informed-choice

Induction of Labour - the new c-section?

Sun, 30 Oct 2011 19:59:53 +0100

These days women in South Africa have become a lot more clued up on the high c-section rate and the benefits of opting for a natural birth. Studies done internationally have shown that the saying "Too posh to push" may have been somewhat of a myth and that many women were instead being pressured by their care provider to opt for a c-section, rather than choosing it themselves from the outset. Certainly in South Africa, women have become much more informed on the subject and will be choosing to "try for a natural birth" with many finding their doctor to be supportive, in the early part of pregnancy at least.

While women have become more vocal in their wishes to have a natural birth and the media has drawn attention to the pressure they come under by doctors to choose a c-section, this seems to have started a new trend of the 38 week induction. Instead of doctors urging the women to have a c-section, they instead compromise by offering an induction at 38 weeks so that the mother still feels that she is being given the option to try for a natural birth, but often she doesn't know that for most women the chance of the induction failing is almost certain - leaving her with no choice but to have a c-section.

With everything we do there is a risk, and it is up to us what risks we are the most comfortable with for any given choice. There are obviously risks involved with induction of labour at any stage of pregnancy (whether pre- or post- due date) and it's up to the individual to decide of the risks associated with induction outweigh the risks of continuing to be pregnant.

1. The risk of the induction resulting in a c-section be required is significant

A research study by Ehrenthal et al. (2010) found an increased c-section rate of 20% for women being induced with their first baby. They concluded that: “Labor induction is significantly associated with a cesarean delivery among nulliparous women at term… reducing the use of elective labor induction may lead to decreased rates of cesarean delivery for a population.” Another study by Selo-Ojeme et al (2010) found induction increased the chance of a c-section by 3 for first time mothers.

2. The need for medical pain relief is higher

Induced labour is not the same as going into labour naturally and studies have shown that it can be much more painful than a natural labour. The drugs used in an induction of labour do not trigger the same responses in the brain that cause a rush of pain-relieving hormones to be released into the blood stream. In a natural labour, a womans own endorphins are released in response to pain. Endorphins as a painkiller are much more powerful than morphine. Twenty different types of endorphins have been discovered in the nervous system. One of the endorphins, beta-endorphin, is 18-50 times more effective than morphine , while another, called dynorphin, is over 500 times stronger.

This means that a first time mother is up to 3 times more likely to request an epidural for pain relief. The risks of epidural then also apply meaning she is more likely to need an assisted delivery - such as forceps, vacuum or a c-section.

3. The risk of Fetal Distress is higher

The drugs used for an induction of labour are much more powerful than those in a natural labour. The hormones of labour also moderate each other, for example, if the mother is feeling a huge amount of pain then more endorphins will be released - or if the baby is not in the correct position, this lack of correct stimulation will cause the contractions not to get stronger until the position is changed. With an induction, the drugs are blindly forcing the body to labour and the drip can not react to any messages the baby or other hormones in the mothers system may be trying to communicate. The first time a problem will be picked up is when the baby goes into distress. This is also why babies born from an induced labour are also more likely to need resuscitation, NICU care and have lower APGAR scores.

A baby who is being born at 38 weeks also has the risk that the due date may have been incorrect and is therefore younger than 38 weeks. A baby born before 38 weeks will be more likely to have comprimised breathing and need special care in NICU.

4. The risk of major maternal complications is higher

When a Pitocin drip is used to induce labour it increases the chance of hyperstimulation of the uterus. This means that the muscles of the uterus are being over-worked and once the baby is born there is a much higher risk of Post-Partum Hemorrhage (excessive bleeding after birth). If the uterus has become overstimulated it will be very tired and unable to adequately contract, thereby sealing off the open blood vessels at the site where the placenta was attached. After a non-induced labour, if such bleeding occurred an injection of a similar drug would be given to assist in contracting the uterus. If Pitocin has already being used then other stronger drugs may be required, or in an absolute worst case senario a hysterectomy would be done or the bleeding could result in the death of the mother.

