Fun "Facts" about Placentas

• The placenta is made up of 50% cells from the mother and 50% of the cells from the baby. If you know anything about organ donation, you will know how amazing it is that the mother’s body doesn’t reject it.

• The sperm is responsible for creating the placenta and umbilical cord. So, technically, the placenta is *his* organ- growing in your body, supporting the baby you both created. How beautiful is that?

• A placenta is typically about 1/6th the weight of the baby (1-3 lbs).

• A baby can send stem cells through the placenta to heal its mother's organs if they are struggling, including the brain, liver, kidney and lung. The placenta also creates cells to protect the mother’s heart and fend of breast cancer.

• The placenta preforms the duties of a lung, liver, kidney and its own endocrine system providing all the hormones for both mama and baby throughout pregnancy.

 

From DoulaSpot

You’re Not Allowed to Not Allow Me

You’re Not Allowed to Not Allow Me 

Author: Cristen Pascucci

For most women, pregnancy and childbirth are one of the few times we let other adults tell us what we are “allowed” and “not allowed” to do with our own bodies. It’s time to change our language around this to reflect the legal and ethical reality that it is the patient who chooses to allow the provider to do something—not the other way around—and to eliminate a word that has no place between true partners in care.

We hear the word “allow” used regularly, by well-meaning care providers and family members, and by pregnant women themselves. During my own pregnancy, I was told I “may or may not be allowed” to hold my baby immediately after he was born, depending on what hospital staff was on shift.  It struck me as so odd that I might be in the position of asking to hold my own precious baby, especially when I’d chosen to hire these care providers. Who was allowing whom here?

Most recently, it has been all over the media following the March 2014 release of guidelines for lowering the primary Cesarean rate from the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine:

“Women with low-risk pregnancies should be allowed to spend more time in labor, to reduce the risk of having an unnecessary C-section, the nation’s obstetricians say.” (NPR.org)

Or:

“That may mean that we allow a patient to labor longer, to push for a longer amount of time, and to allow patients to take more time through the natural process.” (CBS News Philadelphia)

For women giving birth in the American maternity system, these guidelines are welcome, but they are no magic bullet. Medical practices take years and even decades to change, and while that happens, what assurances do women have about the care they are receiving today? Is it ethical to hold women to what an individual provider will “allow,” with the full knowledge that not all providers are practicing to the standards science show is best for moms and babies?

These are not rhetorical questions. In the U.S., outdated, non-evidence-based practice is routine and accepted; Cesarean section rates vary ten-fold among U.S. hospitals; and those rates vary fifteen-fold among the low-risk population. Over 40% of hospitals defy national health policy by “not allowing” vaginal birth after Cesarean, to the detriment of hundreds of thousands of mothers and babies. The United States is the only developed country in the world with a RISING maternal mortality rate. One factor in that rise is our overuse of surgery for childbirth. We simply cannot operate on the assumption that the surgeries women are receiving are always in their best interests, or that of their babies.

But it’s about more than just a stand-alone decision around whether to do a Cesarean. There’s a sequence of events leading up to that possibility, and many women have been relieved of their decision-making well before that time. When women have been given messages all along that they are not the authority in their own childbirth, it’s easy for a care provider to make a unilateral decision about surgery. What woman, who has experienced nine months of language like “we can’t let you” and “you’re not allowed” is going to suddenly have the wherewithal to refuse an unnecessary surgery—or to even know she has the right to do so?

The truth is that women, like all other U.S. citizens, have the right to make decisions about their bodies based on informed consent—a legal, ethical standard which requires the provider to convey all of the information around a suggested procedure or course of treatment, and the person receiving the procedure or treatments gets to decide whether or not to take that advice.  ACOG states clearly about informed consent in maternity care: “The freedom to accept or refuse recommended medical treatment has legal as well as ethical foundations.  In the obstetric setting, recognize that a competent pregnant woman is the appropriate decision maker for the fetus that she is carrying” (ACOG Committee on Ethics Committee Opinion No. 390 Ethical Decision Making in Obstetrics and Gynecology; Dec 2007, reaffirmed 2013).

