Reducing Infant Mortality from Debby Takikawa on Vimeo.
Thursday, August 20, 2009
Tuesday, August 18, 2009
Monday, August 17, 2009
Induction Methods, Pros & Cons
Since I know that many of us who choose hospital births are often faced with the option or pressure to induce, I thought it would be helpful to have some information available of pros and cons of different MEDICAL induction techniques. Then, at a later date, I will post 'natural' or 'herbal' induction techniques to this same thread.
Definitions:
Induction- attempting to start labor before labor has started
Augmentation- attempting to speed labor once it has started
Non-Hormonal Induction/Augmentation Techniques:
Foley Catheter- a method of induction through forced dilation. This method includes inserting a catheter into the vagina, with a balloon attached to the end, which is placed in the cervical opening. Then, throughout a period of time, the balloon is slowly inflated to force cervical dilation.
Pros: many consider it a 'gentle induction'. No synthetic hormones are used.
Cons: greatly increased risk of infection. Increased risk of PROM (premature rupture of membranes - water is broken with no contractions), increased incidence of incomplete dilation, cervical swelling, and pelvic pain.
Stripping/Sweeping the Membranes- This technique involves a medical care giver inserting their fingers or scraping instrument into the vagina, past the cervix, and into the opening of the uterus. Then, in a 'sweeping motion', the bag of waters outermost layer (chorion) is broken away from (the seal) the cervical opening and uterine wall. This induction technique is made effective by the irritation created by the procedure causing the production of oxytocin, along with the forced dilation that is created by the manipulation of the cervix required to accomplish this procedure.
Pros: an outpatient procedure. Considered non-invasive.
Cons: increased risk of infection, increased incidence of PROM, can cause bleeding and pelvic pain with no labor.
Breaking The Bag of Water- aka AROM (artificial rupturing of membranes) or amniotomy. Both an induction and an augmentation technique. This involves snagging and tearing the chorion and amnion of the bag of waters with a amnihook. This is done in hopes that, the increased pressure of the fetus' skull against the cervix will cause dilation and enough irritation that oxytocin will either begin to be produced (induction) or production will increase (augmentation).
Pros: can be very effective. Considered non-invasive. Can be an outpatient procedure. Generally does not indicate the need for continous fetal monitoring, can shorten 1st stage labor by, an average of, 1 hour.
Cons: greatly increased risk of infection, increased risk of fetal bradycardia, cord prolapse, swelling of the cervix, incomplete dilation, or non-established contractions (necessitating another form of induction), increased contraction discomfort is reported, and can cause too fast of a labor.
Synthetic Hormonal Induction/Augmentation Techniques:
Misoprostol/Cytotec:There is a commission out there to stop cytotec use because of the amount of women who have experienced the side effects commonly associated with Cytotec use. There is also a linkherewhich is the label from Misoprostol and its side effects. Note: THIS IS NOT AN FDA CERTIFIED METHOD OF INDUCTION BECAUSE OF THE HIGH INCIDENCE OF RISKS WITH INDUCTION. This method of induction is that it is a cervical ripener - meaning that it is intended to soften, efface, and assist in dilation as a means of induction. It is administered through pill form. the pill is inserted vaginally and set against the cervix. Once administered, it cannot be removed. Also, 'smaller doses' are not a guarantee of less medication as the pill was not scored, manufactured evenly, nor manufactured with the intent to be broken.
Pros: fast acting, considered reliable
Cons: not FDA approved. Has the highest incidence of reported iatrogenic complications of all induction methods, cannot be removed once administered. Generally requires continuous fetal monitoring, and prosterate lie. Side effects include: fetal cranial nerve palsies, fetal death, maternal death, severe postpartum hemmhorage, uterine tetany, decreased uteroplacental blood flow, uterine rupture, necessitating hysterectomy, amniotic fluid embolism, placental retention, maternal and fetal shock, fetal bradycardia, uterine tachysystole, and higher incidence of c-section. Higher incidence of infection than pitocin.
Cervadil:Another vaginally inserted induction method. Generally in pill, wafer, or gel form, it is a synthetic prostaglandin. If administered as gel or wafer through 'tampon insert' or by a string, it can be removed once administered (in case of side effects). It has many of the same side effects as Cytotec, with a much smaller % of reported incidences. It is considered safer, though more expensive, as it carries less risk in ratio to reported incidences.
Pros: effective cervical ripener - considered less invasive than other means of induction. No IV required. Can be an overnight administration (administered, then sent home).
Cons: must remain reclined. Usually requires continuous fetal monitoring. Side effects include: fetal death, maternal death, severe postpartum hemmhorage, uterine tetany, decreased uteroplacental blood flow, uterine rupture, necessitating hysterectomy, amniotic fluid embolism, fetal bradycardia, uterine tachysystole, and higher incidence of c-section.. Carries higher risk of infection than pitocin.
