Cesarean Prevention
The connection of love and trust that I developed with my midwife and knowing
that she trusted the birthing process allowed me to overcome misunderstanding
and fear. Caregivers, be open. Reassure each mom. Watch videos together. Be her
friend. Validate her fears. Educate her about birth, nutrition and exercise. Guide
her to quality childbirth education classes.
- A. Moore, The Birthkit Issue 31
====
Some ways practitioners can help families avoid cesarean births:
- Do you inform parents about the cesarean rates in your local hospitals? Do
you encourage them to question their doctor, midwife, or backup doctor concerning
their cesarean rates?
- Do you explain the postpartum policies at local hospitals regarding cesarean
babies and make them aware of their rights and responsibilities and the possible
long-range outcomes of hospital postcesarean procedures and treatments?
- Are you aware of comfort measures for a cesarean mother's physical and emotional
well being?
- Do you have a resource list for cesarean parents? Does it include support
groups, cesarean and VBAC parents, childbirth educators, midwives and doctors,
counselors and reading materials--all resources that can encourage learning and
growth in regard to cesarean birth?
- Do you emphasize the importance of parents-to-be writing birth plans and requests?
- Do you teach families about normal and natural childbirth and about cesarean
prevention, including that vaginal birth after cesarean (VBAC) is both possible
and advisable?
- adapted from The VBAC Workbook by Barbara Brown Hill and Lynn Baptisti Richards,
excerpted from Midwifery Today Issue 2
====
*Have a doula with the mother during the birth process. Studies have shown that
having a doula present can reduce the chance of a cesarean by 40%.
Never, ever perform an amniotomy! This reckless, irrevocable intervention exponentially
multiplies the chances of increasing infection and starts the cesarean clock countdown.
Remember, one of the biggest determinants in vertical infection (mother to baby)
is length of time the membranes are ruptured. Plus, should you have to perform
lengthy manual reduction of cervical adhesions from HPV treatments, the lack of
barrier into the intrauterine environment further predisposes to infection, and
the baby's bare scalp is exposed to friction from your gloves, so abrasions and
infection are even more likely. Don't do it!
Some cesareans may be prevented by simply refusing to go along with the dominant
paradigm characterized by surgical deliveries of multiple gestations and breeches,
eroding support for VBACs, routine inductions, ubiquitous epidurals, supine positioning,
restricted movement, electronic fetal monitoring and nothing-by-mouth policies.
Just as protesters chain themselves to trees to prevent them from being cut down,
we must attach ourselves to women to prevent them from being cut up. Think of
it as maternity civil disobedience or attachment midwifery. We must all work hard
to transform terror into trust, build self-confidence and courage, prevent and
heal the wounds of sexual abuse, and strengthen family bonds and community health.
By counteracting negative media with stories of wonderful births and viable alternatives,
we must all boldly educate and inform.
- Judy Edmunds, Midwifery Today Issue 57
*It is beyond my comprehension how anyone could give a VBAC woman misoprostol
(Cytotec), oxytocin, or castor oil or strip the membranes or use any other form
of induction when that would triple her chance of having a uterine rupture.
- Gloria Lemay
*One of the reasons that so many of the women with whom I work have successful
VBACs, even with very large babies, is that we pay strict attention to the position
of their babies. Information about tuning in to the baby's position during pregnancy,
in early labor, and then paying careful attention to it throughout the labor,
makes a tremendous difference in birth and in VBAC outcomes.
- Nancy Wainer, Midwifery Today Issue 57
====
If the posterior has not been discovered until complete dilation, or if other
methods have not been applied in early labor, the baby's head can still be turned
to make delivery more likely. With the mother in a knee-chest position, knees
slightly apart, the midwife inserts her hand into the woman's vagina. She should
attempt to lift the baby's head by grasping it firmly, waiting for a contraction,
then turning the baby into an anterior position. As soon as the head is correctly
positioned, hold on tightly. When the uterus contracts again, urge the mother
to push very hard. If the amniotic sac has not ruptured, do so now. This will
assure that the position remains fixed and the baby will usually be born very
rapidly. This procedure is both safe and sane, yet it must be acknowledged that
it will take some physical strength to turn this recalcitrant little head against
the force of a good contraction.
- Valerie El Halta, Midwifery Today Issue 36
====
READ ABOUT OPTIMAL POSITIONING for effective labor and delivery:
"A VBAC Primer: Technical Issues for Midwives" by Heidi Rinehart,
MD, gives the basics of C-sections and VBACs, including types of incisions, types
of closures, risks and contraindications for VBAC. It also includes a sample informed
consent form and a list of references.
In "Choosing Cesarean Section" Marsden Wagner, MD tells us that the
risk/benefit factors of C-sections depend on the reason for doing them: "Where
the baby is not in trouble, the risks to the baby still exist, meaning that the
woman who chooses CS puts her baby in unnecessary danger."