This stands in stark contrast to women being told they are “not allowed” to decline potentially harmful interventions like continuous electronic monitoring in a low-risk pregnancy, or to make an informed decision for a vaginal birth rather than a surgical one–or even to eat, drink, or go to the bathroom in labor.

At its heart, this language is about a lack of respect. It’s how we speak to children, not competent adults. It’s a sloppy way of skipping meaningful and necessary conversations about what should be a common goal for both mother and provider: a healthy, happy birth.

It’s also a reinforcement of deep cultural beliefs about women as passive objects, not full owners of their bodies nor representatives of their babies, and having lesser decision-making capacity than those they’ve hired to support them. These ideas will take time to change. But birth is a great place to start.

Words have power, and we can take back that power  in some simple ways:

-       Don’t stay silent when you hear this kind of language in casual conversation. Say something—even if it’s just a little something. Don’t let it go unnoticed.

-       Be gentle while you are being firm. Remember that most people are just repeating something common and accepted, and they probably haven’t thought much about it. Make it your goal to inform, not convince.

-       Choose to give your business to providers who use respectful language. If you’re hearing this language during pregnancy, you can be pretty sure you’re going to hear it during childbirth—and that can be a problem. You can’t act like a mother when you’re being treated like a child.

-       Partners, stand up for your loved ones. When she is vulnerable, be her voice. There is no one better positioned to be a vocal advocate for her and her baby.

Today, American women are gambling with their bodies when they give birth, with a one in three average Cesarean rate in facilities where practices vary widely, even among individual providers. And we are tying women’s hands when we continue to reinforce this dysfunction by using words like “allow” to describe an outdated dynamic that doesn’t recognize us as competent, rights-bearing adults.

The legal authority in childbirth lies with the woman giving birth, not the providers of care. Yes, they are a team, but of the two, it is the woman who truly bears the rights and the risks of childbirth. Our words should reflect that reality.

Don’t let anybody convince you that you need to step aside for your baby. You need to step up for your baby.

Dear Friend, Birth Doesn’t Have to Suck

Posted by Cristen Pascucci on Jun 4, 2014 in Articles | 27 comments

Dear Friend,

If you’re reading this, it’s because I care about you, and I want you to rock your birth.  I believe you deserve the best.  If “rocking your birth” sounds like something other people do, and you just want to “get through it” with a healthy baby—girl, raise your expectations.  You’re both too valuable to whiff on this one.  If this is your first baby, it’s even more important, because it will set the tone for your future births and may determine your options for the rest of your life.

Please don’t feel judged that I’m sending this to you, or like I’m trying to tell you how to do things.  In fact, I don’t care how you give birth–that’s your business.  But because I care about you and this incredible journey you are on, you have to know you’re facing a system where great maternity care is a gamble for most women.  Nine in ten womenlose that gamble.

I’m not trying to scare you—I’m trying to power you up.  I want you to learn from my experience, and from what I’ve picked up from other women who have gone through this—good, bad, and ugly.  I don’t ever, ever want you to say, “If only I’d known….!” about your pregnancy and birth.

I’m going to lay it out for you here, so get ready.

 

#1 You are in Charge

Now is not the time to “wing it” or let anyone else take over–including your care provider.  This is Step #1 to becoming a mother, when you will be making all kinds of decisions and will be asked to do all kinds of things that are outside your comfort zone and that you may feel completely unprepared or unqualified for.  That’s okay.  Put on your Game Face, because this is one of life’s all-time best learning and growing opportunities.

When I switched care providers at 41 weeks, 6 days pregnant, I believe that’s when I became a mother.  Until then, I’d been floating along, doing my best to advocate for myself while also getting along with my care provider, who I actually really liked.  When I decided to switch from her to someone else, I was choosing my baby over everyone else: over that provider, who had been so sweet and nice to me; over my family, who would surely call me “high maintenance” behind my back; and over my friends, who already thought I was crazy for wanting a natural birth.  But I didn’t feel 100% safe with her, and I knew that’s what my baby and I deserved.