Pitocin:an IV administered induction/augmentation method. It is a synthetic form of oxytocin, the hormone that regulates and initiates contractions. Once administered, it can be accelerated, reduced, and stopped at any time. The most regulatory of the three methods, it is also considered the 'safest'.
Pros: considered the safest, it can be regulated more easily than Cervadil or Cytotec. It carries a lower incidence of infection as it is not vaginally inserted. Can be mobile during administration.
Cons: it is more aggressive and invasive. 'continuous administeration' requires an IV pole. Generally requires continuous fetal monitoring. Risks include: Nausea/vomiting, stomach pain, maternal cardiac arrest, maternal respiratory distress, decreased maternal cardiac output, dizziness, lightheadedness, swelling, postpartum hemmhorage, seizures, headache, blurred vision, fetal and neonatal bradycardia, increased incidence of newborn jaundice, newborn seizures, feteal and maternal death.
Definitions:
Induction- attempting to start labor before labor has started
Augmentation- attempting to speed labor once it has started
Non-Hormonal Induction/Augmentation Techniques:
Foley Catheter- a method of induction through forced dilation. This method includes inserting a catheter into the vagina, with a balloon attached to the end, which is placed in the cervical opening. Then, throughout a period of time, the balloon is slowly inflated to force cervical dilation.
Pros: many consider it a 'gentle induction'. No synthetic hormones are used.
Cons: greatly increased risk of infection. Increased risk of PROM (premature rupture of membranes - water is broken with no contractions), increased incidence of incomplete dilation, cervical swelling, and pelvic pain.
Stripping/Sweeping the Membranes- This technique involves a medical care giver inserting their fingers or scraping instrument into the vagina, past the cervix, and into the opening of the uterus. Then, in a 'sweeping motion', the bag of waters outermost layer (chorion) is broken away from (the seal) the cervical opening and uterine wall. This induction technique is made effective by the irritation created by the procedure causing the production of oxytocin, along with the forced dilation that is created by the manipulation of the cervix required to accomplish this procedure.
Pros: an outpatient procedure. Considered non-invasive.
Cons: increased risk of infection, increased incidence of PROM, can cause bleeding and pelvic pain with no labor.
Breaking The Bag of Water- aka AROM (artificial rupturing of membranes) or amniotomy. Both an induction and an augmentation technique. This involves snagging and tearing the chorion and amnion of the bag of waters with a amnihook. This is done in hopes that, the increased pressure of the fetus' skull against the cervix will cause dilation and enough irritation that oxytocin will either begin to be produced (induction) or production will increase (augmentation).
Pros: can be very effective. Considered non-invasive. Can be an outpatient procedure. Generally does not indicate the need for continous fetal monitoring, can shorten 1st stage labor by, an average of, 1 hour.
Cons: greatly increased risk of infection, increased risk of fetal bradycardia, cord prolapse, swelling of the cervix, incomplete dilation, or non-established contractions (necessitating another form of induction), increased contraction discomfort is reported, and can cause too fast of a labor.
Synthetic Hormonal Induction/Augmentation Techniques:
Misoprostol/Cytotec:There is a commission out there to stop cytotec use because of the amount of women who have experienced the side effects commonly associated with Cytotec use. There is also a linkherewhich is the label from Misoprostol and its side effects. Note: THIS IS NOT AN FDA CERTIFIED METHOD OF INDUCTION BECAUSE OF THE HIGH INCIDENCE OF RISKS WITH INDUCTION. This method of induction is that it is a cervical ripener - meaning that it is intended to soften, efface, and assist in dilation as a means of induction. It is administered through pill form. the pill is inserted vaginally and set against the cervix. Once administered, it cannot be removed. Also, 'smaller doses' are not a guarantee of less medication as the pill was not scored, manufactured evenly, nor manufactured with the intent to be broken.
Pros: fast acting, considered reliable
Cons: not FDA approved. Has the highest incidence of reported iatrogenic complications of all induction methods, cannot be removed once administered. Generally requires continuous fetal monitoring, and prosterate lie. Side effects include: fetal cranial nerve palsies, fetal death, maternal death, severe postpartum hemmhorage, uterine tetany, decreased uteroplacental blood flow, uterine rupture, necessitating hysterectomy, amniotic fluid embolism, placental retention, maternal and fetal shock, fetal bradycardia, uterine tachysystole, and higher incidence of c-section. Higher incidence of infection than pitocin.
Cervadil:Another vaginally inserted induction method. Generally in pill, wafer, or gel form, it is a synthetic prostaglandin. If administered as gel or wafer through 'tampon insert' or by a string, it can be removed once administered (in case of side effects). It has many of the same side effects as Cytotec, with a much smaller % of reported incidences. It is considered safer, though more expensive, as it carries less risk in ratio to reported incidences.
Pros: effective cervical ripener - considered less invasive than other means of induction. No IV required. Can be an overnight administration (administered, then sent home).
