Once again…worth the wait!

I’ve posted this before, but I love this article!  So, for your reading enjoyment, 40 reasons to go the full 40 weeks!

Pregnancy can be very challenging.  Morning sickness and extreme fatigue during the first trimester, that wonderful glucose tolerance test, blood draws, ligament pain, Braxton Hicks, shortness of air as your belly grows, apprehension about delivery…the list goes on an on.  I can’t tell you how many patients I see that are ready to have their baby as early as 34 weeks and ask if they can be induced because they are “tired of being pregnant.”  Sorry, ladies, “tired of being pregnant” isn’t an acceptable medical diagnosis that will warrant an induction prior to 39 weeks.

This article was originally published on www.health4mom.org.  It’s one of my favorite pregnancy sites.  Here’s 40 reasons to allow pregnancy to run it’s course and let your little one come when he or she is ready.  Enjoy!

Your baby needs a full 40 weeks of pregnancy to grow and develop. While being done with pregnancy may seem tempting, especially during those last few weeks, inducing labor is associated with increased risks including prematurity, cesarean surgery, hemorrhage and infection.

Labor should only be induced for medical reasons—not for convenience or scheduling concerns. Baby will let you know when she’s ready to emerge. Until then, here are 40 reasons to go at least the full 40 weeks of pregnancy:

Finish Healthy & Well

1. End right by starting right—keeping all of your prenatal appointments helps ensure a healthier ending
2. Savor the journey—soon you will meet your baby
3. Let nature take over—there are fewer complications and risks for both you and baby through natural birth
4. Recover faster from a natural birth than cesarean, which is major abdominal surgery that causes more pain, requires a longer hospital stay and a longer recovery
5. Birth a brainier baby—at 35 weeks your baby’s brain is only 2/3rds the size it will be at term
6. Set her thermostat—baby will better regulate her temperature when born at term
7. Boost breastfeeding—term babies more effectively suck and swallow than babies born earlier
8. Delight in those kicks and flips—marvel at the miracle of the life inside
9. Enjoy your convenient excuse for every mood swing and crazy craving
10. Nourish your body—diets don’t work but breastfeeding will help you return to your pre-pregnancy size
11. Let others carry the groceries, mail, packages just a while longer
12. Indulge in “we” time before you’re a threesome or more
13. Sport your bump—as your belly increases, so do your chances of getting a great seat almost anywhere

Manage Your Risks

14. Eat healthfully—indulge occasional cravings without remorse
15. Give baby’s development the benefit of time since you may not know exactly when you got pregnant
16. Let baby pick her birthday—if she decides to emerge after 37 weeks there’s no need to try to stop your spontaneous labor
17. Skip an induction—which could lead to cesarean—by waiting for labor to start on its own
18. Reduce your baby’s risks of jaundice, low blood sugar and infection by waiting until he’s ready to emerge
19. Build your baby’s muscles—they’ll be strong and firm, and ready to help him feed and flex at term
20. Maximize those little lungs—babies born just 2 or more weeks early can have twice the number of complications with breathing
21. Ignore people who say an induction is more convenient. Nothing is convenient about a longer labor and increasing your risk of cesarean
22. Respond to requests to speed baby’s birth with the facts that inductions often create more painful labors and can lead to cesarean surgery
23. Let others do the heavy lifting—and the extra housecleaning
24. Splurge on pedicures—or ask a friend to do them for you, especially when you can’t see or touch your feet
25. Relish in the fact that right now you’re the perfect mom—your healthy pregnancy habits are growing baby the best possible way
26. Finish well—more time in the womb usually means less time in the hospital

The nurses of AWHONN remind you not to rush your baby—give her at least a full 40!

Enjoy This Time

27. Relax! Babies are usually so much easier to care for in the womb
28. Shamelessly wear comfy, stretchy clothes
29. Postpone changing the eventual 5,000+ diapers baby will use
30. Be out and about without having to buckle, unbuckle, rebuckle baby into her car seat or stroller while runningerrands
31. Carry your most stylish purses especially the ones too small to hold diapers and wipes
32. Relish parenting—right now you know exactly where baby is and what he’s doing
33. Snooze when you can—what sleep you’re currently getting is actually quite a lot compared to the interruptions ahead
34. Massage remains a must—ask your partner to help ease the aches
35. Enjoy nights out without paying for a babysitter
36. Indulge in shopping without the added responsibilities of baby in tow
37. Redecorate your house around your nursery’s theme
38. Prop up your paperback—your burgeoning belly peaks at just the right reading height
39. Make the best-possible birth experience; don’t rush it
40. Write your own healthy reason—if it gets baby a full 40 weeks of pregnancy it deserves to be on this list

Delayed cord clamping

Over the last year or so, I’ve really stepped back and reevaluated my approach to caring for my patients.  When I first started as a labor and delivery nurse, there were several practiced I followed because that’s what I was taught when I was in orientation.  I did things the way my preceptor did them.  I did what the doctor told me to do.  Luckily, I had a really awesome preceptor who taught me the in’s and out’s of being a labor and delivery nurse, what rules to really abide by, how to think for myself.

