a woman-centered birth
Evidence Based Practice for Women During Birth
book
l The
Middle section
Weeks 15 – 27
01
New Life — The Middle
A Woman’s Confidence, her ability to give birth, and to care for her baby, are either Enhanced or Diminished by every person who gives her care, and by the environment she gives birth in.
The
Middle
Weeks 14 – 27
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A Woman’s Confidence, her ability to give birth, and care for her baby, are either Enhanced or Diminished by every person who gives her care, and the type of environment, she births in.
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Title Page book
section
l
k The Beginning l The Middle m The Arrival n The Postpartum o The Birth Story 01 New Life — The Middle 02 Interventions 03 Evidence Based — Interventions 04 Medical Alternatives 05 Bring Back the Midwifes 06 Inducing Labor 07 Cesarean Delivery 08 Child Birth Education Classes 09 Choosing a Pediatrician
Birth has long-term effects on our society! Good or bad.
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Pregnancy, Birth, and the Postpartum are milestone events in the continuum of life. These experinces profoundly affect all families, fathers, women, and babies, and they have an important and long-lasting effect on our society. Amnesty International 2008 Deadly Delivery Report
colophon
k Designer Stephanie Penland l Photographers 01 Isaiah Beiser Photography 02 Tres Photography 03 Stephanie Penland 04 Catherine Byrd 05 Istock Photography m Writers 01 Stephanie Penland 02 Crystal Wolf 03 Illana Pearlman n Printer 01 Alpha Graphics 02 Kodak M700 03 Cougar smooth text 80#, Natural o Details 01 Font Archer Pro 02 Chartwell
These books are intended for the pregnant mother to learn and make educated decisions about her heath care during and after the birth of her baby. They are a resource and a way for her to share and engage those around her in a conversation about why she has chosen the type of birth she wants, be it a home-birth or a hospital birth.
a woman-centered birth
Evidence Based Practice for Women During Birth
book
l The
Middle section
Weeks 15 – 27
02
Evidence Based — Interventions
It's estimated that the ues of an efm leads to 1 additional Cesarean for every 58 women monitored, and then 1 additional Cesarean for every 12 high-risk women in labor Electronic fetal monitoring is the perfect example of a high-tech, high-cost, low Evidence-Based Care. 2009 the acog, American Congress of Obstetricians and Gynecologists
Evidence Based Practices
Procedures & Interventions
Medicines & Care
section 02 Evidence Based — Interventions
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Evidenced Based — Interventions start | evidencebasedbirth.com © 2012 By Rebecca Dekker, phd, rn, aprn I’ve written before about the lack of evidence for continuous electronic fetal monitoring, but recently I felt the need to write further on this issue. I feel strongly that our maternity care in the usa. has headed down the wrong path with fetal monitoring. Yes, I believe that it is beneficial to monitor a baby’s heart rate during labor. But the majority of American women receive the wrong type of fetal monitoring for their situation. They receive something called continuous electronic monitoring instead of intermittent auscultation. The vast majority of American women are attached to continuous fetal monitors during labor. But what’s the big deal? Well, first of all, everybody else in the world tends to follow our example. usa hospitals have invested over $700 million dollars in electronic fetal monitoring equipment, efm, that is not evidence-based and contributes to unnecessary Cesarean deliveries. Do you think developing countries around the world should be following our example, spending precious resources on this equipment? Second, most women in our country do not give informed consent for electronic fetal monitoring. The vast majority of women in the usa have no idea about the benefits and risks of the #1 most common obstetric procedure used in labor and delivery — the electronic fetal monitoring. One of my readers recently told me that she was going to request intermittent auscultation the evidence-based option for fetal monitoring from her care provider — and her doctor agreed! We were both curious to see how the hospital would react to her seemingly benign request for evidence-based monitoring. The evidence for fetal monitoring In my next article, I will share with you one mother’s quest for evidence-based fetal monitoring, and talk about how other pregnant women can follow her example. The Different Types of Fetal Monitoring Electronic fetal monitoring efm is when you use a Doppler ultrasound machine to monitor the baby’s heart rate while simultaneously using a pressure sensor to monitor the mother’s contractions. Both of these sensors are linked to a recording machine, which shows a print-out or computer screen of the baby’s heart rate and the mother’s contractions, Alfirevic, Devane et al. 2006. There are 2 types of efm continuous and intermittent.
section 02 Evidence Based — Interventions
According to the 2007 Listening to Mother Survey, 87% of the usa described experiencing continuous electronic fetal monitoring during labor. However, just because the monitoring is continuous does not mean that a clinician is continuously watching the monitor. Most of the time, a clinician determines and evaluates the fetal heart rate every 30 minutes during the active stage or the first stage labor when the mother is dilated 5 – 10 cm and every 15 minutes during the active pushing phase of labor. However, if the mother is high risk, or if she is being given Pitocin, then this may be done more frequently, acog, 2009. Intermittent Electronic Fetal Monitoring This generally means that you have to wear the machine sensors for 20 – 30 minutes of every hour I could not find any guidelines that recommend a specific frequency and length of intermittent efm. In 4% of the usa women, efm is used only intermittently during labor Declercq, Sakala et al. 2007. Intermittent auscultation This is used with 3% of the usa women during labor Declercq, Sakala et al. 2007. With intermittent auscultation, the care provider listens to the baby’s heart rate for about 60 seconds using a fetal stethoscope fetoscope or Pinard or a hand-held Doppler ultrasound device. While listening, the care provider also palpates the mother’s contractions by placing a hand on the abdomen. Most guidelines agree that intermittent auscultation should be done every 15 – 30 minutes during the active phase of the first stage of labor from 5 – 10 cm dilation and every 5 – 15 minutes during the pushing phase of the second stage of labor, 2008 The Purpose of Using These Tests Theoretically, the purpose of monitoring the baby’s heart rate during labor is to identify oxygen problems in the baby so that you can intervene and prevent complications such as cerebral palsy, brain damage, newborn seizures, or death. However, at the same time, you do not want these tests to increase the risk of unnecessary interventions, such as unnecessary Cesarean delivery or forceps/vacuum delivery acog, 2009. Beneficial Methods for Labor Based on the evidence, the best option for most women and babies is intermittent auscultation. In a Cochrane review Alfirevic, Devane et al. 2006, researchers compiled the results of 12 randomized, controlled trials with more than 37,000 women. Unfortunately, many of the studies were of poor quality — however, 2 of the studies were of excellent quality. In all of these studies, women were randomly
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assigned to either receive continuous efm or intermittent auscultation. These classic research studies took place mostly in the 1970's and 1980's – meaning that this evidence has been around for at least 30 years. There were no differences between women who received intermittent auscultation and those who received continuous efm in perinatal mortality, cerebral palsy, apgar scores, cord blood gasses, admission to the neonatal intensive care unit, or low-oxygen brain damage. These findings were consistent in both low-risk and high-risk women. There was a lower risk of newborn seizures in the continuous electronic fetal monitoring group; however, overall, seizure events were very rare at only 0.2%. Women in the continuous efm group were 1.7 times more likely to have a Cesarean and were slightly more likely to have a forceps/vacuum delivery when compared to women in the intermittent auscultation group. Women in the continuous efm group were also more likely to require pain medication. Interestingly, the researchers found an interaction between Cesarean rates and continuous efm. This means that in hospitals where there are higher Cesarean rates, continuous efm may lead to an even higher risk of Cesarean delivery. As stated earlier, one of the purposes of continuous efm is to prevent cerebral palsy. However, researchers have found that continuous electronic fetal monitoring is a very poor test for this purpose. False positive rates for predicting cerebral palsy are as high as 99.8% that’s basically 100%, even in the presence of ominous signs, such as multiple late decelerations or decreased variability Nelson, Dambrosia et al. 1996.