Cons: must remain reclined. Usually requires continuous fetal monitoring. Side effects include: fetal death, maternal death, severe postpartum hemmhorage, uterine tetany, decreased uteroplacental blood flow, uterine rupture, necessitating hysterectomy, amniotic fluid embolism, fetal bradycardia, uterine tachysystole, and higher incidence of c-section.. Carries higher risk of infection than pitocin.
Pitocin:an IV administered induction/augmentation method. It is a synthetic form of oxytocin, the hormone that regulates and initiates contractions. Once administered, it can be accelerated, reduced, and stopped at any time. The most regulatory of the three methods, it is also considered the 'safest'.
Pros: considered the safest, it can be regulated more easily than Cervadil or Cytotec. It carries a lower incidence of infection as it is not vaginally inserted. Can be mobile during administration.
Cons: it is more aggressive and invasive. 'continuous administeration' requires an IV pole. Generally requires continuous fetal monitoring. Risks include: Nausea/vomiting, stomach pain, maternal cardiac arrest, maternal respiratory distress, decreased maternal cardiac output, dizziness, lightheadedness, swelling, postpartum hemmhorage, seizures, headache, blurred vision, fetal and neonatal bradycardia, increased incidence of newborn jaundice, newborn seizures, feteal and maternal death.
Pitocin FAQ's
Purpose of Pitocin
What is the purpose of pitocin?
Problems with Pitocin
Are there problems associated with the use of Pitocin?
"It DOES change the nature of the contractions. At the moment, I can't remember how, but they got worse in a way that was qualitative as well as quantitative" -Enid
Alternatives to Pitocin
Are there alternatives to using pitocin?
To induce labor:
Walking
Nipple Stimulation
Intercourse (Only if the bag of water is intact.)
Enemas
Castor Oil
Walking
Change positions
Avoid exhaustion
Nipple stimulation
Contraindications to Pitocin
Are there any contraindications to pitocin?
but are not limited to:
Fetopelvic Disproportion
Fetal Distress
Placenta Previa
Prior Classical Incision or Uterine Surgery
Active Genital Herpes Infections
Pain with Pitocin
Will there be more pain with pitocin?
"It was nothing like the gradual up and down they described in childbirth class. If you have to have labor induced with pitocin, imagine the worse as far as contractions. I had hoped to avoid an epidural but I believe that because of the pitocin, I had to have the epidural. I will try without next time as long as I don't need the pitocin." -Tracy
"The contractions on the pitocin were so intense and so completely different than the normal contractions. They were harsh, sudden and agonizing. I felt like I was utterly out of control and could not stand it." -Gena
When Pitocin Helps
Does Pitocin ever help?
Active Management of Labor
What is Active Management of Labor? And is it successful?
Pitocin After the Birth
Is pitocin necessary after birth?
Resources
Where can I get more information?
The Birth Bookby William and Martha Sears
Good Birth, Safe Birthby D. Korte and R. Scaer
Maternity and Gynecologic Careby Bobak and Jensen
Active Management of Laborby O'Driscoll, Boylan, & Meagher
AMLby Penny Simkin (There is a tape available from ICEA and she wrote an article forChildbirth InstructorSpring 1995.)
Friday, August 7, 2009
Placental Conditions
The placenta is an unborn baby's life support system. It forms from the same cells as the embryo and attaches to the wall of the uterus. The placenta forms connections with the mother's blood supply, from which it supplies oxygen and nutrients to the fetus. The placenta also connects with the fetus's blood supply, from which it removes wastes and returns them to the mother's blood. The mother's kidneys dispose of the waste.
Abruption occurs in about 1 in 100 pregnancies. It occurs most often in the third trimester, but it can happen any time after about 20 weeks of pregnancy.
The main sign of placental abruption is vaginal bleeding. A pregnant woman should contact her health care provider if she has vaginal bleeding.
If the health care provider suspects an abruption, she probably will recommend that the woman go to the hospital for a complete evaluation. The provider will do a physical examination and, most likely, an ultrasound examination. An ultrasound can detect many, but not all, cases of abruption.
How a woman is treated depends on the severity of the abruption and her stage of pregnancy.
The cause of abruption is unknown. However, the following factors can increase a woman's risk for abruption:
In most cases, abruption cannot be prevented. However, these steps may help a woman reduce her risk:
Placenta previa is a low-lying placenta that covers part or all of the opening of the cervix. This positioning of the placenta can block the baby's exit from the uterus. As the cervix begins to thin and dilate in preparation for labor, blood vessels that connect the abnormally placed placenta to the uterus may tear, resulting in bleeding. During labor and delivery, bleeding can be severe, endangering mother and baby.
Placenta previa occurs in about 1 in 200 pregnancies.
An ultrasound examination can diagnose placenta previa and pinpoint the placenta's location. The provider usually avoids doing a vaginal examination when placenta previa is suspected because the examination may trigger heavy bleeding.
