Fear of Childbirth Can Make Labor Longer

I came across an interesting story which was written in response to a study published in BJOG:  An International Journal of Obstetrics and Gynaecology.  The study looked at the "fear of childbirth and duration of labor."  The study found that "duration of labour was longer in women with fear of childbirth than in women without fear of childbirth."  They found that labor was roughly 1 hour and 32 minutes longer in women who feared childbirth.  "After adjustment for parity, counselling for pregnancy concern, epidural analgesia, labour induction, labour augmentation, emergency caesarean delivery, instrumental vaginal delivery, offspring birthweight and maternal age," they found that labor lasted 47 minutes longer.

I found this study intriguing.  While I find the entire birth process fascinating, I did notice that my delivery slowed down when the pain made me too tense.  I had to get induced because my water broke but I had no contractions.  Contractions brought on by induction can be quite painful and pretty regular.   I would tense up when the contractions started which made me stop progressing.  Once I got the epidural, I was able to relax enough to even fall asleep.  Once I awoke from my nap, I had progressed enough that I could start pushing!  What my body was fighting for hours finally happened once I relaxed from the epidural.  I will have to remember this when I am going into labor this time around.

Until then, to ease anyone's fear of labor, I found these tips online to be quite useful:

1. Step away from horror stories and birth videos.
2. Get advice from other moms
3. Know what to expect
4. Let your birth partner know what to do
5. Keep these things in mind
1. There is always the option of pain relief
2. Childbirth is safer than ever for both mothers and babies
3. As labor progresses and gets tougher, you're that much closer to meeting your baby.

I found tips #2 and #3 to be especially helpful.  I got a lot of my questions answered and fears conquered by reading pregnancy message boards and forums.  It was nice to be able to ask questions and read answers for questions I had never thought of on these forums.  It is also helpful when forums are categorized by due date so you can read about and share experiences with people going through the same things you are.  I have never been afraid to ask questions and I found that when it comes to pregnancy and childbirth, there are never too many questions.  Good luck to all those moms who are ready to deliver.

Delayed Cord Clamping

Anyone heard about or did delayed cord clamping?  Delayed cord clamping is when you delay cutting the umbilical cord for at least 30 seconds but as much as 2-3 minutes or until the cord stops pulsing after birth.  I have been reading a lot about this recently and it appears that more and more healthcare professionals are allowing mothers to delay the clamping of the umbilical cord.  Why would you want to delay the clamping of the umbilical cord?

Several major medical journals, including the British Medical Journal and the American Medical Association have published articles regarding delayed cord clamping.  Even the World Health Organization has dropped early clamping from its guidelines and the Royal College of Obstetricians and Gynaecologists have changed their guidelines to indicate that "the cord should not be clamped earlier than is necessary, based on a clinical assessment of the situation."  By delaying the clamping of the cord, more of the cord blood can go back into the baby.  It allows an increase in the baby of red cell counts and iron stores.  With this increase in cord blood, the risk of anemia in the infant was decreased when compared to infants with immediate clamping.  This effect was seen up to 6 months later.  This is especially important in developing countries where mothers have a higher risk of delivering a baby while anemic.

With all of this in mind, why is it a widely accepted practice to clamp the cord immediately after birth even in the absence of any "sound scientific evidence?"  Apparently, it was believed that not immediately clamping the cord would put the mother at risk for hemorrhage or put the baby at risk for jaundice.  However, there is no evidence to suggest that these are issues in clinical practice.  There were no more cases of jaundice in babies who had delayed the clamping of the cord compared to babies who had their cords clamped immediately.  It was also believed to increase the risk of polycythemia which is a condition in which the "proportion of blood volume that is occupied by red blood cells increases."  "Although late clamping was associated with a moderate increase in blood viscosity, none of the polycythemic infants evaluated in this review were symptomatic (ie, had symptoms of central nervous system, cardiopulmonary, gastrointestinal tract, or renal impairment)."

Obviously there are times when delayed cord clamping is not feasible.  If you are planning on donating or storing your umbilical stem cells, then the cord must be clamped immediately after birth.  Also, if a complication were to arise that may harm the baby or the mother (like hemorrhaging), then the cord obviously must be cut immediately.

My two-year old was born with thick meconium.  He had his first bowel movement while passing through the birth canal.  Meconium is what they call the first bowel movement of the baby.  He was in danger of meconium aspiration syndrome so they had to cut the cord and clean him up before he had time to aspirate (breathe in) the meconium.  Obviously this was not a choice when he was born but I am definitely considering it for this child.  We are not going to "bank" our cord blood and our hospital, unfortunately, does not accept cord blood for donation so rather than letting it go to waste, I would rather that blood go straight to my baby.  I'm curious if anyone else has done delayed cord clamping and what was the outcome?

