on her bottom; how she is really in a squat but on her side. Very useful with an epidural. “Tug-of-war” position is usually used for pushing; not labor.

maxresdefaultI’m not sure about this kind of position because while it simulates a squat, it leaves her sitting on her butt. It does, however, allow for that “tug-of-war” position.

fThis position allows you to be asymmetrical while being able to take some weight off of the lower body by leaning on the bar. If possible, spread your legs as wide as you can.

 

Most of these positions can also be good for labor. It is considered best to use the bar for a deep squat during a contraction. Sit back and rest in between. You want to be sure that when you are in that deep squat, you are NOT PUSHING until your cervix is ready.

If your hospital does not have squat bars…start asking for them. This is how change can occur!

Tools for Birth

When you are ready to give birth, you will have an arsenal full of tools you wish to use during this most important and exciting experience.  <<   

You will have all of your recent education, your birth wishes, your doula, your midwife. You will <have your birth ball, your birth pool, your willingness to do what you need to do.

Your desired ambiance will be created through lighting, music and aromatherapy. <And most important…you will have your open mind.

If things might not go as you originally hoped they would…you will have another set of tools that some call interventions. And you will know in your heart that there is a time and place for every intervention that man has created. <And so your tools will have grown to include pitocin, pain medication, epidural, and if need be, a cesarean.

And in the end, you will have your new baby in your arms. <Your dream of many days and weeks will be complete.< Perhaps not exactly as you had hoped and planned. And for that you may need to grieve. And that grieving will be good.

But you will forever know that you had prepared, and used,  your tools. And you had prepared, and used, your open mind. <And then, and for always, you will have your baby; your family.

 

Hypnobabies®

Hypnobabies® says…
“Enjoy your baby’s birth in comfort, joy and love…”

And that is exactly what I witnessed!

But this type of birth is only going to work for you if you believe and if you invest yourself…also known as practice and prepare.

Hypnobabies® was not the only thing going on with this birth.

There was just so much love in this room…between mom and dad and son and parents. It was perfect the way dad read the script while son performed the touching. And, of course, when there is this much love you know that the oxytocin levels are unbelievable. Then add the soothing effect of the warm waters of a birth pool…well, no wonder this labor did not go on for hours on end.

And just to make this birth even more special…a well known doctor, Dr. Stringer of Central Carolina OB/GYN in Greensboro, NC, was the one who had the privilege of guiding this baby to her momma’s waiting arms.

A week or so later and it was finally my turn…

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     I love my work!!! Thank you, Mom & Dad!!!

https://www.hypnobabies.com/

Evidence Based Waterbirth

This is an awesome article

by Rebecca Dekker, PhD, RN, APRN, 

founder of Evidence Based Birth.!!!

A must read for everyone who might even consider a waterbirth.

Just click above to go to the article!

If you would like to chat with some women who have had a waterbirth, just get in touch with me.

If you would like to know how you can have a waterbirth in Greensboro, NC, give me a call, email me or fill out my contact form.


 

Waterbirth…so natural, so gentle, so safe!

Yes…a waterbirth is natural birth. It is so much more gentle for momma and baby. And it is safe…baby is not going to drown; there are no infections.

It can even be safe for VBACs, as is shown here.

Women’s Hospital of Greensboro, NC has the statistics that show the wonderful outcomes.

However, you must be a qualified candidate for a waterbirth and only your care provider can determine this for you. You must also have a midwife attend your birth.

For more information about waterbirths at Women’s Hospital of Greensboro, please feel free to contact me:

THE Card

Thank you Momma, Dad and wee one!

Thank you, also, Tanya Bailey, CNM, Wendover OB/GYN!

 

“The best-laid plans of mice and men oft go astray.”

 

Things can go wrong even though you have carefully planned what you are going to do, as Robert Burns’ poem “To a Mouse” reflects in his words,  “The best-laid plans of mice and men oft go astray.
This, unfortunately, is true in birth as well. Although a cesarean birth was not in her original plans, just look at this beautiful new family!

  If this must happen to you…ask for the “Friendly Cesarean”.

Bed Rest Survival Tips

Have you been placed on bed rest for a medical reason?

How are you spending your time?bedrest-300x200

We all know those reality TV shows about pregnancy/birth/babies are a waste of time. Friends and family are not always available to entertain you. Just how many times can you write your birth wishes???

Grace has been on bed rest for the past nine, yes, that’s NINE, weeks with a couple more to go!!!

She wrote to me the other day about how she has been able to maintain her sanity and we both thought it might be helpful to other pregnant women who are on bed rest, for whatever reason.

Hi Kenny!

Hope you had a wonderful weekend!

 Just want to let you know things that helped me during the whole bed rest season! (I am doing my 9th week!!)

 Journaling, putting your thoughts, hopes and feelings in words definitely helps expressing them in pen and paper

 Books on Bed Rest survival:

*Amy Sprenger- Baby bumps (This is a true story and written in a very comical way of her bed rest journey)

*Kelly Whitehead- High Risk Pregnancy- Why me (I enjoyed this book because there are so many amazing success real life stories, tips on what to do while on bed rest, and statistic on some condition on why pregnancy becomes high risk, and the best part is natural birth is possible with High Risk- the arthur herself had a natural birth after being on Bed Rest since 20 weeks)

 *Wanda Hale- Pregnancy Bedrest – A journey of Love ( I really love this book covers the emotional health and it is really about a journey of love, it encourages positive visualization, relaxation technique, practical breathing exercises, and practical physical exercises on bed rest, very spiritual, and covers post partum following bed rest with a newborn too)

 Of course, Josh mentioned the amazing forums online! I am on Bed Rest club in www.BabyCenter.com and there are groups on Facebook too, and the ladies( and some men) are amazing cheering you on, and knowing you are not alone in what feels like a lonely journey definitely is a boost!

 It’s all about keeping up with the positive!

 We don’t really have much physical help since I’ve been on bed rest, so we’ve learned to set our expectation low, since life doesn’t stop for everyone when you are put on bed rest. We learn to do without, and live simply to the fullest.

 Good Luck and I am cheering on for her!

 

If you would like to chat with Grace about this adventure of hers, her email joshxgrace@gmail.com

If you wish to share some of your tips, please send to KennyShulman@aol.com

Thank you, Grace!!!

THE GIFT OF A DOULA

 If you are in the position to give a daughter, daughter-in-law, girlfriend, 35476_498439723552500_336163383_n 577252_498440090219130_1358449181_nniece, any pregnant woman who is in your life a gift…

                                give her the gift of a birth doula!

<I will create a special gift certificate that will explain the benefits of having a doula attend her birth, as well as what my services include.

I will even come in person to present your gift to her!

<    

  Include the expense of my birth pool, or give separately!

You will find a listing of my services and fees, as well as my contact information, at           TriadBirthDoula.com