Pregnancy Lounge

Tag: delivery

  • Preterm Labor

    Labor that begins anytime before the 37th week of pregnancy is preterm labor (or “premature labor”). Ideally, pregnancies (under normal circumstances), last for approximately 40 weeks from the first day of the last menstrual period, give or take 2 weeks. Most babies are considered “full-term” if they are born after the 37th week of pregnancy. If you have contractions sufficient enough in strength and frequency to start to efface (thin out) and dilate (open up) your cervix or if your water breaks (preterm premature rupture of the membranes or “PPROM”) between 20-37 weeks along, you’d be considered in preterm labor.

    It is estimated that as many as 10-12% of pregnant women in the U.S. will suffer from preterm labor, not including twin or triplet pregnancies. Approximately 60% of twins and about 90% of triplets are born preterm. Overall, the rate of preterm births are rising, mainly due to the large numbers of multiple births in recent years. Twins and other multiples are six times more likely to be preterm than single birth babies. The rate of premature single births is slightly increasing each year. Between 1992 and 2002, the rate of babies born before 37 weeks increased almost 13%. In 2002, there were over 480,000 preterm births (about 1 in 9 live births). The preterm birth rate was highest for black babies (over 17%), followed by Native American babies (almost 13%), Hispanic babies (over 11%), Caucasian babies (over 10%) and lowest for Asian babies (over 9%).

    Early detection of preterm labor is very important, so steps can be taken to stop labor from progressing and to prevent preterm delivery. Being informed and aware of early warnings signs can make all the difference. The early signs of labor can be subtle and hard to detect; some women experience preterm labor without noticing any uterine contractions at all. Don”t hesitate to call your doctor or midwife immediately if you think you are experiencing any symptoms of labor and you are less than 37 weeks along. Always call if you have any reason to suspect you might have preterm labor or you are confused or concerned about what you are feeling. Some symptoms can be especially confusing, because they may occur normally as typical pregnancy discomforts (including pelvic pressure and lower backache).

    Symptoms of preterm labor that you want to watch for include: uterine contractions that are fairly regular (whether they are painless or not) that occur 4 times or more within an hour and abdominal menstrual-like cramping (constant or occasional), with or without diarrhea. It may be difficult to tell the difference between Braxton-Hicks (or “practice”) contractions and the real thing. Monitor your contractions, by timing them (from beginning of one to the beginning of the next) and writing down your results. More than 4 in an hour, especially accompanied by other symptoms definitely warrants a call to your doctor or midwife, to be on the safe side. Other common preterm labor symptoms include: persistent, lower back pain (especially if you don’t typically have back pain), sudden increase in vaginal discharge (particularly gushes or a trickle of watery, mucus-like or blood-tinged fluid), any vaginal bleeding or spotting (some spotting is common after pelvic exams), persistent and/or increased pelvic pressure (painless or not) and frequent diarrhea.

    Back to Labor Stages

  • The Second Stage of Labor

    During the second stage of labor, your cervix is fully-dilated to 10 centimeters and as your baby makes his or her way down the birth canal, your contractions may actually space out to about 2-4 minutes apart and become more regular. This may allow you to rest and take a breather briefly between contractions. Although it may be difficult, rest and save your strength for pushing.

    Pushing and Delivery

    At this point, the pressure on your rectum increases and the urge to push becomes overwhelming, as your baby descends. You may feel more in control once pushing begins, as well as a sense of relief to be able to play a more active role in the birth process. You may also experience a burst of renewed energy as delivery draws ever-so-close. The urge to push usually feels the strongest at the peak of a contraction, then fades toward the end.

    Positioning and breathing will impact your pushing. Unless you are making significant progress, you may be advised to change positions about every half hour, which may enhance progress. Allow your partner (or support person) to help you into a semi-sitting or a semi-squatting position, which allows gravity to work for you, not against you. Squatting utilizes gravity, helping your pelvis to open up and make more room for your baby. It can also take some pressure off your back. Some hospitals even have squat bars that you can hold onto, or you can use your partner for added support.

    The side-lying position may also help ease back pressure, if you are experiencing “back labor” during pushing. For this position, you or your partner may hold up your top leg. A common position for pushing is having your feet in stirrups, while lying on your back. This position is most convenient for your doctor or midwife if you need an episiotomy, although gravity doesn’t help you out much while using this position.