How a woman with placenta previa is treated depends on her stage of pregnancy, the severity of the bleeding and the condition of mother and baby. The goal, whenever possible, is to prolong pregnancy until the baby is at or near full term. Cesarean delivery is recommended for nearly all women with placenta previa because c-sections usually can prevent severe bleeding.
The cause of placenta previa is unknown. However, certain factors can increase a woman's risk:
Placenta accreta refers to a placenta that implants too deeply and too firmly into the uterine wall. Similarly, placenta increta and percreta refer to a placenta that imbeds itself even more deeply into uterine muscle or through the entire thickness of the uterus, sometimes extending into nearby structures, such as the bladder.
These disorders occur in about 1 in 2,500 deliveries. They sometimes lead to the birth of a premature baby.
Like placenta previa, these disorders often cause vaginal bleeding in the third trimester.
These disorders occur most frequently in women who have placenta previa in the current pregnancy and also have a history of one or more c-sections or other uterine surgery.
These disorders can be diagnosed with an ultrasound examination. In some cases, another imaging technique called magnetic resonance imaging (MRI) may be recommended.
In these disorders, the placenta does not completely separate from the uterus as it should following the delivery of the baby. This can lead to dangerous hemorrhage following vaginal delivery. The placenta usually must be surgically removed to stop the bleeding, and often a hysterectomy (removal of the uterus) is necessary.
In some cases the placenta may not develop correctly or function as well as it should. It may be too thin, too thick or have an extra lobe, or the membranes may be improperly attached. Or problems can occur during pregnancy that damage the placenta, including infections, blood clots and areas of tissue destruction (infarcts). These placental abnormalities can contribute to a number of complications, such as miscarriage, poor fetal growth, prematurity, maternal hemorrhage at delivery and, possibly, birth defects. A doctor often will examine the placenta following delivery or send it to the laboratory, especially if the newborn has certain complications, such as poor growth, to help diagnose the cause of the problem.
The placenta has other important functions in pregnancy. It produces hormones that play a role in triggering labor and delivery. The placenta also helps protect the fetus from infections and potentially harmful substances. After the baby is delivered, the placenta's job is done, and it is delivered as the afterbirth.
The mature placenta is flat and circular and weighs about 1 pound. But sometimes the placenta:
Is structured abnormally
Is poorly positioned in the uterus
Does not function properly
Placental problems are among the most common complications of the second half of pregnancy. Here are some of the most frequent placental problems and how they can affect mother and baby.
What is placental abruption?
Placental abruption (sometimes called abruptio placentae) is a condition in which the placenta peels away from the uterine wall, partially or almost completely, before delivery. Mild cases may cause few problems, but severe cases can deprive the fetus of oxygen and nutrients. Severe cases also can cause bleeding in the mother that can endanger both her and the baby.
Placental abruption increases the risk of premature birth (birth before 37 completed weeks gestation). Studies suggest that abruption contributes to about 10 percent of premature births. Premature babies are at increased risk for health problems during the newborn period, lasting disabilities and even death. Abruption also increases the risk for poor fetal growth and stillbirth.
How common is placental abruption?
Abruption occurs in about 1 in 100 pregnancies. It occurs most often in the third trimester, but it can happen any time after about 20 weeks of pregnancy.
What are the symptoms of abruption?
The main sign of placental abruption is vaginal bleeding. A pregnant woman should contact her health care provider if she has vaginal bleeding.
The pregnant woman also may experience uterine discomfort and tenderness or sudden, continuous abdominal pain. In a few cases, these symptoms may occur without vaginal bleeding because the blood is trapped behind the placenta.
How is placental abruption diagnosed?
If the health care provider suspects an abruption, she probably will recommend that the woman go to the hospital for a complete evaluation. The provider will do a physical examination and, most likely, an ultrasound examination. An ultrasound can detect many, but not all, cases of abruption.
How is placental abruption treated?
How a woman is treated depends on the severity of the abruption and her stage of pregnancy.
A mild abruption usually is not dangerous unless it progresses. If a woman has a mild abruption at term, her health care provider may recommend prompt delivery (either by inducing labor or by c-section) to avoid any risks associated with a worsening abruption.
If a woman has a mild abruption and her fetus would be very premature if delivered immediately, her provider will probably admit her to the hospital for careful monitoring. If tests show that neither mother nor baby is having difficulties, the provider may try to prolong the pregnancy to avoid prematurity-related complications for the baby.
If the provider suspects that the abruption is likely to result in premature delivery between 24 and 34 weeks of pregnancy, she will probably recommend treatment with drugs called corticosteroids. These drugs speed maturation of the fetal lungs and significantly reduce the risk of prematurity-related complications and infant deaths.
Some women with mild abruptions may be able to go home after the bleeding stops, while others may need to stay in the hospital until delivery.
If an abruption progresses, a woman is bleeding heavily, or the baby is having difficulties, a prompt delivery, usually by c-section, probably will be necessary.
What causes placental abruption?