The evidence against continuous electronic fetal monitoring is so clear that the usa Preventive Services Task Force issued a recommendation saying that continuous electronic fetal monitoring should not be used in low risk women. Even acog has endorsed intermittent auscultation as an appropriate and safe alternative to electronic fetal monitoring ACOG, 2009.
section 02 Evidence Based — Interventions
It is estimated that efm leads to one additional Cesarean for every 58 women monitored and one additional Cesarean for every 12 high-risk women in labor Alfirevic, 2006. Some guidelines suggest that efm should be used when there is an abnormal intermittent strip, or with severe pregnancy-related illness, multiples, post-term pregnancy, efm for v bacs, intrauterine growth restriction, premature rupture of membranes, epidurals, and Pitocin Bailey, 2009; acog, 2009. However, this recommendation is based on clinical opinion, as there is no research evidence to support this recommendation. My doctor says that they will just put me on the monitor for 20 minutes of every hour. Is that any better than continuous electronic monitoring? There is no evidence that intermittent monitoring with the electronic fetal monitor is any better than continuous electronic monitoring. In one study Herbst & Ingamarsson, 1994, researchers randomized more than 4,000 high-risk women to receive either continuous efm or intermittent efm. They defined intermittent efm as being on the monitor for 10 – 30 minutes every 2 hours, with stethoscope auscultation every 15 – 30 minutes in between monitoring periods. The researchers found no differences in any outcomes. There are no studies that compare intermittent efm with intermittent auscultation. However, because intermittent auscultation is superior to continuous efm — and continuous efm and intermittent efm have similar outcomes — it is possible that intermittent auscultation is also better than intermittent efm. What harm could it really do? What if I don't mind wearing the efm. To make a fully informed choice, you need to understand the risks and benefits of the electronic fetal monitor. Compared to intermittent auscultation, continuous efm has the benefit of a decrease in the risk of newborn seizures a rare outcome. However, it also increases the risk of Cesarean delivery, increases the risk of forceps/ vacuum assistance, and increases the risk that you will need pain medication. In addition to these risks, efm restricts your ability to walk and change positions. Even a portable or wireless monitor is cumbersome, restricts the ability to use water immersion to ease pain, and likely carries with it the same risks as
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regular efm. Watching the monitor can create fear and distraction. Many caregivers watch the monitor instead of actually watching and caring for the laboring woman! A fundamental principle that we teach nursing students in nursing school is Look at your patient, not the monitor. Having a monitor in the room makes it easier for people to focus on the monitor, not the mother and baby. It also makes it easier for the nurse to monitor the woman from outside the room — possibly decreasing the amount of support a woman could get from her nurse. If intermittent auscultation has the best outcomes, why don’t more hospitals use it? Liability Various hospital administrators need the electronic recording archived in their computer database in case of a lawsuit. With intermittent auscultation, the care provider can document what they hear, but there is no strip — there is no continuous electronic recording. Lack of resources Many hospital labor and delivery units may own only 1 or 2 handheld Dopplers — or none at all — and if they do own one, it may have walked off and can’t be found anywhere on the unit. Time The nurse, midwife, or doctor has to actually be at the bedside of the woman every 15 – 30 minutes and take a minute or two to listen to the heart rate while palpating the contraction. It is easier for nurses to just look at the monitor on a screen at the nurse’s station. Big Business Electronic Fetal Monitoring is a big business. There are approximately 28,000 fetal monitors in more than 3,400 hospitals in the usa, representing an investment of over $700 million dollars. I find it interesting that hospitals can spend more than $200,000 per hospital on electronic monitor systems, but they cannot afford to pay $400 – 500 a piece for handheld Dopplers to use with intermittent auscultation. Electronic fetal monitoring is the perfect example of a high-tech, high-cost, low evidence-based care. Clinical Experience Many doctors and nurses have never used a fetal stethoscope some do not even know they exist. Some ob’s may have never even heard of intermittent auscultation. Although ob’s seem to be comfortable using a handheld
section 02 Evidence Based — Interventions
Doppler to listen to the baby’s heart rate during prenatal appointments, many have never had any training or experience in using this technique during labor. As one doula told me, I have yet to meet an OB or nurse that even knows what a fetoscope is let alone how to use it, and I’ve never seen an OB or nurse use a Doppler outside of prenatal appointments. Nurses and ob’s are much more comfortable using efm, since they have probably had a lot of training and experience with it. In summary, as one midwife wrote on her own blog… You can say no to the fetal monitor, but you’ll need to bring your own Doppler — and nurse. Lack of leadership from acog. In their 2009 practice guidelines for fetal monitoring, acog states that despite the frequency of its use, limitations of EFM include poor inter observer and intra observer reliability, uncertain efficacy, and a high false-positive rate, pg. 193. acog lists all of the risks of efm that I have described in this article increased risk of Cesarean delivery, vacuum/ forceps delivery, etc., and the overall lack of benefits compared to intermittent auscultation. But then it goes on to state that either option EFM or intermittent auscultation is acceptable pg. 196 and that logistically, it may not be feasible to adhere to guidelines for how frequently the heart rate should be auscultated pg. 196. The rest of the article focuses on how to conduct efm. Until acog makes a clear statement that intermittent auscultation is preferable to efm, obstetricians in the usa will probably stick with the status quo of efm— even though the research evidence overwhelmingly supports intermittent auscultation, and this evidence has been around for more than 30 years now. The American College of Nurse Midwives openly disagrees with acog and says that intermittent auscultation — not electronic monitoring — should be the preferred method.