    Whatever position you choose when pushing, take a deep breath, hold it in, bear down and concentrate. Curl into the push as much as you can, rounding your shoulders, putting your chin to your chest, allowing all of your muscles to work to help ease your baby into the world. Don’t be alarmed if you pass small amounts of urine or feces during the pushing stage, because many women do and it’s completely normal. It can even mean you are pushing effectively. Remember, every push brings you that much closer to holding your baby in your arms.

    Birth

    Some women want to use a mirror to see their baby’s head and may want to touch it as well. Seeing or feeling your baby’s head crown may give you added inspiration to keep pushing. Just before your baby is born, you may feel a burning, stinging or stretching sensation at the opening of your vagina. This often happens as your perineum widens to allow your baby’s head to descend (often called “crowning”) and your baby to pass through the birth canal.

    As your baby’s head emerges, it typically turns to one side to allow the shoulders to align. Once your baby’s head is delivered, you may be asked to stop pushing, so his or her airway can be cleared of excess mucus, by suctioning your baby’s nose and mouth. After that’s done, your doctor or midwife may assist the rest of the body out, usually with one last push. Congratulations! You have a brand new baby!

    Back to Labor Stages

  • More on Episiotomies (continued)

    Many recent studies have shown that routine episiotomies shouldn’t be performed, because they are not helpful to the majority of women, although there are certain circumstances when they are needed. Having an episiotomy can increase pain during the postpartum period, leading to a longer recovery time. In addition, women who have episiotomies may have weaker pelvic floor muscles as well as more pain when resuming intercourse postpartum.

    Episiotomy rates have declined over the years, but the number still remains high. Despite all the evidence against routine episiotomy use, close to 50- 80% of first time moms end up with an episiotomy in the U.S. The majority of women having them done are young white women, who have private insurance, according to a recent study.

    There are a few situations when an episiotomy may be medically necessary. If there is a sign that your baby is in distress while in the birth canal, such as slowing of your baby’s heart rate, an episiotomy may be unavoidable for the sake of your baby’s well-being. If your baby’s shoulders get stuck, if your baby has a very large head that cannot fit through the vaginal opening or if delivery happens too quickly for the skin of your perineum to stretch naturally, you may need an episiotomy.

    Perineal message helps reduce the chance of tearing during birth and the need for an episiotomy. It can make the perineum more flexible and increase elasticity, in preparation for birth. It’s a good idea to start doing perineal massage around the 34th week of pregnancy or before. To perform perineal massage, wash your hands thoroughly (or your partner). Place K-Y jelly, vitamin E oil or another mild lubricant on one or two fingers and gently stretch the lower part of the vagina until you feel a slight burning sensation. Hold the pressure steady for about 2 minutes or so. Repeat this daily for about 8-10 minutes.

    Warm compresses during labor (especially during the pushing stage) encourage the stretching and relaxing of the perineum. Make sure they are only warm, but not hot, which can cause some swelling. Positioning during labor and birth may contribute to whether you need an episiotomy or not. Squatting can help reduce tearing. Avoid laying directly on your back, if possible and keep changing positions if you can. Talk to your doctor or midwife early about your feelings regarding episiotomies, especially if you wish to avoid one.

  • Depression During Pregnancy (continued)

    Possible triggers for prenatal depression include: family or personal history of depression, relationship problems or martial conflict, living alone, unplanned pregnancy, financial troubles, a complicated or high-risk pregnancy, being confined to bed rest, fertility treatments, previous pregnancy loss (fear that something may happen to this pregnancy), stressful life events (such as a recent death in the family, divorce, separation or job loss), being young at the time of pregnancy, history of substance abuse, limited support from family and friends as well as past history of being abused either emotionally, sexually or physically. There may be a number of reasons why a woman may get depressed during pregnancy, although at other times, the cause isn’t quite as clear.

    Depression during pregnancy can be dangerous, since when it’s severe, it may result in decreased ability for women to care for themselves or their unborn baby, along with interference with prenatal bonding. Women may not eat properly, get adequate rest or receive prenatal care. Depression can also put women at risk for increased use of substances such as tobacco, alcohol and drugs. Women with severe depression may be at a much higher risk of suicide, if the depression is left untreated. Depression during pregnancy is linked to premature delivery, low birth-weight and possibly even depression and behavioral problems later on in the child.

    In addition, depression during pregnancy is one of the strongest predictors of postpartum depression after delivery. About 50% of women suffering from depression during pregnancy go on to develop postpartum depression. The good news is treatment during pregnancy can reduce that number dramatically.

    Many women suffer needlessly because they don’t seek help. Depression can be treated and managed during pregnancy, but the first step of seeking out help and support, is the most important. Treating depression is just as important as treating any other health concern during pregnancy. Without proper treatment, depression can get worse or be harmful to the baby or mother.

