Water Birth – Part 2

THE USE OF WATER FOR LABOR

Water Birth Tub-from"Birth Pool in a Box"

Water Birth Tub-from”Birth Pool in a Box”

Some suggestions for labor:

• The temperature should be body temperature
or slightly lower.
• Be equipped with an efficient pump, heater, and
a thermostat.
• A thermometer and large plastic strainer to
clear the water.
• At least 2 feet deep, to cover the abdomen when
she is doing squats or is kneeling. In order to
encourage the “freestyle movement” it should
be a pool that is at least 5 ½ feet wide.
• Optimum time: during active labor (5-8
centimeters in dilation).
• When having back labor, get into the water. The water relaxes and acts as a counter-pressure.
• If you have previously had an active labor and then stalls once in the water, get out of the pool
and move: squat, kneel. Walk, sway hips.
• Or if the labor is stalled, get into the pool, sometimes it’s just the relaxation you need to get
things started again.

It is safe to use the pool once your membranes have ruptured. Birthing centers with experience using the pool have not had any increase in infections reported.

Don’t expect all pain sensation to cease. It will decrease the pain, but does not make it completely go away. Often it’s how you move in the water, not just the pool of water.

An advantage of using the water pool for labor in the hospital is that you can really feel a sense of privacy, allowing space to sink into your own intuitive self for labor. Anxiety and blood pressure both are lowered when in the water. The stressors of hospital atmosphere is diminished, lowering the catecholamine (stress hormones) and “the secretion of endorphins” which are the relaxants that you body naturally produces, and the hormones that produce pain relief.

WATER FOR BIRTHING

Water birth is perfectly safe.

Sears & Sears state “The school of water-birthing that practices slow emergence (baby is left under the water, SIC) can be dangerous (156).” They use the example of water mammals that birth in the water, and how these mammals assist the newly born immediately to the surface.

An additional need when doing a water birth, is some salt. Adding salt allows for the pool water to have the same salinity as the amniotic fluid of the womb. The amount necessary is a generous tablespoon of salt. Before filling the pool be sure it is cleaned with mild disinfectant, and rinsed, “unless disposable liners are provided to contain the water (Balaskas, 208)”.

If your membranes break while in the water, there is no need to change the water. The amniotic fluids and “bloody show” are both sterile.

During birth in the water, the relaxation of the sphincter muscles may cause some fecal matter to be excreted. This is when that suggested plastic strainer comes in handy. There is no “evidence to show that it contaminates the water sufficiently to contribute any risk of infection (Balaskas, 212)”
You can kneel on all fours, squat, or be in a semi-sitting position to birth. Your partner can be in the pool with you or sitting just outside the pool.

Once the baby is born, the attendant (doctor or midwife) check to be sure the cord is not around the baby’s neck, and unravel the cord if it is. The baby may float to the surface on its own, or you may gently guide the baby to the surface.

Breathing will not occur until the baby emerges to the air, the coolness of the air causing the reaction to breathe. Occasionally the baby may need suctioning to clear the air passages. The cord has not been cut yet, so there are dual sources of oxygen. “In the rare circumstance that the baby doesn’t breathe, it is wise to take baby gently out of the pool into a cooler atmosphere. This will trigger the breathing reflex (Balaskas, 214)”. If necessary oxygen can be administered.

The baby can be held in the water, at breast level. It is best to sit or kneel in a vertical position. The rooting reflex will be strong, so turn the baby to face you, yours and baby’s bellies facing, to make breastfeeding easier.

You can stay safely in the water until the placenta is expelled, which generally takes place 10 -20 minutes later. Pay attention to the cord, if the pulse decreases it means the placenta is about to be expelled. The baby can be handed to the partner, and you can stand up slowly and leave the pool. If the expulsion occurs sooner and you feel the placenta released from the body, you can still stand up slowly once you have realized it, the cord can be cut before leaving the pool.

The persons you have present to assist the birth can cover you and baby as you leave the pool. It would be important at this time to have the temperature raised in the room. If you had not expelled the placenta before leaving the pool, you can stand or squat at this juncture to deliver the placenta. Then sit upright and enjoy your baby with comfortable warm coverings.