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Until acog makes a clear statement that intermittent auscultation is preferable to efm, obstetricians in the usa will probably stick with the status quo of efm — even though the research evidence overwhelmingly supports intermittent auscultation, and this evidence has been around for more than 30 years now. The American College of Nurse Midwives openly disagrees with acog and says that intermittent auscultation — not electronic monitoring — should be the preferred method.
colophon
k Designer Stephanie Penland l Photographers 05 Istock Photography m Writers 01 Stephanie Penland 02 Crystal Wolf 03 Illana Pearlman n Printer 01 Alpha Graphics 02 Kodak M700 03 Cougar smooth text 80#, Natural o Details 01 Font Archer Pro 02 Chartwell
These books are intended for the pregnant mother to learn and make educated decisions about her heath care during and after the birth of her baby. They are a resource and a way for her to share and engage those around her in a conversation about why she has chosen the type of birth she wants, be it a home-birth or a hospital birth.
a woman-centered birth
Evidence Based Practice for Women During Birth
book
l The
Middle section
Weeks 15 – 27
03
Interventions
Inducing labor is to do something that encourages labor to begin. hospitals often use pitocin which is a synthetic form of oxytocin. Midwives often encourage more types of natural induction by having the mother do something such as take long walks or drink castor oil, or having sex.
section 02 Interventions
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Interventions start | Bring The Midwifes Back — 2011 by Crystal Wolf Labor can be unpredictable. There are many interventions and medical procedures that can potential help your body and the baby. These recommendations will of course be different depending on whom you choose for a heath-care provider. It is best to have information about these procedures long before labor begins. In a lot of cases it is not possible for a doctor to sit down and take the time to explain them all. These are the most commons ones, what they are why they are used. Interventions can disrupt the natural birth process of birth and can be pushed by the hospital when there is no medical need for it. Many things, some of which including: inhibiting the body's natural hormonal and chemical reaction during labor and after affecting natural pain control contracting the uterus back to size after birth and releasing the signals for milk production, restricting the mother's ability to feel her body and let it guide her so that she and the baby can work together e.g. natural contractions and feeling which position to move into to help the baby move down the birth canal, and passing drugs to the baby affecting latch for breast-feeding, as well as temperament and alertness. More complications will be addressed below as describe what the interventions are and to tell you what each of them do. Interventions are when a doctor or midwife intervenes in the
In the USA there is a term cascade of interventions. This term has become common place because it is the most common scene in a hospital birth setting.
natural process of birth by using some external tool or drug to promote certain effects. The most common interventions include: epidurals, inductions, pitocin, and episiotomies. The usa has a term, Cascade Intervention. This term has become common place because it is the most common scene in a hospital birth setting. A woman comes into the hospital to give birth and is not progressing quickly enough so her doctor can suggest pitocin to get the labor jumped started. The pitocin then leads to extremely strong contractions so the woman needs pain relief, an epidural. efm's or Electronic Fetal Monitors are in place and the woman is stuck in bed. After having the epidural, labor slows down so more pitocin, synthetic oxytocin is often needed. At this point the baby most likely goes into fetal distress and then a cesarean is necessary. It doesn't always lead to the cesarean but that is a brief summary of what the Cascade of Interventions is.
section 02 Interventions
The EFM also increases the changes of a c-section.
The Electronic Fetal – efm The efm monitor is used in hospitals. Usually it is strapped to the belly by a tight but comfortable piece of material. It is done with the intention of making sure the baby is well. It is best to try and avoid having this on for long periods of time and opt for hands on checks instead. One reason is the doctors and nurses and the helpers you have in your room will monitor the efm machine and put more weight in that then what is going on with you. There is no scientific proof that the efm is helpful in determining the health and or distress of the baby, the cdc states that it is better to check in 30 minutes with a stethoscope so as not to jump to conclusions. The efm also increases the changes of a c-section. As doctors can not explain scientifically why the heart rate of a baby can drop. They assume it is a negative thing but in reality they don't know and if they used a hand held Doppler every 30 minutes they would be less likely to jump to conclusions. Sometimes it is obvious, the cord could be wrapped around the neck but most of the time they can not explain it so they just rush the mother off stating that the baby is in distress. So make sure there is an actual medical reason before you allow one on you. There is also an efm that is a small electrode that is attached to the baby’s scalp by a thin wire. This is invasive as it has to be pinned onto the skin of the head. The baby may have some bruising and a small scab where the wire was attached. This also greatly limits your ability to move and birth your baby in a natural way. Vacuum Extractions This is a small cup connected to a suction pump that may be used to help with your baby’s birth. The cups placed on the babies head. While pushing the doctor uses this to help pull your baby out. This too is invasive and limiting to the mother and the baby. It can cause damage and though is widely used today to speed up the process it is starting to become known as a last alternative. If you have a midwife she will use her skillful hands to help aid the baby through or turn the head if needed, or move you into another position such as squatting. This is not usually done with doctors in the delivery room as they are not taught this type care.
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Forceps These are metal devices that resemble salad tongs. Put on babies head to help with the birth while you push, the doctor pulls. It was decided in the early 60’s that even though forceps were better than the Vacuum Extraction and very helpful for births that needed it, the time and talent it took to learn how to use them was more of an art form and obstetrics was not about art but systematic procedures. This resulted in very few doctors today being able to use the forceps in an artful and beneficial way.
This procedure is often times used exclusively when forceps are used
Episiotomy This procedure is a cut into the perineum, the area between the vagina opening and the anus to help the baby pass through better. It use to be regarded as standard procedure done to most women in fear they might tear. It is now known that it is better for the body to tear naturally, easier for it to heal and less likely to be cut. Though this is known a lot of doctors still practice this regularly so be sure to ask your health-care provider in what circumstances they would perform this if at all. This procedure is often times used exclusively when forceps are used. Some other things you can do to avoid a episiotomy is to practice kegal exercise during pregnancy, maintain a healthy diet, have the caregiver use perennial massage and a warm compress during pushing period, and use the squatting position.
The disturbing side of episiotomies is that they can be avoided and often are not necessary. They also take quite some time to heal, a couple of weeks or more which makes the postpartum period much more challenging and uncomfortable. Midwives have been using tricks to prevent tearing and episiotomies for decades with great success. It generally doesn't matter how large the baby is or how small the woman, they have seen many women birth large babies without even the slightest tear. The two main things midwifes do is perennial massage, and compresses. They also encourage different positions for the mother that put less pressure on the perineum, as well as help the mother birth slowly so that she stretches nicely. The slow mode of birth that occurs in a natural setting is the exact opposite that occurs in the hospital setting. end |
section 02 Interventions
Reasons for Assistance If you have had an epidural, the pelvic muscles which usually helps to turn the baby’s head and shoulders into the best position for birth, may not be as able to function properly. It may also be difficult to feel your contractions, so pushing is less effective, and other help will be needed.
k If your baby is not receiving enough oxygen, which could result in permanent brain damage. l If you are too tired.
m Your health-care provider may suggest forceps if your baby is coming feet first or in a breech position.
n If you are trying to have a natural birth, anesthesia may be necessary during an assisted delivery. Ask when it is. If so, what types are recommended and less invasive? Usually when assistance is neces- sary for delivery, some form of anesthesia is suggested.
o You may want to discuss pudendal block, a local anesthetic injected directly into the nerves just inside the vagina, with your health-care provider. A pudendal block is most commonly chosen by women at 10 centimeters and were hoping for a completely unmedicated delivery, but need a little assistance at the end. However, pudendal block is effective 80% of the time and the effects do not last long.
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Warning Signs After an Assisted Delivery Following effects that may occur if your baby’s delivery is assisted with forceps. k There may be a reddened area on the face, which fades in a few days. l There may be small bruises, which should also fade quickly.
m Though rare, there may be temporary damage to the baby’s facial nerves. This is rarely permanent and is gone in a few days.
n Your baby may have a somewhat cone-shaped head, which is normal even in any vaginal delivery.