Is Your Hospital "Baby Friendly?"

Pediatrics, the American Academy of Pediatric's Official Journal, published a study today entitled, "Baby-Friendly Hospital Practices and Meeting Exclusive Breastfeeding Intention."  The purpose of this study was "to describe mothers’ exclusive breastfeeding intentions and whether Baby-Friendly hospital practices are associated with achieving these intentions."  The Centers for Disease Control and Prevention (CDC) surveyed pregnant women about their intentions for exclusive breast-feeding (meaning only breast milk but no other liquids or solids) and then followed up with surveys conducted monthly over a year.

The study found that 85% of mothers had intended to exclusively breastfeed for the first three months.  However, only 32% (about 1/3) of mothers had actually breastfed as long as they had intended.  The study found that "increased Baby-Friendly hospital practices, particularly giving only breast milk in the hospital, may help more mothers achieve their exclusive breastfeeding intentions."

What exactly is a "baby-friendly hospital practice?"  In 1991, UNICEF and the World Health Organization (WHO) started the Baby-Friendly Hospital Initiative (BFHI).  The purpose of the BFHI was to, "ensure that all maternities,whether free standing or in a hospital, become centers of breastfeeding support."  There are currently 152 countries around the world implementing this initiative.  The United States even has an accrediting body for this initiative.  This organization, called Baby-Friendly USA, is a non-profit organization that implements the BFHI in the United States.

"A maternity facility can be designated 'baby-friendly' when it does not accept free or low-cost breastmilk substitutes, feeding bottles or teats, and has implemented 10 specific steps to support successful breastfeeding."

The 10 specific steps are:

1 - Have a written breastfeeding policy that is routinely communicated to all health care staff.
2 - Train all health care staff in skills necessary to implement this policy.
3 - Inform all pregnant women about the benefits and management of breastfeeding.
4 - Help mothers initiate breastfeeding within one hour of birth.
5 - Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
6 - Give newborn infants no food or drink other than breastmilk, unless medically indicated.
7 - Practice “rooming in”-- allow mothers and infants to remain together 24 hours a day.
8 - Encourage breastfeeding on demand.
9 - Give no pacifiers or artificial nipples to breastfeeding infants.
10 - Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic

According to the CDC, "Hospitals that wait to start the first breastfeed, or separate babies from mothers, or routinely give formula to breastfeeding babies make it harder for mothers and babies to be able to breastfeed.  When hospitals support mothers to feed their babies only breast milk, it helps mothers to continue feeding only breast milk at home."  Also, "babies who are fed formula and stop breastfeeding early have higher risks of obesity, diabetes, respiratory and ear infections, and sudden infant death syndrome (SIDS), and tend to require more doctor visits, hospitalizations, and prescriptions."

When I had my first child, I could not understand why we could not have our baby sleep in a "nursery."  As any new parent will tell you, those first few hours after birth can be exhausting and you just want to get some rest.  However, my hospital refused to let the baby leave my side.  At the time, I could not figure out why.  In retrospect, they were only practicing the steps outlined by the BFHI.  The hospital we had our baby initiated breastfeeding immediately after birth, had a lactation consultant who made daily visits, only allowed "rooming in," did not give pacifiers or artificial nipples and most importantly, did not give us any samples of formula.

I thought that my hospital was "unique" in this since many of my friends who had babies at other hospitals had been given formula samples, pacifiers, and other things prior to leaving the hospital.  However, on March 30, 2012, a "letter was sent to 2600 hospitals across the country. Over one hundred organizations signed on to the letter calling on hospitals to stop allowing formula companies to market infant formula in their facilities."

Mothers already face many obstacles when trying to initiate and maintain breastfeeding.  As mentioned in earlier posts regarding maternity leave in the US and breastfeeding and the working mother, we can now add, un-baby friendly hospitals to the list of obstacles facing mothers who are breastfeeding.

Making Post-Partum Recovery Bearable

Just before having my first child, I stumbled across an interesting blog post about "your post partum life." Until reading this, I never really thought much about what was going to happen to my body AFTER I had the baby.  In all honesty, I'm glad I read this post.  I recently found the link to the post and decided to re-read it after having my first baby but before having my second.  I still found the information to be helpful and a good "reminder" of what I need to do this time around.

