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Assessing Dilation from External Signs




I love this post: How Dilated Am I? Assessing Dilation in Labor WITHOUT a Vaginal Exam [11/20/12] - "The topic of vaginal exams in labor (minimizing them, eliminating them, finding alternatives to them) is one of my very favorite topics, and my blog this week features a guest post by Sarah Vine who lists a variety of techniques mothers and caregivers can use."  I love that it includes a reference for
 the ‘bottom line’, which is a shadow that extends from the anus up towards the back along the crease of the buttocks. It begins as 1cm and lengthens to 10cm, and its length correlates with cervical dilation.. Here is current research verifying the existence of the bottom line, and in their trial it was measurable and had acceptable accuracy for 76% of women checked.

The purple line as a measure of labour progress: a longitudinal study.  [full text]
Shepherd A, Cheyne H, Kennedy S, McIntosh C, Styles M, Niven C.
BMC Pregnancy Childbirth. 2010 Sep 16;10:54.

CONCLUSIONS: The purple line does exist and there is a medium positive correlation between its length and both cervical dilatation and station of the fetal head. Where the line is present, it may provide a useful guide for clinicians of labour progress along side other measures. Further research is required to assess whether measurement of the line is acceptable to women in labour and also clinicians.


The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues [10/9/12]

Assessing Dilation from External Signs


To VE or not to VE? That is the question by Sue Hanson


I think it's a rare instance where one needs to assess dilation in order to provide appropriate care.  Eventually, she'll either feel an urge to push or you'll see the head between her legs.


I'll be working as a doula with a client who has an abuse history and wants to avoid all vaginal exams in labor.  What can I do if the nurses become insistent about assessing cervical dilation?


In general, hospital nurses are clueless about external signs because they're not used to watching the labor progress. They arrive and leave at random points in the labor, and they only know how to assess dilation by checking the cervix.

When I'm labor coaching at a hospital birth, where cervical exams are generally off limits to me as the labor coach, I look first at the contraction pattern, then dilation bleeding, then early decels to reflect coming up against the resistance from the pelvic floor, then movement of the location of the heart (having a mechanical fetoscope is best for this) to reflect descent/rotation, and then expect an urge to push.

I would be prepared to study up on the alternative techniques and then bluff your way like crazy that you really can assess dilation that way, start your estimate on the low side, make regular progress, and do everything you can to make sure she gets to the "urge to push" phase before they get too curious.

And remind the client that she can always say no.  Ideally, she will have discussed this with her care provider and it will be charted that no vaginal exams are to be done for the first twelve hours, or something like that.  Get clear guidelines from your client, and remind them that touching her without her consent is criminal assault.


At the initial exam, I let them know when and how many standard vag exams women have and then explain that many women, however, choose to have two... one for the PAP and one when the membranes rupture. I let her decide how many she wants, but that two is the minimum.

During the 3rd Tri, reminding her again about the vaginal exam when her membranes rupture (or if she chooses, when she arrives, when membranes rupture, urge to push, etc.).


Why? We see many clients who for religious reasons refuse vaginal exams; so we don' t do them. We explain the "usual" of course, and that VEs may help by giving additional info in certain instances -- -- but if a mom wants to refuse a VE, Pap, etc; then why not go along with her wishes?.

If we listen to heart rate when membranes rupture --the FHTs will tell us if there is a problem with the cord. (which is unlikely anyway if she is full term and vertex).

If she has the urge to push and can't stop pushing then let her push -- you will either see the baby soon, or she will get discouraged and stop pushing. This is an easy call! Vaginal exams in labor are almost never REALLY necessary! Watch mom and baby from the outside -- outward signs/symptoms of progress in labor are pretty reliable.


A research study in 1997 hypothesized that the purple line that creeps up the natal cleft can be an indicator of cervical dilatation.  The line begins at the anal margin at the start of labour and rises like a mercury thermometer.  When it reaches the top, the woman is fully.

Lancet 1990 Jan 13;335(8681):122
Clinical method for evaluating progress in first stage of labour.
Byrne DL, Edmonds DK

A midwife, Lesley Hobbs, has just published an article in the Practicising Midwife(1998) 1:11, and she is finding this a quite reliable indicator of cervical dilation (after much practice)  She gives a diagram of the various dilatations but you'll have to access the article to see it.

The natal cleft begins at the anal margin running towards the sacrum.


The original research behind this has never been published in full but was summarised in a letter to the Lancet (reference below).

The authors propose that an "increase in intrapelvic pressure causes congestion in the ... veins around the sacrum, which, in conjunction with the lack of subcutaneous tissue over the sacrum, results in this line of red purple discoloration".

In personal correspondence Dominic Byrne (co-author of the study) pointed out that different skin colours make identification of the red line variable.

Lesley Hobbs article in the Practising Midwife also appears in Sara Wickham's "Midwifery Best Practice (reference below).  It includes a diagram of the direction of the line illustrating its ascent in centimetres.  In fact, in the original study, centimetres were not used.  Instead Byrne divided the distance from anus to nape of buttocks (which he didn't define exactly) into tenths.  I have no idea if that is on average 10 cms as I haven't measured!!

I've been using this as a marker of dilatation for the past year and it does seem pretty consistent.

Byrne DL and Edmonds DK (1990) Clinical method for evaluating progress in first stage of labour in The Lancet Vol 335 No 8681 p122

Hobbs L (2003) Assessing cervical dilatation: Watching the purple line in Wickham S (Ed) Midwifery: Best Practice, Books for Midwives, Edinburgh Ch 4.3 p77-8


In Polly's Birth Book, it mentions a point on the sole of the foot that can be used to tell once a woman has reached 5 cm.  Apparently, if you look at the bottom of the foot with the toes pointing up, the spot "above" the heel, center, will tighten and release as the uterus contracts IF she is at least at 5 cm.

And, a midwife I know who attended one of my births told me, as I did this uncomfortable thing, that if a woman's water breaks and she pukes at the same time, that's "The 7 cm Stretch".


I don't like to check for cervix at full dilation because it's so hard on the Mom to have an exam then and cervix can be missed and pushing begun too early.  I think it's artificial to think there is a first and second stage.  There should be a fluid flow of the phases together.

Here are my indicators of full dilation:

  1. passing stool involuntarily.  (We say, around here, where there's s--t there's usually a little head not far behind it).
  2. bearing down begins at the beginning of the contraction and not just at the height of it.
  3. head visible at the perineum (I know that sounds obvious but I have  heard European midwives say they are taught that is the ONLY way you can be sure of full dilation.  Assume there is still cervix until you see a bit of head at the introitus.

I have on several occasions seen head visible on the perineum with a large anterior lip of cervix in front of it.  This is not an assurance of full dilation.  Usually the lip disappears once the head rotates to OA, but it is a sign that that rotation needs to be facilitated.


Please describe how do you facilitate rotation in this circumstance?


Usually by rolling the mother from side to side.  A few contractions on one side, usually in exaggerated Sims, then a few on the other, and try to get her to push as little as possible during this time (little grunts or blows only to take the edge off).  Generally does the trick.


Assessing Dilation from Xyphoid/Fundal Distance

The contracting uterus swells upwards as it pulls in the dilating cervix.  Before a woman begins to dilate and is about at term, you can get about 5 finger-breadths of measurement between the fundus and the tip of the breastbone (xyphoid).  As she dilates, this measurement decreases at about 2 cms per finger-breatdh.  At the described point in my sister's labor, I could only get about 1 1/2 finger-breadths between these two points.  So that would be equal to 7-8 cms. dilatation.  It's an old trick I learned several years ago.  It's been discussed on the doula list before but I think it's been a while.  It really works but, like vag exams, it takes practice.  Unlike vag exams, it's not out of the scope of practice as a doula to do this type of exam because it's not done internally and not "really" considered a clinical test.

Well, I can see this might be helpful for some labors, but not for all, for a couple of compounding reasons...

Yes, the fundus does become thick and elongated and does seem to rise during many labors (the fundus thickens as it "takes up" the cervix -- the cervix and lower uterine segment become thin). The uterus elongates -- thins from side to side -- and you can see this in some labors. It's a sign of a progressing labor -- though it can also be a sign of obstructed labor.

In the usual case though, the baby is also descending into the pelvis during the dilation phase of labor -- so even though the fundus is getting thicker (and a bit higher) the uterus itself is dropping as the baby descends, the vertex flexes, the baby becomes compacted, and maybe the bag of water breaks. All of these factors could mask the rise in fundal height, but it might be something to keep an eye on --- It might be more accurate in multips than in primips since multips often don't have descent until second stage begins.

There are a couple of old methods of assessing dilation through abdominal signs. One which is pretty accurate for late dilation is that thin line or "crease' above the symphysis. It's visible in most moms unless they carry a lot of abdominal weight. As labor progresses and the baby descends with increasing dilation, the line/crease becomes wider side to side. Near transition it is usually about three-quarters of the way across. When the begins to slip through the cervix and settles into the birth canal it is usually almost all the way across.  It's a sign that mom is gonna start pushing REALLY SOON!


Avoiding Vaginal Exams for Abuse Survivor at a Hospital Birth



Assessing Descent from External Signs



Paper on Fifths: Crichton,D S. Afr. Med. J., 48:784-787,1974 It is entitled "A reliable method of establishing the level of the fetal head in obstetrics."