Effects if your baby is assisted with Suction
k There may be a blood blister on the scalp, or cephalhematoma. This may take 6 – 8 weeks to completely heal. This does not impact the brain. l There may be slight bruising on the scalp, which fades in a few days.
colophon
k Designer Stephanie Penland l Photographers 01 Isaiah Beiser Photography m Writers 01 Stephanie Penland 02 Crystal Wolf 03 Illana Pearlman n Printer 01 Alpha Graphics 02 Kodak M700 03 Cougar smooth text 80#, Natural o Details 01 Font Archer Pro 02 Chartwell
These books are intended for the pregnant mother to learn and make educated decidions about her heath care during and after the birth of her baby. They are a resource and a way for her to share and engage those around her in a conversation about why she has chosen the type of birth she wants, be it a home-birth or a hospital birth.
a woman-centered birth
Evidence Based Practice for Women During Birth
book
l The
Middle section
Weeks 15 – 27
04
Medical Alternatives
Other pain relief options, including medication are available. It is important to know how they can help you as well as possible side effects for you, your baby, and your recovery. Your caregiver can help you with decisions about pain relief options in labor. We encourage you to find out more about these options before your labor starts.
Know Your Options
Be Wise & DO
Your Research
section 04 Medical Alternatives
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Medical Alaternatives start | Bring The Midwifes Back — 2011 by Crystal Wolf Many women find that using self help techniques such as changing positions, relaxation, showering and massage are all they need to cope with the labor pain. Some women find that they need or want more help. Often times they are not given this chance, they do not know there are other ways to relieve the pain and stress and stress of labor besides medication.
To induce labor is to do something to encourage labor to begin or progress when it does not seem to be in action. Inductions in a hospital usually use pitocin, a synthetic form of oxytocin. Midwives usually avoid inductions, however they do sometimes break the bag of waters or encourage natural induction by having the mother do something such as take long walks or drink castor oil or having sex. A n induction is not always a bad thing. There are times when the mother should be induced, it's simply a matter of doing it when it is appropriate versus a protocol. There are valid medical reasons for induction, which apply to about 10 percent of pregnancies. Doctors induce about 40 percent of all women, with the most common reason being that the caregiver says they are overdue. This means many more women are being induced than are medically necessary Lake & Epstein. As they explain, there are certain situations when a woman's birth should be initiated. A few good reasons are that the baby is in distress, the baby is not getting nutrients, it's past forty-two weeks, or the bag of waters has broken but labor isn't progressing. This last reason has a different time frame in the medical community and in the natural birth world. For the hospital a doctor will wait 0 – 6 hours whereas a midwife will wait twenty-four hours. A doctor will induce labor by using pitocin, whereas a midwife will do as stated above. Pitocin This is an artificial form of oxytocin, a hormone that is naturally produced by a woman that causes contractions. Another thing occurs in combination with the natural release of oxytocin is when oxytocin reaches a high level, endorphins are released. Endorphins, the body's natural pain-reducing hormone, help women cope with labor pain. With pitocin, artificial oxytocin given through an IV, does not reach the brain; therefore, it does not cause the release of pain-reducing endorphins. So, now the woman has the contractions initiated but not the signal
section 04 Medical Alternatives
to produce her natural pain killers. The pain can also be more intense because pitocin hyper stimulates the uterus and creates contractions that are much stronger than they naturally are. These stronger contractions can cause fetal distress which can spike the baby's heart rate, and cause meconium to be in the amniotic fluid, which means the baby may swallow it and then need monitoring immediately after birth, again whisking the little life away from it's mother. The increase in pain can also increases the need for an epidural, as mentioned in the cascade of interventions. end | Other pain relief options, including medication are available. It is important to know how they can help you as well as possible side effects for you, your baby, and your recovery. Your caregiver can help you with decisions about pain relief options in labor. We encourage you to find out more about these options before your labor starts. Medical Options tens Stands for Transcutaneous Electronic Nerve Stimulation Given through electrodes taped to your skin, a mild electric current tricks your nerves so that you feel less pain, tens works best if you begin using it in early labor so you would need to have the unit rented and in your home before you go into labor. These machines can be rented from a medical supply store. You usually need to put down a deposit along with the rental fees and come with instructions on how to use the unit you rent or you can get advice from a physical therapist. Benefits
› Can provide good pain relief in early labor › You control the strength › Takes your mind off the pain › Mom is able to move around › No effect on labor or on baby
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Disadvantages and Risks
› Not as effective in active labor › Not as effective if you don't know how to use it before labor begins › Can't be used in the bath or shower
Entonox This is also known as laughing gas and is inhaled through the mouth. It is a mixture of 50% oxygen and 50% nitrous oxide like what most dental offices use. This is self administered often toward the end of labor. This can make your mouth dry so offering water, ice chips, and lip balm can help. Taking slow deep breaths into the mask in between contractions then breathing regular air is what is recommended. Benefits
› Can provide good pain relief in late labor without long-lasting effects › You control the amount you receive › Can be used with other methods of pain control › Helps you focus on breathing › Little effect on baby
Disadvantages and Risks
› Should only be used for 2 – 3 hours › May cause dizziness, numbness, or tingling, or nausea › Doesn't eliminate pain
Narcotics intravenously or Intramuscular, Pain medication such as Demerol ®, Morphine ®, Fentanyl ®, are usually given by injection.
section 04 Medical Alternatives
Benefits
› Can be used throughout labor › iv, injected into a vein, works in 2 – 3 minutes; lasts 1 – 2 hours › iv, injected into muscle, works in 20 – 30 minutes; lasts 2 – 3 hours › Decreases the perception of pain felt in labor › May help you to relax so that you can use self help techniques more effectively
Disadvantages and Risks
› May cause dizziness, nausea, drowsiness › May make your baby drowsy and may affect breathing and breast-feeding › A drug can be given to temporarily reverse these effects, until the narcotic is no longer active › May slow labor if given too early › Does not eliminate all the pain
Support after use of a Narcotic in Labor The medication may make you dizzy and feel uncoordinated so you will need help moving. Continue to use comfort measures such as massage and touch. It's helpful to have someone wipe your face with a wet cloth during or after contractions. You might get very sleepy. It might be difficult to know when a contraction is happening until the peak is reached. Having someone keep one hand on your belly and abdomen to feel the uterus tighten will help you know when that contraction is starting. After the birth, keep baby skin to skin with mom or dad, as much as possible. Epidural This is used as anesthetic. It numbs the nerves using medication going through a tube that was placed in the base of the spine. The tube is there until after the baby is born. You choose how much or little medication is going into you or it can be hooked up to a regulator.