I can’t say this enough: this is your show.  It’s your body.  It’s your baby.  You are responsible for the decisions you make, and you will bear the consequences–good or bad–for any decisions made about your care.  There are a few ways this can go: it can be traumatic and life-changing in a bad way; you can “get through it” just to get to the other side with some minor complications; or you can grab the bull by the horns and do everything possible to make it the safest, most positive, most life-affirming experience you’ve ever had, and something that will make you love and respect your own body in a profound new way.

Childbirth is unpredictable, but that is all the more reason to prepare for it and embrace it.  You will never have another chance to give birth to this child.

 

#2 Education

“Unlearning” about birth is almost as important as learning about it.  There’s so much inaccurate, outdated information and so many negative messages out there, you kind of have to start from scratch.  Accept that a lot of what you think you know is simply not true.  We live in a country where 1 out of 3 births is by surgery, and many of those surgeries are “emergency,” even though optimal care says that the majority of women could give birth safely without medical interventions and without complications.  We create a lot of emergencies in the U.S.  (How many of your friends have had unplanned C-sections?)

Do not waste your time on What to Expect and websites like BabyCenter.com.  Don’t even think about taking the “childbirth class” at the hospital.

Do start with Birth Book by Steve and Sarah Blight.  It’s easy to read and high quality.

Do get over and watch The Business of Being Born.  Today.  Right now.  (It’s on Netflix, too.)

Here is a list of great, evidence-based, websites and other resources.

Finally, get in a good, reputable childbirth class outside of a hospital.  This is an amazing process and the more you know, the less there is to fear.  Education is power.

 

#3 The Thing About Routine Birth

I’m going to skip you ahead a few steps here.  When you start researching and really learning how awesome birth can be–and not some emergency horror show like you see in the movies–and when you start formulating a plan for how to make birth the safest it can be, you’re going to find that what most places provide for care doesn’t match up to what your research shows as most beneficial and least risky for you and your baby.

Here’s a (really long) example:

>  Evidence-based care for you means freedom of movement, freedom to eat and drink as you like, intermittent auscultation to monitor your baby’s heart rate during labor, one-to-one continuous support by someone who is educated in childbirth, water immersion for pain management, privacy so you can focus, no vaginal exams during labor unless there is a specific reason for it or you want to know your dilation, and freedom to push in whatever position feels comfortable to you.  It includes interventions when medically necessary and not before, and, if medical interventions are recommended, full and accurate information on their risks, benefits, and alternatives, and support of whatever decision you make.  It also means that labor and pushing go as long as you feel comfortable and you and baby are doing fine.

>  BUT Routine hospital care usually looks more like: strapped into bed with belts for continuous monitoring of your baby (this kind of monitoring has an over 99% false positive rate), no food or drink allowed (they might give you ice chips), no one-to-one support, maybe a tub for water immersion, but you can’t get in if you’re on monitoring belts, an automatic IV into your hand that hurts and makes it hard to move, lots of interruptions by people wanting to give you vaginal exams (that serve absolutely no medical purpose, but increase your odds of infection down there), and constant pressure to “hurry things along” with medication or “give you a break” with an epidural.  It’s unlikely that anyone will tell you the significant risks of medications that speed things up (Pitocin causes fetal distress, which is a #2 cause of C-sections) or the downsides of an epidural (primarily, that you won’t be able to move around to get baby positioned better, which makes it much harder for him or her to descend through the birth canal and can result in a need for episiotomy/forceps or vacuum or even surgery!).

You are free to choose any of these things!  There is no judgment here.  The thing is that most women don’t choose these things–they’re just done to them–or they “consent” without all the information about what’s being done.  I don’t want that to happen to you.

So what’s a girl to do?

 

#4 Get a Damn Doula

Have you ever cut your hair yourself?  It might turn out okay, but then you get it done at the salon with the hypnotizing head massage and the mysterious, magical products and the blow-out-you-can-never-replicate and you realize, yeah, that was better with professionals.  That’s kind of what doulas are to birth.