I think one of the best skills to develop as a midwife, is being able to gauge progress of a labor without doing VEs.


I recently had a baby in Australia, and VEs are rarely done in labour over there, even in hospitals. There is nothing routine about it. How come it's treated as a "given" In American birth practice?

I'm sure it's a valuable diagnostic tool in many cases, and important technical skill to learn. But unless there is some exceptional reason for it, I sure don't want it in labour.


You can assess descent fairly well by watching the crease that forms parallel to the symphysis.  In a lean mom, you  might not have any crease at all at the beginning of labor, but the line gets wider as labor progresses and it should be nearly fully across at fill dilation. Can't always see it if mom is real heavy, but it is pretty dang reliable.

I think it's caused as the bulk of the baby's shoulders come closer to the symphysis.


Have you heard also of the Rhombus of Michaelus (sp), indicating descent of the head through the pelvis?



Intrapartum Vaginoscopy as Alternative to Vaginal Exams




Vaginal exams during labor are very uncomfortable.  For women from some cultures, they can also be humiliating or have other seriously negative emotional implications.  For women with a history of sexual abuse, they can feel like a recapitulation of the original abuse or trigger a response that is very difficult for a laboring woman to handle.

So . . . are there alternatives?  It occurs to me that fiber optics are used for looking into places that are normally dark and difficult to access.  Heh, if automotive mechanics and police investigators can use fiber optics, why can't obstetricians?  Yes, sometimes a cervical exam really tells you a lot more than dilation, but often they do not.  Especially in early labor, the simple insertion of a small fiber optic rod would be a lot more comfortable.  And later in labor, it would allow cervical checking with the woman in an "alternative" position, such as standing or on hands and knees.

Vaginoscopy would even have some significant advantages over manual or digital exams . . . it could diagnose a stenotic cervix or verify the complete dilation of a very thin cervix.  It might also be able to diagnose rupture of membranes more accurately than other methods which rely on the simple presence of amniotic fluid, which can be present with a high leak or with the rupture of the chorion, even with an intact amnion.


OK, here's an article on Pediatric Vaginoscopy, as used by doctors investigating cases of child sexual abuse.


These scopes are designed for other medical procedures, but they might be helpful for intrapartum vaginoscopy.

URA-1 Flexible Fiber Optic Nasopharyngoscope and Laser Tripter Ureteroscope


I like the look of this Welch Allyn® CompacVideo™ Otoscope.  Something just like it for vaginal visualization would be an ideal tool for intrapartum diagnosis as well as for patient education!!!


These sources might have something close to what I'm looking for:

ackermanninstrumente.de/englishindex.html - endoscopic instruments

intelemed-usa.com - lists an amnioscope, really an endoscope


This article about Pediatric Gynecology references a fiberoptic vaginoscope, hysteroscope, pediatric cystoscope, or endoscope with irrigating properties.[4,5]


This Belgian article [in French] discusses the use of a vaginoscope to assess the adult cervix.


Use of the flexible cystoscope as a vaginoscope to aid in the diagnosis of artificial sling erosion.
Chai TC, Sklar GN.
Urology. 1999 Mar;53(3):617-8.

"Vaginoscopy is a valuable adjunct procedure in detecting this problem."


Fulkerson combination female-vesical-sphincteroscope and virginal-vaginoscope.
Urol Cutaneous Rev. 1951 Oct;55(10):628-9.



Self-Checking of Dilation and Descent




From: "Childbirth Quotes from Gloria Lemay" How to Check Your Own Cervix- "it's not rocket science"

"I think it's a good and empowering thing for a woman to check her own cervix for dilation. This is not rocket science, and you hardly need a medical degree or years of training to do it. Your vagina is a lot like your nose- other people may do harm if they put fingers or instruments up there but you have a greater sensitivity and will not do yourself any harm.

"The best way to do it when hugely pregnant is to sit on the toilet with one foot on the floor and one up on the seat of the toilet. Put two fingers in and go back towards your bum. The cervix in a pregnant woman feels like your lips puckered up into a kiss. On a non-pregnant woman it feels like the end of your nose. When it is dilating, one finger slips into the middle of the cervix easily (just like you could slide your finger into your mouth easily if you are puckered up for a kiss). As the dilation progresses the inside of that hole becomes more like a taught elastic band and by 5 cms dilated (5 fingerwidths) it is a perfect rubbery circle like one of those Mason jar rings that you use for canning, and about that thick.

"What's in the centre of that opening space is the membranes (bag of waters) that are covering the baby's head and feel like a latex balloon filled with water. If you push on them a bit you'll feel the baby's head like a hard ball (as in baseball). If the waters have released you'll feel the babe's head directly.

"It is time for women to take back ownership of their bodies."
-Gloria Lemay, Vancouver, BC <http:



Archive for the ‘How To Check Your Own Cervix’ Category from Birth Balance Blog



Bandl's Ring - Pathological Retraction Ring



From pg 855 of "Principles and Practice of Obstetrics: Joseph DeLee, Saunders Publishing"

    1. A restless excited, anxious patient, high pulse (90-110), irregular respiration, temperature 99.6 to 100.4 and if infection is beginning, 101 to 103F.
    2. Strong uterine contractions without proportionate advance of the presenting part
    3. The uterus hard and drawn up over the child, which lies in the dilated lower uterine segment. The fundus is thick, hypertonic and hyperergic, but not in pure tetanus, and the lower uterine segment is soft; it balloons out during the pains, allowing the fetal body to be outlined with startling distinctness. The latter seems to lie under the skin. This finding is possible under anesthesia -- the exquisite tenderness prevents it otherwise
    4. A  groove is visible and palpable, running obliquely across the belly, higher on the side of the greatest stretching -- the pathologic retraction ring or ring of Bandl. It may rise as high as the navel or higher
    5. The round ligaments are inserted high on the uterus, are tender, hard, and wiry, and particularly the one on the side which is going to burst may be tense and taut.
    6. The bladder is drawn up high, but the distended lower uterine segment may imitate a full bladder
    7. A general abdominal tenderness is present, but he lower uterine segment is so sensitive that the woman will hardly allow it to be touched
    8. Internal examination will reveal the cervix, either imprisoned in the pelvis and swollen, black and blue, or drawn up out of he pelvis with e vagina on the stretched, taut around the presenting part, and hot, reddened, and dry. A caput succedaneum may reach the perineum with the head at the inlet
All my texts are in agreement with the statement that the uterus seems to be working exceptionally  hard -- contractions are frequent, intense and painful.  This diagnostic point is important I think since modern thinking is that CPD is often shown by weak, erratic and ineffectual contractions. If a mom has a good labor pattern many of us were taught that all will be well. In fact, if she does NOT have a good labor pattern we might even use medications (pitocin)  to bring on harder contractions. Yet this is the scene which can lead to rupture.

The prolonged labor pattern we usually deal with is a  result of weak  and irregular  contractions. These moms usually do very well if they get enough food and rest during labor, even if it continues for many hours longer than average. But a mom  with frequent, hard, STRONG contractions should have a rapid labor -- not  a prolonged labor! This is the mom  which the older authors thought most at risk of uterine rupture.

To sum up the signs/symptoms of impending rupture:

Rising pulse and perhaps temperature (possibly due to dehydration, exhaustion, ketosis??)

STRONG UTERINE CONTRACTIONS WITHOUT PROPORTIONATE ADVANCE OF THE PRESENTING PART

Bandl's Ring becomes visible and rises. Fundus is thickened and tense

Round ligaments become visible and tense

Uterus is extremely painful and sore to the touch. The mother complains of  severe abdominal pain.



Dancing Out Babies from an Android Pelvis



I, too have found the android pelvis a challenge. I tell these mothers now that they may need to dance their babies out. literally!! Higher percentage in black population in my experience though I have heard high in Hispanic I have not seen this. Those Hispanic and Anglo women with this pelvis are generally taller than average and in the slender, narrow side. It really seems to help to have these women up and moving and putting good music on really seems to help even more.



Risk of Cord Prolapse when Waters Break




My question is, if my water breaks before labor and my baby is high, is it safe to stay home before and during first stage labor?
This is a big question: if the baby has not been engaged, and your waters rupture with a gush, there's a chance of cord prolapse. Normal heart tones are good reassurance that there's no cord problem; this is actually more useful than an internal exam, which might reveal an obvious prolapse but might miss an "occult" cord prolapse. (Occult meaning hidden, i.e. when the cord comes down alongside the head but still doesn't come out the cervix - it's still compressed between the head and the pelvis and can limit the baby's oxygen supply.)

If the baby's head is engaged and/or it's a slow leak, it's very unlikely the cord will prolapse.

The ideal situation is to be at home with someone who can assess the baby's heart rate. This could be your partner - especially in late pregnancy, other people may be able to hear the baby's heart just by pressing an ear where the baby's heart is likely to be. Try it and see. Normal heart rate is between 120-160 bpm - much faster than is typical for an adult. In fact, it should be about twice as fast, which is an easy way to do a very rough assessment.

It's a little easier with a specialized stethoscope, or any stethoscope for that matter, and a hand-held Doppler can be helpful for people who aren't skilled at timing heart rates. But these are pretty basic skills.

However, entire conferences are held on listening to the baby's heart rate and interpreting different patterns and how they correlate to the contraction pattern. It's a complex subject.