Perspective

While these risks are present for any induction, it's important to look at the reason why it may be necessary. If a mother is sure of her due date and the baby is most definitely overdue and showing signs of less movement or dips in heart rate, then an induction would by far outweigh the risks of continuing to wait for labour to occur naturally.

The best thing to do if you are being pressured to have an induction at 38 weeks is to ask for more information about what your Bishop Score is. This will help you to know if there is any chance that the induction will be successful or if it will be more beneficial to wait until your body is more ready to go into labour.

The Bishop Score

Bishop score is a pre-labour scoring system to assist in predicting whether induction of labour will be required. The total score is achieved by assessing the following five components on vaginal examination: The Bishop score grades patients who would be most likely to achieve a successful induction. The duration of labor is inversely correlated with the Bishop score; a score that exceeds 8 describes the patient most likely to achieve a successful vaginal birth.

**Bishop score**
Parameter\Score	0	1	2	3	Description
Position	Posterior	Intermediate	Anterior	-	The position of the cervix varies between individual women. As the anatomical location of the vagina is actually downward facing, anterior and posteriorlocations relatively describe the upper and lower borders of the vagina. The anterior position is better aligned with the uterus, and therefore there is an increased likelihood of spontaneous delivery.
Consistency	Firm	Intermediate	Soft	-	In primigravid women the cervix is typically tougher and resistant to stretching, much like a balloon that has not been previously inflated. Furthermore, in young women the cervix is more resilient than in older women. With subsequent vaginal deliveries the cervix becomes less rigid and allows for easier dilation at term.
Effacement	0-30%	31-50%	51-80%	>80%	Effacement is a measure of stretch already present in the cervix. It is analogous to stretching a rubber band; as the rubber band is stretched further, it becomes thinner. This is affected by individual variation and previous surgery such as loop excision for cervical dysplasia or cancer.
Dilation	0 cm	1–2 cm	3–4 cm	>5 cm	Dilation is a measure of the diameter of the stretched cervix. It complements effacement, and is usually the most important indicator of progression through the first stage of labour.
Fetal station	-3	-2	-1, 0	+1, +2	Fetal station describes the position in of the fetus' head in relation to the distance from the ischial spines, which can be palpated deep inside the posterior vagina (approximately 8–10 cm) as a bony protrusion. Negative numbers indicate that the head is further inside, above the ischial spines.

If your Bishop Score is lower than 8 then it is unlikely that induction will be successful.

Using a Birth Stool

Sun, 30 Oct 2011 18:22:24 +0100

A birth stool is a great addition to your options when having an active birth. It's probably one of the oldest birth tools around, as even the Goddess Isis is depicted in ancient carvings as giving birth on a birth chair, or stool.

In fact, the modern origin of giving birth in the Lithotomy Position (ie. flat on back, legs apart) was the result of a certain King who found it to be the optimal position for his mistresses to give birth in for his viewing pleasure. As the role of birth moved from being the realm of women and midwives to that of the male doctor it was used for the doctors benefit only.

Before this, all depictions of women giving birth have been ones of them in upright positions that normally involve squatting or kneeling. Not only does this position allow some help from gravity but prevents the full force of the babies head being directly on the perineum and therefore reduces the chance of severe tearing.

A birth stool helps the woman maintain a squatting position, without having to support all her weight on her legs. Her partner or Doula can also sit behind her in order to provide something for her to lean against and rest between contractions.

You can hire your own birth stool from BirthWorks - http://www.birthworks.co.za .

Here is a great video that shows how a birth stool can be used during birth:

Dianatal Obstetric Gel

Sun, 30 Oct 2011 14:02:05 +0100

This Obstetric Gel is now available in South Africa. It is essentially a lubricant for the birth canal and has been found to assist in easing childbirth and protecting against damage to the perineum.

More information can be found on their website. In order to use this during your birth in a South African hospital you just need to speak to your Gynecologist or Midwife who will be able to obtain it for you.

Early Signs of Pregnancy

Thu, 28 Oct 2010 13:52:23 +0100

What are the earliest signs of pregnancy?

The early signs of pregnancy can often be difficult to detect, and can often be confused with certain illnesses as the symptoms are rather general.