And that's just the beginning! Midwifery Today Issue 57 has more articles on
this important topic, including "7 Steps toward Cesarean Prevention"
by Judy Edmunds, CPM, "Suturing a Cesarean Wound" by Gretchen Humphries,
MS, DVM, "Midwifery Care for the VBAC Woman" by Gloria Lemay, and "Cesarean
Birth: What About the Baby?" by Robin Lim, CPM.
You'll also be able to read articles on subjects such as Cytotec, fetal positioning,
homeopathic medicine and birth in Spain, Mexico and the Yukon.
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A Web Site Update for E-News Readers
BIRTH WITHOUT BLOODSHED
is one of several conference audiotapes about cesarean section that are offered
at the Midwifery Today storefront.
CESAREAN BIRTH: EXPERIENCE,
PRACTICE, AND HISTORY, book by Helen Churchill.
GENTLE BIRTH CHOICES,
book by Barbara Harper. This well-loved book guides readers through empowering
birth choices.
Midwifery Today's Online Forum
I know that tea-tree oil is excellent to cure and prevent candida. Can someone
tell me how to use it for vaginal candida?
To share your thoughts and experience, go to Midwifery Today's Forums.
Question of the Week
Has any one had experience with pertussis contracted during pregnancy? I have
searched all the textbooks I have, many from local medical library, and the Internet
with no significant results. My common sense tells me it could cause PROM, fetal
and maternal hypoxia, and very possibly preterm labor. Any information?
- Susan Padilla
Send your responses to:
Birth Center For Sale
Birth Center for sale in beautiful Eugene Oregon. Licensed Birth center in 100
year old fully renovated home filled with antiques and amazing birth art. Practice
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for more details.
Question of the Week Responses
Q: I am 30 weeks pregnant with my second child. Breastfeeding
was tremendously difficult for me with my first child because I have extra large
breasts and extremely flat nipples. My daughter was not able to latch on to the
right breast (it's even bigger than the left one) and rarely latched on the left.
I used pumps and syringes to bring the nipple out but the nipple never stayed
extended long enough for an effective latch on. I very much want to breastfeed
this baby. Does anyone have suggestions?
- Anon.
====
A: Can the baby's dad, who would be stronger than the baby and maybe
better than a pump, help extend the nipples? I've read they will eventually stay
out better on their own if you keep at it.
====
A: If you are not at risk for preterm labor, I would recommend wearing
breast shells (with the back disk with the smaller round opening in place) for
several hours a day during the remaining weeks of your pregnancy. They may help
make your nipples protrude farther. Definitely find a lactation consultant in
your area who'll be a resource for you after you deliver. Only with a lactation
consultant's assistance would you want to consider using nipple shields to facilitate
the latch initially. (These can cause serious problems when used indiscriminately.)
Occasionally, the brief application of ice is helpful just prior to offering the
breast to the baby. Finally, remember, this is a different baby, and, in combination
with the likelihood of your milk 'coming-in' sooner for the second baby than for
the first, the problem may not repeat itself!
- Kate Adams
====
A: I suggest you find a lactation specialist through your provider or
hospital or birth center or La Leche League.
They often can help you hands-on both before and after the birth with successful
nursing. La Leche League would also be a good resource, both for advice and support
meetings.
You might consider using breast shells (or Netsy cups) starting at 36 weeks. They
fit in your bra and gently draw out your nipples. When nursing, if a pump or the
baby can't bring a nipple out, and if the baby is unable to latch on, the lactation
specialist might suggest temporarily using a nipple shield. There is a modern
kind that is more successful that what was used 15 years ago. Also, if latch-on
is again a huge problem, you might consider whether it's worth it to you to pump
your colostrum and milk out and feed it to the baby with a bottle. Certainly not
ideal or easy to keep up long-term, but if that's the only option in the end your
baby would still benefit from your milk.
- KM
Please Support Our Advertisers
California Association of Midwives Conference
California Association of Midwives presents 23rd Annual Conference
Retreat and General Meeting
October 12-14, 2001
Hidden Valley Center for the Arts
Carmel Valley, California.
Questions about the conference? Contact Tammy 831-338-1712 or the California
Association of Midwives 1-800-829-5791
Switchboard
Midwives, how do you approach the matter of infertility when couples come to
you with a need for advice or support? What have you found that works? And how
do you charge for this service if you do offer it?
- Shannon Bohjanen, apprentice
Dallas
====
I am a second-year direct entry midwifery student in New Zealand. At the moment
my sister is expecting her fourth child and is undergoing an elective caesarean
section. My sister asked for my opinion on tubal ligation at the same time as
the section. What is your view on having this done at the same time in respect
to effectiveness and recovery. If anyone knows of a website I can access that
would be much appreciated.
- Cheryl Goodall
====
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