Should I restrict movements such as squatting? How do I or my labor assistant know if the cord prolapses. And how would an obstetrician know without doing an internal exam? I would like to avoid internal exams to reduce the chance of infection so I can have the maximum amount of time for labor to begin spontaneously.
To repeat, the baby's heart rate is the only reliable indicator of cord problems. Many protocols call for doing an internal exam also, but this could easily miss a problem. So they don't really tell you what you need to know, i.e. that there is no problem.

The big risk in going into the hospital is that they will almost certainly want to do an exam right, even if your membranes are ruptured. It's appalling, but it's true.

If you have a labor assistant who is competent to assess the baby's heart rate, you're much better off at home, where nobody will be introducing antibiotic-resistant bacteria into your body.



The Hyde Maneuver for Reduction of Cord Prolapse


I was a labor nurse in an Oklahoma hospital where the service was just an absolute zoo. It was like a MASH unit for OB. I was the charge nurse and was pregnant. Can you imagine white scrubs in OB? Puh-leese. I looked like the Goodyear Blimp with fat little swollen feet ( I lived 75 miles away, and spent all my time in my little red car zooming down I35, dodging tornados, or on my feet at work.)

One night we had a grand multip who spoke no English. She was laboring away and had spontaneous ROM and prolapsed a cord. The resident, who was a tiny little thing, jumped into bed with her, I put the bed in trendelenberg, she elevated the head off the cord and we went racing to the OR. The route to the OR had a few corners in it. This was not a place where a lot of people came to your aid, since they were all coping with their own obstetrical disasters, so this 8 month pregnant woman (me ) is pushing a bed with 2 people yelling and screaming.

Anyway, you know how fast those hospital beds get going...I was flying down the corridor and smashed the bed into the wall. Hit it hard enough to make a 6 inch hole in the sheetrock. Hit it hard enough to do a whiplash number on that fetus who flew to about a minus 10 station, taking his little cord with him. I quickly threw the bed into a straight up sitting position, the head slammed into the pelvis and mom went on to deliver normally. I don't think any of our Spanish was good enough to ever explain to this poor bewildered woman just exactly what we were trying to do!! So that is what was labeled the Hyde maneuver during a very silly thread a while ago.



Largest Baby Records



12 Pound Baby Born in S. Utah
Monday, October 22, 2001
THE ASSOCIATED PRESS

LAVERKIN -- A woman gave birth to a 12-pound, 9-ounce boy at home without the aid of pain medication or an incision.

Stannah Wood "worked so hard to get him here," midwife Ivy Duncan said.

Theo Wood was the largest baby born in southern Utah for at least 10 years, said nurses at Dixie Regional Medical Center in St. George and Valley View Medical Center in Cedar City. Wood had a healthy pregnancy without any disorders that can contribute to an oversized baby, such as gestational diabetes. The baby arrived Thursday just two days after his due date.

Big babies run in the family.

The mother weighed more than 11 pounds when she was born. The father, Dayne Wood, who played football for Hurricane High School with the Class of 1996, weighed 9 1/2 pounds at birth.

The couple's first child, 2-year-old Braylee, weighed nearly 11 pounds.

The second child inherited his father's broad-shouldered build.

The baby was sent for observation to Dixie Regional Medical Center, where he barely fit into the newborn isolette. He needed two connected name bands to fit around an ample wrist.

Theo Wood sports three rolls of neck fat, a head that measures 15 inches in circumference and a chest 17 inches around.

Even at that size, the baby isn't a contender for a world record. The heaviest baby, according to the Guinness Book of Records, was born in 1939 at 29 pounds but died two hours later with respiratory problems. The two heaviest babies to survive matched 22.5 pounds in 1955 and 1982.



Emergency Pitocin



Pitocin on a cotton ball can be rubbed into the wrists and axilla.


Emergency Use of Intrapartal Pitocin



Birth for Women with Back Injuries



Does anyone have experience of birthing women with whip-lash injuries? How do you deal with the whip-lash pains, at birth in a hospital setting or at home and during the pregnancy? Information and suggestions will be appreciated. Thank you.


Last year, I had a client come to me who had been rear ended and was seven months pregnant. She was quite sore and had a whip lash. This is what we did and it worked to relieve her pain and she went on to have an uncomplicated birth:

  1. Scheduled regular chiropractic care
  2. Massages twice a week
  3. St. John's Wort Oil applied directly to achy spasming muscles
  4. St. John's Wort tincture (20 drops) and Skullcap (6 to 10 drops) for pain and muscle spasm.
  5. Ice compresses or hot compresses to particularly sore areas as needed to relieve pain and spasms.
  6. Encouraged to maintain good nutrition, lots of fluids, increased fruit and vegies, etc.
  7. Increased rest (extra naps), and mild exercise, working up the amount as tolerated.
I was not familiar with the use of Arnica at the time but would suggest it now if confronted with a similar situation.


Disseminated Intravascular Coagulopathy (DIC)



Disseminated Intravascular Coagulopathy (DIC)



How to Help Women Urinate in Labor or Immediate Postpartum



For not being able to pee, both directly after birth and later you can try these homeopathic remedies. Cantharis 6x, 12x use when mom has an urge to pee, but can't (1 or 2 doses ), or Aconite 30x can't pee, from fright, from inflammation in the area, from tightening whole body, Arnica 30 if there has been trauma to the urethral area. Give the mom plenty of alone time to relax and pee.


I forgot to mention a trick I use sometimes when I have trouble urinating. I lightly stroke my sides and my thighs. For some reason, this helps me relax enough to pee.


Does any one have any other tricks for helping women wee when they get to that point of being unable to distinguish full bladder sensations from contractions?


This is usually due to swelling around the urethra. If she can reduce the swelling, she should be able to pee again. (Try arnica?)


Have the mom blow bubbles through a straw into a glass of water. I've seen this work immediately during late labor or while waiting for placenta.


I experienced this with the birth of my third child born in about 2 hours and over 10 pounds. My bladder was bruised and swollen. So we did lots of tricks finally getting in a bathtub of warm water was helpful. I just did not have those sensations for a while. It took about 1 week until my body was able to give me accurate signals regarding urination.


"Spirits of peppermint are sometimes used to aid the woman to void naturally. "Spirits" are concentrated alcohol solutions of volatile substances; they are also known as essences. Spirits of peppermint give off vapors. these vapors have an external, local relaxing effect on the sphincter muscle of the urinary meatus. Use of peppermint spirits may make it unnecessary to catheterize. The nurse places a bedpan under the woman and pours a few drops of peppermint spirits into the bedpan. The vapors rise to flow over the vulvar area, the urinary meatus relaxes, and urine is released. Nothing touches the woman except the vapors; the woman feels no sensation, only notices the aroma of peppermint."

Maternity & Gynecologic Care, 5th Ed., page 511 by Bobak & Jensen


I have found that peppermint essential oil is invaluable to me at a birth, for two reasons. First, to combat nausea, ( I put it on a q-tip and wave it under her nose) and for the bedpan/toilet. Two or three drops in the toilet work great.... I am unfamiliar with "spirits" but the essential oil works great!!!



Herbs for Perineal Compresses



See: Comfort Measures for Postpartum Perineum



Lubricants



In my practice, I have found Astroglide to be far superior to KY jelly.


Not only is Astroglide superior in every aspect to any other lubricant for sexual intercourse, it also is GREAT in the exam room. I use it EXCLUSIVELY for pelvic exams now - NO MORE K-Y. My patients don't walk out sticking...

BioFilm, Inc.
3121 Scott St.
Vista, Ca. 92083
800) 848-5900 in Ca.
800) 325-5695 rest of U.S.


I know of something even better than Astroglide. You all ought to check out Slippery Stuff, manufactured in Washington by a certified women's business called Wallace-O'Farrell. Not only is it water-based, but unlike other lubricants like KY, it doesn't contain glycerin, which may increase the amount of bacteria in the vagina by acting as food. It's a wonderful personal lubricant (my clients to whom I gave samples loved it) and I have midwife friends who use is as a lubricant during the birth as well (esp. those in hospitals who worry about oils somehow being inhaled by the baby during the birth process). I used it once when the couple forgot to have any oil ready and thought it worked great. The company will send out free samples on request. Their number is 1-800-759-7883.



Dangers of Betadine



[Iodine status and the used of iodized antiseptics in the mother-newborn pair]
Zahidi A, Draoui M, Mestassi M.
Therapie. 1999 Sep-Oct;54(5):545-8.  [Article in French]

Iodine status was evaluated by assessment of urinary iodine excretion in 221 mothers and their 223 newborns. During the first month after childbirth, 59.3 per cent of the mothers and 26.5 per cent of the newborns received applications of iodized antiseptic containing Polyvidone-iodine. 50.2 per cent of the newborns and 24.9 per cent of the mothers had a urinary iodine of more than 20 micrograms/dl (iodine excess). For the mothers and the newborns who had received applications of iodized antiseptic, 38.2 per cent and 74.6 per cent had an iodine excess, respectively. This iodine excess is directly related to use of iodized antiseptic. Such high iodine levels may contribute to the risk of thyroid disorders, and particularly to transient congenital hypothyroidism at a critical age for normal development of the nervous system.

For a thorough discussion of the issue, review the Related Articles to this article.


I have heard a couple of references to Betadine and problems with its use at births. What exactly are the problems, and what are the
alternatives.


there's data that indicates that iodine is taken up by the fetal thyroid

but the FIRST question should be --- "Why use betadine"? What's the purpose? Is it necessary"?