Doulas are trained to support women in continuous, one-to-one support throughout pregnancy and childbirth, and their use is strongly supported by science, includingnew guidelines from the nation’s obstetricians that call doulas “one of the most effective tools to improve labor and delivery outcomes.”  They will answer your questions if you’re having heartburn at 28 weeks or refer you to a great chiropractor if your hips hurt, and help you create a birth plan; during labor, they will gently help you get in different positions, encourage you, inform you about what is going on, bring you snacks, and let your partner have bathroom breaks so he can stay comfortably by your side when you want him.  If you or your partner is wondering what a doula does, read this.

But they are so much more than just a luxury.  They really, truly, are a safety measure. Look at these stats!  Look at the decrease in the risk of C-section!

Doulas can also help you with #5 “Best Provider Ever” because they work together with many different providers and see how they practice!  They know if Dr. A tends to be more patient with first-time moms, or Dr. B’s bedside manner sucks during birth even after being so laid-back during pregnancy, or that the nurses at Hospital C are exceptional.  Hospital cultures are VERY different, and doulas can help you figure out where you’ll have the best shot at the safest, best birth possible.

 

#5 Best Provider Ever

Every provider is different, and research shows that the #1 determinant of whether or not you end up with a C-section isn’t you–it’s your provider!  That’s saying something.

Know that your options include obstetricians, family doctors, and midwives.  This is significant, because the U.S. is unusual in that we send low-risk, uncomplicated pregnancies to surgeons rather than normal childbirth experts: midwives.  Midwives specialize in preventing complications, including surgery.  Speaking of, don’t be shy about vetting your provider.  What is his or her rate for Cesarean section?  What about episiotomy and other common but usually unnecessary interventions?  This is your vagina we’re talking about.  You have a right to know.

Know that whomever you pick owes you the best.  If you’ve done your research, you have an idea of what to look for.  If you hear things like, “You’re not allowed” or “We can’t let you,”–if you are getting any of these “red flags”–please, take your business elsewhere, to someone who will treat you like a competent adult.

 

#6 You don’t have to go to a hospital

If you’re a healthy, low-risk woman, birth centers are a stellar option: comfortable, high-quality, family-centered care with a Cesarean rate of approximately 6% and a less-than-2% urgent transfer rate (for either mother or baby) with no adverse health consequences compared to hospitals.  More here.

Home birth is another option that more and more women are taking advantage of, as they recognize the benefits of truly supportive one-to-one, individualized care and avoiding the routine risks of a hospital.  The acceptance of home birth as a legitimate health choice makes it more safe in some places than others.  If you’re open to this possibility, do some homework and see if it’s a fit!

 

#7 Know Your Rights

Most women are totally unaware about what their rights are or why they’d ever need to know them.  Pregnant women have the same rights as everyone else, but women are very often treated as if they’re in a special category because they’re pregnant.  Legally, you are entitled to informed consent and refusal: a full discussion with your care provider about the risks and potential benefits of anything they are suggesting, and about your alternatives, with the right to say “no” to anything.  You’ve got to know your rights if you’re going to use them!

 

Once again…

Birth doesn’t have to suck.  Keep your expectations high and do the work to have those expectations met.  Don’t let anybody convince you that you need to step aside for your baby.  You need to step up for your baby.  

I’m rooting for you in this once-in-a-lifetime process.  I know you can rock this thing.

California ranks 35 in maternal mortality. Yikes!

In its new report, Amnesty disclosed maternal mortality ratios (per 100,000 live births) for each of the 50 states, and the nation’s capitol:

51 — Washington, DC (34.9 deaths per 100,000 live births)
50 — Georgia (20.5)
49 — New Mexico (16.9)
48 — Maryland (16.5)
47 — New York (16.0)
46 — Louisiana (15.9)
45 — Mississippi (15.2)
44 — Arkansas (14.6)
42 — Delaware, Michigan (13.6)
41 — Florida (13.1)
40 — Nebraska (12.6)
39 — Oklahoma (12.3)
38 — Tennessee (11.7)
37 — North Carolina (11.4)
35 — New Jersey, California (11.3)
34 — W. Virginia (11.2)
32 — South Carolina, Idaho (11.1)
31 — Colorado (11.0)
30 — North Dakota (10.7)
28 — Missouri, Montana (10.5)
26 — Nevada, New Hampshire (10.4)
25 — Alabama (9.6)
24 — Rhode Island (9.2)
23 — Illinois (9.1)
22 — Kentucky (8.8)
20 — Texas, Utah (8.6)
19 — Pennsylvania (8.5)
18 — Ohio (8.4)
17 — Virginia (8.0)
16 — Wyoming (7.8)
15 — Washington (7.5)
13 — Arizona, Wisconsin (7.2)
12 — Iowa (7.0)
10 — Oregon, South Dakota (6.2)
9 — Kansas (5.9)
8 — Connecticut (5.1)
7 — Alaska (5.0)
6 — Hawaii (4.7)
5 — Minnesota (3.7)
4 — Indiana (3.3)
3 — Massachusetts (2.7)
2 — Vermont (2.6)
1 — Maine (1.2)

Can Hospitals Keep Moms and Babies Together after a Cesarean?

The answer is Yes!!!  Fight for your right to stay with your baby during and after your cesarean birth.  

Find the full article here

© by Rebecca Dekker, PhD, RN, APRN of www.evidencebasedbirth.com

In my previous article on skin-to-skin care after a C-section, I wrote that skin-to-skin care after a C-section has many benefits for moms and babies. However, I have come to realize that women cannot do early skin-to-skin if they are routinely separated from their babies after a C-section. In order to do early skin-to-skin, women and newborns must stay together—a process known as “couplet care.” However, the vast majority of women are separated from their babies after a C-section.

Why don’t more women and babies receive couplet care? Is it possible for hospitals to make the switch from routine separation to routine couplet care after a Cesarean? Keep reading to find out.

What is the history of mother-infant separation after birth?

Separation of human mothers and newborns is unique to the 20-21st centuries and has been a complete break from natural human history. In the past, infant survival depended upon close and virtually continuous mother-newborn contact.

The practice of routinely separating mothers and newborns started around 1900. At the time, most women received general anesthesia that made them and their babies incapable of interaction after birth. Because mothers couldn’t care for their babies, hospitals created central nurseries to care for newborns, and infants were typically separated from their mothers for 24-48 hours. Separation from parents was also meant to “protect” infants from maternal illnesses (Anderson, Radjenovic et al. 2004).

In her book Hypnobirthing, Marie Mongan described her experience of being separated from her infant in the 1950′s…

My head was held as the ether cone was forced onto my face. That was the last I remembered. I awakened sometime later, violently ill from the ether, and was informed that I had “delivered” a beautiful baby boy, whom I would be able to see in the morning…. My husband saw our son only through the window of the nursery for the next five days, as no one was allowed to visit when “the babies are on the floor.” Our family bonding was nonexistent.

When did things begin to change?

In 1961, Dr. Brazelton published a classic study showing that general anesthesia was harmful to newborns (Brazelton 1961). As a result of his research, more people began to move away from using general anesthesia during birth, which resulted in mothers and infants being more alert—and capable of interaction—immediately after birth (Anderson, Radjenovic et al. 2004). In addition, most mothers who give birth by Cesarean receive regional anesthesia instead of general anesthesia, so these mothers, too, are usually alert after giving birth.

Furthermore, in the past 30 years, an abundance of research evidence has shown that when mothers and babies are kept close and skin-to-skin after birth, outcomes improve (Moore, Anderson et al. 2012).

It is very important for you to understand that when researchers study human mother-newborn contact, keeping mothers and babies together is always considered the “experimental” intervention. In contrast, when researchers study other non-human mammals, keeping mothers and babies together is the control condition, while separating newborns from their mothers is “experimental” (Moore, Anderson et al. 2012).

What is routine practice today?

Although most mothers now are capable of taking care of their babies after birth, and despite the fact that research overwhelmingly supports couplet care—hospital practices have been very slow to change.

Routine separation of moms and babies during the recovery period still happens at 37% of vaginal births in the U.S., with rates ranging widely from state to state. In Alaska, only 5% of babies are separated from their mothers after a vaginal birth, while in Mississippi, 81% of infants are separated from their mothers after a vaginal birth. (Centers for Disease Control, 2010)

How often are women separated from their infants after a C-section?