The cause of abruption is unknown. However, the following factors can increase a woman's risk for abruption:
Cocaine used
High blood pressure
Cigarette smoking
Abdominal trauma (such as may occur with an automobile accident or abuse)
Certain abnormalities of the uterus or umbilical cord
Being more than 35 years of age
Pregnant with twins, triplets or more
Premature rupture of the membranes (bag of waters)
Having too little amniotic fluid
Having certain inherited disorders of blood clotting
Having an infection involving the uterus
What is the risk of an abruption happening again in another pregnancy?
A woman who has had an abruption has about a 10 percent chance of it happening again in a later pregnancy.
What can a woman do to reduce her risk for abruption?
In most cases, abruption cannot be prevented. However, these steps may help a woman reduce her risk:
Keep high blood pressure under control.Women who have high blood pressure should see their health care provider regularly and take medication, if recommended. Women who are not yet pregnant should see their provider for a preconception checkup to get their blood pressure under control right from the start.
Avoid cigarettes and cocaine.These contribute to abruption and other pregnancy complications.
Wear a seat belt.This can help prevent trauma resulting from auto accidents.
Discuss possible treatments for blood clotting disorders with a health care provider.Some women with inherited blood clotting disorders may benefit from treatment, for example with blood-thinning drugs, during pregnancy. Some providers recommend treatment to affected women who have had an abruption or other pregnancy complication that may be linked with a blood-clotting disorder.
What is placenta previa?
Placenta previa is a low-lying placenta that covers part or all of the opening of the cervix. This positioning of the placenta can block the baby's exit from the uterus. As the cervix begins to thin and dilate in preparation for labor, blood vessels that connect the abnormally placed placenta to the uterus may tear, resulting in bleeding. During labor and delivery, bleeding can be severe, endangering mother and baby.
As with placental abruption, placenta previa can result in the birth of a premature baby.
How common is placenta previa?
How common is placenta previa?
Placenta previa occurs in about 1 in 200 pregnancies.
What are the symptoms of placenta previa?
The most common symptom of placenta previa is painless uterine bleeding during the second half of pregnancy. Women who experience vaginal bleeding in pregnancy should contact their health care provider.
How is placenta previa diagnosed?
An ultrasound examination can diagnose placenta previa and pinpoint the placenta's location. The provider usually avoids doing a vaginal examination when placenta previa is suspected because the examination may trigger heavy bleeding.
Some women who have not experienced vaginal bleeding learn during a routine ultrasound examination that they have a low-lying placenta. A pregnant woman should not be too worried if this happens to her, especially if she is in the first half of pregnancy. More than 90 percent of the time, placenta previa diagnosed in the second trimester corrects itself by term.
How is placenta previa treated?
How a woman with placenta previa is treated depends on her stage of pregnancy, the severity of the bleeding and the condition of mother and baby. The goal, whenever possible, is to prolong pregnancy until the baby is at or near full term. Cesarean delivery is recommended for nearly all women with placenta previa because c-sections usually can prevent severe bleeding.
When a woman develops significant bleeding due to placenta previa after about 34 weeks of pregnancy, her provider may recommend a prompt c-section. Babies born after this time usually do well, though some have mild prematurity-related health problems during the newborn period.
Women who develop bleeding as a result of placenta previa before about 34 weeks are generally admitted to the hospital, where they can be monitored closely. If tests show that mother and baby are doing well, the provider will probably attempt to prolong the pregnancy. In some cases, when there has been a significant amount of bleeding, the mother may be treated with blood transfusions. She also will be treated with corticosteroid drugs if she is likely to deliver before 34 weeks.
Some women are able to go home after bleeding stops, but others must remain in the hospital until delivery. At 36 to 37 weeks, if she hasn't delivered, the provider may suggest a test of the amniotic fluid (obtained by amniocentesis) to see if the baby's lungs are mature. If they are, the provider will likely recommend a c-section at that time to prevent risks associated with any future bleeding episodes.
At any stage of pregnancy, a prompt c-section may be necessary if the mother develops dangerously heavy bleeding, or if mother or baby is having difficulties.
What causes placenta previa?
The cause of placenta previa is unknown. However, certain factors can increase a woman's risk:
Cigarette smoking
Cocaine use
Being more than 35 years of age
Second or later pregnancy
Previous uterine surgery, including a c-section; a D&C (dilation and curettage, in which the lining of the uterus is scraped), which is often done following a miscarriage or during an abortion
Pregnant with twins, triplets or more
What is the risk of placenta previa happening again in another pregnancy?
A woman who has had a placenta previa in a previous pregnancy has a 2 to 3 percent chance of a recurrence.
Can a woman reduce her risk for placenta previa?
There is no way to prevent placenta previa. However, a woman may be able to reduce her risk by avoiding using cigarettes and cocaine. She also may be able to reduce her risk in future pregnancies by avoiding having an elective c-section (i.e., a c-section scheduled for convenience), unless there is a medical reason.