The most obvious and accurate sign of pregnancy is a missed menstrual period, but many women would like to know if they are pregnant even before this. Here are some tips for seeing early signs of pregnancy.

Swollen, tender breasts

The hormonal changes in very early pregnancy cause the breasts, and nipples, to become tender and sometimes sore. You might notice this small change in breast size very early on, and perhaps a few of veins (if they are visable) may seem more apparent.

Spotting

This might occur shortly after ovulation and once fertilization has occurred. Bleeding at this time is also known as implantation bleeding as it is when the egg begins to implant in the uterus. Some women have mistaken this for an early, light period without knowing that they are indeed pregnant.

Temperature

If you are trying to fall pregnant, you may be able to see when conception occurs due to a rise in body temperature. In order to use this as a predictor you would need to have a good idea what your normal body temperature is.

Sense of Smell

Some women notice that their sense of smell is heightened very soon after falling pregnant. They will be extra sensitive to both good and bad smells as a result.

Nausea and Dizziness

These are two signs which are common side effects of pregnancy but are not always present from conception. They are generally a result of the changing hormone levels in your bloodstream and would only become high enough to cause side effects approximately two weeks following conception.

Early Pregnancy Tests

When you are unsure of the early signs of pregnancy being correct, you can also do an early pregnancy test up to three days before your period is due.

Remember that with a pregnancy test there can be false negative results, but not a false positive. This means that if you get even the faintest line indicating a postive test, then it means you are pregnant!

The Most Effective Drug to Have in Labour!

Mon, 25 Oct 2010 17:52:21 +0100

This Miracle Drug is shown to have the following effects:

50% reduction in the caesarean rate
25% shorter labor
60% reduction in epidural requests
40% reduction in oxytocin use
30% reduction in analgesia use
40% reduction in forceps delivery

The are no contraindications
There are no side effects
It is 100% safe to use by all women

This miracle does not come in a bottle or a box though. It comes in the form of a woman called a Doula! She is a trained, professional, labour companion who will support you during pregnancy, birth and beyond with emotional support, informational support and even physical support during your labour.

A doula does not replace your husband or other birth partners, and research has shown that women who have had positive birth experiences have had the ideal combination of a doula and another birth partner. A doula also provides the other birth partner with support so that s/he can also take a break and the mother is never left alone.

While a doula does not do any nursing or other medical techniques, she has indepth knowledge about them and can help you with information in order to make informed choices during labour. She can also make suggestions about how to help speed up a slow labour, or what other positions you can try if you are uncomfortable.

Even if you are planning a c-section, a doula can be an invaluable resource to help look after you and your partner during surgery and then help you with breastfeeding and comfort measures following the surgery.

BirthWays is a team of WOMBS Accredited Doulas who work in and around Cape Town!

Read more about us here.

Looking for a doula in other areas? Visit WOMBS for a national database.

Or phone the National Call Centre on 0860-410 032

How to choose a hospital for childbirth

Sun, 17 Oct 2010 09:27:06 +0100

When autumn comes to New Mexico, the aroma of green chile being roasted fills the air. Locals buy big burlap sacks of chile which are poured into a big drum that turns over a fire until the chile is charred (which then allows the skin to be peeled off).

Chile is mild, medium, hot, or very hot! Locals know enough to ask, “How hot is your chile?”

One day a newcomer to New Mexico stopped at the Grocery Emporium on Girard Boulevard and bought a bag of roasted Chile. The aroma made her mouth water all the way home. Using her chile, she prepared a traditional New Mexican dinner. A few bites into the meal, her eyes began to water and her tongue burned painfully.

The following day she marched up to the chile roaster and began complaining that the chile he sold her was too hot. “Look lady,” he replied, “I just roast and sell chile. If you don’t like your chile hot, you should have asked me about it!” (from Birthing From Within, by Pam England and Rob Horowitz)

So what do YOU think this has to do with birth?

