Three Rivers Birth Services

Women who give birth in prison in most states are regularly shackled, preventing them from moving about during labor, and as anyone knows who’s ever attended one, women almost always move and change position during birth.  Although the American College of Obstetricians and Gynecologists (ACOG) has released a position saying that this is inhumane, only five states have outlawed the practice.  New York state will soon sign a bill into law and become the sixth state to outlaw shackling during childbirth. Incarcerated women in Washington State may are not shackled during birth as corrections policies forbid it, although there is no law on the books banning the practice. Quote from the NYT article:

“It is unbelievable that in this day and age a child is born to a woman in shackles,” Mr. Erato [a husband of a woman who was shackled during birth who had committed a nonviolent crime] said. “It sounds like something from slavery 200 years ago.”

In most cases, people who have studied the issue said, women are shackled because prison rules are unthinkingly exported to a hospital setting.

“This is the perfect example of rule-following at the expense of common sense,” said William F. Schulz, the executive director of Amnesty International U.S.A. “It’s almost as stupid as shackling someone in a coma.”

Clearly this is a controversial subject, as women who have been imprisoned are sometimes a violence risk, even if most are not.  Yet, could there be other ways of handling the situation, with guards standing by?  Is shackling inhumane treatment?  Thought-provoking articles from Salon.com and the New York Times here and here.

I often get emails and phone calls from doula clients or moms who have taken my class when they learn that because of a medical necessity (interuterine growth restriction, gestational diabetes,  high blood pressure, 41+ weeks pregnant, etc.) they face induction at a certain date if they don’t go into labor on their own.  This happened recently as a matter of fact, so I wanted to share with you what I tell them.

Dear [mom]:

You know you are down to a few days of needing to go into labor on your own soon or else you will face induction.  And that’s bound to bring up a lot of anxiety (and with it, adrenaline).  Sometimes just feeling this anxiety can actually keep our bodies from going into labor (remember the tigers exercise from class).  I understand it can be quite stressful to feel a time crunch like this and that is very natural.  So be gentle with yourself.  I also think it may be beneficial to try and stay in this moment as much as you can, knowing you are in the laborinth and that you don’t know what twists and turns you will make but that your baby is in the center of this journey.

I totally support you looking to try and go into labor before your induction date as long as you don’t feel it is putting undo pressure on yourself or causing more anxiety than it solves (remember – adrenaline can block birth hormones) .  Perhaps something will work.  Or – perhaps your mind may want to go into labor to avoid induction, but your body has other plans and there may not be much you can do about it.  So because we cannot know which outcome will happen, if you do try some things, try to holding no attachment to a specific outcome but instead approach each thing you try as an experiment and with curiosity.  Oddly, this can do wonders for success.  This is because if you hold a specific outcome in your heart, it can be easy to start blaming yourself or your body when you can’t force labor to start – and that can translate into negative feelings in the middle of the birth itself if you do need to go the induction route.  A few things you can try are nipple stimulation, getting your membranes stripped, having sex a lot with the semen staying inside of your vagina (I know, TMI), going in for an acupuncture and/or chiropractor appointment (ask me for names of providers who have specific experience with overdue mothers).  You can also try walking but that may also wear you out more than it may do much good and depleat your energy reserves you’ll need for the birth.  And walking hasn’t shown to induce labor, statistically, but it can help align the baby.

Another idea – perhaps in addition to or instead of trying to make labor start, how about focusing your energies on helping yourself relax.  It can actually help you go into labor by stopping any adrenaline, but even if it does not, it make help you to relax for the induction itself and allow your induction to be more successful.  This also helps you to be less attached to a specific outcome.

So how do you relax normally?  A bath?  A swim?  Music?  A movie?  A romantic dinner?  Time with friends?  Reading a book alone?  Meditation?  Yoga?  A massage at the spa?  A pedicure?  More of the acupuncture?  Or you can try to release some of the anxiety with some birth art, journaling, prayer, or talking about the situation with someone who helps you feel better when you are in a difficult situation.  You can even do something nice for yourself each day you are still pregnant.  You know yourself well and know what will help you release physical and emotional tension more than anyone else.