An interesting side note or placenta previa:
Many women are told at the 20 week scan that they have placenta previa. Im told the percentage is high, probably 8 out of 10 women. This is because at 20 weeks you are only half way through your pregnancy and your baby and placenta still have lots of growing to do. Most of the time the placenta will "move" and you will no longer have true placenta previa. Now the placenta wont actually move. When it implants it stays in the same spot. To give you an example, when you take a deflated balloon and you draw a spot on it with a marker and then you blow it up that spot appears to move location even though it is not moving. Likewise with the expansion of the uterus the placenta is more than likely going to "move". So if you get this diagnosis at your 20 week scan, no need to worry just yet.
What is placenta accreta?
Placenta accreta refers to a placenta that implants too deeply and too firmly into the uterine wall. Similarly, placenta increta and percreta refer to a placenta that imbeds itself even more deeply into uterine muscle or through the entire thickness of the uterus, sometimes extending into nearby structures, such as the bladder.
How common are placenta accreta and related disorders?
These disorders occur in about 1 in 2,500 deliveries. They sometimes lead to the birth of a premature baby.
What are the symptoms of placenta accreta and related disorders?
Like placenta previa, these disorders often cause vaginal bleeding in the third trimester.
Who is at risk for placenta accreta and related disorders?
These disorders occur most frequently in women who have placenta previa in the current pregnancy and also have a history of one or more c-sections or other uterine surgery.
How are placenta accreta and related disorders diagnosed?
These disorders can be diagnosed with an ultrasound examination. In some cases, another imaging technique called magnetic resonance imaging (MRI) may be recommended.
How are placenta accreta and related disorders treated?
In these disorders, the placenta does not completely separate from the uterus as it should following the delivery of the baby. This can lead to dangerous hemorrhage following vaginal delivery. The placenta usually must be surgically removed to stop the bleeding, and often a hysterectomy (removal of the uterus) is necessary.
When placenta accreta is diagnosed before birth, a c-section immediately followed by a hysterectomy may be planned in order to reduce blood loss and complications in the mother. In some cases, other surgical procedures can be used to save the uterus.
What are some other placental problems?
In some cases the placenta may not develop correctly or function as well as it should. It may be too thin, too thick or have an extra lobe, or the membranes may be improperly attached. Or problems can occur during pregnancy that damage the placenta, including infections, blood clots and areas of tissue destruction (infarcts). These placental abnormalities can contribute to a number of complications, such as miscarriage, poor fetal growth, prematurity, maternal hemorrhage at delivery and, possibly, birth defects. A doctor often will examine the placenta following delivery or send it to the laboratory, especially if the newborn has certain complications, such as poor growth, to help diagnose the cause of the problem.
Thursday, August 6, 2009
The Benefits of the Placenta
Placentophagia- the practice of eating the placenta- has been observed throughout history in many parts of the world. In Western cultures, eating the placenta is often viewed as barbaric, but thanks to new information about the surprising benefits, there has been a recent push amoung young mothers to eat the placenta after giving birth. While many Western doctors discourage placentophagia with the claim that it carries no inherent benefits, studies have shown that eating the placenta can curb postpartum depression, replentish nutrients, increas milk production, and slow postpartum hemmorrhage.
Placentophagia may deter the onset of postpartum depression
The placenta contains high levels of various vitamins, such as B6, which can help curb postpartum depression. Eating the placenta enables the mother to "reclaim" these vitamins and put them to use in her own body. Placentophagia may also increase a mother's blood levels of a hormone known as CHR (corticotrophin-releasing hormone), a known stress-reducer. This hormone is normally secreted by the hypothalamus. According to a study performed by the National Institues of Health (NIH), "During the last trimester of pregnancy, the placenta secretes so much CRH that the levels in the bloodstream increase threefold. However, it was also discovered that postpartum women have lower than average levels of CRH, triggering depressive symptoms. They concluded that the placenta secreted so much CRH that the hypothalamus stopped producing it. (http://placentabenefits.info/medical.asp). After childbirth, the hypothalamus doesn't immediately recieve the signal to begin producing CRH again, which can lead to postpartum depression. Eating the placenta can raise a mother's CRH levels, reducingsymptomsof postpartum depression.
Placentophagia may help replentish nutrients lost during childbirth
Human placenta is rich in various essential nutrients such as iron and protein. Placentophagia can help replentish these nutrients, which are often depleted during childbirth due to blood loss. This benefit of placentophagia may be especially important for vegetarian or vegan mothers, who may have slightly lower blood iron levels to begin with. (Many animals also practice placentophagia, presumably for this reason.)
Placentophagia can increase breastmilk production, especially in women at risk for low supply
For centuries, the Chinese have consumed the placenta as a way to increase insuffient milk production. In 1954, a study was conducted in wich 210 women, expected to have a low milk supply, were administered dried placenta. 86% of the mothers noticed a significant increase in milk production (http://placentabenefits.info/medicinal.asp). It follows, therefore, that placentophagia can be beneficial in stimulating breastmilk production, even for mothers who are not at risk for a low supply.