The big take home message for me from this post was the peri bottle.  I had not even heard of this before reading about it.  What is a peri bottle?  "Peri" is the shortened name for "perineal" or "perineum."  The "perineum" is generally considered to be the area of the body which includes the genitals and anus.  It is a bottle with tiny holes on the top.  You can fill it with warm tap water and it can then be "sprayed" out of the bottle.  It is designed to help "irrigate" the areas that just went through the traumatic birthing experience.  It's a great way to cleanse yourself after going to the bathroom without having to use any toilet paper.  I would have never thought that good old toilet paper would be such a painful thing to use.  I used bidets in Japan and this reminded me of a "manual" bidet.  I was so happy to use this, I made sure to stockpile two bottles from the hospital before being discharged.

Another bit of advice I found helpful was using pads soaked with Witch Hazel (a.k.a. Tucks Pads).  Witch Hazel is an astringent which helps with irritation and burning in the anorectal area.  Dabbing the cooling pads on the sensitive areas of my bottom was such a nice feeling.  I also made sure to stock up on this before leaving the hospital.

Benzocaine spray (a.k.a. Dermoplast Spray) is another nice thing to have on hand.  Benzocaine is an anesthetic.  It basically acts like a topical anesthetic (pain reliever).  It can be sprayed onto the "sensitive" areas.  This was another thing that I made sure to get a lot of before being discharge.

Perineal cold pads were an absolute wonderful thing to have immediately after delivery.  They are absorbent and provide a nice cooling feeling.  I just wore this with a chux pad and those lovely hospital mesh panties (upon the suggestion of my nurse) and I was set.  Things as you can imagine get a little "messy" post-partum so not having to worry about ruining my own underwear was a good thing.

Since I am going to have baby #2 in a few weeks, I started searching online for any other tips to make things more comfortable.  I found this post with a few more interesting bits of information.  This post, from the Mayo Clinic, recommends chilling the Witch Hazel pads which I think is a brilliant idea.  They also mention sitting on a pillow or padded ring.  I had forgotten how tender my bottom was.  We have wooden chairs at home and I could not sit on them for a few weeks.

Am I missing anything else?  I'm open to any suggestions to make the post-partum recovery easier.

Is Squatting Better than Kegels for Childbirth?

In the wee hours of the morning, when I am suffering from a horrible case of pregnancy-induced insomnia after having to wake up for the umpteenth time to use the bathroom, I start looking at a running list of webpages that I have been intending to read when I have the chance.  The pack rat in me can't help but "keep" things even if it is in an electronic format.  Anyway, I stumbled upon an interesting blog post that I first read about shortly after my first baby was born.  It was entitled, "Pelvic Floor Party Kegels are NOT invited."  At the time this was posted, I had just had my first baby and didn't give it much thought but the premise intrigued me.  Now that I am expecting my second baby, it seems very interesting.  The premise of this post (written by a runner - which I used to do a lot of once upon a time), is that weak gluteal muscles (the buttocks) in conjunction with doing too many kegels are BAD and can lead to  "pelvic floor disorder" (PFD).

PFD can cause stress incontinence.  Stress incontinence is something many pregnant women (including myself) experience.  It is the inability to maintain bladder control under "stressful" situations like sneezing or coughing.  The theory behind this post was that by strengthening weak gluteal muscles through squatting exercises and by eliminating excessive crunches and doing more "plank" positions to strengthen the core, you can avoid PFD.  A weak pelvic floor can also cause uterine prolapse.   Uterine prolapse can be a result of childbirth.  A prolapse happens when the "ligaments supporting the uterus become so weak that the uterus cannot stay in place and slips down from its normal position."  In a follow-up post, they also explored how too many kegels (which all pregnant women are told will help labor and delivery) may actually make labor and delivery harder by tightening the pelvic floor.

These posts were very much "anti-kegel" and very "pro-squatting" as a way to prepare for labor.  I'm not sure what to think since I couldn't find any scientifically published peer-reviewed articles detailing these findings in a study.  However, as I began to think about it, throughout human history, people have been squatting to do things.  I remember going to Korea and Japan and seeing toilets that you had to squat over to use.  My western-raised self recoiled in horror at the thought of having to squat over an open hole to use the bathroom but maybe there is something to it.  In western society, we rarely squat when we do anything (including giving birth).

The post recommends squatting three times a day in preparation for childbirth to help strengthen the pelvic floor.  The following website gives detailed instructions on how to do a "proper" squat in the "hunting and gathering mama" way.  Having a nice round rear end is a good thing when it comes to having strong gluteal muscles and subsequently strong pelvic floor muscles.

At this stage of the game, I'm willing to try anything that will make the prospect of childbirth easier.  Squatting doesn't seem like it would hurt so I may start my squatting routine now.  I may also consider (depending on the pain and if I need an epidural) squatting during labor.  I can help strengthen my pelvic floor and allow gravity to help get this baby out.  I guess we'll just have to see how successful this theory really is.