Here are some things to think about with regards to induction, which should be discussed with your provider:

• - Cervidil (prostaglandins) vs. Cytotec (misoprostol) for cervical ripening, if your cervix is not very dilated.  Cervidil is a lot more expensive and more gentle.  Cytotec is very cheap for the hospitals and therefore favored by many docs but produces very strong labor patters that are hard to stay on top of without an epidural (but I have seen it done a couple of times).  The upside to Cytotec is that since it is stronger, it works better some believe. (Hard decisions in birth…)
• - Ask for a “whiff” (low dose) of Pitocin to get things started.  Ask to be part of the decision-making process on when to up the dosage (the way Pitocin works is they up the dosage every few minutes to mimic the way labor increases oxytocin).  Ask if you can get it shut off if things are very active – your body may take over on its own.
• - If the induction doesn’t seem to be working, and if your membranes are still intact, you can ask about having the induction stopped and trying again in a few days.
• - You can opt not to do any Pitocin and have the doctor release your membranes to start your labor up instead.  However, know that once your waters are broken, you don’t have the option to stop the induction – the baby has to come out one way or the other to avoid infection.  Most providers will put your on a 24 hour timeline.  However, most providers probably want you to have the baby before then anyway (although some will wait longer as long as everything looks great on the monitors).  Some providers who are normally more patient may change things when they switch to induction (active management vs. expectant management of labor).  It is good to know where your doctor stands on this issue before you get into the induction.
• - Ask what your Bishop’s Score is.  It is a score out of ten and you get two points each for things like dilation, how low the baby is, cervical softness, etc.  http://en/wikipedia.org/wiki/bishop_score You may even be able to deduce the score yourself, or at least your score from the last appointment (knowing it has only gotten better).  If it is over an eight, there is a very good chance that an induction will work easily.  On the other hand, a score that high also means that you will go into labor very soon…  If it is less than seven, the induction has a lesser chance of being successful (but a cervical ripening agent such as Cervidil or Cytotec can help).  Knowing this score may help you with your provider decide how to proceed with the plan for induction including medications and timing.
• - It may be good to have the pain medications discussion again with your doula/husband/provider, and with yourself.  Many women’s choices change once they know they will be having an induction, and it is important you let people know who will be at the birth with you if this is the case for you.  You can look up the “Pain Medications Preference Scale” in the packet you got from me in class.  I’ve seen women opt for epidurals when they know that they are having an induction, and I’ve seen an equal number of women choose to go without and succeed – and all were happy with their choices for pain management.
• Also know that any type of induction is going to automatically mean that there will be more interventions to keep you safe.  It may not have been part of your original plan and even the plan you had talked about with your provider in the first place will probably change in the event of an induction.  If you decide to proceed with induction, it is prudent to have a detailed conversation about labor options all over again, now that the game plan is changed.

I know I may have totally overwhelmed you with information, but remember, having this many options is a good thing!  My goal is to help you still have some control even as control seems to be slipping away from you right now.  You can OWN this induction!  I have faith that you will be able to navigate the path of your birth, no matter what it brings!

I don’t wish morning sickness (which should really be called all-day sickness!) on my worst enemy, but if you do happen to have a really severe case of it where you have persistant nausea and vomiting and significant weight loss, it is called hyperemesis gravidarum and calls for treatment.  Morning sickness this severe is rare, but it can lead to serious problems like dehydration, malnutrition, electrolyte imbalance and, in severe cases, neurological disorders, spleen tearing, kidney failure and lung collapse. The condition also is linked with restricted fetal growth, preterm delivery and low birth weight.  Yep, that’s the worst case scenario – the ultimate morning sickness horror story – but most of us, on average, feel some nausea in the first trimester and may throw up a time or two, then things start to slow down at the 12 week mark.  Still, it’s not fun.  So what, if anything, can be done about it?