Is it necessary to use betadine to soak instruments? absolutely not! Sterilise your instruments and keep them in an unopened or covered
container. There is no need to soak them. (and a squirt of betadine in water is not an effective sterilizing agent anyway - studies have been done where s. aureus was cultured from the rim of a bottle of betadine! )

Is it necessary to use betadine in a peribottle to rinse the perineum postpartum? Absolutely not. There is no benefit to rinsing -- with or withOUT betadine. There is no decrease in infection rates. (there may be a comfort benefit, but plain water is as effective as water with additives) There is data to back that up in GECP..

If it is not necessary to use betadine, then why use it?

Is there harm in using it? Betadine is caustic to tissues. It may delay healing. It is absorbed by mucus membranes and is taken up by the fetal thyroid. Postpartum iodine can even be detected in

If it is not necessary to use betadine, then why use it?

Is there harm in using it? Betadine is caustic to tissues. It may delay healing. It is absorbed by mucus membranes and is taken up by the fetal thyroid. Postpartum iodine can even be detected in nursing mom's milk at a "therapeutic level" if she uses betadine rinses! (there is data to back that up)

pouring betadine solutions over mucus membranes is not only not needed, but it can but can delay healing for the many moms who are sensitive to it.

And if scissors are soaked in betadine, is it possible for the baby to get a good dose of iodine when you cut the cord?

There is NO need for the stuff. Let's quit using it and get it OUT of birth kits!

The iodine question is a good one. We should always ask ourselves WHY we do what we do. Is there a reason why we use -- or do -something? Is it effective? Is it safe? Is it Harmful? Is there an alternative which may be better, safer, more effective?

NOTE: I know we are using a brand-name in casual conversation. I don't' mean to single out a particular brand of iodine solution. Is Povidine-Iodine the generic name?


- Well, as the ANTI-BETADINE QUEEN, I'll make the announcement. "In place of povidone Iodine I use.. NOTHING"

Instruments are boiled or baked to sterilize and then NOT OPENED until delivery. I use individual packets of sterile lubricant (or an newly
opened tube), and latex or copolymer gloves for exams. I do NOT wash, douche, shave or otherwise "prep". There is no need for mom to
wash, douche, pour, or otherwise anoint her parts after birth with a germicide such as betadine... If she wants to use water then that's just fine.
(I can back up each of these statements too....)

So... What on earth would I need Povidone Iodine for? Ain't no need for it! Throw it away! There is NO NEED for a substitute!

It does NOT reduce infections. It interferes with healing (sometimes) by irritating tissues. It "can" be absorbed by the mother and received by
the baby. It's use is just an old hangover from the old days when we used a variety of merely ritual cleansing procedures (y'know..shave,
enema, scrub, Lysol or carbolic acid douche etc. etc.).


Betadine is not to be used on pregnant or NURSING women! Hospitals started using it years ago and midwives followed suit, but it has
ALWAYS been controversial. The iodine in it is rapidly absorbed thorough the mucus membranes lining the vagina, it's absorbed by the fetus
-- found in the amniotic fluid even! -- and depresses the baby's thyroid. In fact: a mom who uses a betadine douche or periwash (our little
squeeze bottles with a squirt of betadine) can absorb enough betadine, and excrete it through her milk; her baby can receive THREE TIMES
his therapeutic dose! (The amount the doc would give as medicine if he had a problem)!



Catching Bare-Handed (i.e. not wearing gloves)



Genital Tract Shedding of HIV Can Occur in Non-Viremic Subjects [Medscape registration is free]

"The results of this study suggest that the absence of detectable HIV in the bloodstream does not necessarily equate with absence of HIV in genital secretions," the investigators note. "Several local and systemic factors likely influence the kinetics of HIV viral replication in cervico-vaginal secretions."

I'm reminded of midwives who are willing to be lax about universal precautions for clients who've had a negative HIV test. Personally, I don't require my clients to be tested, and I just assume I need to be careful. Let's all be careful out there!


"I just re read Odent's book Birth Reborn...one midwife in there says how she no longer uses gloves for the birth as she wants baby to have skin to skin contact rather then latex. Now i tend to not want to use gloves during the birth but i wonder what y'all think? anyone not use them?


Interestingly, it's Michel Odent who says that "The first germs on the baby's skin will rule the kingdom." . Read more about Colonization of Baby's Skin Flora


I know some midwives who say it's OK to catch bare-handed because they wash their hands really well. Maybe they'd be surprised that their hands are even more germy after all that hand washing!

Hygiene of the Skin: When Is Clean Too Clean? [Medscape registration is free]

"[F]requent handwashing is not only potentially damaging to skin, it is also time-consuming and expensive[68]. Finnish investigators demonstrated that after frequent washing the hands of patient-care providers became damaged and posed greater risk to themselves and patients than if they had washed less often."


When I started midwifery 20+ years ago, I never wore gloves until another midwife's son caught something from the toilet seat after an affected client sat on it. Eeewww! That cured me, although I missed the "human touch". I agree with someone else who said there are lots of bugs out there, and that first touch should come from a parent. Also, remember when Birth Reborn came out, I would say early 80's at the latest, pre-HIV, Hepatitis C? Makes a difference.


I did one birth barehanded for a dear friend who requested it, and it was ICK! I like the gloves, thank-you-very-much.


Why I Wear Gloves At a Birth


This is interesting. I was recently given pix of a birth I attended and here is this sweet baby nestled in her mother's arms with the big (8 y.o.) sister stroking the baby and my gloved hands tying off the cord. Those gloves really were glaring. I have thought about the latex problem. I use vinyl in my office and will buy vinyl for births when I run out of latex. But the question is - are gloves necessary to protect the mother-baby after excellent hand washing? I would certainly wear them for sewing but do have to wonder about for the birth? Although I might want to have gloves on for that rare instance of needing to quickly go in for a placenta with PPH...interesting.


I have the opposite reaction. I think bare midwife hands are a glaring indictment of non-standard care. I can't believe that there are midwives who allow pictures of themselves catching bare-handed to be posted on web pages!


I believe that we should all stop wearing latex because of latex allergies. But this doesn't mean I think we should catch bare-handed! There are a lot of good non-latex alternatives out there.


What seems like a contradiction to me is wearing gloves to catch the baby, cut cord etc. But within about 30 min. my gloves are off and I am doing the newborn exam without gloves. Do others wear gloves during the newborn exam and every time you touch the baby PP?


I don't touch the baby without gloves for the first 24 hours. I want that baby to be colonized with their family's germs, not mine!


I will continue to wear gloves because I do not think I have any business touching anyone's genitals with my bare hands if I am not in an intimate relationship with them. Now being a midwife to a woman is intimate, but not quite that intimate. Knowing there are caregivers out there in the world who take advantage of their patients and perform sexual acts on them makes me very careful. Anyway, I tell young women that they need to pay attention to what is being done to them during an examination of their genitals and not let anyone who is not their spouse touch them without gloves, or touch them with other than hands.


With the statistic floating around that 1:4 women have been sexually abused ( and the true number is probably higher) the use of gloves adds the additional sign to the client that this is a professional interaction. There are so many ways in which one can trigger memory of abuse and I believe the use of gloves can help to delineate the difference. Especially to women in labor, they are in a vulnerable position, in labor and someone is examining them... Think about it. It makes me sad though.


I think it's dangerous, unwise, unprofessional and rude to the clients to not wear gloves on purpose. They are not necessarily able to give implied consent to this, and we are generally better able to understand the risks than they ever could. I won't reiterate all the right-on reasons everyone else has brought up about the importance of gloves, but one other reason is simply convenience. When dealing with the birth or a slimy baby, if gloved hands get too slimy/bloody, you strip them quickly and don another pair. If your bare hands are gunky, you'd have to go to a sink and wash them every time they got too gunky to work. EEEeww.


I get some raised eyebrows about delivering with clean gloves rather than sterile, but when you think about it, what is the big deal, as long as you aren't poking inside.


But how do you know you won't have to poke around inside? Shoulder dystocia is the potential complication that comes most readily to mind. Even bringing up a loose loop of cord involves close contact with the vulva.

Some years ago on one of the lists, someone mentioned that if they're concerned about shoulder dystocia, they run a finger up from the baby's neck to see if they can feel the shoulder, i.e to make sure the baby's shoulder isn't impacted behind the pubic bone. I don't do this at every birth, but I do it if there isn't prompt restitution and/or there appears to be some turtling. I definitely want to have a sterile glove on for going into a vagina that's just passed a baby's head, but I can't predict when I'll need to do that.

Am I missing something here about the cost of sterile gloves?
Mine cost about 50 cents apiece. This is 45 cents more than nonsterile gloves. Even though I'm paying for them personally, I don't begrudge the birthing woman that 45 cents.


Gloves at Waterbirth?

You can buy gauntlet gloves but, for the most part I have noticed that many women prefer to take positions that make "catching" nearly impossible. I have found that many women will feel their perineums and slowly ease their babes out without my help at all. It is hard to keep from drowning your gloves if you are wearing short gloves though!

I like to "pre-fill" my gloves with clean water, either poured in from a pitcher or filled from the tub water furthest from the mom's bottom. Once the gloves are filled, the water in there tends to keep out the contaminated water. Anyway, it's an easy way to reduce risk.