Separation of mothers and infants is very common after a surgical birth or C-section. In the U.S.,  86% of women who give birth by C-section are separated from their babies for at least the first hour (Declercq, Sakala et al. 2007). With more than one-third of U.S. women now giving birth by Cesarean, this means that a substantial proportion of mothers and babies experience a critical delay in bonding, skin-to-skin contact, and breastfeeding.

Research shows that most of the time when babies are separated from their mothers after a C-section it is so that the hospital can provide routine mother/baby care in separate rooms—not because the babies need any kind of special care (Declercq, Sakala et al. 2007). When infants are brought to the nursery while their mothers recover separately, it is common for a nurse to give a first feeding of formula(Elliott-Carter and Harper 2012).

What are the benefits to keeping moms and babies together?

To read the benefits of keeping moms and babies together, please refer to my article on skin to skin care after a Cesarean. To summarize, babies who receive couplet care—in other words, who stay with their mothers and receive early skin-to-skin care—are 2 times more likely to be exclusively breastfeeding at 3-6 months, compared to babies who receive routine hospital care. You can read about the many other benefits of early skin-to-skin care—and the potential harms of separating mothers and babies—here.

Are there any potential harms to keeping moms and babies together after a C-section?

It is important to know that some mothers may not capable of independently caring for their infants immediately or for several hours after a C-section. For example, if mothers received strong sedatives, are nauseous, or were sleep-deprived for many hours before the Cesarean, then they may need supervision or assistance in caring for their newborns.  The mother’s level of awareness and her ability to remain awake when caring for and feeding infants must be assessed and closely monitored by nursing staff, especially when a Cesarean follows a prolonged labor or when sedative drugs have been given (Mahlmeister 2005). In this case, then the father or partner can do skin-to-skin with the infant. 

Is it possible for hospitals to keep moms and babies together after a Cesarean?

Yes, it is possible for hospitals to keep moms and babies together after a Cesarean. Three different hospitals have published quality improvement reports describing how they switched from routine separation to routine couplet care after C-sections (Spradlin 2009; Elliott-Carter and Harper 2012; Crenshaw et al. 2012).  As the first two reports were very similar, I will focus on the article by Elliott-Carter (you can read the article for free in its entirety here).

Why did this hospital decide to make the change?

In 2011, nurses at Woman’s Hospital in Baton Rouge, Louisiana, led a switch from routine separation after Cesareans to couplet care—keeping moms and babies together. The hospital was motivated to change for several reasons, including a desire to stay competitive with other hospitals and repeated requests from patients to not be separated from their babies.  

Perhaps most compelling, the staff felt it was simply “not fair” that moms who gave birth vaginally were allowed to stay with their babies, while moms who had C-sections were automatically separated from their babies. The C-section rate at Woman’s hospital was 40%, and they have more than 8,000 births per year. So making this change affected 3,200 families per year.

How did the hospital change to couplet care?

One of the first things the hospital did was put together a leadership team to plan for the change. This team included nurse managers from labor and delivery, postpartum, and newborn care, as well as pharmacists and materials management. The team communicated the plan to other groups (such as medicine). One of the team’s challenges was finding a large enough space where moms and babies could recover together after a C-section. They ended up choosing overflow labor and delivery suites that were big enough to accommodate the couplet. They also modified the existing recovery room (PACU) so that it could be used in case the overflow rooms were full. They moved curtains to make each patient’s space big enough for both mothers and infants to recover together, and they put a radiant warmer for the infant in each recovery space.

The team had to make several other small changes. They had to train the recovery (PACU) nurses in neonatal resuscitation. They made sure baby blankets were placed in the heated blanket warmer, and that appropriate medications for both moms and babies were stocked in each room.

Perhaps most importantly, staff made a commitment to provide care where the mothers and babies were, instead of always taking the baby away to the nursery. Although taking the baby to the nursery was easier and more convenient for the staff, they realized that keeping the couplet together was best for moms and babies. It took about 6 weeks from the beginning of this process until couplet care was fully implemented.

How did it go for this hospital in Louisiana?