Over the years, there have been several things I’ve changed my approach/attitude towards.  Most recently, I’ve had a change of heart about cord clamping.  There was a point in my career, whenever we had a patient requesting to either not clamp the cord immediately or to even wait until the cord stopped pulsating, I was right out at the desk with all the other nurses and doctors talking about what a bizarre/new age/”crunchy granola” idea that was.  Of course, we never would say such a thing in ear shot of the patient.  How unprofessional.  But, nevertheless, we all thought it was a weird thing to do.

What is delayed cord clamping?

In a nutshell, delayed cord clamping means to ‘delay’ the surgical intervention of clamping the umbilical cord at birth.

The definition of ‘delay’ is subjective and can range from 30-45 seconds, two to three minutes, once the cord has stopped pulsating or the placenta delivered.  There is currently no agreed clinical definition of delayed cord clamping, and wide variations exist in clinical trials.

The benefits

After doing some research into delayed cord clamping, I’ve had a change of heart about it.  There’s a lot of evidence to the benefits of delaying clamping the cord, even for a minute.  I read one particular article written by Nicholas Fogelson, MD suggesting that delaying cord clamping should be standard practice.  There’s plenty of evidence out there backing this statement up.  PLENTY.  Taken from Fogelson’s blogcast on Academic OBGYN, here’s a bit of data supporting the practice of delayed cord clamping.

Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial

Randomized 72 VLBW infants (< 1500 grams) to immediate or delayed cord clamping (5-10 vs. 30-45 seconds).  Delayed cord clamp infants had significantly less IVH (5/36 in delayed group vs. 13/36 in immediate group, p = 0.03) and less late onset sepsis (1/36 vs. 8/36, p = 0.03).

The Influence of the Timing of Cord Clamping on Postnatal Cerebral Oxygenation in Preterm Neonates: A Randomized, Controlled Trial

Randomized 39 preterm infants to immediate clamping vs. 60-90 second delay, and examined fetal brain blood flow and tissue oxygenation.  Results showed similar blood flow between groups, but increased tissue oxygenation in the delayed group and 4 and 24 hours after birth.

Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomized controlled trial

Randomized 476 infants to immediate or 2 minute delayed clamping and followed them for 6 months.  Delayed clamped babies had higher MCVs (81 vs. 79.5), higher ferritins (50.7 vs. 34.4), and higher total body iron.  Effects were greater in infants born to iron deficient mothers.  Delayed clamping increased total iron stores by 27-47mg.  A follow up study showed that lead exposed infants with delayed clamping also had lower serum lead levels than immediate clamped infants, likely due to iron mediates changes in lead absorption.

A randomized clinical trial comparing immediate versus delayed clamping of the umbilical cord in preterm infants: short-term clinical and laboratory endpoints

Infants delivering at 30 to 36 weeks gestation randomized to immediate vs. 1 minute delay.  Delayed group had higher RBC volumes (p = 0.04) and hematocrits (p < 0.005), though there was no difference in RBC transfusions.  There was a small increase in babies requiring phototherapy in the delayed group (p = 0.03) but no difference in bilirubin levels between groups.

Immediate versus delayed umbilical cord clamping in premature neonates born < 35 weeks: a prospective, randomized, controlled study

Randomized 60 infants to clamping at 5-10 seconds vs. 30-45 seconds.  Delayed clamping infants had higher BPs and hematocrits.  Infants < 1500 grams with delayed clamping needed less mechanical ventilation and surfactant.  Trend towards more polycythemia in delayed group, but not statistically significant.

Fogelson isn’t the only one out there publishing articles about the benefits of delayed cord clamping.  Dr Andrew Weeks, a senior lecturer in obstetrics at the University of Liverpool, looked at the evidence behind cord clamping as well.  In his article in the British Medical Journal, Weeks stated clamping and cutting of the umbilical cord should be delayed for three minutes after birth, particularly for pre-term infants.

For the mother, trials show that early cord clamping has no ill effects, he writes. But what about the baby?

At birth, he says, the umbilical cord sends oxygen-rich blood to the lungs until breathing establishes. So as long as the cord is unclamped, the average transfusion to the newborn is equivalent to 21% of the neonate’s final blood volume and three quarters of the transfusion occurs in the first minute after birth.