I use elbow length gloves and try not to reach in much.


Gloves for Breastfeeding Assistance

I've twice acquired bilateral thumbnail yeast from helping breastfeeding in one-week postpartum women I didn't know had breast yeast (sx manifested later). DUH. I now wear gloves for lactation problems as well. Sorry to say that before then, it hadn't occurred to me to use gloves to help her with her positioning....I was used to wearing gloves on the birth day, but not at postpartums unless I was doing perineal checks.

BTW, gentian violet eradicated the nail yeast.


About Newborn Sterility

"Shortly after birth, resident microbes begin to educate the gut’s immune system . . . " from a summary of a Science article [Hooper LV, Wong MH, Thelin A, Hansson L, Falk PG, Gordon JI. Molecular analysis of commensal host-microbial relationships in the intestine. Science, Feb. 2, 2001. ]


Walking in Labor



Lack of effect of walking on labor and delivery.
Bloom SL, McIntire DD, Kelly MA, Beimer HL, Burpo RH, Garcia MA, Leveno KJ
N Engl J Med 1998 Jul 9;339(2):76-79


I read the study. There were 500 and some women randomly assigned to the 'walking' group and similar number in the 'usual care group'. In the 'walking' group only 300 and some actually walked. Of those, they walked a total of around 55 minutes. Walking was quantified by pedometer. There was no statistically significant difference in length of 1st stage or the need for augmentation between the two groups. The authors (which included a CNM and an RN) concluded that ambulating neither helped nor hindered. And women should not be encouraged to lie in the bed.

The authors did the study for unclear reasons, but cited 4 previous studies on walking in labor - two that said it helped shorten 1st stage, two that said didn't. They said that 'usual care' of making the woman lie in the bed often created a lot of problems between patient and caregiver. They cited some of the (weak) rationale for keeping them in bed (falling down etc.) didn't give much credibility.

The studies methodology was fine. But I agree that the biggest problem with it is the actual nature of how these women were encouraged to ambulate. Does not go into that at all.


Seventy-eight percent of the women who were asked to walk actually did so, and they spent an average of an hour on their feet during the first stage of labor. They took an average of 553 steps, compared with 30 steps - mostly trips to the toilet - for women assigned to stay in bed.


Does the math here look a little funny to you? They were on their feet for an average of an hour, and they took an average of 553 steps. I timed how many steps I take at a very leisurely pace like you'd do with a woman in labor, and it came out to 72 per minute. Figuring 553 steps at 72 steps per minute, that amounts to just over 7 1/2 minutes of walking. Even counting time out for stopping with contractions, that's still not what I would call a significant amount of walking, especially for early labor.


Excuse Me!!!! They spent an average of an hour on their feet?????? So some of them only walked for thirty minutes and some walked for an hour and a half? Does not sound at all like what I would call ambulation. Our clients often spend most of their labor on their feet, not necessarily walking -- standing by the bed, rocking over the ball, standing in the shower. Probably adds up to an average of at least 4 hours upright (off the top of my head). In active labor they are often sitting in the tub or sidelying in the bed, but in early labor and early active labor they are up and about.

No wonder they didn't see any difference --standing up for an hour total out of a complete labor does not meet my definition of ambulating during labor. Of course, they probably made the women come back every hour for monitoring and once the women were all strapped in they asked for an epidural and stayed in bed until the cesarean for failure to progress <VBG>. I used to work in a hospital where they encouraged what they thought was "walking during early labor": this meant if you were less than two cms you would walk the halls, once you were actually having regular painful contractions you were in bed with an epidural. Sheeesh, this study has really ticked me off.


The Relationship of Ambulation in Labor to Operative Delivery Albers, Leah et al .... Journal of Nurse Midwifery Vol 42, No 1 jan/feb 1997

Abstract: An abbreviated version of the Nurse-Midwifery Clinical Data Set was used to gather data on all women (n=3,049) who began Intrapartum care with a nurse- midwife in three sites. Demographic information, Intrapartum care and outcomes were recorded. The association of ambulation in labor with operative delivery was examined in a low-risk sample (n=1,678) of women who did not receive care measures (epidural anesthesia, oxytocin induction or augmentation) that preclude mobility in labor. Women who ambulated for a significant amount of time during labor (compared with those who did not ambulate) had half the rate of operative delivery (2.7% vx 5.5%) 1997 by the American College of Nurse Midwives.



Grand Multiparas



The labor curve of the grand multipara: does progress of labor continue to improve with additional childbearing?
Gurewitsch ED, Diament P, Fong J, Huang GH, Popovtzer A, Weinstein D, Chervenak FA.
Am J Obstet Gynecol. 2002 Jun;186(6):1331-8.

"Once parity exceeds 4, progress of labor slows. "Poor progress" beyond dilatation of 4 cm should not be considered abnormal for a GM, because she is likely still in the latent phase until dilatation of 6 cm is attained. Nor should she be expected to progress through her active phase any faster than lower-parity multiparous women."


yeah.. they can poke and putz and take all week to get beyond 6 centimeters... because it's still latent phase till 7 or so. But once they get to seven, their active labor goes pretty quick.

the problems can come when we treat them at 4 cms for lousy labor  -- or when we get tired of being there for two days with off and on contractions.

they labor just fine once they get to active labor -- but it can take them forever to get into it.

I confess to having TRIED in early years, to stimulate and kickstart grandmultips in latent phase.

a few times it's worked....but usually we just got flurries of contractions -- just enough activity to keep us at her home, and just enough to make her tired.



Unplanned Unassisted Childbirth, aka "Emergency Childbirth"



As they say, it's an emergence, not an emergency.  :-)


Emergency Childbirth Reference Guide
U.S. Department of Defense

Emergency Childbirth - A Reference Guide for Students - Medical Self-Help Training
Course Lesson No. 11
Emergency Childbirth What To Do
1. Let nature be your best helper. Childbirth is a very natural act.
2. At first signs of labor assign the best qualified person to remain with
mother.
3. Be calm; reassure mother.
4. Place mother and attendant in the most protected place in the shelter.
5. Keep children and others away.
6. Keep hands as clean as possible
7. Keep hands away from birth canal
8. See the baby breathes well.
9. Place the baby face down across the mother's abdomen.
10. Keep baby warm.
11. Wrap afterbirth with baby.
12. Keep baby with mother constantly.
13. Make mother as comfortable as possible. 14. Identify baby.
What Not To Do
1. DO NOT hurry.
2. DO NOT pull on baby, let baby be born naturally.
3. DO NOT pull on the cord, let the placenta (afterbirth) come naturally.
4. DO NOT cut and tie the cord until the baby AND the afterbirth have been
delivered.
5. DO NOT give medication.
DO NOT HURRY - LET NATURE TAKE HER COURSE.
{emphasis is not mine - I copied this exactly as written}


During a natural disaster, it may not be possible for the midwife to get to the laboring woman.  Her family and friends may be called on to help her in this situation.  (This is sometimes called Emergency Childbirth, but, as the saying goes, Birth is an Emergence, not an Emergency!)

Here are some web pages that provide useful tips for helping a woman during childbirth:

Basics of Birth for those who don't know nothin' 'bout birthin' babies! - a lay person's guide - for help with an emergency OB kit.


4 Rules of Precipitous Labor, or, What If I Give Birth Before I Get to Hospital? [3/3/10] by sarahvineBasics of Birth for EMTs

Giving Birth "In Place" - A Guide to Emergency Preparedness for Childbirth
Copyright © 2003 American College of Nurse-Midwives

General Guidelines - Birth is designed to happen without any assistance at all, and 95% of the time, everything goes just fine.

If you're having an unplanned unassisted homebirth, do your best to locate someone who can help.  Call 911 and think about your neighbors - perhaps one of them is a midwife, doctor or nurse who might be able to help.

In general, nobody needs to be putting their hands inside the woman's body.

Early labor pain is often helped by being in a warm bath if available, or in a warm shower if there is no bath available.

Nobody needs to tell the woman when it's time to push; she will know when it's time!

If there is trouble during the birth process, such as painful back labor or a very long pushing stage, it is often a good idea to help the woman get into different positions, such as hands and knees or side-lying.

There is typically a one-minute delay after the head is born before the body starts to come.  If the mother is pushing with the next contraction and the baby's shoulders seem stuck, help her to move to her hands and knees or to stand up.  Be sure to be ready to catch the baby when it falls out!  If the baby is still stuck, have the adult with the smallest hands put a clean hand on the baby's back (inside the mom's body), and move the hand sideways to tuck the baby's shoulders in closer to the body.

Once the baby is completely out, the mom should be holding the baby next to the bare skin on her chest or belly to warm the baby and so that the mom's healthy skin bacteria seed the baby's skin.  Dry the baby's hair and body with a clean, soft towel, and then use another dry towel to keep the baby's body covered.