There are lots of natural remedies for morning sickness that may help, and if nothing else, might keep you busy for a while and give you hope.  Try some of these ideas in hot teas, in popsicles, in foods, as aromatherapy…you get the idea.  Here are a few ideas:

ginger (in foods, as aromatherapy, in tea…)

vitamin B6 (ask your care provider for dosage guidelines)

peppermint (in foods, as aromatherapy, in tea…)

hypnotherapy

acupressure spots on your wrist (SeaBands or ReliefBand, or do them manually – P6 is 3 finger widths down from your inner wrist)

a visit to the acupuncturist

MorningWell CD

Preggie Pops and B-Natal – Lollipops with Vitamin B6 in them, which has been shown clinically to reduce morning sickness

See your care provider for a prescription – Zofran is a prescription and has great results for many women but it is always good to read the drug information with  any medication.  It is a pregnancy category B drug, which is the second-safest category out of several.  Also, a care provider may be able to get you IV fluids which can help.

Eating small meals instead of large ones, watching what foods seem to set you off, and keeping a food/nausea journal.

Keeping saltine crackers by the bed to eat as you first wake up, so you have a gentle food in your stomach first thing

It’s been a while that I’ve updated this little blog of mine – oh my! – but I am committed to keep you all in the know about the latest birth research.  My lack of posting doesn’t mean I’m not working – in fact, I’m so busy teaching childbirth classes and doing doula work that I have overlooked updating my website! Check back here more often and I promise more good stuff is on the way.  I’ve got quite a slew of interesting studies tagged from the last few months that I need to let you know about.

First up – we’ve known for a long while that exercise is a good thing in pregnancy, yet there are still misconceptions out there – that exercising during pregnancy will make the baby too small or that it will cause a miscarriage or stillbirth.  But it actually turns out that remaining physically active even while pregnant may actually reduce the risk of complications.  And…drum roll…moderate exercise may actually reduce the length of labor.

“There has been quite a dramatic change in regards to pregnancy and exercise,” said Pivarnik, who has studied the topic for more than 20 years. “While it used to be thought that avoiding exercise meant avoiding harm to the fetus, research now shows physical activity can not only improve health of the mother but also provide potential long-term benefits for the child.”

The researchers recommend at least 150 minutes of moderate-intensite aerobic activity per week, spread out over several days.  So how can we get this activity in here in our community?

• Yoga or water aerobics classes for pregnant ladies: Check out Mid-Columbia Birth Network’s page on local fitness resources or just do a yoga tape at home.  Yoga is perfect for pregnancy – you get to learn breathing and meditation as well as exercise and it really helps prepare you for birth!  I do caution you to discuss with your provider and do some research if you really want to do Bikram-style yoga (also sometimes called “hot yoga” – the room is heated to very hot temperatures) as it raises the body’s core temperature, but normal yoga with a certified prenatal yoga instructor or a tape on yoga for pregnancy should be fine.

• Go for a walk on any of our great trails.  If you already have a child, you can push the babe in a stroller and you don’t have to pay for childcare – plus it’s a great to do with friends!  My personal faves are the Keene Road trail (stop by my house if you are in the neighborhood! I’m only a block and a half away!); the path along the Columbia River at either Columbia Park or between Howard Amon Park and Leslie Groves Park; or if you are feeling like a more strenuous workout, walk to the top of Badger Mountain.

• Pilates at Northwest Pilates or at one of the local gyms or with a pilates for pregnancy DVD.  Pilates builds strength at your core (abdominals, back and pelvic floor muscles) which is great for birth and also for after the baby is born!

While exercise in pregnancy is very beneficial, it is still a good idea to talk to your doctor or midwife before starting a program, especially if you are in a high-risk category.

And to end, watch this video just for fun!

Pregnant ladies breakdancing