Amniotomy – Why it should be avoided.

So I know many of us have seen in the movies that the first sign of a woman in labor is her “water” will break. In reality, it happens less than 15% of the time. So that means that you are more likely to have your water break sometime during early or active labor. Now the question begs, “Should the “water” be artificially broken by your provide?”
My opinion is no, if there is not medical reason for it (i.e. if the baby is already in fetal distress). The risk of an amniotomy far out weight any benefits, according to studies. The main reason practitioners perform this procedure is to “speed things up” but in reality this is not guaranteed and if it does, not significantly.

On the other hand the risk include:

  • Increased chance of cord prolapse. When the cord drops down below the baby and is squeezed between babies head and cervix.
  • Increased chance of cord compression. When the cord is squeezed by the babies body with the uterus.
  • Increase chance of infection.
  • Increased risk of Cesarean section.
  • Increased risk of fetal distressed. Caused by the cushion around the baby being gone therefore the baby takes a much harder hit during contractions.
  • If the baby is not already in the “right” position, lack of fluid prohibits proper placement.
Obviously these risk can happen whether or not the rupture of the membrane is artificial or spontaneous but more likely when you have a spontaneous rupture it is happening at the appropriate time for your body and baby, not when your practitioner says is a good time.

Speeding up labor should not be seen as a necessity (unless for medical reasons) and you should trust that your body will work things out in the right time. Letting nature take its course is usually the best option.

How much is my responsibility?

How much is my responsibility? This question has been one that reoccurs in my mind from time to time during this pregnancy. During my pregnancy and birth of my first son I did not take much responsibility on myself but relied heavily on what others said and rested in their training and/or knowledge.

For instance, my midwife choice. I did no research on her other than a short interview but made the decision almost exclusively because she was recommended my my sisters friend who had delivered with her a few times. While this is great, I did not take into account what really makes a good midwife and good fit for you. She could be to blunt instead of kind, rely to heavily on test and less on intuition, hold alternative world views (especially in religion) rather than have commonality. All these things make a big impact on whether a successful relationship will take place between yourself and your practitioner. I took these things for granted the first time around. I recall even telling my husband midway through my pregnancy that “while I know my midwife is very experienced I will not use her again as we just don’t mesh”. I felt obligated to stay with her as I had already paid her in full up front.

Another example of this reliance was in the way of knowledge. I held no real knowledge about a plan for a successful birth or how to labor efficiently, or how to handle complications. I just assumed that I just had to have the contractions and push and the midwife would do everything else. I did not take into account that I am by far the best judge as everything is happening to me and I don’t have to explain. Obviously I believe that a midwife’s knowledge should be there to encourage and even correct but this should be only needed when you either are out of your depth (i.e. less common complications) or your emotions are getting the better of you and you need a stabilizing figure.

This time around I am taking more on my shoulders and it feels empowering. First, in my selection of my midwife I took my time. I researched and I let my intuition and the Lord lead me to my choice. I picked someone with far less experience but much better suited to my personality. I knew that she, like most midwifes, would give me the “right” answers to my list of questions so instead of talked more in conversation that in interview style and feel I learned a lot more this way.  In regards to knowledge, I am reading and talking with others as much as possible. I am reading the basics and the not so basic. From “Heart and Hands: A Midwife’s Guide to Pregnancy and Birth” which is a basic guide to midwifery and natural birth, to “The Labor Progress Handbook: Early Interventions to Prevent and Treat Dystocia” which is a much more descriptive book on labor complications. Both I highly recommend. I am reading other blogs and books that give be both knowledge and encouragement. I process this information and store it away for hopefully what turns out to be a pretty uneventful birth.

My overall point is that I want to make sure that I don’t just point the finger in blame on others (midwifes and/or doctors) while realizing that we are somewhat in control. This information may make no difference at the end of the day when something just comes to steal away that ideal birth, but it more likely that not will make a difference. Of course, experience sometimes just has to happen to learn these lessons, as in my case, but if you don’t want to chance it, take responsibility for yourself.

Newest Book I Have Started Reading

Ina May’s Guide to Childbirth by Ina May Gaskin. I got this book in yesterday and skipped over Active Birth for a few nights to start reading it. I really like the way she comes across. Quite honestly I expected her to be really pushy and unapproachable because of her fame and experience. Not so… so far. She seems to genuinely care about woman and childbirth. I also like the way it is set up. It gives the reader a little story time, the essentials of birth, and other useful information. It is not just a one note book.

With that being said, I also feel that a lot of these natural childbirth books put birth up on a pedestal and make it sound like it affects every aspect of a woman’s life. I believe birth is important, moving, inspiring, and even life affirming but I also think that the actual mothering, being a wife, having faith, serving others, and even daily interaction cannot be pushed a side as we delve into learning more about this process. When I was pregnant with my first son I got sucked into this world where little else mattered. I ate, drank, and slept my upcoming birth. I put so much importance of this one day and dedicated much less time to what motherhood would be like or even remember to live in the present as well. This time around I think I have a more balanced view. Again, I am spending a lot of my time thinking and reading about birth but I also have the joy of thinking about more. I am happily anticipating a wonderful birth with this child, but I am also no so focused on the birth being the end of the story. No… it is only the beginning.