You will know the baby is fine if the baby's arms are bent, with the hands up by the shoulders, and if the eyes are open.  Babies often cry, but not always.  If the baby is unconscious (completely limp, with eyes closed), stimulate the baby to start to breathe by rubbing UP along their back with a towel or your hand.  You can also blow on the baby's face to encourage it to take a breath.  If there is NO response within a minute after birth, then you need to move air into the baby's lungs

There is no hurry to cut the cord!!!  The placenta will come sometime after the baby, and you just need to wrap it in a towel to keep everyone clean.  It is often best to wait until AFTER the placenta is out before cutting the cord.  It is always best to wait until the baby is breathing fine on its own before cutting off baby's oxygen supply!  It is always best to take the time to sterilize the string and scissors you're going to use to cut the cord by scrubbing the scissors clean and then leaving it in BOILING water for 20 minutes or soaking it in rubbing alcohol or hydrogen peroxide for 20 minutes.  If trained personnel are on the way, it's best to leave the cord intact so they can cut it with sterile equipment and use appropriate clamps.  If no help has arrived after a while, use sterile string (or dental floss or a STERILIZED shoelace) to tie off the cord about 2 inches from the baby's body before cutting the cord about 2.5 inches from the baby's body.

If there is more than two cups of blood coming from the woman's body after the birth, use nipple stimulation to generate uterine contractions to stop the bleeding.  (Use your thumb and forefinger about an inch back from the nipple to squeeze the breast tissue, simulating the way the newborn's mouth would put pressure on the breast tissue.  In an emergency, an adult could try to mimic the way a baby would suckle on the breast.)

Encourage the mom to breastfeed the baby within an hour after the birth.  If you just leave the baby on the mom's belly, with the head near the left breast, the baby will probably manage to get itself latched on.  Sometimes it helps to shape the woman's breast so that the nipple makes more of a point, which is easier for the baby to get the mouth around.



Unassisted Childbirth



Born Free: Unassisted Childbirth in North America - Rixa Ann Spencer Freeze's dissertation


Third National Husband / Wife Homebirth Conference in Liberty, Missouri
July 4th weekend, 2009


Most families who plan unassisted childbirth will have very safe, very lovely births, but 2-5% may have life-threatening situations arise.  These 2-5% are the ones who benefit tremendously from having a trained midwife immediately available.  If you're thinking about having an unassisted birth, you might want to consider hiring a midwife who is open to being present in another room in your home and ready to respond immediately to an overt emergency.  Obviously, she can't be providing the typical standard of midwifery care, but she may be able to turn those 2-5% of births from very scary situations into just another bump in the road.


TIP:  If you're planning to give birth unassisted, do not advertise this to the general public and particularly not to healthcare practitioners; some of them might feel obligated to call your local CPS - Child Protective Services. These agencies often have the right to take all of your children away from you on the assumption that you're guilty until proven innocent.  So use some common sense here!


Empowered Childbirth.com was created out of a deep and abiding love for women, men, children and the sacred healing powers of childbirth. Here, we share our experiences with each other in hopes of restoring our faith in our own birthing power and encouraging our sisters to restore theirs.


Purebirth Australia - This website came about to light the way back to the primal path of instinctive pregnancy, birthing and mothering.


Psalm & Zoya - The Unassisted Homebirth of Our Twins - this is a terrific new video.  Wow!  www.earthbirthproductions.com


A Clear Road to Birth: An Exciting New Film about Unassisted Childbirth - review by Laura Shanley. Order from homebirthvideos.com


BirthLife Universal celebrates the experience of responsible maternity and paternity as worthy of one's best efforts and fosters awareness of the enormous significance and value of parenthood. They offer Sacred Birth, a beautiful video about unassisted outdoor birth in Peru.  This video is also available from homebirthvideos.com.


Great collection of links about unassisted childbirth from BirthLove.  [As of spring, 2002, the BirthLove site is by subscription only - it's well worth the $10 membership fee; you can get a "sampler" by reading BirthLove's Top Twenty- For Free! .]  [Ed: birthlove.com is not available at this time.]


Bornfree! The Unassisted Childbirth Page - When I first heard about the unassisted childbirth movement, I was dumbfounded. It sounded so terrifying, so risky, almost irresponsible even to consider it! Then I read the book. Wow! What a gift Laura Kaplan Shanley has given us.

I don't expect most women would be comfortable with the concept of unassisted childbirth, and I'm not sure I would be, even after seeing more than a hundred births that would have been just as safe (maybe even safer) unassisted as with professional assistance.

The true value of this book and this movement is the energy focused on renewing an understanding of where true birthing power lies - in the birthing woman. Regardless of what kind of birth you're planning, reading this book and this website can only increase your confidence in yourself and the birth process; this increased confidence will support a much safer birth than a labor that is begun in fear because, after all, the laboring woman is the only one who can truly keep the baby safe.

Thank you, Laura, for this labor of love . . . it's clearly borne out of love for birth, babies and mothers everywhere.


The Power of Pleasurable Childbirth by Laurie Morgan (free e-book on her website.)


Do-It-Yourself Delivery by Sandra G. Boodman [Washington Post, 7/31/07]


Unassisted Childbirth Statistics from The Center for  Unhindered Living - A Learning Community


Archives from CBirth, the Unassisted Childbirth Email List - By Topic [You may notice a striking resemblance between the formats of these two archives - they graciously requested my permission to copy my format.]


Mango Mama's HOW TO PREPARE FOR AN UNASSISTED BIRTH


She did it her way - Doctor-wary Folsom woman chooses to give birth all by herself -By Deanna Broxton


I ordered this book after seeing the web site about unassisted childbirth. I am not sure I agree with everything in it, but it certainly contributed to a major change in my philosophy and attitude towards childbirth over the last year. I liked the unassisted birth stories on the web pages, particularly one by a couple called Allison and Michael Scimeca. That is what I would like to achieve. I printed it off recently and gave it to my husband to read and he thought it was interesting if a little scary, which just shows how much he has changed as well, as if I had shown it to him this time last year he would have thought I was out of my tree.


Laura passed along the following stats for unassisted birth:

Intended UCs (unassisted childbirths) March 1999-March 2000
Total:
54 babies
8 born in the hospital (one was a C-section)
2 born at home with a midwife
44 born at home unassisted

The 8 women who went to the hospital said they essentially went due to fear, pain, or lack of support from their husbands. One woman was losing her vision and thought it best to go. The C-section was a breech. The woman went because she was in a lot of pain. The doctor gave her the option of either a vaginal birth or C-sec and she chose the C-sec. The 2 women who called midwives were a little nervous during the birth. Both their midwives were very good, and non-interventive. With the UCs, there were 2 transfers after the birth. One woman was losing too much blood (VBAC), the other gave birth prematurely and thought it best to take the baby to the hospital. Both women were happy they had had a UC, as were the other 42. So the outcomes were very good. These stats are from all the women who have contacted me in the past year and said they were intending to have a UC.


I don't honestly think husband/wife childbirth is natural in any way shape or form. Even elephants have midwives. I truly believe unassisted birth as we know it today came about solely because women cannot find Traditional Birth Attendants anymore (the few who do it for religious reasons not withstanding). I think it's sad honestly that we've lost our tradition of women helping women and it's gotten to a point where people assume (accurately in many cases) the only way to protect the purebirth is to go alone.


This has literally left me in tears today because it's so true and so personal. Nearly every woman I know who chose unassisted birth came to it by way of being failed by birth attendants or by not trusting them in the first place.


I sometimes think this is "symbolically". I want to be left "alone" in the sense that *I* want to do this, *I* need to be w/myself and my baby and only myself and my baby, more than a statement of being "physically" alone.


Midwives "On Call" for Unassisted Births

I have couples call me occasionally to help them with their unassisted births.  Talk about an oxymoron.  Me be on call, them call me during labor to figure stuff out.  I DON"T THINK SO.  I figure if people have problems during an unassisted birth they can call 911.  I don't care if people want to do this.   But I don't agree with it and I don't' want to "help" with my  hands tied.  Any one else having to deal with this?

Depending on the situation, I will consider being on call for a family planning an unassisted birth, BUT, I treat them like regular clients who are expected to come for prenatal appointments and to pay my full fee.  Then, like all my clients, they have the option not to call me for the labor and birth if they feel they don't need me and/or they can call me and ask me to wait nearby (in the next room or the next house if they're cozy with their neighbors) in case they need emergency assistance.

I've only gotten a few calls about being "on call" as a backup for an unassisted birth.  I like to offer the families the option of having the dad catch the baby with me there "ready to assist" as needed.  I am happy to allow them to decline any and all routine midwifery interventions (including listening to fetal heart tones) if they are willing to sign a thorough informed consent and waiver.

No, I will not take responsibility for a birth in a family I've never met before.


How to Deal with Child Protection Workers in Unassisted Births by Capper, a former child protection worker (called Child Protective Services in the US) and now police officer. [As of spring, 2002, the BirthLove site is by subscription only - it's well worth the $10 membership fee; you can get a "sampler" by reading BirthLove's Top Twenty- For Free! .]  [Ed: birthlove.com is not available at this time.]


A Book for Midwives - a free, downloadable midwifery text from Hesperian.org



Unplanned Unassisted Homebirth



Homebirth at 36 Weeks



Does anyone have experience of having a baby or attending a birth at home when woman 35 plus 5 days pregnant?  What would the risks be?  Obviously I can think of a few, but there may be some I haven't thought of.  Would I be in the wrong attending her if she insisted on staying at home?  I am not bound by hospital policies.


Your considerations should be:

1. is she GBS pos or does she have some other bacterial/nutritional problem that is causing the babe to come early?? that will cause problems for the baby. Keep a close eye on the neonate for signs of infection and get help if you're worried.

2. almost -36 weekers usually do well at first but will not have a good sucking reflex.  If you decide to do it at home, have a professional quality electric breast pump and sterile syringes to dropper feed with.

