Sphincter Law – Part 2

doula at work

Sphincters May Close Suddenly if the Owner is Frightened

The sudden contraction of the Sphincters is a fear-based reaction, as a part of the fight-or-flight response of adrenals. The Adrenaline/catecholamine level will rise in the bloodstream when frightened or angered.

If a female animal in the wild is in process of birth, the birth process will reverse if the animal is startled by a surprise encounter with a predator. Humans can do the same thing.

In her book, Ina May’s Guide to Childbirth, Ina describes a situation where during labor a woman developed a fever; soon it became apparent that there was a bladder infection. She was seven centimeters dilated, but stalled in labor. So Ina chose to transport her to a hospital.

The laboring woman was examined by a doctor that was rough…who stated she was only 4 centimeters. Her dilation retracted from 7 to 4 centimeters as an automatic response to the roughly-handled internal exam…a natural self-protection, evidence of the function of the sphincter function.

What Helps the Sphincters?

• Trust, comfort, familiarity and safety
• Laughter
• Slow and deep [abdominal] breathing
• Immersion in warm water which calms and relaxes
• Relaxation of the mouth and jaw
o Relax the throat and jaw by singing
o Release an audible low moaning sound (similar to the sounds of lovemaking)
o “horse-lips” similar to the tone that horses make when they make that sound with their lips flapping, or “raspberry” sound.
• Relaxed labor supporters

~This information was taken from Ina May’s Guide to Childbirth. Ina May is an internationally known Midwife, who has delivered babies and written books on Midwifery and natural childbirth. She works at THE FARM, in Tennessee.

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Sphincter Law- Part 1

doula at work
In birth work, obstetricians use the Law of Three Ps:

• Passenger (baby)
• The Passage (the pelvic structure and vagina)
• And the Powers (strength of uterine contractions)

From these Ina Gaskin believes stems the misunderstood capacity of a woman’s body from both the pregnant woman and the doctors who work with them. From the misunderstood capacities are the causative factors leading to all the interventions and procedures that now create problems in birthing, such as: Cesarean sections, Forceps use, vacuum extractors, etc.

The blame is placed upon women, for what obstetricians see as “dysfunctional birth”. Women have birthed for eons without a hitch; doctors perceive having a baby as “a problem of physics rather than a millions-of-years-old physiological process (168)”.

The Basics of Sphincter Law

• They function best when the atmosphere is private, and familiar.
• They do not open “at will” and do not respond to commands such as “Push!”
• When in the process of opening (relaxing) they will suddenly close down if a person is upset, frightened, humiliated, or self-conscious. This is the reason why in most traditional cultures women assist women in birth.
• If the mouth and jaw are relaxed, there is a direct correlation to the ability of the sphincters opening in the cervical and vaginal area (or the anus, for that matter).

What are the Sphincters?

These are a grouping of muscles that surround the rectum, bladder, the cervix and vagina. Each has a function for the body. These muscles remain contracted to keep the openings of certain organs held shut until something needs to pass through.

How do they work?

They work in conjunction with the brain. The brain has two sections that directly influence the functions of the Sphincters. These sections are the neocortex and the brain stem (or “primal” brain).

The brain stem is the portion that is directly connected to hormonal functions, and more instinctual. The hormones it releases (related to birth) are oxytocin (the main ingredient in the drug Pitocin, used to induce labor), endorphins, and prolactin.

Whereas the neocortex stimulation works to inhibit the brain stem from hormone release. It is “stimulated” during labor by asking too many questions of a woman in labor, bright light, and failure to protect her privacy during birth.

The sphincters work with the brain stem (and its many hormonal excretions) by a relaxation response. They respond to emotions. A good example of this relaxation response is what happens when toilet functions are interrupted. Everything gets held in, and it takes a while to relax again, right?

~more on the “Sphincters” next week!

The Vocabulary of Pain

 

father in delivery room

The following information was written in order to understand pain in childbirth. This is a preliminary to understanding what your body senses when in labor.

Pain Threshold

The definition is “the point in which an individual first perceives the presence of pain”. This could be when ice or heat no longer is affective for blocking and / or reducing pain.
Each person has their own threshold. It is thought that threshold remains the same throughout ones life. But, Childbirth educators have found that the threshold is quite flexible. It is found that when comfort measures are used that effectively reduce pain or make it easier to bear, and the woman is distracted from her comfort measures, then the comfort measures no longer are useful. It will take a stronger stimulus to then break through the pain. Nothing had changed in the strength of the pain itself, “rather, her distraction reduced her pain threshold so that less pain was necessary in order for her to notice it (162)”.

Intensity
Intensity is defined as “the quantitative measure of how strong or severe the pain is (Ibid.)”. The usual measurement is a scale of 0 to 10. O being no pain, and 10 meaning that the pain is out of control.

Character
Character is a qualitative measure, using verbal or pictorial descriptors and analogies. Pain character may be described as burning, aching, tearing, or sharp like a knife. Character is the most important aspect to consider when managing pain.