In the first year after starting couplet care, the percentage of infants who were separated from their mothers dropped from 42% to 4%. Nurses stated that everyone was extremely satisfied with the change—including staff, physicians, and mothers. Nurses report that mothers are able to have skin-to-skin contact earlier, and that the first breastfeeding session goes smoother. Inspired by the bonding they witnessed between moms and babies, nurses decided to delay administration of erythromycin ointment and the vitamin K shot until after the initial breastfeeding. As nurses from the Woman’s Hospital said,

“If a hospital that delivers 8,000 infants annually can find a way to decrease the separation of mothers and newborns, concerned nurses everywhere should be able to implement this type of care.”

In another hospital, researchers used an innovative way to inspire staff to switch to immediate skin-to-skin in the O.R. They did an “intervention.” This intervention included formal training sessions on the benefits of skin-to-skin, and then videotaping 11 births (5 vaginal, 6 Cesarean) in which immediate skin-to-skin was used. Afterwards, they showed these videos to staff. Watching the videos helped the staff get engaged in problem-solving in how they could make the process work smoother. Before the intervention, about 58% of moms and babies had immediate skin-to-skin care. In the months afterwards, the rate of immediate skin-to-skin care increased to 83%. Almost all of the increase was due to moms who gave birth by C-section having immediate skin-to-skin in the O.R (the hospital did not routinely do skin-to-skin in the O.R. before the study). (Crenshaw et al., 2012).

So what is the bottom line?

Evidence has shown that it is possible—and best practice—for moms and babies to stay together after a Cesarean.

If a hospital staff member tells a mother that it is “impossible” for her to stay with her baby after a C-section, that statement is false. Making the switch from routine separation to couplet care can be done—some hospitals have already done so. Although couplet care may be more inconvenient for staff in the beginning, in the end, keeping mothers and babies together after a Cesarean is what is best.

Mothers who want to do very early skin-to-skin care and interact with their babies after a C-section should talk with their providers about this mother-friendly and baby-friendly practice. Moms should also talk with their anesthesiologists to make sure that they do not receive sedative drugs unless medically necessary, as these drugs may make some women incapable of early interaction with their newborns.

If you want to read more medical research:

The U.S. ranks 50th in maternal mortality globally

Improving maternal care in the U.S. will involve much more than increased spending. Better care can be provided at lower costs simply by recognizing that child birth is more than just a medical process that needs very expensive technical expertise. In many cases much lower cost alternatives can provide more care and more effective and humane care as has been shown by the example in the many industrialized countries that have universal health care systems. 

Read more

Doctors Urge Patience, And Longer Labor, To Reduce C-Sections

Read the full NPR article here

Women with low-risk pregnancies should be allowed to spend more time in labor, to reduce the risk of having an unnecessary C-section, the nation's obstetricians say.

The new guidelines on reducing cesarean deliveries are aimed at first-time mothers, according to the American College of Obstetricians and the Society for Maternal-Fetal Medicine, which released the guidelines Wednesday online and in Obstetrics and Gynecology.

About one-third of all births in the U.S. are done by C-section, and most of those are in first-time mothers. There's been a 60 percent increase in these deliveries since the 1990s, but childbirth hasn't become markedly safer for babies or mothers.

That discrepancy has led many to conclude that the operation is being overused. A C-section is major surgery. The procedure can increase complications for the mother and raise the risk during future pregnancies.

Women giving birth for the first time should be allowed to push for at least three hours, the guidelines say. And if epidural anesthesia is used, they can push even longer. Techniques such as forceps are also recommended to help with vaginal delivery.

Early labor should also be given more time, the doctors say, with the start of active labor redefined to cervical dilation of 6 centimeters, rather than 4.

It seems that a key point of the new guidelines is that doctors and patients shouldn't rely too slavishly on fetal heart rate monitors when trying to figure out if the baby's in distress. Is that right?