3. the baby must be kept consistently warm (no drafts, good heat source in the house) as it will not have extra body fat.  Plan to have hot towels, receiving blankets, hot water bottles, heating pads, etc.  Keep mom and baby nested skin to skin (a la Kangaroo Care).  A good quality sling is helpful to carry baby.

4. Parents should be very motivated to do the intensive caring that will be needed to keep the baby hydrated.  If there is a conscientious grandmother in the picture, that helps a lot, too.

5. By Day 3 the baby will become very jaundiced and sleepy (very immature liver).  The dropper feeding needs to continue despite the sleepiness.

If you want some inspiration about preemies doing well despite being born under very harsh conditions, read "The Dionne Years" by Pierre Burton (Canada).  It is the story of the Dionne quintuplets, born at about 30 weeks and all weighing just over a pound.  The midwives kept them alive on the oven door of the wood stove (this was in the l930s) by feeding them donated breastmilk from the village women.

It is a big commitment of time and energy to watch over these little ones.


I think it's very important to appreciate that some human genes consider 37 or 38 weeks to be full term.  In particular, I notice that my Asian clients often have babies come 2 or 3 weeks early, weighing 8-10 pounds.  So if an Asian client carrying a good sized baby went into labor at 36 weeks, I wouldn't be all that concerned.  Obviously, keep an eagle eye on the baby at birth, but if the Ballard's assessment tells you the baby is "40 weeks", that's a happy term baby.



Hotel Birth



Okay, here is a brainstorm idea. What about a homebirth in a hotel. Here is my reasoning. Lets start with the mess. Need I say more? I will be moving before baby is born and I do not know where. This way I can pick a MW anywhere in the bay area. Hot tubs with unlimited hot water. I will pick a hotel with in-room jacuzzi. I may be able to find a hotel near a good hospital.

Do I have to tell them at check in what we are doing? Is it any of their business? Anything I am overlooking?


You wouldn't be the first. :-)

We have a good residential inn near our local hospital, and I've investigated this option but never been involved myself.

The jacuzzi was one of the big attractions.

You want to make sure there's good soundproofing in the rooms; you ask under the guise of being a really light sleeper and not wanting to hear people in the rooms around you. This way, they'll probably put you on an end unit or somewhere where fewer people would be bothered by the noise.

A kitchen is really nice and/or an all-night restaurant or coffee shop nearby.

It would be really helpful to be close to an exit in case you decide to transport to the hospital. Also, you need to be close to parking so the midwife isn't hauling her equipment too far.

Have you considered a birth center? :-)

P.S. Most people are surprised at how little mess there actually is at a homebirth; this is generally a non-issue.


my MW in FL does this. They get a really nice penthouse hotel room. Then they even order room service when the mother wants to eat. Also it saves a lot of planning ahead with getting & preparing food for everyone even during the labor.


I have done a waterbirth in a hotel room for a couple who flew in from a long distance. I brought sheets, towels, baby things, birth kit, oxygen - all packed in suitcases. No one ever knew the difference.

Ordering room service for everyone after the birth was heavenly and flowers and a fruit basket mysteriously showed up on the third day.

The couple stayed there for a week and took long walks on the beach before, during and after.


Writing from the ranks of "been there and done that", I have attended a birth in a hotel room. This was while I was living in the US (Illinois specifically). The midwife lived in one town, I lived in another and the couple lived out on their herb farm and this all took place in the middle of winter and only the couple had a vehicle that was designed for off road use. We used a perfectly lovely suite with an upstairs bedroom loft and a living room w/ fireplace kitchenette below. We did not announce our intentions and as with most of the births I attend there was no more than one large trash bag to dispose of. The placenta had it own container for transport to the couple's home the next day. We brought along our own sheets so that we could just pack them up and take home to wash if the mother chose to use the bed for the birth. One extremely handy item in my birth bag is a a few meters of the flannel backed plastic fabric (picnic table cloth like stuff) that is great to protect the floor/carpet. Nice and fuzzy underfoot and impermeable to water, blood and the like. It is great to use as a "carpet" from the watertub/pool/bath to the toilet. I have also "hosted" two waterbirths in my own home so do have both experiences for comparison. The only difference I found was that when it was my home I felt more responsible for the food preparation and was more obsessive about getting the laundry done right away. From that stand point, the hotel birth was more fun. Since I experience inertia every time I have to head out in the car, I loved the comfort of receiving the other couples here and avoiding the drive.


I'd imagine that if you were a vocal birther, you'd have the neighbors calling the front desk, a manager at your door, with perhaps a freaked out set of medics and cops at the door from a 911 call down the hall ;)


I would still bring my own bedding though.... you never know what bacteria lurks on theirs or how often they wash it.


I worked in a large hotel once -- any bacteria that survived that washing procedure, you probably couldn't kill with straight bleach and alcohol! The washing machines are huge, and usually use near-boiling water, and after they're washed, they are dried very hot, and then put through these giant, dangerous rollers (several feet wide and at least 2' diameter) to iron them. You could ask to see the laundry of any hotel you wanted to 'audition' I expect.


I meant the comforters. I saw that 20/20 investigation. The sheets were clean but the comforters had bacteria all over them.


In retrospect, the germs you'd get in a hotel might be just as bad as the ones we hear about in the hospitals, because hotels are for folks "from away" and local bacteria and viruses differ significantly across county lines, much less state or national boundaries. I once heard it said that if you leave town for three months, you'll come back to an entirely different microbial suite, and have to build immunity again. This is not a problem for healthy people.


I have done it a few times; it works out just fine.  More cost to the mother.  I generally have them get a room at the end of a corridor so it is close to an outside entrance.  I don't bring my things in through the lobby, and we don't tell them what we plan to do.

I have the parents bring a plastic mattress cover (check on the bed size) and their own towels and sheets.  They need to remember a car seat. They will probably want a cooler with food and drinks.  The mom I worked with brought candles, incense, colored scarves to throw over the light fixtures, and had a room with a huge Jacuzzi.  We did scrub it out before she used it.



Birth and Ecological or Environmental Considerations



The Ecology of Raising Children by Peggy O'Mara

The Technocratic Body: American Childbirth as Cultural Expression by Robbie Davis-Floyd

How do we change this trend toward more drugs for birth, more machines?....If we get back to caring about the Earth, being caretakers, it would be difficult not to translate that into other parts of our lives. Sooner or later people will ask themselves how they can give birth drugged and hooked up to machines, when they are trying to stop treating their own Mother Earth that way.


Birthing Noises



See also:  Vocalizations/Singing/Sounds During Labor


The whole Katie Holmes thing has everyone talking and it's got me thinking. Most women make noise in labour, and during my training i regularly heard my mentors telling women " Making noise uses up energy = put that energy into your pushes" but is this the case? I honestly don't know, it rings true, but if it uses up essential energy then why do most women do it? I have a belief that left to its own the human body does what is necessary to birth a baby, so these noises can't be expending all this energy- any thoughts?


It does depend on the noise - birth noises to me are a great thing, and women who are making them are acting spontaneously and following their bodies, but some of the noises heard on the labour ward are those of fear and a lack of support etc. by being in a place that is artificial with regard to physiological birth and therefore may be expending energy that is being wasted. Perhaps your mentors should not so much have been trying to encourage quiet but should be looking at why these women feel the need to make these fearful noises.

With regard to Katie Holmes I did get the feeling that some of the media comments may have been taken a little out of context in that they may actually want quiet at the birth not so much a case of silencing Katie but ensuring a quiet atmosphere for the moment of birth - or I may be wrong!!


I read some of the religious teaching, and I think it is totally silent due to their beliefs about memory, also read the baby cannot be spoken to or endure any medical testing for 7 days because the trauma of birth is such it is subconsciously stored and any other communication/activities that occur around this time would also be "recorded".  Seems she could have all the pain meds desired to assist with this though (unlike the media have stated).

This is from scientology.org

What is a quiet or silent birth?

Having a quiet, gentle birth is all about providing the best possible environment for the birthing mother and her new baby. It is labor and delivery done in a calm and loving environment and with no spoken words by everyone attending as much as possible. Chatty doctors and nurses, shouts to "PUSH, PUSH" and loud or laughing remarks to "encourage" are the types of things that are meant to be avoided. As L. Ron Hubbard, Founder of Dianetics and Scientology, wrote, "Everyone must learn to say nothing within the expectant mother's hearing during labor and delivery." And, "A woman who wants her child to have the best possible chance will find a doctor who will agree to keep quiet especially during the delivery, and who will insist upon silence being maintained in the hospital delivery room as far as it is humanly possible."

Does this mean that a mother cannot scream or moan at all? Of course they can make noises - the point of silent birth is NO WORDS. This is a principle of Dianetics and to fully understand why, read the book Dianetics the Modern Science of Mental Health, by L. Ron Hubbard. It is words that are the culprit. Outside of not speaking, the objective is generally to have as peaceful and relaxing an environment as possible for the mother and child. It is doubtful that any woman could give birth without making any noise at all.

Mothers naturally want to give their baby the best possible start in life and thus keep the birth as quiet as possible.

Does the application of these principles preclude a mother from using medicines?
The Church has no policy against the use of medicines to help a person with a physical situation. This, too, is up to the mother and her doctor.