Duration
Concerning when pain is first noted, and how long it lasts, and whether it is a steady pain or sporatic. It is particularly significant in that smaller diameter nerve fibers may, after repetitive signals become more responsive to pain signals. Many management strategies that are not pharmaceutical focus on the larger nerve fibers, which respond well.

Location
It is where the pain is perceived in the body. Depending on the location, the distress level may rise and start to interfere with eating, breathing, sleep, concentration, or the ability to otherwise function normally. If she is unable to concentrate due to location or any other aspect of the pain, she will be less able to use the pain management strategies she has learned.

Sensation Threshold
It is the point where the stimulus was first perceived. When reached, it is when the client first is aware of itching, cold, pressure, pain, or any other sensation. Of these, pain is the most important in that it could signify potential or actual tearing. Other sensations that may later become concerning may eventually grow strong enough to be perceived as pain.

Pain Tolerance
Defined as the greatest severity of painful stimulation an individual is able or is willing to tolerate. “Encouraged Tolerance” is the highest level of pain a person will tolerate when encouraged to try to tolerate more”. It serves a purpose, but not for women in labor as it may lower the tolerance to pain. It actually would translate to suffering rather than just pain.

Categories of Pain

Cutaneous
Occurs at the dermal level, and is sharp, localized, and generally tonic. An example would be the prick of the needle when given an injection.

Visceral
Occurring at the organ level, could be sharp or dull. There is less localization and could either be tonic or episodic. Examples: uterine contractions, severe constipation, and intestinal gas.

Somatic
It occurs at the soft tissue level. It is dull, aching, not localized and usually tonic.

Nerve Compression
The pain results from pressure on one or more nerves. It may be localized, or be referred pain to one or more regions of the body.

Prenatal Vitamins

PRENATAL VITAMINS

2013-03-combo[The image to the left is not an endorsement of the brand, but illustrative of a typical type of package prenatal vitamins may come in]

There is an ongoing argument about the use of vitamin supplementation whether you are pregnant or not. I would say weigh out the pros and cons of the argument.

From my nutrition studies, I learned that even when we eat very well, our bodies will often not absorb all the nutrients within the food. The cause of this can be the natural digestive make-up of the body or a particular health issue we may have. This would hold true, even if we were to eat the best of natural and organic foods.

Unfortunately, most of the American populous chose to eat lousy diets. We also do not exercise properly, nor drink enough plain old water. But, during pregnancy it is important to make sure you eat well, and that your diet is full of pure natural and organic foods.

Even with a great diet, supplementation may be a wise choice. Doctors will recommend a prenatal vitamin supplement, so be sure it contains the nutrients you need.

Look for a prenatal vitamin that includes :

• 400 micrograms (mcg) of folic acid.
• 400 IU of vitamin D.
• 200 to 300 milligrams (mg) of calcium.
• 70 mg of vitamin C.
• 3 mg of thiamine.
• 2 mg of riboflavin.
• 20 mg of niacin.
• 6 mcg of vitamin B12.
• 10 mg of vitamin E.
• 15 mg of zinc.
• 17 mg of iron.

“Keep in mind that it is possible to jeopardize your baby’s (or your own) health by taking inappropriate amounts of synthetic vitamins, so be sure your health care provider is aware of any supplements you are taking (American Pregnancy. Org).” Notice this quote discusses “synthetic vitamins”? I would recommend prenatal vitamins that are sourced from natural or organic nutrients, not a synthetic vitamin.

As with herbs containing multiple nutrients and constituents within its structure, a range of nutrients comprise the whole of the vitamin you glean from food. The same could be said of a natural or organic nutrient used in the production of a multi-vitamin.

Be sure your diet is balanced and contains the nutrients you need for good health. See my hand-outs on nutrition for the information about a healthy diet during pregnancy. “Getting your nutrients from food is generally the best route. Foods contain other compounds your body needs — such as fiber — that supplements don’t provide.

You shouldn’t use a supplement to correct a poor diet, but rather to supplement a good one (Pari-Keener)” I would liken this concept to building a house. If built on a good foundation (proper whole foods diet) an addition built onto the house, will stand a long time (supplemental vitamins/Prenatal vitamin intake = healthier baby).

Some women may experience nausea, irritated stomachs, and constipation from prenatal vitamin use. If the vitamins are taken properly, and you are eating a good diet, the effects will be greatly reduced.