Placentophagia can stimulate uterine contractions and slow postpartum hemmorhage
Oxytocin is a naturally-occurring chemical in the brain that stimulates uterine contractions that lead to the onset of labor. This same chemical also enables the uterus to contract and quickly return to its pre-pregnancy size, as well as slowing postpartum bleeding. Studies have shown that eating the placenta triggers the release of oxytocin into the bloodstream, enabling the uterus to quickly heal and tone itself after childbirth.
Does placentophagia carry any inherent risks?
Many doctors, especially in Western culture, have expressed some concern that eating the placenta may spread disease such as HIV, hepatitis, and other blood-borne illness. However, placentophagia is traditionally practiced only by the mother and not by other parties, so there is no risk of spreading disease. If she has a disease, she cannot reinfect herself, and if she is not currently ill, she cannot become ill from eating her own placenta.
Other than that, there is little risk involved in placentophagia. As with any meat, the placenta must be properly cared for before consumption. Fresh placenta may be eaten raw, but if the placenta is to be stored and used at a later time, it should be frozen or otherwise prepared to prevent bacterial infection.
It is important to note that with some birth practices, such as lotus birth (in which the umbilical chord is left uncut until it dries and detaches naturally days after birth), eating the placenta is not possible due to the treatment of the placenta. However, in instances such as this, the placenta may be used for other purposes, such as placenta art, or the ritual of burial.
If you are interested in having your placenta encapsulated please contact me and I will find a certified specialist in your area.
Monday, August 3, 2009
Do You Have A Birth Plan?
What is a Birth Plan?
Communicating Your Wishes
Read more:http://www.myspace.com/genesisbirthservices/blog?page=3#ixzz0we7cDUK4
The term birth plan can actually be misleading — it's less an exact plan thana list of preferences. In fact, the goal of a birth plan isn't for you and your partner to determine exactly how the birth of your child will occur — because labor involves so many variables, you can't predict exactly what will happen. A birth plan does, however, help you to realize what's most important to you in the birth of your baby.
While completing a birth plan, you'll be learning about, exploring, and understanding your labor and birthing options well before the birth of your child. Not only will this improve your communication with the people who'll be helping during your delivery, it also means you won't have to explain your preferences right at the moment when you're least in the mood for conversation — during labor itself.
A birth plan isn't a binding agreement — it's just a guideline. Your doctor or health care provider may know, from having seen you throughout the pregnancy, what you do and don't want. Also, if you go into labor when there's an on-call doctor who you don't know well, a well thought-out birth plan can help you communicate your goals and wishes to the people helping you with the labor and delivery.
A few important notes
Birth plans are best kept short and to the point -- lots of details may be lost on medical support staff. You may wish to make several copies of the plan: one for you, one for your chart, one for your doctor or nurse-midwife, and one for your birthing coach or partner. And bringing a few extra copies in your labor bag is a good idea, especially if your doctor ends up not being on call when your baby is born. (about 10 copies in all)It isvery importantthat you talk about the procedures and/or choices that appear your plan with your caregiver(s). Not only do obstetric practices often vary by caregiver, hospital, state and country, there are often important factors involved. It is your responsibility to evaluate and understand each choice you make.
What Questions Does a Birth Plan Answer?
A birth plan typically covers three major areas:
1. What are your wishes during a normal labor and delivery?
These range from how you want to handle pain relief to enemas and fetal monitoring. Think about the environment in which you want to have your baby, who you want to have there, and what birthing positions you plan to use.
2. How are you hoping for your baby to be treated immediately after and for the first few days after birth?
Do you want the baby's cord to be cut by your partner? If possible, do you want your baby placed on your stomach immediately after birth? Do you want to feed the baby immediately? Will you breastfeed or bottle-feed? Where will the baby sleep— next to you or in the nursery? Hospitals have widely varying policies for the care of newborns — if you choose to have your baby in a hospital, you'll want to know what these are and how they match what you're looking for.
3. What do you want to happen in the case of unexpected events?
No one wants to think about something going wrong, but if it does, it's better to have thought about your options in advance. Since some women need cesarean sections (C-sections), your birth plan should probably cover your wishes in the event that your labor takes an unexpected turn. You might also want to think about other possible complications, such as premature birth.
Factors to Consider
Before you make decisions about each of your birthing options, you'll want to talk with your health care provider and tour the hospital or birthing center where you plan to have your baby.
You may find that your obstetrician, nurse-midwife, or the facility where they admit patients already has birth-plan forms that you can fill out. If this is the case, you can use the form as a guideline for asking questions about how women in their care are routinely treated. If their responses are not what you're hoping for, you might want to look for a health provider or facility that better matches your goals.
And it's important to be flexible — if you know one aspect of your birthing plan won't be met, be sure to weigh that aspect against your other wishes. If your options are limited because of insurance, cost, or geography, focus on one or two areas that are really important to you. In the areas where your thinking doesn't agree with that of your doctor or nurse-midwife, ask why he or she usually does things a certain way and listen to the answers before you make up your mind. There may be important reasons why a doctor believes some birth options are better than others.