The incidence of a child being injured in the womb is pretty low, probably about 1 percent in a normal pregnancy. In 100,000 women you're going to have 1,000 problems. If you miss one that's really bad, that's an injured baby, that's an upset family. It really impacts the doctors and the nurses, and, of course, it's costly to the hospital. We don't want to miss things. But if we're trading off hundreds of C-sections to prevent one injury, the question is what that trade-off should be. At some point that number is too high. The harm on the moms is too high, and on future pregnancies, too.

Is that different from what you learned in medical school?

My practice really changed when I came to San Francisco in 1999. I was initially horrified by how long the physicians and the midwives allowed women to labor. I came from an environment where we had benchmarks, and we followed them. Then we started looking at the second phase of labor, just when you're pushing. We found, lo and behold, that women who pushed longer than three hours, longer than four hours, even five hours, the babies didn't have worse outcomes than the babies delivered in the second hour. And they did better than babies delivered in the first hour.

How can it be that we're just now finding out what's a normal length of labor?

You know, before 1955 there was essentially no quantitative data on the length of labor. Then Emanuel Friedman said we should study this. He studied 500 women, and, of those, he said here are the 200 women who have idealized labors. We then managed 4 million a women a year for the next 50 years based on 200 women. It's not that the wrong approach was taken; it's that we started science and then didn't continue to do the science.

How is science done? A lot of it is driven by economic demand. There's no money in being patient in labor. I don't think they're going to come up with a special stopwatch. Because of that, nobody has really pushed to look at this again.

 

Epidurals Prolong Labor Longer Than Doctors Previously Thought (STUDY)

By Bahar Gholipour, Staff Writer
Published: 02/06/2014 06:40 AM EST on LiveScience

Using epidurals for pain relief during a baby's delivery may prolong labor more than previously thought, a new study finds.

In the study, the researchers looked at more than 42,000 women in California who delivered vaginally between 1976 and 2008, and compared the length of the second stage of labor, which is the time it takes for "pushing" the baby out after the cervix has fully opened, among women who had received epidurals and those who hadn't.

Although it was thought that epidurals lengthen labor by about one hour, the researchers found that women who had epidurals actually took two to three hours longer to get through the second stage of labor, compared with women who hadn't received this pain medication, according to the study, published today (Feb. 5) in the journal Obstetrics & Gynecology.

The findings could affect doctors' decisions to perform cesarean-section deliveries, the researchers said. Some C-sections are performed because labor is judged as taking too long. The new findings suggest that for women who receive an epidural, doctors may be able to wait a little longer before opting for the surgery.

"When epidural is used, it may be normal for labor to take two hours longer, and physicians don't necessarily have to intervene, as long as women are progressing and the baby is OK," said Dr. Yvonne Cheng, one of the researchers on the study and an obstetrician at University of California, San Francisco. [8 Odd Changes That Happen During Pregnancy]

Current definitions of "normal" labor account for one additional hour for women who have epidurals. This means that women who take longer than that may get a label of "prolonged second stage," and their doctors may choose to intervene by performing a C-section, or use either a vacuum device or forceps to help the baby out of the birth canal.

"Although the American College of Obstetricians and Gynecologists specifically says that the doctor doesn't have to intervene based on the passage of time alone, it is still kind of a gray zone," Cheng said.

Most definitions of what is normal during labor are based on norms established by Dr. Emmanuel Friedman in the 1950s, and may not properly fit the contemporary population, experts say. Today, women and babies are heavier on average, more women give birth at older ages and more women use epidurals.

"In the Friedman population, epidural was used in 8 percent of the population," Cheng said. "Today, it's closer to 60 percent."

In the new study, in women who were having a baby for the first time, the second stage of labor took 336 minutes with epidural, and 197 minutes without epidural — a difference of 2 hours and 19 minutes.

For women who had given birth before, the length of second stage was 255 minutes with epidural, and 81 minutes without epidural — a difference of 2 hours and 54 minutes, the study found.

The researchers cautioned that labor norms should not be established based on their study alone, and that more research is required to re-establish what should be considered normal labor in the contemporary population.

It is not fully understood exactly why epidurals prolong labor, but experts speculate that the drug relaxes the pelvic muscles and the woman has less urge to push.

 

http://www.huffingtonpost.com/2014/02/06/epidurals-prolong-labor_n_4738949.html