For pre-term babies the beneficial effects of delayed clamping may be greater, he says. Although the studies are smaller, delayed clamping is consistently associated with reductions in anaemia, bleeding in the brain (intraventricular hemorrhage), and the need for transfusion.

His article didn’t specify the gestational age of the preterm infants.

My opinion now

Providing all things go in a most uncomplicated manner with my next pregnancy, I plan for a delayed cord clamp delivery.  I’m not one who will necessarily insist on waiting until the cord has stopped pulsating, but I will insist on not waiting a few minutes before my doc clamps the cord.  I’m fortunate enough that my doctor is very open minded.

 

Fun labor and delivery facts

Just for fun…

In the US: Pregnancy tidbits

There are approximately 6 million pregnancies every year throughout the United States:  (hmm…wow.)

• 4,058,000 live births
• 1,995,840 pregnancy losses (not sure how many, if any, of these are terminations, but I know it includes all gestational ages, from 5 week miscarriages to term still borns.  Not really a fun fact, and I debated putting it in here).

Choosing a care provider

83% of women did not meet with multiple care providers before choosing theirs.  79% of expectant mothers chose OB/Gyn, 8% family physician, 9% midwives.

About 3 in 10 women have a visit to a health care provider to plan their pregnancy before they conceive.

• 83% of mothers learned about their pregnancy from a home pregnancy test.
• Women who received prenatal care in their first trimester: 84.1%.
• 17% of women reported that they could not get their first prenatal appointment as early as they wanted to.
• Women receiving late or no prenatal care: 3%

Ultrasound

99% of women had one. 59% had 3 or more. 15% had six or more.n  I was a part of that 15% with both of my babies.

The biggest day

The most popular day for babies to make their entrance is Tuesday, followed by Monday. Sunday is the slowest day, with 35.1 fewer births than average. Scheduled c-sections and induced labors have a big influence on the fact that far fewer babies are born on the weekend, but spontaneous (non-scheduled) deliveries occur less often on the weekend too.  My first was born on a Sunday and my second on a Thursday.

The biggest month

In 2010 more newborns arrived in September than in any other month. The second, third, and fourth most popular birthday months were August, June, and July, in that order.  May and August for me, although I was due in June and September.

Birth numbers and rates in the states

The number of births went down for 40 states and remained about the same for the rest of the states in 2009. Birth rates ranged from 51 births per 1,000 women age 15 to 44 in Vermont to 88 per 1,000 in Utah.

States with the most births

California, Texas, and New York (in descending order) had the greatest number of births.

States with the highest birth rate

Utah had the highest birth rate, with 88 births per 1,000 women age 15 to 44. Alaska, Arizona, Arkansas, Hawaii, Idaho, Kansas, Mississippi, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, South Dakota, Texas, and Wyoming had more than 70 births per 1,000 women.

States with the fewest births

Vermont had the fewest births, followed by Wyoming, North Dakota, and District of Columbia.

States with the lowest birth rate

Vermont had the lowest birth rate, with 51 births per 1,000 women age 15 to 44. Connecticut, Maine, Massachusetts, Michigan, New Hampshire, and Rhode Island had fewer than 60 births per 1,000 women.

The age and fertility of moms

Age of first-time moms

Over the last three decades, women have been waiting longer to start having children. In 1970 the average age of a first-time mother was about 21. In 2008 the average age was 25.1.  I was 22 with my first in 2007.  How old were you?

Birth rate

In 2009 the birth rate in the United States was 66.7 births per 1,000 women ages 15 to 44. This was a 3 percent decline from 2008 and a reversal of the increases seen in 2006 to 2008. In 2010 the birth rate dropped another 3 percent, to 64.7 births per 1,000 women ages 15 to 44.

The marital status of new moms

A rising number of new moms are not married: 41 percent of babies were born to unmarried women in 2009. That percentage has been on the upswing since 2002.

Teens accounted for 21 percent of births out of wedlock in 2009, continuing a steady decline over the past several decades. By contrast, in 1975, 52 percent of these births were to teens. The largest increase in births to unmarried women has been in women age 30 and older.

In 2010, 9.9 million single moms were living with kids under 18 in the United States, up from 3.4 million in 1970.The work status of pregnant and new moms

Stay-at-home moms in 2010: 5 million

First-time moms who worked during their pregnancy in 2008: 67 percent (and 57 percent of them worked full-time)

Between 1961 and 1965, 44 percent of first-time moms worked while pregnant.