At this point, the midwife or doctor will check both you and the baby. After their examination, you can go to your bed and “…relax with your baby tucked warmly beside you (Balaskas, 215),…”.

 

REFERENCES

Balaskas,Janet. Active Birth: the new approach to giving birth naturally, Rev. (1992) The Harvard Common Press
Sears, William and Martha Sears. The Birth Book: everything you need to know to have a safe and satisfying birth. (1994) Little, Brown and Company.

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Positions for Labor-Part 2

POSITIONS FOR LABOR – PART 2

Variations of the Squat

The Supported Squat

birthing• Your partner sits or squats behind you, toboggan-like style with back against the wall or bed, or using a chair for support
• Or your partner can be in front, doing a squat, and hold your hands for balance.
Standing Supported Squat
• As you relax down into the squat, take the weight off your feet and melt into the arms and against the body of your partner.
• In this position your body will tell your mind to relax
• You then surrender your mind and body to your labor
Dangle Support Squat
• Your partner supports from behind, or two people supporting you (one on each side) helping in supporting you in the squat position.

Kneeling

image004This position is a natural extension of the squat position when the labor is too intense.

• Kneel on the floor with a pillow
• Lean against a chair
• Or get on all fours
o especially good for back labor
o to try and turn a posterior positioned baby
o or if your labor is accelerating and seems unmanageable.

Kneel-Squat Position

• Kneel with one knee while squatting with the other leg.
• Alternate between legs, or you can do a rocking and swaying motion.
Knee-Chest Position
• Your knees are on the floor, while your head and arms are on a pillow
o Slows overly intense contractions
o Counteracts an urge to push when your cervix is not fully ripened.

Sitting

CHAIR STRADDLE• Sit straddled over a low stool, toilet seat, chair or birthing bed angled like a seat
• The best of these is the sit-squat over a low stool, for the same reasons as the plain old squat position

 

Side-Lying

SIDE-LYING• Does NOT use GRAVITY in the same manner as the SQUAT.
• Best on the left side, to prevent the uterus from compressing major blood vessels that run along the right side of the backbone
• It provides a way to labor without pressure of the uterus on the back, and allows for some sleep in a long labor.
• Use pillows for your head, and pillows under the knee of the right leg, and support pillows behind your back.
o It allows you to quickly roll into the kneel or up into a squat
o Once the contraction is done you can roll back into your nest of pillows.

 

*Images from The Birth Book, Sears & Sears (1994) and internet birthing images/stock photos*

REFERENCES:

Balaskas, Janet. Active Birth: the new approach to giving birth naturally, rev. (1992) Harvard Common Press.

Dick-Read, Grantly. Childbirth Without Fear: principles and practice of natural childbirth, 2nd ed. (2013) Pinter & Marition.

Sears, William and Martha Sears. The Birth Book: everything you need to know to have a safe and satisfying birth. (1994) Little, Brown and Company.

Water Birth – Part 1

WATER BIRTH

Water Birth Tub-from"Birth Pool in a Box"

Water Birth Tub-from”Birth Pool in a Box”

In the 1960s Russia began using the Water Birth technique, and Michel Odent (a French Obstetrician) studied its use to benefit the process of birthing in the seventies and eighties. Odent shared what was discovered in the book Birth Reborn. Until the 1990s, the United States still did not use the method even though it had gained world-wide respectability.

WHY IT WORKS

Water relieves pain during labor because of “the law of buoyancy” also known as Archimedes principle. It says that when an object is placed in water, it will displace a volume of water in equivalence to its own weight.

A pregnant women feels an almost weightlessness when she is in the water which supports muscles and bones. This allows for the uterus to spare its energy. As the muscles of the abdomen, thighs and back relax…so will the birth passage.

More depth the mother has in the pool, the greater effect of weightlessness. This is especially good for back labor. As the muscles of the back relax, the internal tissues will also. It then will allow baby to maneuver, especially if positioned in the posterior direction.