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Benefits
› Can be used throughout labor › Can provide effective pain relief › A low-dose block can sometimes give effective pain relief and still let you walk around with help, this is not always possible and you may have to stay in bed › A full block completely blocks feeling › Pain relief can be achieved in 2 – 3 contractions › You can be awake if a cesarean birth is needed
Disadvantages and Risks
› You may develop a fever and the need for more blood work and monitoring for you and your baby › May slow or stop labor if given before active labor is established › If contractions slow down, oxytocin may be needed to stimulate labor, this is called the snowball effect. One medication leads to another › An epidural may lower your blood pressure. You must have an iv › Decrease in your blood pressure could slow the baby's heart rate for a short time causing distress and increasing chances of a c-section › Sometimes the dose needed to give pain relief causes weakness of the legs and you may have to stay in bed › Pain relief may be patchy, which means you may still feel pain in some areas. This can usually be fixed but cause confusion and difficulty › You may lose bladder tone temporarily and you may need to have a catheter a tube in your bladder during labor to drain the urine › You may lose the urge to push with contractions. Your nurse can direct you to push with contractions, sometimes forceps or vacuum extraction is needed for the birth of your baby › You may experience shivering and or itchiness › You may have a severe headache after delivery › Minor back pain bruised feeling at the site of the epidural is common › Very rarely, breathing problems, infection, nerve damage or paralysis
section 04 Medical Alternatives
Top-Ups More Medications are easily given, and often this can be controled by the laboing woman herself but more often it is controlled by the nurses whom decided how much an how often they are given. Support after the use of an epidural or anesthesia These positions can help you move the baby down the birth canal when limited by an epidural. Side lying on your left side for about 20 – 30 minutes, semi prone on left side hands and knees supporting you, and the same on the right side and semi sitting. You are more likely going to need help from your birthing team to get in and out of these positions. Your birth team should remind you to change again every 20 – 30 minutes. The Support Team Be aware of her position in bed. Does she look like she would be comfortable staying in that position for an hour? A woman with an epidural anesthesia may not be aware of her body and may remain in a position that she would normally change because she was uncomfortable. If she remains in a poor position for a long period it could cause back, shoulder, or hip pain in the postpartum period. Continue with comfort measures such as offering sips of fluid, wiping her neck and face with a cool cloth or massaging her hands, shoulders, scalp, feet, face, or whatever she wants. Ask to delay pushing until the baby has progressed down in the pelvis and the mother feels an urge to push. Have a towel or sheet wrapped around the squatting bar while she pulls herself up from flat to push. In the postpartum period keep baby skin to skin with mom, or dad if she is unable, as much as possible this will also help baby with breast-feeding.
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Inductions in a hospital usually begin by pitocin, a synthetic form of oxytocin. Midwives usually avoid inductions, however they do sometimes break the bag of waters or encourage natural induction by having the mother do something such as take long walks or having sex.
colophon
k Designer Stephanie Penland l Photographers 01 Isaiah Beiser Photography m Writers 01 Stephanie Penland 02 Crystal Wolf 03 Illana Pearlman n Printer 01 Alpha Graphics 02 Kodak M700 03 Cougar smooth text 80#, Natural o Details 01 Font Archer Pro 02 Chartwell
These books are intended for the pregnant mother to learn and make educated decisions about her heath care during and after the birth of her baby. They are a resource and a way for her to share and engage those around her in a conversation about why she has chosen the type of birth she wants, be it a home-birth or a hospital birth.
a woman-centered birth
book
l
Evidence Based Practice for Women During Birth
The
Middle section
Weeks 15 – 27
05
Inducing Labor
An induction is not always a bad thing. There are times when a mother should be induced, it's simply a matter of doing it when it is appropriate, versus a protocol; about 10% all pregnancies have a medical reason for induction. Lake & Epstein The Business of Being Born
Make Educated Decisions
That Empower You &
Strengthen You
section 05 Inducing Labor
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Inducing Labor Inducing labor can mean a lot of different things. For the hospital birth it means giving the woman artificial medications that mimic real hormones in order to get labor started. A natural way might include using caster oil or taking a walking. If you choose to induce your labor it is called an elective induction. When electing to induce there is a greater risk of an emergency c-section and other medical interventions. According to the American College of Obstetricians and Gynecologists acog, labor should be induced only when it is more risky for the baby to remain inside the mother’s uterus.
Reason to Induce Labor There are some serious complications such as hypertension, preeclampsia, heart disease, gestational diabetes, or bleeding during pregnancy that might endanger a baby if not delivered immediately or in a somewhat controlled environment and if the baby is in danger of not getting enough nutrients and oxygen from the placenta. Another reason to induce labor is if your amniotic sac ruptures and labor has not started with in 24 – 48 hours. And generally doctors will not let a pregnancy last longer than 42 weeks. Some babies may be at risk due to the fact the placenta starts to break down after that. There are also some infections that can occur in the uterus like chorioamnionitis that are very serious. All of these complications are watched and assessed before, during and after labor by both the doctor or the midwife. Prostaglandin Suppositories This medication is inserted into the vagina in the evening to cause the uterus to go into labor by morning. A good advantage to this method is you are free to move around the labor room. It is not uncomfortable and is very easy to administer. Pitocin is the artificial copy cat so to speak of the natural hormone oxytocin that is used to stimulate contractions. Pitocin and Syntocinon are brand name medications that are forms of oxytocin that can be given through an i v at a low doses in order to stimulate contractions.
section 05 Inducing Labor
Disadvantages of Stimulating labor Can make labor progress too quickly, the contractions can become too intense and increasing the need for pain medications. a ll opiate pain medications cross the placenta. It can also cause the membranes to rupture if they have not already and that might speed up the process too quickly in an unnatural way again causing pain and distress on the woman and baby. Rupturing the Membranes This can be useful in some cases to examine the amniotic fluid for the presence of meconium, which can be a sign of fetal distress, but generally unless there is a medical reason this should not be done. Disadvantages Rupturing the Membranes The baby could turn into a breech position, the umbilical cord to slip out first, and infection can occur if there is too much time between rupture and the birth. It is not natural and sometimes can be done without the consent of the mother but shouldn't. Ask Yourself these Questions k How will it help me and my baby? l Are other options available? If so, what are they? m What are the risks? n What might happen if the procedure isn’t done? o What will happen if we wait an hour?
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All Opiate type medications cross the placenta during birth if they are taken. Remember every labor is just that, labor. Using medications can take away the pain for that moment, but it also makes labor that much more difficult when the body is no longer able to get it's natural signals about what it needs to do. Taking away one type of pain can cause other unanticipated complications and more even pain down the road.
colophon
k Designer Stephanie Penland l Photographers 04 Catherine Byrd m Writers 01 Stephanie Penland 02 Crystal Wolf 03 Illana Pearlman n Printer 01 Alpha Graphics 02 Kodak M700 03 Cougar smooth text 80#, Natural o Details 01 Font Archer Pro 02 Chartwell
These books are intended for the pregnant mother to learn and make educated decisions about her heath care during and after the birth of her baby. They are a resource and a way for her to share and engage those around her in a conversation about why she has chosen the type of birth she wants, be it a home-birth or a hospital birth.