First-time moms who worked during the month before they gave birth: 80 percent

Between 1961 and 1965, 35 percent of first-time moms worked during the last month of pregnancy.

Percentage who were working six months after they gave birth: 55 percent

In the early 1960s, the percentage of first-timers working six months after giving birth was 14 percent.

Birth and delivery

Doctors and hospitals

In 2008 most moms in the United States (99 percent) gave birth in hospitals with the help of a physician (91.3 percent). Midwives attended about 8 percent of all births (most midwife-attended births are in hospitals), up from less than 1 percent in the mid-1970s.

Of the 1 percent of births that took place outside the hospital in 2008, 66 percent were in homes and 28 percent were in birth centers. These numbers have remained largely the same since 1989, although birthing centers and home births appear they might be on the rise.  I couldn’t find any more recent statistics past 2009.

Midwives attended 61 percent of  home births in 2008. Montana and Vermont had the highest rate of home births.

Use of epidurals

Of the 27 states that kept track of epidural use in labor, 61 percent of mothers who delivered a single baby vaginally in 2008 received an epidural or spinal block

C-sections

Cesarean deliveries rose in 2009 to 32.9 percent of births, a 2 percent rise from 2008 and another record high. The c-section rate has climbed almost 60 percent in the United States since 1996.

Induction and other techniques

The number of women whose labor is induced has more than doubled since 1990. In 2008, 23 percent of labors were induced, compared with 22.5 percent in 2006.

The number of babies delivered with the help of forceps or vacuum extraction, though, is on the decline, down to 3.9 percent in 2008 from 4.3 percent in 2007. In 1990 almost 1 in 10 babies was delivered with forceps or vacuum extraction, compared with fewer than 1 in 25 in 2008.

Positions for Birth

74% of moms lay on their backs, 23% upright (propped up, squatting or sitting), 3% side-lying, 1% hands and knees.  I was the 3% with my last!
Boys vs. girls

With about 1,048 male babies born for every 1,000 female babies born in 2008, boys are keeping the edge in a ratio that’s stayed about the same over the past 60 years.

Twins

The number of twins born in the United States increased just 1 percent in 2008 – to 32.6 pairs of twins born for every 1,000 births. While this is the highest rate on record, the numbers have remained roughly the same since 2004 after skyrocketing 70 percent between 1980 and 2004.

Triplets and more

The rate of triplets and higher in 2008 was 147.6 per 100,000 births, about the same as the 2007 rate. After shooting up by more than 400 percent between 1980 and 1998, the rate has dropped, especially since 2003, in part because of improvements in fertility treatments. The 2008 rate of triplets and higher multiple births was 24 percent lower than the 1998 rate.

Big families

In 2008, 18,986 mothers gave birth for the eighth or more time.

Premature babies

The preterm birth rate declined in the United States for the third straight year to 12.18 percent of births in 2009. Between 1981 and 2006, the percentage of infants born preterm (less than 37 completed weeks) rose by more than one-third.

Weight at birth

The average U.S. newborn weight in 2008 was 7 pounds, 4.26 ounces. About 8 percent of babies born in 2009 were at “low birth weight” (defined as less than 5 pounds, 8 ounces, or 2,500 grams) – basically unchanged from 2005.

Home birth part 2

After posting my last bit about home births, I was saddened to of the legal issues associated with home births.  I was already aware that most insurance companies didn’t pay for doulas and midwives for home births, but I was surprised to learn in 23 states, it’s illegal for women to have a home birth attended by a midwife.  Obviously, the police aren’t going to bust down your doors if you deliver your baby at home, but if you have a midwife attending the delivery, she could be arrested and prosecuted.

Taken from an article on time.com:

When Hillary McLaughlin found out she was pregnant, she was unable to legally obtain the service she needed. So she looked for an underground contact. She got a woman’s name — just a first name — and a phone number from a friend who advised her to destroy the evidence as soon as she made the call. When McLaughlin reached the woman, however, the woman told her she no longer “did that” and that she wasn’t willing to risk going to jail for it anymore. Turned off by all the “whisper, whisper, cloak-and-dagger stuff,” McLaughlin decided to “jump state lines” from Illinois to Missouri to find a legal provider.

Forty years ago, you might have assumed McLaughlin was looking for an unlawful abortion. Rather, what the small-business owner, 33, sought was a certified midwife who could deliver her baby at home in Edwardsville, Ill. “It’s completely ridiculous that I had to do all this because midwives aren’t licensed to practice here,” says McLaughlin, who delivered her son in April at her parents’ home in St. Louis. “I wanted a home birth, but I wanted to do it legally, because I wanted some assurance that the midwife I chose knew what she was doing.”