Anterior Cervical Lip – Beware

So this is what happen to me during my first birth. If I knew what I know now I would not have ended up with a c-section, I am sure of it.

I had an anterior cervical lip at 9 1/2 cm (see first two pictures below). My midwife told me to push and the baby’s head would most likely move it out of the way. This did not happen but instead my cervix swell, I couldn’t stop pushing, and we transferred to the hospital.

What should have happen is that my midwife should have instructed me to get into the knee chest position and hold there for a few contractions until the lip dilated (see last picture). According to Janet Balaskas in Active Birth this would usually happen is just a few contractions. This position would also have been helpful to assist me in stopping pushing as the baby’s head is pulled away from your cervix causing less pressure.

Sorry to say, this just makes me so frustrated.

First Prenatal Appointment with New Midwife

So I had my first prenatal appointment and while I enjoyed the visit and still believe I have made a good choice it was not what I expected. For one, I find it much easier to open up on this blog than I do in person. I can’t just speak out my fears and say I need support. That would be great and I am sure she would support me but I just can’t make myself that vunerable. I am the type of personal that has to stay put together and strong at all times. Secondly, I think I need someone who is more available to be a friend and a support. Seeing someone once every 4 weeks is just not going to be enough to develop a deep relationship, especially in just 5 months.

Other than that, she is very different from my first midwife. She did not ask as many medical questions, didn’t probe into every aspect of my life, and just seems to be interested in the basics. I am not saying this is good or bad but I guess I was expecting it to be more thoughout. It has got me thinking, though. When woman gave birth in the past, nature was just allowed to take its course. No asking questions to see if you fit into some prescribed box. No, just take care of yourself and the rest is pretty much out of your control. If things are normal you know it and you will say something if it is not. Relax. It is different and I am going to have to change my thinking but I think I just might like it.

Active Birth and Confessions

A new book I have just started reading is “Active Birth: The New Approach to Giving Birth Naturally” by Janet Balaskas. I have only made it through the Preface and Introduction and all I have to say at this point is this:

I did not taken resposibility for my own pregnancy and birth with my son. I relied on “experts” to tell me what to do and where I “should be”. I have been fooling myself into thinking that I was so enlighted and educated on the subject of birth but reality was that I watched “The Business of Being Born”, read “Baby Catchers” and called myself well informed. What a joke!

Not this time. I have decided to get my hands on as many materials as I can over the next 5 months and practice what I read in preparation of this child’s birth. I want to know the best ways to give birth, the practices and procedures of midwives, the risk and rates, and anything else I can.
I have also been reading Heart & Hands by Elizabeth Davis and have already learned so much about what a midwife should do and be looking for in the various stages of labor and has also given me a better idea of what to be looking for and preparing my mind and body for.

I am not trying to be too hard of myself but I do want to be honest and take at least some resposibility for not being actively involved in my birth. If I had only known then what I am starting to know now…

Decided on a Midwife

So I am happy to report that I decided on a midwife. To be honest, I don’t know much about her or her history as a midwife. I was referred to her by another midwife who is not currently accepting HB clients but I really liked. My midwife’s name is Heather Hilton and she is the owner of Central Texas Birth Center in Georgetown. She also assist at HB.
So far what I like about her (I have only had one visit) is her laid back younger personality. She takes a hands-off approach to birth and believes in letting your body work by itself. She shares my faith, which didn’t enter my mind for my first birth but I wished that it had. She did reassure me about my first birth experience and I was trying to share all the facts and not embellish. She believes, had I been left alone to listen to my body’s cues, I would have delivered at home successfully. Her office is nice and staff seems sweet. 

I have my first prenatal appointment with her tomorrow and have more questions to ask her but I am confident at this point we will get along fine. I am excited to finally have someone to talk to about this birth that will be supportive and accepting.

I will report back tomorrow about our appointment.

http://texasbirthcenter.com/

Key Factors in VBAC Success – From VBACFacts.com

I found this information very helpful and encouraging.
Below is an excerpt from http://vbacfacts.com/vbac/
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In all the reading and research I have done, there are a few behaviors that continually reappear among women who achieve VBACs. This is not scientific, just anecdotal.
Philosophy:
A woman who accepts her personal responsibility in her own health care by educating herself while believing in her body’s ability to give birth.

Behaviors:
  1. Supportive husband
  2. Educated herself
  3. Supportive care provider
  4. No drugs whatsoever
  5. Refused induction
  6. Refused rupture of membranes
  7. Stayed ACTIVE and changed positions the entire labor
  8. Ate and drank as she wanted to
  9. Remained completely relaxed and therefore had plenty of energy
  10. TRUSTED HER BODY!