Lamaze Magazine 2009

for example, if your labor is induced or augmented with Pitocin, or if you have an epidural. If your baby’s heart rate changes, or you or your baby have a health problem, you also may be monitored continuously. lower your risk: The american College of obstetricians and Gynecologists (aCoG) supports periodic monitoring (once every 30 minutes in active labor) via eFm or auscultation, which is “listening” to what’s going on with the baby and the contractions using ultrasound. If that’s not an option in your hospital or birth center, talk with your nurse about being upright (such as in a rocking chair or on a birth ball) when being monitored, as opposed to laboring in bed. or, ask for a mobile monitoring unit so that you may continue to walk, go to the bathroom, stretch or slow dance. Try not to labor in bed for long periods. Don’t be distracted by the monitor – turn it away and lower the sound. remind your support team to focus on you, not on the machine. induction What: An artificial way to start labor using one of the following induction methods: 1. membrane stripping or sweeping via your health-care provider’s finger to separate your cervix from the tissue around your baby’s head. 2. rupture of membranes using a sterile hooked instrument. 3. Cervical ripening with the insertion of either a prostaglandin gel or a balloonlike catheter. 4. Pitocin, a synthetic hormone given through an IV drip in steadily increasing amounts to stimulate contractions. In addition, some non-medical induction methods may be suggested, including acupuncture, homeopathy and/or herbs, sexual intercourse and nipple stimulation. Discuss the pros and cons with your healthcare provider. If you do try one of the above, keep him or her updated on your progress. Why: aCoG recognizes various medical reasons for inducing labor (see “When Induction Is Necessary,” right). However, the number of inductions in the United States is on the rise, due to a recent trend of inducing for non-medical reasons. These include the mother’s desire to plan the baby’s birth date, to minimize end-of-pregnancy discomfort, or to have a favorite health-care provider attend the birth. In addition, many women are induced because their health- care provider suspects the baby is large. according to aCoG, this is not a medical reason for induction. Studies show that the birth of a big baby is not affected by inducing labor versus letting labor begin on its own. lower your risk: Unless there is a clear medical reason for induction (see right), it is far less complicated and far more healthy for you and your baby to let labor start on its own. Going into labor naturally is the best way to know that your baby is ready to be born and your body is ready for labor. (See “The Waiting Game,” page 23, for more information.) If a medical concern does arise, spend as much time as possible with your healthcare provider weighing the benefits and risks of each labor-induction method. dirEctEd Pushing– BrEath holding What: Women are instructed to take a deep breath in and hold it for 10 counts, then push throughout the contraction – regardless of her natural urge to do so. often, women are put in a semi-recumbent position, with legs up and chin tucked in a C-position. Why: Directed pushing during childbirth became the standard half a century ago when women were heavily medicated during labor and birth. It’s still a common practice in labor rooms, but evidence shows that this technique should be avoided. Instead, women should be encouraged to follow their bodies, pushing only when they feel an urge. lower your risk: ask your labor support team to follow your lead when it comes to pushing. Change positions often during this stage. remember, there is often a “rest and be thankful” stage between urges. Try moaning or exhaling while you push. Ninety percent of the work is done by your uterus. You can focus on relaxing your perineum and pushing with your body cues. Visualize your baby rotating and descending. If you have an epidural, remember that your pushing can be impeded by the numbness. Talk with your support team about the practice of “laboring down.” This means allowing the uterus to move the baby down without your active pushing, until the baby is low enough in the pelvis and triggers the receptors that will give you the urge to push. Patiently allowing time for the baby to descend naturally reduces the chance of requiring an instrument delivery (see “Instruments to Know,” right) or a cesarean. When induction is necessary Here are ACOG’s medical indications for induction: | The water bag breaks and labor does not begin. | Pregnancy reaches 42 weeks. | The mother’s blood pressure is high. | The mother has health problems that can harm the baby. | Infection of the uterus. | The baby has stopped growing or there’s a problem with the placenta. instruments to Know There are times when doctors rely on forceps or a vacuum extractor to help them quickly pull a baby from the mother’s vagina. Fetal distress, a mother’s diminished pushing ability, or to turn the baby are just a few reasons. However, these tools do pose risks to the baby, including injury to the head and sluggishness while feeding for the first day or two. And, the use of tools requires an episiotomy.To help lower your chances of needing these tools, try changing positions often (see “Position Statement,” page 14). Keeping your bladder empty and declining an epidural also help. Finally, patience is key.The goal for your entire birth team is to let your baby descend naturally. lamaze maGazINe 2009 21 lamaze.orG http://www.lamaze.org

Table of Contents Feed for the Digital Edition of Lamaze Magazine 2009

Lamaze Magazine 2009 Contents Essential Lamaze for Pregnancy Making Connections Body Beautiful Birth Day, Your Way Mother Knows Best Essential Lamaze for Birth Supporting Cast Labor Day Position Statement Comfort Zone Intervention Intelligence The Waiting Game Essential Lamaze for Parenting Nursing School Reality Check Sleep Tight Unforgettable

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