Each year, some 25,000 American women like McLaughlin opt to deliver their babies at home. Although that accounts for fewer than 1% of all births in the U.S., the figure is probably on the rise. From 2004 to 2006, the most recent year for which estimates are available, home birthing in the U.S. increased 5% after having gradually declined since 1990, according the Centers for Disease Control and Prevention. While the recent uptick is not conclusive proof of a trend, home-birth advocates say anecdotal evidence and informal surveys from the field also point to growing demand.

Why? Largely because women wish to avoid what they deem overmedicalized childbirth. Compared with hospital deliveries, 32% of which end in cesarean section, those taking place at home involve far fewer medical interventions and complications. Some women, like McLaughlin, who have had cesareans in the past, elect to have a home birth because they want to attempt vaginal delivery — what is known as vaginal birth after cesarean, or VBAC, a procedure that most obstetricians and hospitals have banned to avoid liability lawsuits.

But midwife-assisted home births are not always easily or legally arranged. Today, just 27 states license or regulate so-called direct-entry midwives — or certified professional midwives (CPMs) — whose level of training has met national standards for attending planned home births. In the 23 states that lack licensing laws, midwife-attended births are illegal, and midwives may be arrested and prosecuted on charges of practicing medicine or nursing without a license. (Unlike CPMs, certified nurse midwives, or CNMs, who are trained nurses, may legally assist home births in any state. But in practice, they rarely do, since most of them work in hospitals.)

Putting aside the fact that the threat of arrest makes for a stressful work environment, midwives say it also increases risks for the mother and child. In the worst case, it could dissuade or delay a midwife from transferring a patient in medical need to a hospital. (Doing so might expose the midwife to the attention of law enforcement.) But now a campaign is under way to expand state licensing of CPMs, which would not only grant mothers increased access to home births, midwives say, but also make them safer.

Momentum appears to be growing. Of the 27 midwife-friendly states, eight began licensing midwives only in the past decade. And legislatures in 10 other states are now considering bills to institute licensing of CPMs — a fact that has not gone unnoticed by the medical establishment.

The Battle over Birth
The turf war between midwifery and medicine has been long-running. Both the American Medical Association (AMA) and the American Congress of Obstetricians and Gynecologists (ACOG) — the professional groups that write official medical and obstetrics guidelines in the U.S. — oppose home birthing on grounds of safety. In 2007 ACOG stated that the “safest setting for labor, delivery and the immediate postpartum period is in the hospital or a birthing center within a hospital … or in a freestanding birthing center.” The statement was supported in a resolution passed by the AMA in 2008. Choosing to deliver a baby at home, ACOG said, is to give preference to the process of giving birth over the goal of having a healthy baby.

Midwives counter that for low-risk mothers, planned home births are no less safe than hospital births. A study published in the BMJ in 2005 found that among 5,418 mothers in the U.S. and Canada who planned home births, the rate of neonatal or intrapartum death was 1.7 per 1,000 births — similar to the rate of neonatal deaths (those occurring within the first 28 days) in hospital births found in other studies. And home birth can be a favorable experience for both mother and child, midwives say. Women who give birth at home not only recover faster after delivery but also are more likely to breast-feed and avoid postpartum depression, according to home-birth advocates.

The political debate ratcheted up on July 1, when the American Journal of Obstetrics & Gynecology published online a controversial new meta-analysis of the safety of planned home births. The authors of the paper, which consists of a review of 12 previous studies, acknowledged significant benefits associated with home birth: fewer maternal interventions, including epidurals, episiotomies and C-sections; and fewer cases of premature birth and low birth weight.

But the finding that made headlines was that planned home births led to a two-to-three-times higher risk of neonatal death than planned hospital deliveries among healthy, low-risk women. The result was especially striking, the authors wrote, because women planning home births generally had fewer obstetric risk factors than those who chose hospital births: they were less likely to be obese and had fewer previous C-sections or pregnancy complications.
Read more: http://www.time.com/time/magazine/article/0,9171,2011940,00.html#ixzz1oHRm4zJm

For those who feel very stingily about birthing at home, desire a midwife to attend but live in one of the twenty three states in which midwife-attended home births aren’t legal, fear not.  Birthing centers are on the rise, and from what I’ve gathered thus far, there aren’t any legal issues associated with birthing centers.  Birthing centers offer a very home-like environment in which deliver in.  I’m adding birthing centers to my list of topics to research, and I’ll share what I find.  I’ve had several family members deliver at a birthing center and had nothing but good things to say.