Just my personal opinion-( not sure if there's any research etc.)., But if that's the way a woman copes with labour, especially if it's largely drug free, then it should be positively encouraged.

I'm not talking about the shouting at the dad " I hate you, you *******!!' etc., but the moans, moos, grunts etc., that most women will do, if left to their own devices. After all, birthing is a primal act- why should we try to civilise it? A woman feeling in control and relaxed enough to go with her body, is a large factor in  lessening  the chances of medical intervention.

I sincerely hope there isn't too many awful stern matronly midwives out there nowadays on labour ward that would try out and out to quiet a labouring woman?  perhaps any of you working on labour wards could enlighten us on this?


i found screaming my baby out during the last 20 minutes to be the right thing to do. my birth companion thought i ought to be quieter  and gently encouraged me to push instead (i didn't take any notice and she was worried as the midwife only arrived with 10 minutes to spare). if a professional asked me to be quiet i would have told her where to go.


I LOVE it when women moan, groan and are comfortable with what they need to do to get them through. Makes it easier for me too - can often be guided as to about where the woman is at in labour.


All I can think of is tennis players- that grunt along with that powerful swing.

Try pushing something over holding your breath, then try again with a grunt. There is no doubt in my mind that a grunt works wonders.


Yes, I suggest that my clients prepare their children for noises at birth by pretending to push a refrigerator across the room, and making big, loud noises, and telling children that labor is a lot of hard work and mommy may be making hard-work noises.


There's a commercial birth video called "Channel for a New Life" with Elizabeth Noble and Leo Sorger birthing their child in an outdoor hot tub.  She takes the record for the loudest noises I've ever heard at a birth.  Maybe when you're outdoors it feels easier for women to make those big noises.



Sexuality of Labor and Birth



How to have a sensual, drug-free birth - Forget epidurals. Midwives say they can train women to have births that are not only drug-free, but pleasurable - and even orgasmic. Anastasia Stephens reports [3/20/07]

For Katrina Caslake, giving birth was not the terrifying, painful ordeal most women experience. Far from it. The midwife, from Wallington, south London, says she found it blissful, even orgasmic. "I found giving birth very sensual," says Caslake, 44, who didn't take painkillers for the birth of either of her sons, Aaron and Tomas, now 18 and 17.

"All my erogenous zones were stimulated. I was making sounds very similar to a sexual climax. And it was a very definite climax. I was doing the most feminine thing a woman can do and it felt fantastic."

It's a sentiment with which Frederika Deera, a PR officer at John Lewis in London, would agree. She had a similar experience giving birth to her two-year-old daughter Delphine.

"Giving birth filled me with the most indescribable euphoria," says Deera, who gave birth at a midwife-led unit in Portsmouth. "Of course there was pain, but my overall sense was of peace and happiness.  . . ."


Sensual Pregnancy and Birth Articles from Laura Shanley's pages


The Benefits of Having Sex in Labour by Laura Shanley


Birth Erotica & The Truth About Birth, excerpts from the writings & research of Laura Kaplan-Shanley


Passionate Childbirth - Birth is a unique feminine experience. When giving birth, our feminine sexual organs are stimulated and our sex hormones activated. Birth is an instinctive and primal act that connects us to our powerful feminine roots. Learn how to connect with your femininity prior and during birth, embrace your sexuality, and allow the birth process to empower you!



Miscellaneous




Which Birth Dates are Most Common?

Fun things to notice:




Full moon birth effect 'cast in shadow'
Source: American Journal of Obstetrics and Gynecology 2005; 192: 1462-4

Examining whether the frequency of deliveries or delivery complications varies with the lunar cycle.

An analysis of 5 years of data has failed to confirm a predictable influence of the lunar cycle on the frequency of deliveries or birth complications, casting doubt on the pervasive superstition that the delivery floor is busiest during the full moon.

The effect of the lunar cycle on frequency of births and birth complications.
Arliss JM, Kaplan EN, Galvin SL.
Am J Obstet Gynecol. 2005 May;192(5):1462-4.

CONCLUSION: An analysis of 5 years of data demonstrated no predictable influence of the lunar cycle on deliveries or complications. As expected, this pervasive myth is not evidence based.

[Editor - This "pervasive myth" assumes that people are living in an environment influenced by lunar light, which is no longer the reality for the women involved in this study.  From the abstract, it does not appear that this study took into account inductions and scheduled cesareans, which would naturally be scheduled to fill in the spaces left by naturally occurring births.  And from an evidence-based point of view, the conclusion reveals the strong bias of the "investigators".]


I like this Pain Faces Scale, also called the Faces Pain Scale.


Being a mom can boost brain power - In "The Mommy Brain: How Motherhood Makes Us Smarter" (Perseus, $15), author Katherine Ellison faces down fears many women harbor that kids will make them too scattered, frazzled and ditsy to be valuable in the business world. Her book tracks Ellison's exploration of on-the-cusp scientific research in neurology and psychology. It all suggests that motherhood has the potential to make women better at many tasks, including managing stress, multi-tasking and dealing with people.


Biggest Baby - this is the beginnings of a collection of stories about big babies:


19.2 Pound Bundle of Joy - Ani from Indonesia gave birth to a 19.2-lb. bruiser, the heaviest newborn ever recorded in the country.  The birth was a cesarean.

Baby Charlie Stokes - 15lb 2oz, born to Joanne Stokes of Calne, England, by natural childbirth at the Royal United Hospital in Bath on February 16, 2005

A Colombian woman has given birth to a 15-pound baby, the largest in 40 years in Madrid's main maternity hospital. [2/22/06, MADRID, Spain]

The record belongs to an American infant born in 1879. He weighed 23 pounds, 12 ounces. Sadly, he died a few hours after being born. An ABC station reports that the heaviest baby to survive weighed 22 lbs., 8 ounces.


One in 300 Births Occurs in Motor Vehicle, Survey Says - [May 29, 2003] Kaiser's Daily Reproductive Health Report


Doctors 'find dead foetus in boy' - [6/26/05] - Doctors in Kazakhstan, Bangladesh,  say they have removed a long-dead foetus from the abdomen of a teenage boy who was complaining of stomach pains. Abu Raihan was admitted to the Bangabandhu Medical University hospital in the capital, Dhaka was carrying a foetus weighing two kilograms (4.5lbs) in his abdomen,".  The condition is known as "foetus in foeto", or inclusion twin.

In April, 2003, doctors at Chimkent Children's Hospital in Kazakhstan discovered the dead foetus of a twin brother when operating on a seven-year-old boy. The foetus had developed into a tumour but was found to have hair, nails and bones.


Boy born with fetus in his stomach - Condition occurs in 1 in 500,000 live births [11/24/06]

SANTIAGO, Chile - A boy has been born in Chile with a fetus in his stomach in what doctors said was a rare case of "fetus in fetu" in which one twin becomes trapped inside another during pregnancy and continues to grow inside it.
Doctors carried out a scan on the boy's mother shortly before she gave birth on Nov. 15 in the southern city of Temuco and noticed the 4-inch-long fetus inside the boy's abdomen.
It had limbs and a partially developed spinal cord but no head and stood no chance of survival, doctors said.
After the birth, doctors operated and removed the fetus from the boy's stomach. The boy, who has not been named, was recovering at Temuco's Hernan Henriquez hospital.
"It's very rare," said Maria Angelica Belmar, head of the hospital's neonatal wing, speaking of fetus in fetu cases.
"It occurs in only one in every 500,000 live births," she told Reuters, adding that the number of cases recorded worldwide was fewer than 90.


When do Babies Come? - Childbirth prefers early afternoon [4/11/04]

"WASHINGTON: A new research has shown that early afternoon is the most common time for child birth with fall the most common season.

According to a report in Web MD, in labor-and-delivery, 1 pm to 2 pm is the prime time, reports researcher Peggy J Mancuso, a nursing professor at the Texas Women's University.  Her paper appears in this month's Obstetrics and Gynecology.

In her study, Mancuso analyzed one year's worth of deliveries at Parkland Hospital in Dallas. Only spontaneous-labor births (not cesarean sections) of one baby - not  multiples - to women considered low risk for complications.

Mancuso found that child-births occurred equally on any given day and every hour of the day, a baby was born. Also, fewest births were between 10 am and noon. She also found that most births occurred in the fall, between September and November and child-births were least common in the winter during the months December through February.

The mother's age didn't make a difference in delivery time. Daylight Savings Time didn't affect the birth patterns either. It's not clear what influences the time of a birth, but it may be the mother's and baby's hormones, Mancuso wrote.

The seasonal patterns in child-birth have been observed in other studies, and appear to be related to the weather."

I wish they had studied when labor STARTS, which is of much more interest to families and midwives.  I guess hospitals need to know when babies are actually born, since that's when they need extra staff.  But labor tends to start either with contractions in the middle of the night from the nightly surge of oxytocin, or during the day if the baby pokes a hole through the membranes and starts leaking some amniotic fluid, with all those lovely prostaglandins for ripening the cervix and starting labor.


Contraction Master is a great new tool for helping pregnant mothers and their partners easily and accurately time labor contractions.


Foaling Pictures and The Gentle Art of Equine Imprinting from Glory Gait Walkers


Mother Care, Whelping Information & Beautiful Canine Birth Pictures! from Mari-May Kennels


Information about Hydrocephalus and D&X



This Web page is referenced from another page containing related information about Waterbirth

 




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