a woman-centered birth
Evidence Based Practice for Women During Birth
book
l The
Middle section
Weeks 15 – 27
06
Cesarean Delivery
The Midwifery Model of Maternity Care is appropriate for 60 – 70% of all pregnant women in the usa. How can one choose a doctor that has rarely assisted the kind of experience and birth most women claim they do not want to want to have? Deadly Delivery — The Maternal Health Care Crisis in the usa
section 06 Cesarean Delivery
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Cesarean Delivery Cesarean birth or c-section for short is the birth of a baby through an incision or cut made into the abdomen and the uterus. Some cesarean births are planned; others are done in an emergency, and others are done unnecessarily. Here are some reasons you may need a c-section. In some cases, vaginal birth is not possible or would cause undue risk to the mother or baby. Cesarean birth may be necessary for several reasons. The w.h.o. states that 15% of births delivered this way is medically necessary, anything more than 15% is considered unnecessary and putting the mother and baby at risk. Fetal Distress This can occur at anytime for any number of reasons. It is usually determine the baby has fetal distress if the heart rate changes or if there is meconium in the amniotic fluid. Cephalopelvic Disproportion cdp This is very rare and is not entirely scientifically proven to be true but a lot of medical professionals will claim that the pelvis is too small to pass the baby, claiming the baby is too big to safely fit through the birth canal. The vagina is made like a rubber band and stretches out purposely to allow the baby to fit. When in a squatting position the pelvis also changes size and allows for the baby to pass through. This is much more difficult of course if the birthing mother is on her back. Breech Position This is a position the baby is in where the buttocks and feet are coming out first instead of the head. If the doctors are unable to turn the baby they may suggest a c-section. Midwifes generally have experience in turning and even birthing babies in breech position. Complicated Multiple Births There are cases where multiple babies can cause complications where one is breech or in transverse or on it's side. But don't think just because you are having twins you have to have them in the hospital or have to have a c-section. You can have a perfectly natural birth at home with a midwife. The midwife will monitor you and watch for complications and if necessary will transfer you to the hospital like any other birth.
section 06 Cesarean Delivery
Vaginal Bleeding This can be serious or not. It's good to find out where it's coming from and if it is the placenta bleeding this could be the problem. If it has separated or is below the baby which is rare this is a good reason to do c-section. Malpresentation If the baby is lying in the transverse, or a sideways position the cesarean birth is necessary as a vaginal birth is not possible. Some other malpresentation may include brow or face presentation Active Herpes Virus infections will also require delivery by cesarean birth as the baby can become infected as it passes through the vagina. Cord Prolapse Rarely, if membranes rupture in a gush, the cord can be carried along and become caught between the baby and your pelvis. If this occurs, every contraction compresses the cord and decreases the blood supply to the baby Preparations for C-section If it is a planned or elective c-section the doctor books the date with the hospital. You go in the same day your surgery is booked. You should have your bags packed and ready for the surgery. They usually restrict eating and drinking after midnight so as not to interfere with the anesthetic. They might suggest taking a shower before coming to the hospital. Prep for Surgery Lots of blood work will be done, blood pressure, pulse, temperature and fetal hear rate. They do insert a catheter into your bladder to make sure it's empty and start you on an i v. They should put support stockings on your lower legs to prevent blood pooling and clotting. If they don't demand they do because Embolism is the number one cause of maternal mortality in months after this surgery. Operating room Procedures You lie down on the operating room table which will tilt a bit to the left there are supports on the side to keep you from slipping. Your abdomen and thighs will be washed and covered with sterilized cloths, leaving only a small area on your abdomen exposed. The arm with the i v, or possibly both arms, will rest on an arm board away from your body with straps to help you hold them in place. The order of these events will differ depending on whether you have a general or regional anesthetic epidural or spinal. When you are completely anesthetized, the surgery will begin your baby is ready to be born
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Incisions Options The most common is a Low Transverse and Lower Segment Incision. This incision heals with little scarring and is in an area that is better able to withstand the stress of a future vaginal birth. The surgeon will make the first incision on your skin low on your abdomen, along the bikini line. The next incision will be on the lower segment of your uterus. Less commonly used is the vertical or classical incision. The doctor may choose to do a classical incision if it is a critical emergency, if the baby is very premature and the lower segment of the uterus is not developed, or the baby is in a position such that a lower segment incision is not safe. The classical incision is through the main part of the uterus because it may be less likely to withstand the stress of a future vaginal birth. During the delivery of your baby you will feel pulling and tugging as the doctors help your baby to get in a position to be born. It helps to do some nice slow deep breaths. People Involved during the Operation It may seem there are a lot of people in the operating room during a cesarean birth. Each person is there to do a certain job to ensure that the procedure goes well. There will be a group of professionals to care for you and another group to care for your baby once it's born. The Anesthetist Administers anesthesia and monitors the vital signs of you and your baby during and throughout the entire surgery. The Doctors An obstetrician is in charge of performing your surgery, another doctor will assist. It is possible that a third doctor or resident doctor may also assist you in this delivery. The Nurses There are 2 or 3 nurses assisting the doctors and care for you. The Baby Team Can be made up of professionals depending on the circumstances of your baby's birth such as scn nurse. scn Nurse A nurse from the special care nursery or Neonatal Intensive Care Unit nicu. Pediatric Resident and or Neonatologist from nicu
section 06 Cesarean Delivery
Respiratory Therapist to assist your baby if he or she needs it. Two types of Anestesia may be Used Both have some risks and benefits. Regional Anesthesia Epidural or Spinal This involves freezing your abdomen. The medicationis given through a needle inserted into a space surrounding your spine. If you choose regional anesthetic, you'll be awake and alert. After the birth if your baby is healthy, she or he will be bundled and given to you or your support person to cuddle. Near the end of the surgery the anesthesiologist may inject additional pain medication into the epidural space to help keep you comfortable after surgery. General Anesthesia You will be asleep during the birth of your baby. When you wake up after surgery, you and your baby can snuggle together all you want, though you may need help holding the baby. Support Person It is highly encouraged that your support person to be present during the birth. In most case one support person can be with you in the o.r. They will have to change in to clean scrubs, put on shoe and hair covers, and wear a mask covering their nose and mouth. They are usually situated at the pregnant woman's head and are given a stool to sit on. If it is an emergency cesarean birth there may be no time to get the support person ready. It helps to know the following. You will have some abdominal pain. Medication is available to help you feel more comfortable. The medication offered is safe to take while breast-feeding, and decreasing your pain will aid in your recovery. However it is not entirely necessary, and labor is painful, so you should expect to have pain and discomfort as well as joy from the birth. Don't just medicate yourself because they offer it to you. Having a cesarean birth may or may no affect your milk supply at first. The nurse or a lactation consultant will help you find a comfortable breast-feeding position. You will most likely start on a liquid diet. You will have an i v in your arm until you are able to keep fluids down. You may have a catheter in place for a few hours to help you pass your urine.
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Some types of sutures, stitches, are absorbed. If your sutures are not this kind or if you have staples, your hospital nurse or public health nurse will remove them. You are not only recovering from the birth of your baby but from surgery as well. Taking care of yourself will help you recover more quickly. A good diet, plenty of fluids and rest are important. Ask for and accept help from others. If the cesarean birth is an emergency, you may have very little time to prepare. Emotions after a cesarean birth vary widely. Some new mothers feel relief when it's all over, yet may also feel a little disappointed. If you are upset or worried, talk with your caregiver, partner or someone you can trust. Many women who have had a cesarean birth ca n have a vaginal birth with a later pregnancy, called v bac. Discuss this with your doctor before or during your next pregnancy.