Finally, you should find out if there are things about your pregnancy that might prevent certain choices. For example, if your pregnancy is considered high risk because of your age, health, or problems during previous pregnancies, your health care provider may advise against some of your birthing wishes. You'll want to discuss, and consider, this information when thinking about your options.
What Are Your Birthing Options?
In creating your plan, you're likely to have choices in the following areas:
Where to have the baby.
Most women still give birth in the hospital. However, most are no longer confined to a cold, sterile maternity ward. Find out if your hospital practices family-centered care. This usually means the patient rooms will have a door, furnishings, a private bathroom, and enough space to accommodate a family, including the baby's crib and supplies.
Additionally, many hospitals now offer birthing rooms that allow a woman to stay in the same bed for labor, delivery, and sometimes, postpartum care (care after the birth). These rooms are fully equipped for uncomplicated deliveries. They're often attractive and have gentle lighting.
But some women believe that the most comfortable environment is their own home. Advocates of home birth believe that labor and delivery can and should occur at home, but they also stress that a certified nurse-midwife or doctor should attend the birth. An important thing to remember about home birth is that if something goes wrong, you don't have the amenities and technology of a hospital. It can take a while to get to the hospital, and during a complicated birth those minutes can be invaluable.
For women with low-risk pregnancies who want something in between the hospital and home, birthing centers are a good option. These provide a more homey, relaxed environment with some of the medical amenities of a hospital. Some birthing centers are associated with hospitals and can transfer patients if necessary.
Who will assist at the birth.
Most women choose an obstetrician (OB/GYN), a specialist who's trained to handle pregnancies (including those with complications), labor, and delivery. If your pregnancy is considered high risk, you may be referred to an obstetrician who subspecializes in maternal-fetal medicine. These doctors have specialized training to care for pregnant women with medical conditions or complications, as well as their fetuses.
Another medical choice is a family practitioner who has had training and has maintained expertise in managing non-high-risk pregnancies and deliveries. In some areas of the United States, especially rural areas where obstetricians are less available, family practitioners handle most of the deliveries. As your family doctor, a family practitioner can continue to treat both you and your baby after birth.
And doctors aren't the only health care providers a pregnant woman can choose to deliver her baby. You might decide that you want your delivery to be performed by a certified nurse-midwife, a health professional who's medically trained and licensed to handle low-risk births and whose philosophy emphasizes educating expectant parents about the natural aspects of childbirth.
Increasing numbers of women are choosing to have adoula, or birth assistant, present in addition to the medical personnel. This is someone who's trained in childbirth and is there to provide support to the mother. The doula can meet with the mother before the birth and can help communicate her wishes to the medical staff, should it be necessary.
Your birth plan can also indicate who else you'd like to have with you before, during, and immediately after the birth. In a routine birth, this may be your partner, your other children, a friend, or other family member. You can also make it clear at what points you want no one to be there but your partner or doula.
Atmosphere during labor and delivery.
Many hospitals and birthing centers now allow women to make some choices about the atmosphere in which they give birth. Do you want music and low lighting? How about the freedom to walk around during labor? Is a hot tub something you'd like access to? If possible, would you like to eat or drink during labor? You might be able to request things that may make you the most comfortable — from what clothes you'll wear to whether you'll have a VCR or DVD player in your room.
Birth plans are relatively new inventions, and your doctor or nurse-midwife may not be completely comfortable with them. For this reason, make sure you communicate clearly that you intend to create a birth plan. Give your health care provider your reasons for doing so —not because you don't trust him or her, but to help ensure cooperation and to cover the possibilities if something should go wrong. If your caregiver seems offended or is resistant to the idea of a birth plan, you might want to reconsider whether this is the right caregiver for you.
Also, think about the language of your plan. You can use many online resources to create one or you can make one yourself. Here are some tips:
Make your birth plan read like alist of requests or best-case scenarios, not like a set of demands. Phrases such as "I would prefer" and "if medically necessary" will help your health care provider and caregivers know that you understand that they might have to alter the plan.
Think about the other personnel who'll be using it — hospital staffers might feel more comfortable if you call it your "birth preferences" rather than your "birth plan," which could seem as though you're trying to tell them how to do their jobs.
Try to be positive ("we hope to") as opposed to negative ("under no circumstances").
Once you've made your birth plan, schedule a time to go over it with your doctor or nurse-midwife. Find out and discuss where you agree or disagree. During your pregnancy, review the birth plan with your partner periodically to make sure that it's still in line with both of your wishes.
Strive to keep the plan as simple as possible— preferably less than two pages — and list them in order of importance. Focusing on your priorities will help ensure that the most important of your wishes are met.
Although you might not be able to control everything that happens to you during your baby's birth, youcanplay a role in the decisions that are made about your body and your baby. A well thought-out birth plan can help you to do that.
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