Tuesday, December 13, 2016

10 Things You & Your Prenatal Care Provider Should Know

Birth is highly medicalized in today’s society. The C-section rate is double what it should be, and our intervention rates are high. Most interventions are overused and abused, putting the mother and child at risk without necessity. Care providers may be motivated by ignorance, greed, or impatience–just like any other fallible human being. There are a few things that all women and care providers should know. Knowing these things decreases your risk of premature birth, an uncomfortable and painful delivery, unnecessary and dangerous interventions, and various other things.

A woman does not have to deliver within a time limit of going into labor. Too often care providers expect labor to progress within a specific time frame. Each phase is only supposed to last a set number of hours. If a labor is not proceeding fast enough for their liking, they will augment labor with pitocin. This can cause the contractions to become more intense and painful than natural ones that build gradually, and it increases risk of fetal distress and various other things. All women labor at their own pace. It is normal for some labors to be quick, some slow. It is also normal for labor to slow down, speed up, stop, start, and even regress. You do not need to deliver your baby within a certain time period of labor starting. This is true even if your waters have broken, as the placenta continues making amniotic fluid until the baby is born, and this steady trickle will prevent bacteria from entering the womb–unless it is aided by human fingers.

A broken bag of waters can repair itself, and the placenta continues making water throughout the pregnancy. If your membranes rupture prematurely, you do not need to be hospitalized–unless they are going to monitor you to try to prolong labor. You do not need to give birth within 24 hours. Many times when the amniotic sac breaks too early, it will repair itself. There is no danger of having a dry birth, as the placenta keeps making fluid for the baby. The baby will not be in there without amniotic fluid just because your water broke. Moreover, while you do need to take precautions such as not bathing or allowing anything put into your vagina, you don’t need to worry about infection. Even if your bag of water does not fix itself, the slow trickle will push bacteria out of the vagina so that it does not penetrate the womb.

A women does not need to gain a specific amount of weight during pregnancy. Many women have found that their weight gain had little to do with the size of their baby at birth. Some women will gain a lot with one baby, not much with the next. Some women regularly gain only 20lbs. Others will gain in excess of 50lbs. It is when a mother exhibits signs of malnourishment or Gestational Diabetes that she needs to worry about her diet. Her weight should not be fretted over, her caloric intake increased and decreased to meet a specific weekly goal. Do not try to gain weight; do not try not to gain weight.

Some people question the safety of Doppler. One minute of Doppler is equal to 30 minutes of ultrasound. As we have not had this technology long enough to know if there are long-term effects on fetuses, Doppler should be used sparingly. Doppler is the only way to detect the heartbeat up until 18 weeks. After that, a fetal stethoscope can be used. It is far less invasive and completely safe. They do make versions of these where two people can listen at once. There is no benefit to using Doppler instead of fetoscope.

Postdate pregnancy isn’t dangerous until 42 weeks, and women can take to 44-45 weeks to go into labor naturally. While postdate pregnancy was once considered 42+ weeks, now women are considered overdue at 40 weeks. Most women go into labor naturally between 38 and 42 weeks, so there is no reason for a pregnancy to be considered post term so soon. It is at 42 weeks that risks of stillbirth, placental aging (and thus low amniotic fluid, oxygen and nutrient deprivation, etc), and meconium (baby passes a bowel movement in utero) increase. Even then, it isn’t by much. Due dates are based on the first day of a woman’s last menstrual period, but as all women ovulate at different times, due dates are never certain. Even ultrasound dating is not always completely accurate. Due dates can be off by a few days or even a few weeks. Some women will not go into labor naturally until 44 or 45 weeks! There is no reason to induce a postdate pregnancy until 42 weeks.

It is best not to induce labor or schedule a C-section prior to 40-42 weeks, except in case of emergency. Many times doctors expect the baby to be large or breech, so they schedule a C-section. Often this is scheduled for 37 weeks, the earliest a baby is considered term. This puts the baby at a huge risk of being born premature if the mother’s due date is off even by a week. Scheduling an induction or C-section for non-emergency reasons prior to 40-42 weeks puts the baby at an unnecessary risk.

Doctors are advising now that breech babies and twins be born by C-section. The risks with vaginal birth are increased in these cases, yet the risks associated with C-sections are much higher. If you feel otherwise, you can of course chose a C-section for these deliveries. However, you do not have to do so. Your breech baby can possibly be turned, and even if not, he or she can still be born vaginally. Twins can also be born vaginally, especially if the care provider is experienced and patient. Do not let a care provider convince you that you absolutely cannot have a vaginal birth if you have a breech baby or are expecting multiples.

A mother’s pelvis size is no indication as to how big of a baby she can deliver. The female pelvis is made to stretch apart to allow the passage of babies down the birth canal. Comparing her measurements to the baby’s estimated size, which is often inaccurate even with ultrasound estimation, will not tell if she can deliver the baby. When a big baby is expected, even if the mother is very petite, there is no reason to assume it will not come out of the vagina. Even if shoulder dystocia is encountered, often by changing positions or corkscrewing the infant out, vaginal birth is still successful. A mother’s pelvis opens far wider when she is squatting, sitting, standing up, or on her hands and knees than when she is lying back. There is no reason not to attempt a vaginal birth simply because your baby might be big. Big babies can be born vaginally, and often times doctors anticipate babies to weight 10lbs when they really only weigh 7lbs!

Never pull on an umbilical cord, as it can cause hemorrhage–not to mention extreme pain. If the placenta is taking “too long” to come out, patience is the best treatment. Certain herbs may help, as can breastfeeding. A shot of pitocin will also do the trick. A care provider should never pull on an umbilical cord to free the placenta. He should never try to dislodge it with his hands by sticking them inside the mother. This increases risk of infection. Both methods put the mother at risk of hemorrhage or of the placenta not coming out in one piece.

The baby’s cord doesn’t HAVE to be cut and should NOT be cut until it has stopped pulsating. Most providers cut the cord as soon as the baby is born. This is taking a risk. The baby continues receiving oxygen through the umbilical cord. Leaving the cord alone for a bit decreases risk of respiratory distress. Cutting the cord too soon increases risk of bleeding. The cord doesn’t really have to be cut at all. You can leave the cord alone and let it fall off on its own within a few days. This comes with a lower risk of infection. The baby gets all the nutrients and oxygen the placenta has to offer. The baby can have a bath right away, and there won’t be an ugly umbilical cord stump hanging around.

Whether you are birthing at home or in the hospital, you will benefit if you and your care provider know these things. You have a much higher chance of succeeding in vaginal birth if you know these truths. Your baby has a better chance of being born at term and healthy. There is no reason to allow a doctor to forbid you from vaginal birth for a large or breech baby, even a twin delivery. One of the best things your doctor can do for you is let nature take its course and intervene only when medically necessary. Moreover, he should keep his hands out of you to prevent risk of infection. If women and doctors knew these things, as most midwives do, then birth would be even safer for mothers and babies–and far more pleasant.

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