Many of us will will have certain things we’d like to have or do during pregnancy and childbirth, some people write a birth plan and others just have a vague wishlist of what they would and wouldn’t like to do. The birth plan or wish list might contain things like:

- no interventions unless they are absolutely necessary

- to use breathing techniques or gas and air for pain relief

- my husband and mother to be with me

- to hold my baby straight after he or she is born

- to breastfeed my baby and have him or her in the room with me

Other vague ideas you might have in the back of your mind during labour might be things like

- I might like to take a bath during labour

- I think I might like to be squatting when I give birth

- I’ll drink water and apple juice to keep my energy up

Just like the lady and her chile, with the idea of having a delicious meal that wouldn’t blow the roof of her head off and clear her sinuses like never before, she was doomed to disappointment before she even took the first step.

Hospitals too are selling a product, and there is often some very fine print that stipulates certain protocols that are in direct opposition to what you might be planning or wishing for. It’s important to know what you’re buying so you don’t discover at the point of being in labour that your hospital is only in the business of selling extra-hot chile when your preference is for ultra-mild! (hows that for a mixed metaphor? Ha!)

When we choose to buy something as like a car, we ALWAYS explore our options, read up on different makes and models, test drive a variety of cars and really weigh up all the different options available so we get something that suits our needs and our pocket too.

When you think of something as important as the day your baby arrives in the world, shouldn’t we be exploring ALL our options too?

I can honestly say I know nothing about cars. I can differentiate between the different types according to size and colour, but that’s about it! I can totally understand how parents can find exploring all their care options for birth quite daunting, as it can be a huge learning curve. That’s a lot like me trying to choose what car to buy. While I’d love to be able to walk into a car dealership and tell them what kind of car I’d like to be driving, they’re only going to sell me one of theirs and not suggest the dealership across the street instead!

Some hospitals offer their own childbirth classes but there is something important to remember about those classes. If a hospital expects women to lie flat on their backs with feet in stirrups when it comes time to deliver they aren’t going to give you information on alternative positions or giving birth in water. That’s not part of the product they are selling, so there is no reason why they should inform you of other versions of the product that are available elsewhere.

You might have seen some of those adverts for insurance options where a third party website will get you quotes and options for cover from a variety of places. This is the kind of approach we need for childbirth. We need to seek out a classes that aren’t helping sell a specific product, but rather give us all the available options.

It’s also one of the frustrating things most Doula’s encounter quite a bit. We see women who would really like to have a natural birth and be free to move around as they feel comfortable and be free to birth as they please. Then they go and choose an obstetrician as their primary care-giver who works in a hospital with a c-section rate that is over 80%. To use the car metaphor again, that’s like wanting to buy a cheap and economic car but going to a high end car dealership to buy it. When the mother is asked why, she can give a variety of reasons but the doula knows deep down that what this mother believes to be true about birth is very different to what she says she says she wants.

The Birthing From Within classes that I give are about helping mothers discover what this truth is. I ask them directly - What is it that YOU need to know, or do, to give birth? This is a harder question than one might realise, because it leads you to the real crux of things – what do you believe is the truth about giving birth?

To discover what your truth is, just imagine someone saying the word “childbirth” and draw the first image that comes to mind - like you would in a game of pictionary. This immediate image is often created by these “truths” that we are both consciously and subconsciously influenced by.

In most cases I see pictures that resemble this:

It’s important to be aware of these images because once you are, you can strip away the preconceptions and truly start to look within the deepest parts of yourself to understand what birth is to you, and you alone.

Like life and death, birth is not something we plan but something that unfolds before us with many surprising twists and turns along the way. When you start exploring what you want and need to give birth, it’s about exploring options and then setting sail in a particular direction but not having a “lust for result” or caring too much about how to get to your final destination. What you do want to prepare for is the journey and for dealing with whatever unfolds.

This exploration is more than just about childbirth, it’s actually about learning more of who you are and even expands to other areas of your life. Everything becomes so much more of an adventure when you find harmony between having a goal and also being open to go with the flow of the present moment.

Like I now say – how you give birth is not whats important, it’s feeling loved, supported and cared for along the way and knowing that each step you took to get there was done in awareness through making informed choices.