Stress and anxiety causes the release of the stress hormones, which may not be the best idea for both baby and mother during labor. Stress hormones in the effort to protect will move the blood from non-vital areas of the body, which includes the uterus (considered by the natural hormonal reactions as a non-vital organ). Without the full flow of blood the uterus, the baby becomes oxygen deprived.

Water also “tricks the pain sensing system (Sears & Sears,153).” When the body of the pregnant woman is immersed it acts like a continuing body massage, and the temperature and touch-sensitive nerve receptors of the skin are stimulated. This process floods the nervous system with “pleasant sensations, virtually gridlocking the gate to painful stimuli (Ibid.)”.

WHAT THE RESEARCH SHOWS

In The Birth Book, Sears & Sears state that from 1985 to 1995 about 18,800 women used a Jacuzzi like pool at a birthing center in Upland, California. Dr. Rosenthal, the director and obstetrician stated that the women had almost always experienced shorter / easier labors, and had 1/3 the cesarean section than hospitals.

Other benefits experienced:

• Another birthing center used water birth for VBAC and had 87.5 success rate.
• Mothers labeled “high risk” because of high blood pressure which had reduced dramatically within a few moments after submersing in the pool.

How To Have a Normal Vaginal Birth

HOW TO HAVE A NORMAL VAGINAL BIRTH

baby-loading-tshirtEat Well During Pregnancy (See the post: Pregnancy Diet or Teen Pregnancy & Nutrition)

Exercise Regularly During Pregnancy (See up-coming post: Exercise during pregnancy)

Seek out the company of Other Women:

• A woman in labor needs other women or a woman to give support
• This was the old traditional way with Lakota women, as well as many other cultures!
• We learn about giving birth and about breastfeeding when in the company of other women.

Stay Home During Early Labor:

  • Early labor is not “true” labor.
  • It is what assists the thinning of the cervix in preparation for labor
  • Often it starts and stops
  • This is when you should rest
  • Your body is getting you ready for birth
  • Look at the length of the contraction itself, not the distance between each one. This will be your true indicator.
  • When you sense the early signs of excitement and nervousness, you are not ready
  • When you are concentrating and seriously working with your contractions is the second sign, but you are still not ready.
  • It is when you have been in the emotional space of the last sign, and feel aggravated when made to move…now you are getting into “real” labor.

This is IMPORTANT:

Turn your FOCUS INWARD and TRUST YOUR INSTINCTS!

  • Think comfort: Use pillows to cradle your body when resting
  • Dr. Odent states that the warm baths assists in the highest level of relaxation
  • Use soft music
  • Lower the lighting in the room
  • Walk, Rock or Sway, Dance, Squat, kneel and rock (especially for back labor)
  • There is no need to RUSH to the hospital!Final Stage / Delivery

    • Upright positioning is best for delivery of a baby. It uses gravity to assist the baby in birth.
    • If you cannot do an upright position, see if you can use a squat or kneeling position (have someone assist you)
    • Trust your body
    • See POSTS for pain management if you need to.

 

ProfessionalLaborSupport-Pt3

doula at workMONITRICE /MIDWIFE’S ASSISTANT

The Monitrice can assist in providing a continuity of care, from pre-pregnancy through post-partum. They are trained in all the basic skills that a midwife is trained, but without the certifications to actually “catch” the baby.

At the point of a woman going into labor, the Monitrice/Midwife’s Assistant attends the birth in the manner of a Doula. See the blog post: ProfessionalLaborSupport-Pt1 regarding how a Doula assists in childbirth.

A Monitrice/Midwife’s Assistant:

-Assists women with the pre-pregnancy and fertility issues they may have, along with natural birth control methods.

-Has knowledge of local resources

-Monitors the pregnancy with training in taking the blood pressure, FHT, and urine collection
They enter the labor room in a Doula capacity.

-Assist with neonatal care

-Supports breastfeeding of the baby

-May assist in post-partum care

-Knows alternative complimentary methods for pregnancy and childbirth