    If you suspect that you are becoming depressed, it’s important to talk to your doctor or midwife about how you are feeling. He or she may want to prescribe anti-depressant medication and/or refer you to a therapist who can provide you with some much-needed support, if your depression is moderate to severe. Besides medication and therapy, alternative approaches include light therapy, support groups as well as self-help approaches that may help you feel better. These include: building a support network that can help with such things as household responsibilities, preparing meals and other daily tasks to help keep you from feeling fatigued, exercising, which can be very beneficial, especially walking and stress management. Make sure to take plenty of breaks, get adequate amounts of sleep and eat a well-balanced diet. Talking things out with your friends, partner and family may also be very helpful.

    << Postpartum Depression >>

  • Reasons for Cesareans

    There are many reasons for cesareans and they vary with the individual woman, as well as the individual pregnancy. The chance of needing a cesarean depends on how your pregnancy is progressing and what complications may arise as your due date draws near. Sometimes cesareans aren’t the only option and the reasoning is questionable, while other times there are legitimate medical reasons making a cesarean unavoidable. In some situations, cesareans can be life-saving for mothers and babies.

    Occasionally, an emergency arises when your baby may need to be delivered within a matter of minutes. An emergency cesarean may be caused from such things as: a prolapsed cord (when the umbilical cord comes through the cervix before the baby’s head, preventing blood flow and oxygen from reaching the baby), which occurs in close to 4% of births, placental abruption (when the placenta separates from the uterine wall before birth), placenta previa (when the placenta is low and covers the cervix either partially or completely) and uterine rupture (when the uterine tissue tears).

    Fetal distress is another cause for the need of a quick delivery leading to a cesarean. This happens when there are concerns about the baby’s health during labor. Changes in the baby’s heart rate (when it’s very fast, very slow or irregular) may signal a problem such as he or she is not responding ideally to contractions or is not getting enough oxygen, either because the umbilical cord is being compressed (pinched or wrapped around something) or the placenta isn’t functioning properly.

    If the baby is mal-positioned (not in a good position for vaginal birth), a cesarean may be recommended, although sometimes babies can be turned or can be delivered vaginally anyway. Some common positions include: transverse (lying sideways) and breech (feet or bottom first). Breech positions account for between 12- 15% of all cesareans.

    << click for the rest of the article on reasons for cesareans >>
    << Avoiding Cesareans >>

  • Cesarean – When is a Cesarean Delivery Necessary

    When pregnant women think about childbirth, they rarely envision having a c-section. Most assume they will deliver vaginally, although with the United States’ cesarean rate at an all-time high, the odds are good that you may, in fact, have a c-section. If you’ve had a previous cesarean, you are much more likely to have another, with a decline in vaginal birth rates following previous c-sections. A recent study found that 47% of moms who’ve had a previous c-section aren’t even considering a vaginal birth the next time. Also, pre-planned or “elective” c-sections are becoming more and more common, when many times there is no identifiable medical reason. Cesareans are the most common surgery performed and it’s believed that between 25- 50% are unnecessary. More below:

    If you live in the United States, there is about a one in four chance your baby will be delivered by cesarean, which is a very steep rise since 1970, when only 5% of all deliveries were by cesarean. In the late 1980s and early 1990s, there was an overall decline in the number of cesarean deliveries in the U.S.

    In the mid 1990s, the rates began to increase rapidly. From 1999 through 2001, the percent of “elective” c-sections grew from about 1.56% to 1.87%, which is a 20% rise. In 2002, cesarean deliveries increased by 67% among low-risk women. Low-risk, first-time moms who were 40 and older were more than five times more likely to have a c-section than first-time moms between the ages of 20 and 24. In 2002, the number of vaginal deliveries was less than 3 million, while the number of cesarean deliveries were about 1.1 million (approximately 634,000 were first time c-sections and 409,000 were repeat c-sections). Now the rate has jumped to well over 27% of all deliveries in the United States, which translates to about 27 c-sections for every 100 births. Some hospitals have a staggering cesarean rate of over 50%!

    Why the increasing cesarean rates? It is believed that the rates of c-sections among women in the United States are on the rise for a number of reasons including: increasing age of pregnant women, more underlying conditions such as diabetes and hypertension, for convenience purposes, fertility treatments yielding more twins and triplets, improved fetal monitoring (which has made it easier to tell if the baby is stressed), as well as liability reasons for doctors and hospitals, who may feel as if their risk of being sued is greater if complications occur during a vaginal delivery.