After a Cesarean Birth Going Home Generally it takes about 4 – 6 weeks for the incision to heal completely, but most women feel very well before this time. Until you are healed, it is very important to Take it easy During your recovery, avoid housework, and do not lift anything heavier then your baby. Don't lift your baby in it's car seat. Have someone put everything that you and your baby might need on the same level in your house so you will not have to go up and down stairs continuously. If you are having a planned cesarean, you can do this before the baby arrives. Support your abdomen Use good posture when standing, sitting, and walking. Hold your abdomen near the incision during sudden movements caused by coughing, sneezing or laughing. Limit Company for the First Few Weeks Too many visitors will keep you from getting the rest you need to recover and care for your newborn. Accept helpers, people who will make you meals, do your laundry and tidy your home. Rest Take daily naps for the first 3 – 4 weeks or longer. Stay Hydrated Drink lots of fluid. You will likely need extra fluids to replace those lost in delivery and breast-feeding. Also, empty your bladder frequently to help reduce your risk of urinary tract infections.
section 06 Cesarean Delivery
Avoid Driving Until you can deal with making the sudden movements you need to make when driving in traffic, let someone else take your place behind the wheel. It is best to wait about two weeks before you try to drive. Before you take the car and baby out together, make sure you can manage the baby's car seat without hurting yourself. It is a good idea to contact your car insurance provider to find out how your coverage may be affected. Special Situations If you are constipated or bowel movements are painful, try over-the-counter stool softeners or a milk laxative such as milk of magnesia. Drink lots of water and eat plenty of fruits and vegetables. Severe pain in your abdomen or redness, swelling, and oozing pus at your incision site may mean you have an infection. Contact your caregiver immediately. Sometimes mothers and babies need specialized care. Your baby may need to be admitted to the Special Care Nursery, an scn, for closer observation. If your baby needs further medical treatments, the baby may be moved to a Neonatal Intensive Care Unit, or nicu for short, perhaps to another hospital. My Doula was essential in helping me through the tough phases and played a completely different role than my husband.
Every hospital provides specific services. Sometimes this means that a baby's birth may be at a different hospital from what was planned. It may also mean moving the mother or the baby to another hospital. If this is necessary, the doctors — together with the parents — will make the decision. A mother's or baby's hospital stay may be stressful for the whole family. The health-care team should provide you as much information and support as possible to help your family cope. After your baby leaves the hospital your family's doctor's, public-health nurses and other agencies will continue to provide support.
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Decreasing Chances of a Cesarean Birth Though it may be necessary for some women, but there are a number of things that you can do to decrease your risk of needing a cesarean on maintaining your health during pregnancy and about normal labor and birth. Hiring a Doula research has shown that women who have a trained doula supporting them in childbirth use less medication, have fewer interventions and have a lower cesarean rate. Communicate with your caregivers, be it a doctor or midwife about all aspects of your pregnancy will help you prevent one. Staying at Home in early labor as long as you can is another way to help prevent a c-section. Avoiding unnecessary interventions such as you are tired of being pregnant, your mother is flying in to town, you want to schedule the birth on a certain day. Having an induction for these may increase your chances of needing a cesarean. Avoid using pain medication especially in early labor. Stay Upright and moving during labor.
section 06 Cesarean Delivery
start | American College of Obstetrics and Gynecology They should not use oxytocin, a drug to start or speed up labor for more than 1 in 10 women, which is only 10% of births. They should not do an episiotomy on more than 1 in 5 women 20%. They should be trying to bring that number down. An episiotomy is a cut in the opening to the vagina to make it larger for birth. It is not necessary most of the time and has proven to cause more harm. They should not do c-sections on more than 1 in 10 women, 10% if it’s a community hospital. The rate should be 15% or less in hospitals which care for many high-risk mothers and babies. A c-section is a major operation in which a doctor cuts through the mother’s stomach into her womb and removes the baby through the opening, then closes it up. Mothers who have had a c-section can often have future babies normally. Look for a birth place in which 6 out of 10 women, 60% or more of the mothers who have had a c-section go on to have their other babies through the birth canal, vbac vaginal birth after c-section. end |
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Cesarean Delivery in usa
10 – 15% Safe
and Medically Necessary
w.h.o. says for Developed Nations Cesarean Birth should be between 10 – 15% usa average 32.8%. The term arrested dilation or Failure to Progress — is estimated to account for approximately 60% of c-sections in America.
colophon
k Designer Stephanie Penland l Photographers 05 Istock Photography m Writers 01 Stephanie Penland 02 Crystal Wolf 03 Illana Pearlman n Printer 01 Alpha Graphics 02 Kodak M700 03 Cougar smooth text 80#, Natural o Details 01 Font Archer Pro 02 Chartwell
These books are intended for the pregnant mother to learn and make educated decisions about her heath care during and after the birth of her baby. They are a resource and a way for her to share and engage those around her in a conversation about why she has chosen the type of birth she wants, be it a home-birth or a hospital birth.
a woman-centered birth
Evidence Based Practice for Women During Birth
book
l The
Middle section
Weeks 15 – 27
07
Child-Birth Education Classes
A good class will give you specifics about how the baby is born, with alternative birthing positions showing you how to open your pelvis and encourage the baby to pass through. They will teach you about massage and relaxation and breathing techniques such as alternatives to medications. The class should cover medications as well.
Choose Your Classes
Be Wise & DO
You Research
section 07 Child-birth Education Classes
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Child-Birth Education Classes Child-birth education classes are good for you to take regardless how many children you have had. Things may have changed since you last had education on the subject or perhaps you've never had any education. A class can help ease your anxiety, help you plan for the birth. You can discuss your fears about labor with the instructor and other couples going through the same thing you are. Your partner will also feel more involved if do it together. It can be a time of bonding with a mom or a friend as well. A good child-birth class will give you all the specifics about how the baby comes through the birth canal, alternative birthing positions, showing you how to open your pelvis and encourage the baby to pass through. The class should teach you about massage and relaxation, breathing techniques, and alternatives to medications. The class should cover medications as well. Along with the class it is a good idea to take a tour of the place you will either be giving birth or your alternative for a transfer if your doing a home-birth. Classes taught outside the hospital may equip you with in-depth information about coping skills, physiology of labor and birth, emotional aspects, and Child-birth options. Child-birth education classes are usually offered at hospitals, birth-centers, physicians’ offices, and private homes.