Weather changes and pregnancy

Weather and labor

Have you ever heard of someone say, “Wow, the emergency room was hopping last night.  It must have been a full moon.” Or “If your due date comes close to a full moon, that is when you’ll have the baby.”  Is this documented and evidence-based or simply Urban Legend.

While there is no single point of agreement among medical professionals, many recognize that barometric pressure affects physical conditions in the human body.  Dr. Leiber’s study (J Clin Psychiatry. 1978. May 39(5): 385-92), postulates “the existence of a biological rhythm of human aggression which resonates with the lunar synodic cycle.”  Conditions most commonly associated with changes in barometric pressure involve chronic pain and joint problems, but many pregnant women report being affected by changes in air density in other ways, including nausea, gas and headaches. Others claim that barometric pressure can affect labor pain, and some evidence exists to suggest a sudden change in barometric pressure can even induce premature labor.

So, the question of the day is, does a change in the weather or a full moon trigger labor?

The Full moon and labor

There are plenty of us that believe in the power of the full moon when it comes to triggering labor.  Especially those giant orange full moons.  We (the OB techs, nurses and doctors I work with) joke about “there’s no room at the inn” on such nights.

There are published works that show that there is such a relationship. One study looked at 5,927,978 French births occurring between the months of January 1968 and the 31st December 1974. Using spectral analysis, it was shown that there are two different rhythms in birth frequencies: –a weekly rhythm characterized by the lowest number of births on a Sunday and the largest number on a Tuesday and an annual rhythm with the maximum number of births in May and the minimum in September-October. A statistical analysis of the distribution of births in the lunar month shows that more are born between the last quarter and the new moon, and fewer are born in the first quarter of the moon. The differences between the distribution observed during the lunar month and the theoretical distribution are statistically significant.

People are 80% water.  And the changes in barometric pressure changes tides…does that change how we act or react?  Some say yes, others no.  Those that say no site the power of folklore/tradition/urban legends, misconceptions and cognitive biases (all bad events don’t occur during the full moon and all events that occur during the full moon aren’t bad!).  Talk to nurses who work labor and delivery on a regular basis, midwives,  busy doulas or experienced childbirth educators and they will all tell you that they believe in the power of the full moon plus changes in barometric pressure from cold/warm fronts.  I can tell you from personal experience, more often than not, full moons equal a full labor and delivery unit.

Examined was the relationship between lunar position and the day of delivery and the synodic (in astronomy, length of time during which a body in the solar system makes one orbit of the sun relative to the earth) distribution of spontaneous deliveries, especially in relation to the presence of a full moon. A retrospective analysis of 1248 spontaneous full-term deliveries in three-year period (36 lunar months) was done at the Department of Obstetrics and Gynaecology, Civil Hospital, Fano (Marche, Italy). The results showed a connection between spontaneous full-term deliveries and the lunar month. The effect of the phases of the moon seems to be particularly relevant in mothers who had birthed before.

What is barometric pressure and what role does it play in triggering labor?

Barometric pressure, also referred to as air pressure or atmospheric pressure, is the weight of the Earth’s atmosphere on the surface at a given location. It is dependent upon the amount of air above a location, and consequently, drops as one ascends higher while flying on an airplane.

To determine whether there is any correlation between sudden decrease in barometric pressure and onset of labor, a non-experimental, retrospective study at a 948-bed tertiary care hospital was done. Pregnant patients of 36 weeks gestation or more who presented with spontaneous onset of labor during the 48 hours surrounding the 12 occurrences of significant drop in barometric pressure in 1992 were included in the study. Significantly more occurrences of onset of labor were identified in the 24 hours after a drop in barometric pressure than were identified in the 24 hours prior to the drop in barometric pressure (P < 0.05). Therefore, the overall number of labor onsets increased in the 24 hours following a significant drop in barometric pressure.

Premature Membrane Rupture

• Barometric pressure changes are thought to possibly affect premature rupture of the membranes.  In 1985, the Journal or Reproductive Medicine reported a significant increase in obstetric complications in women thought to be affected by barometric pressure changes, resulting in premature rupture of the membranes and labor. The study found that evidence suggests an influence of barometric pressure on pregnancies that are notable near the end of term. Although no definitive proof of this effect has been made, the effects of barometric pressure on other physical conditions lend credibility to this claim.  One hundred nine patients with this obstetric complication lived within an area small enough to be subject to the same barometric pressure changes; onset of labor was used as a comparison point in 109 control patients. The two groups did not differ when demographic data were compared. There were no differences in other obstetric complications or neonatal outcome. There was a significant increase, however, in premature membrane rupture within three hours after a fall in barometric pressure. No such increase in the onset of labor was seen in the control group.