    << Reasons for Cesareans
    << Avoiding Cesareans

  • more Reasons for Cesareans

    Failure to progress, or “dystocia” accounts for close to 30% of all cesareans. When the cervix won’t dilate or if it slows down or stops altogether at some point and labor is taking longer than average, a cesarean may be suggested. Also, prolonged labor may be caused by the baby not descending or contractions that aren’t strong enough, even after an attempted augmentation with cervical ripening agents or Pitocin.

    If the baby’s head is too large to fit through the pelvis (which is often called cephalopelvic disproportion or “CPD”), either because the mother is too small or the baby is too big, a cesarean may be necessary. Sometimes a woman has a deformed pelvis because of a birth defect or a debilitating disease such as rickets or polio, which makes a vaginal delivery incredibly difficult or impossible.

    A cesarean may be necessary if certain maternal health conditions are present. Toxemia, high blood pressure, gestational diabetes (which can lead to an extra large-sized baby), pre-eclampsia, heart or pulmonary disease, HIV infection, obstruction of the birth canal by fibroids and active genital herpes lesions are all possible indicators that a cesarean may need to take place, but not in all situations. Maternal exhaustion accounts for a small number of cesareans.

    Problems with the baby such as genetic deformity, neural tube defects, hydrocephalus or heart problems can lead to a cesarean. Some babies may not survive the process of labor and vaginal birth. Also, multiple births run a higher risk of complications if a vaginal delivery is attempted. Cesareans are routinely performed with the delivery of twins, triplets (or more), since giving birth to multiples poses unique challenges. Multiples are much more common now, as a result of fertility treatments, which also contributes partially to the increase in the overall cesarean rates.

    Close to a third of all cesareans are repeat cesareans, although more and more women are electing to try VBAC (vaginal birth after cesarean). On the other hand, many hospitals and doctors are choosing not to offer VBACs any longer.

    The reason for the high number of repeat cesareans is partly because of the concern for a possible uterine rupture. Pre-planned or “elective” cesareans (for non-medical reasons) are becoming increasingly popular. The reason for this jump is mainly simply for convenience purposes (for the doctor, as well as the mother).

  • Avoiding a Cesarean

    A high percentage of cesareans done in the United States are medically unnecessary, therefore many are preventable. There are measures that can be taken to help possibly avoid an unnecessary cesarean. However, clearly there are times when cesareans are very necessary, such as instances of a prolapsed cord, placenta previa and uterine rupture, which would all lead to an emergency c-section to save the lives of the mother, baby or both.

    Become Cesarean Educated

    During your pregnancy, attend childbirth classes. This may allow you to talk with others who have been there and may also give you many great coping skills for labor to increase your comfort and decrease the need for medications and intervention. Read and learn as much as you can about the birth process, all of your birth options and what to expect during labor, which may help you to appropriately express your choices for birth to your doctor or midwife. When choosing a doctor or midwife, interview more than one and ask lots of questions, including what their philosophy is on cesarean birth. Ask them what their “primary cesarean rate” is in their practice. The number should preferably be no more than 10%. Ask them if there is a time limit for labor and the pushing stage and also ask what they feel can interfere with the normal labor process. If you’ve had a previous c-section, be sure to ask about the possibility of a VBAC (vaginal birth after cesarean).

    Delivery Options

    Once you choose a doctor or midwife, discussing your delivery wishes early on is extremely important. Preparing a flexible birth plan is also very helpful and important. After researching and creating a birth plan, make copies and give them to everyone who will be involved in your labor and delivery, including your labor support people, your doctor or midwife, as well as the hospital or birth facility. Discuss it extensively with your doctor or midwife and share your goal of avoiding a cesarean birth unless absolutely necessary.

    Choose a labor support person, such as a doula (an experienced labor companion who provides continuous emotion support and information during labor and delivery) . Cesarean rates for women who choose professional labor support are significantly lower. Professional doulas are trained in the ways of labor support using massage, relaxation (including aromatherapy), coping techniques and physical comfort measures.

    Labor Induction

    If possible, try to avoid an induction of labor, which can lead to an increased risk of needing a cesarean. For a labor that is progressing slowly, try other things such as nipple stimulation instead of Pitocin for augmentation. Explore your pain relief options. Epidurals and other anesthesia can slow down labor progression (especially if done too early during labor). With the use of an epidural, you cannot walk, therefore you can’t use gravity to help labor along and also because of the numbness, you may have trouble pushing effectively. If you feel the need for an epidural, wait until you are past 5 centimeters, if possible, and in active labor.