South African Unassisted Homebirth

Wed, 13 Oct 2010 17:19:48 +0100

This is a beautiful story of an unassisted homebirth by a woman living in South Africa. It contains photo's and also the most fantastic video of the little boy following the birth, who is very alert and peaceful!

Unassisted Homebirth Story (this link will take you do a different website - please use your browser "back" button to return)

What is a Doula?

Mon, 20 Sep 2010 17:07:24 +0100

"If a Doula were a drug, it would be unethical not to use one" - Dr John Kennell

Doula is an ancient Greek word for a woman in service of another woman, but today it has come to be know as a woman who supports a couple through labour and birth. A doula should also be a trained professional who has completed a training program and continues to update her knowledge on a regular basis.

In South Africa, a Doula is also referred to as a Birth Companion and most professional Doulas will be accredited by WOMBS, South Africa's only accredited Doula organisation.

Why have a Doula when the father / your mother or friend will be there?

It's normally the Dad's who don't see the point of having Doula present at the birth. So we ask them, would they prefer to drive a Rolls Royce or a 1983 Ford Escort? Having a Doula present at the birth is like having the Rolls Royce version of a birth experience! Doula's look after Dad's too, giving you the chance to regroup and refuel during long labours.

A doula brings not only an extra pair of hands to massage, take photos, bring food and water, but also provides a knowledgeable resource who can explain things that happen during birth when you don't have the option of reading a book or looking something up on the internet. The staff may not always have the time to explain in-depthly about a treatment or procedure so your doula becomes your resource to ask all the questions you need to, and to reassure you!

A doula will be with you for the whole time, unlike various medical staff who need to come and go while they deal with other clients. She also stays after the birth and nurtures the new family so that they can focus completely on bonding in those precious first hours.

The studies speak for themselves:

Having a Doula present during a birth, in addition to other birth partners has shown:

50% reduction of caesarean rate
30% decrease in requests for drugs
Increased success with breast-feeding
25% decrease in length of labour
40% decrease in use of Syntocinon
Less postpartum depression
60% decrease in epidural requests
30% reduction in forceps delivery
Greater maternal satisfaction with the birth experience

6 weeks after the birth it was found that mothers were

Less anxious and depressed
More confident with their baby
More satisfied with their partner (71% vs 30%)
More likely to be breastfeeding (52% vs. 29%)

Homebirth Videos

Sun, 29 Aug 2010 08:06:24 +0100

Home Birth Gathering

Sun, 25 Jul 2010 17:13:09 +0100

For those:

who have had a home birth
who have wanted a home birth
who are planning a home birth
whose home birth didn't go according to plan
who are thinking about having a home birth
who have ‘caught’ babies born at home
who have supported mothers giving birth at home
who are interested in home birth...

R30 per person,

R50 if there's two of you

Visit the website for upcoming dates - www.homebirth.org.za

Contact:

Ruth

021 780 9510

078 557 9070

ruth@homebirth.org.za

Lana

021 703 4291

073 514 9754

doulalana@vodamail.co.za

Home Birth is a valid and safe yet overlooked birthing option.

Here in South Africa, we have one of the highest caesarean rates in the world (on average 70% in private hospitals). Women are realising that in a hospital environment their options and freedom to give birth as they wish,are often limited through hospital routine protocol and intervention.

This gathering is a support group for those who have given birth at home, for those who have wanted home births, for those who are planning a home birth or are thinking about it or are just curious. It also for those whose home births did not go as they had wished. We welcome midwives who attend home births and those who have supported mothers giving birth at home (partners, family, friends and doulas).

There will be a guest speaker, a short film on home birth and the opportunity to meet and speak to midwives, doulas and others who have had home births or are planning to. There will be opportunity for discussion.

Refreshments will be served.

Venue: The Forge, 12 Windsor road, Kalk Bay

Date: Sunday, 22nd August 2010

Time: 2pm - 4pm

Price: R30 per person, R50 if there’s two of you

Contact: Ruth ruth@homebirth.org.za or 021 780 9510 or 078 557 9070

Lana doulalana@vodamail.co.za or 021 703 4291 or 073 514 9754

Website: www.homebirth.org.za