Lamaze® International uses a contemporary curriculum that supports birth as normal, natural, and healthy and empowers expectant women and their partners to make informed decisions. Though this is a somewhat outdated way of breathing while birthing there is still good information they provide. Class Content Should Include
› Normal labor, birth and early postpartum › Positioning for labor and birth › Relaxation and massage techniques to ease pain › Labor support › Communication skills › Information about medical procedures › Breast-feeding › Healthy lifestyle
section 07 Child-birth Education Classes
The Bradley Method ® Helps women prepare for a natural labor and birth without the use of medication. This comprehensive 12 – week course covers:
› Importance of nutrition and exercise › Relaxation techniques to manage pain › Labor rehearsals › How to avoid a cesarean birth › Postpartum care › Breast-feeding
The Hypnobirthing Method This method teaches mothers that they can remove fear and tension, severe pain does not have to be the main part of labor. Intense relaxation will enhance natural birthing instincts that lead to a calm and serene birth experience. The curriculum teaches women how to experience a feeling similar to daydreaming, while remaining controlled and happy during the labor and the birth. Birthing from Within Birthing from within prepares a mother to give birthin-awareness, not to just achieve a specific birth outcome. The class curriculum is adjusted to meet the specific needs and differences of parents. This method also recognizes that pregnancy, birth and postpartum are a time of continuous learning; holistic support and education should be available throughout that entire period. Before Choosing a Class
› Is the instructor certified to teach child-birth classes? › What is the instructor’s philosophy about labor and birth? › What topics are included in the curriculum? › Will my partner learn how to play an active role in labor and birth? › What is the cost? › How many couples will be in the class? › How often will the class meet?
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Questions to Ask Will Various Birth Philosophies be Taught in Class?
k l
Will a woman wanting an unmedicated birth learn coping skills for success? Will a woman wanting an epidural learn how to cope with a medicated labor and birth?
Do you Offer Different Types of Child-Birth Classes? Some locations offer child-birth basics, refresher class, and natural child-birth classes.
colophon
k Designer Stephanie Penland l Photographers 01 Isaiah Beiser Photography m Writers 01 Stephanie Penland 02 Crystal Wolf 03 Illana Pearlman n Printer 01 Alpha Graphics 02 Kodak M700 03 Cougar smooth text 80#, Natural o Details 01 Font Archer Pro 02 Chartwell
These books are intended for the pregnant mother to learn and make educated decisions about her heath care during and after the birth of her baby. They are a resource and a way for her to share and engage those around her in a conversation about why she has chosen the type of birth she wants, be it a home-birth or a hospital birth.
a woman-centered birth
Evidence Based Practice for Women During Birth
book
l The
Middle section
Weeks 15 – 27
08
Choosing a Pediatrician
Next to the person who will deliver your child the next most important care giver is the pediatrician you choose. It is best to start the search as early in your pregnancy as possible.
Choose Babies Caregiver
Be Wise & DO
Your Research
sect ion 08 Choosing a Pediatrician
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Choosing a Pediatrician Next to the person who will be delivering your child the next most important care giver is the pediatrician you choose. It is best to start the search as early in your pregnancy as possible. Pediatrician Is someone who is a medical doctor who specializes in the care of infants, children and adolescents, usually from birth up to age 21. Many pediatricians are also trained in subspecialities, such as neonatal medicine or cardiology. Pediatricians provide preventive care to children who are healthy, and medical care to children who are ill. This care includes physical, mental and emotional support. A lot of pediatricians offer a variety of services to meet your child’s needs. They can evaluate your child’s growth and development, they provide education about children’s safety concerns, healthy lifestyle and breast-feeding. A pediatrician administers immunizations and can detect problems such as developmental disorders and behavioral problems, diagnosing common illnesses such as ear infections and stomach flu, and rescribing medications to treat illnesses. How Pediatricians are Trained Pediatricians must complete the requirements set by the American Board of Pediatrics abp upon graduation from an approved medical school. They complete three years of pediatric residency training. After completing the residency training, pediatricians must pass a test that is administered by the American Board of Pediatrics to be board certified. Pediatricians must be recertified every seven years. Ask Friends and Relatives about their Pediatrician
› Do you feel rushed at your appointment? › Are all your questions and concerns answered by your pediatrician? › Do your children like their pediatrician? › How are emergencies handled on the weekend or after hours? › Does the pediatrician include you in the decision-making process? › Does your pediatrician explain the side effects and risks of all medications they recomend? › Does your pediatrician respect your choices? › Does your pediatrician respect you if you choose not to vaccinate?
sect ion 08 Choosing a Pediatrician
Questions for the Pediatrician
› What is their educational background? › What hospital would you admit my child to in an emergency? › What is your philosophy concerning breast-feeding? › Do you offer referrals to lactation consultants? › Do you have separate waiting areas for sick children and healthy children? › What is your philosophy on circumcision and antibiotic use? › If I cannot speak to you when I call, will your nurse be available? › Does your office accept my insurance plan? › Do they handle payment arrangements? › Can my child see a health-care provider other than a Pediatrician?
A pediatrician is not the only health-care provider trained to see your babies, children, and adolescents. Some parents choose a general practitioner, family physician, or chiropractor for their child’s care. These parents may visit a pediatrician only if their child experiences a serious medical problem or complication to their health. Find the Right Pediatrician for Your Child Asking friends, relatives and your prenatal provider for referrals to a trusted pediatrician is a good start. You should then create a list of important questions to ask your friends, relatives and the pediatrician candidates. You may already have some criteria in mind such as if you prefer a male or female pediatrician? Does the age of the pediatrician matter to you? Scheduling an interview with several pediatricians may sound overwhelming, but it usual takes less than 10 minutes to get a feel for their style and habits.
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Choosing the right Pediatrician for you and your baby is just as important as chooing where to birth your baby. They may or may not be comfortable with your decisions to prolong vacines or refuse other treatments.
colophon
k Designer Stephanie Penland l Photographers 01 Isaiah Beiser Photography m Writers 01 Stephanie Penland 02 Crystal Wolf 03 Illana Pearlman n Printer 01 Alpha Graphics 02 Kodak M700 03 Cougar smooth text 80#, Natural o Details 01 Font Archer Pro 02 Chartwell
These books are intended for the pregnant mother to learn and make educated decisions about her heath care during and after the birth of her baby. They are a resource and a way for her to share and engage those around her in a conversation about why she has chosen the type of birth she wants, be it a home-birth or a hospital birth.
a woman-centered birth
Evidence Based Practice for Women During Birth
book
l The
Middle section
Weeks 15 – 27
00
Note Book
Take notes and begin this journey...
Choose Babies Caregiver
Be Wise & DO
Your Research
sect ion 00 Note Book
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Notes for Book 2
sect ion 00 Note Book
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sect ion 00 Note Book
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sect ion 00 Note Book
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colophon
k Designer Stephanie Penland l Photographers 01 Isaiah Beiser Photography m Writers 01 Stephanie Penland 02 Crystal Wolf 03 Illana Pearlman n Printer 01 Alpha Graphics 02 Kodak M700 03 Cougar smooth text 80#, Natural o Details 01 Font Archer Pro 02 Chartwell
These books are intended for the pregnant mother to learn and make educated decisions about her heath care during and after the birth of her baby. They are a resource and a way for her to share and engage those around her in a conversation about why she has chosen the type of birth she wants, be it a home-birth or a hospital birth.