Labor Pain

• The functioning of the autonomic nervous system, which controls labor pain, can be heightened or deadened by changes in weather and environmental changes. Other functions of the autonomic nervous system include control of heart rate, respiration rate, perspiration and micturition which, if significantly changed, can also affect the comfort and safety of the mother during delivery.

Joint Ache and Pain

• As with other conditions affected by changes in barometric pressure, such as arthritis and MS, chronic pain in the legs and lower back due to increases and shifts in body weight may increase with changes in barometric pressure and other atmospheric conditions. Changes in the density of the air can be responsible for expansion and contraction within the joints, leading to new pain or more intense existing pain due to these changes.

Aggravation of Existing Conditions

• Other side effects of pregnancy include headaches, migraines, nausea, gas and intestinal discomfort. These are all common symptoms of pregnancy that can affect the mother at various times throughout the pregnancy. All of these conditions are normally influenced by the weight of the atmosphere and can increase in intensity due to environmental changes such as barometric pressure.

Bottom line, some maternity units actually have more staff available during periods of full moon.  I can tell you from personal experience, triage is at least a very happening place.  I’ve noticed that expectant mothers often experience false signs of labor during full moon.  Over the years, many researchers have sought to determine whether more babies are born during full moons than at other times of the month — often with contradictory or inconclusive results.  While the growing moon may not hasten the arrival of that little bundle of joy, an incoming storm might.  One study I read stated that on days with a larger change in barometric pressure, regardless of whether it was increasing or decreasing, the number of deliveries increased and the relationship was statistically significant.

I’ve decided throughout the rest of the year, I’m going to keep note of what happens on my unit delivery wise in relationship to the phases of the moon and weather changes.  I can tell you that over the last few nights, between going from 70 degree weather to tornados to several inches of snow on the ground in less than four days, our unit was hopping!

Home births

For me, a home birth was never an option.  For one, my pregnancies have both been a bit of the complicated side.  My first, preeclampsia, polyhydraminos and borderline IUGR.  My second, gestational diabetes, polyhydraminos (again) and preterm (35 6/7 weeks).  For two, as a labor and delivery nurse, I had a very low opinion of home births.  My only encounters with women who tried for a home birth were the ones who ended up in with a stat c/section and a baby that did poorly and went to the NICU.

I will be honest.  I thought opting for a home birth was stupid and unnecessarily risky. 

Let me be honest again.  My opinion of home births has drastically changed.  Again, I would never opt for a home birth personally, but my opinion about home births has changed dramatically.  On a whim, I recently did a bit of research into home births and was pleasantly pleased with what I discovered.  I sat in on a few “support groups” for moms desiring a home birth, listened, really listened to what they had to say about previous experiences in hospitals, home birth experiences, and why they chose a home birth or were planning on choosing a home birth.  I got schooled.

Bottom line, after doing some research, I have a new outlook on home births.  Again, I wouldn’t personally choose to deliver at home, but to each their own.  I certainly no longer think of home births as risky, stupid or in any other negative light.  In fact, after hearing of some women’s experience delivering in the hospital, I can’t help but think the women choosing to birth at home are the smarter ones.

Could home birth be for you?

Home birth might be an option for you if:

• You are having a healthy, low-risk pregnancy
• You want to avoid episiotomy, cesarean section, epidural and other interventions
• You want to be surrounded by family and friends
• You want to be free to move around, change positions, take a shower, and eat or drink freely during labor
• You want to enjoy the comforts of home and familiar surroundings

Home birth is not for you if:

• You are diabetic
• You have chronic high blood pressure, or preeclampsia (also known as toxemia)
• You have experienced preterm labor in the past, or may be at risk for preterm labor now
• Your partner does not fully support your decision to give birth at home

Most midwives will bring the following with them the day of delivery:

This was the part that really impressed me and truly changed my opinion about home births.  I didn’t realize this was standard practice for most midwives. 

• Oxygen for the baby if needed
• IV’s for mom if she becomes dehydrated or needs additional nutrients
• Sterile gloves, gauze pads, cotton hat for the baby, drop cloths, waterproof covers for the bed, a thermometer, a pan for sitz baths after birth
• Fetoscopes or ultrasonic stethoscopes
• Medications to slow or stop a hemorrhage
• Special herbal preparations, homeopathic remedies, massage supplies/techniques and even acupuncture needles
• Items for suturing tears

How often and in what situations would transfer to the hospital occur:

According to a study in the United Kingdom, approximately 40% of first time moms and 10% of women who have previously given birth are transferred to the hospital for delivery. The following are some of the reasons women are transferred:

• Mom decides to go because she feels exhausted and does not want to continue
• Premature rupture of membranes
• High blood pressure
• No progress
• Fetal distress
• Cord prolapse
• Hemorrhage

For a breakdown of percentages you can look at the following study:http://www.homebirth.org.uk/transferstudies.htm

Some pointers when considering a home birth:

• Compile a health care team by hiring a midwife and obstetrician
• Interview several midwives to discuss their birth philosophy; you may be more comfortable with a midwife who shares your view of birth
• Write out a Plan B in case a hospital transfer is necessary
• Consider hiring a doula
• Ask your midwife if she works with a backup OB/GYN
• Choose a pediatrician to see the baby within 24 hours of the birth

Home birth perks:

Home birth may be significantly easier on your pocket book. An average uncomplicated vaginal birth costs about 60% less in a home than in a hospital.  I know with my last baby, my unmedicated labor that I was in the hospital a whopping 2.5 hours and the 1.5 days I stayed in postpartum cost me right at $2000 out of pocket.  This was after insurance, and includes the “preemie” workups my daughter had.

Home birth provides immediate bonding and breastfeeding. Early breastfeeding helps mom stop bleeding, clear mucus from the baby’s nose and mouth, and transfer disease-fighting antibodies in the milk from mother to baby.  Most hospitals staffed by AWHONN (Association of Women’s Health, Obstetric and Neonatal Nurses) promote “Kangaroo Care” or “Couplet Care” in which the baby stays with you after delivery, which allows for bonding and breastfeeding immediately after delivering. 

Home birth allows you to be surrounded with those you love. When you include children, family, and friends in the birth process, it provides you with many helpers and allows a very intimate bonding experience for everyone involved.

 

 

Power Positions

I just found this article from http://www.fitpregnancy.com, and it was one of those “Yes, Yes, Yes!” moments.  Every shift I work, I have docs insisting patients deliver in a dorsal lithotomy position (on your back), and it drives me crazy.  I delivered my last baby in a crazy cock-eyed on my side position.  I also pushed in between my contractions, but that’s besides the point.  The point is, I love this article and wanted to share it.

Women all over the world give birth squatting, leaning or even standing. We lie down. What do they know that we don’t?

If your car stalled at the bottom of a hill, you certainly wouldn’t try to push it uphill. So why does it make sense to fight gravity by lying down during labor? This is just one reason why the standard hospital labor position—semi- or fully reclining—is not ideal. For one thing, when you’re lying on your back, your uterus compresses major blood vessels, potentially depriving the baby of oxygen and making you feel dizzy or queasy. “Most women feel better when they are not lying on their back during labor,” says certified nurse-midwife Katy Dawley, Ph.D., C.N.M., director of the Institute of Midwifery at Philadelphia University in Pennsylvania. In addition, when you’re reclining, the baby’s head puts pressure on pelvic nerves in your sacrum, increasing pain during contractions. Remaining upright and leaning forward reduces this pressure while allowing the baby’s head to constantly bear down on your cervix. As a result, dilation tends to occur more quickly.

“Lying on your side, standing, sitting, walking, rocking—anything that keeps you active can help decrease pain and speed up labor,” says Dawley. Just be aware that a prenatal visit is the time to discuss with your doctor or midwife the different positions you think you’d like to try. “In the throes of labor, you’re not going to be able to advocate for yourself,” she explains.

Seven soothing labor positions

Here’s another reason to be open to the possibilities: Fetal heart monitoring during labor can help determine which positions you can sustain without impairing circulation to the baby, so it’s best to have a repertoire available. Some options:

1. Get on all fours This position eases back pain and helps the baby rotate into the optimal position for delivery—facedown. (When the baby is faceup, the result is the dreaded “back labor.”)

2. Lean forward This can help make uterine contractions more effective in bringing the baby down. Drape your chest over a table, bed, countertop, pillow or exercise ball.

3. Lie on your left side This may increase blood flow to your baby and can help reduce back pain. Support your belly and legs with pillows.

4. Lunge Place one foot on a sturdy chair or footstool and lean into that foot during contractions.

5. Rock Sit on an exercise ball, the edge of the bed or a chair and gently rock back and forth.

6. Sit and lean Sitting in a chair, prop up one foot and lean forward into it during contractions.

7. Sway Put your arms around your partner’s neck and sway back and forth; pretend you’re slow dancing.

Ready, set, push! While the position may be less convenient for hospital personnel, squatting is especially effective when you’re ready to push. In fact, squatting is sometimes called the “midwife’s forceps” because of its ability to work with, not against, gravity, enlarge the pelvic opening and speed the pushing phase of labor.

(FYI, I just want to draw a big red line through this pic)