Prenatal Vitamin Warnings

• Tell your doctor about unusual or allergic reactions you have had to any medications, especially to any vitamin, mineral, or iron products.
• Be sure to tell your doctor if you have ever had bone disease, liver disease, kidney disease, or stomach ulcers.
• Because prenatal vitamins may mask the symptoms of pernicious anemia, they should be used only under a doctor’s supervision.
from How Stuff Works

REFERENCES:

Consumers Guide, Eds. Prenatal Vitamins. How Stuff Works. http://health.howstuffworks.com
/wellness/food-nutrition/vitamin-supplements/define-prenatal-vitamins.htm

Maria Pari-Keener, MS, RD. (n.d.) Prenatal Vitamins Best from Food or Supplements. http://www.parents.com/pregnancy/my-body/prenatal-vitamins/

Pregnancy and Prenatal Vitamins. WebMD. http://www.webmd.com/baby/guide/prenatal-vitamins (2012). Reviewed by Trina Pagano, MD. 5-29-14

Prenatal Vitamins. American Pregnancy Association. http://americanpregnancy.org/pregnancyhealth/prenatalvitamins.html

Non-Professional Labor Support

NON-PROFESSIONAL LABOR SUPPORT

father in delivery room

 

 

 

 


By the baby’s Father or Partner of the woman:

• Can speak for her, to interpret her needs and desires to the staff.
• Assurances, relaxation, encourage her to drink and eat snacks.
• Assistance in walking during labor, assist in getting in and out of the shower or birth tub, etc.
• If knowledgeable, help with breathing and focus in the 2nd stage of labor

Note: to work effectively, the father needs to be well informed. He needs to know what to expect. If he gets panicky he should leave the room to regain composure and then re-enter. First-time fathers especially need to be informed and may still have need of assurance. This can be assisted by his attendance at the Childbirth Education classes.

By a female relative (Grandmother, mother, aunt or sister):

• [At the hospital] Can speak for her, interpret her needs and desires to the staff.
• If they have experienced a natural birth, their assurances are “gold”. They will know what and when to do things to support the process.  If not, they need to become informed about natural childbirth.
• Assurances, relaxation, encourage her to drink and eat snacks.
• They can assist in labor as well, by walking with and supporting the laboring mother; assist her getting into and out of the shower or birth tub, etc.
• Can help with breathing and focus in the 2nd stage of labor.

RECOMMENDED POSTS To READ:

Let Your Monkey Do It
Overdue Pregnancy


FUTURE POSTS YOU WILL NEED TO READ:

Hospital VS. Midwifery Model of Care
Pain in Childbirth
Normal Vaginal Birth
Optimal Fetal Positions
Positions for Labor
Water Birth
Premature Rupture of Membranes
Fetal Distress
C-Section
VBAC

Your Birth Stories

Share your birth story! I am asking for volunteer submissions of your birth story that you wish to share on my blog.

baby-loading-tshirt

My 3rd Birth:

I was going to county hospital for checkups. I was a week over-due and they put the monitor on me. It was way too tight when I had contractions [Braxton Hicks]…so I pulled it off.

The nurse came to check it and decided there was something wrong with the baby. “The heart beat dropped during contractions”, she said. I explained what had happened, she would not hear me. They began to talk C-Section.

I said “I have my daughter with me, and would need to go home and get her to a sitter. I need arrange for the older two children’s care, and find my husband…” (no cell phone).

I went home and called my mother. I told her I was NOT going back to that hospital. They were C-Section crazy! We discussed that it was too late for a midwife (obviously) and she suggested I go into the emergency room of another hospital.

Downtown San Jose had a hospital, so I took the bus there. The doctor on call said, after I explained what happened, that he wanted to put a monitor on to be sure. I could understand his reasoning, so the monitor was placed on my abdomen. We had to wait awhile for a contraction and after four hours, he says “Baby looks fine. I will call the other hospital and explain that you will be here”…[taking off the monitor] he says “You can get up an walk around”.

At that point, I had been having regular contractions 20 minutes apart. My mom arrived just before that, so we walked the halls of the hospital.

My water broke, and the monitor was put back on. I was dilated 6 centimeters. Contractions were getting stronger, too. 2 contractions 9 minutes apart…I could feel the baby crowning.

The nurse was called in. I told her the baby was coming NOW.

“Oh no, sweetie, you couldn’t be having the baby now. Your contractions are too far apart!”

“The head is coming OUT!! I know what that feels like, I have had two babies previously…LOOK!!”

She looks under the sheet. Hits the buzzer, slaps the rails up, while saying “Oh shit, the baby IS coming!”

Not longer after, my youngest was born. No stitches, a couple tears, no complications. So much for needing a C-Section.

I am making a page that will feature birth stories. Look for it!

ProfessionalLaborSupport-Part2

mom and babyChildbirth Educator

The childbirth educator teaches and assists women in understanding the nature of childbirth, from pre-conception through the first year of baby’s life.  The information they give assists women in having a better and safer birth experience.

The professional Childbirth Educator trained at Birth Arts International adheres to the “Midwifery Model” of care, as outlined by MANA. This is where I am training (and near completion of).

Here are some things that may be covered:

  • Nutrition – preparation to conceive, during pregnancy, and post-partum
  • Pre-natal tests: What is required and why
  • Exercise: for optimal health, and to tone muscles in preparation for birth, as well as post-partum exercises
  • Stages of labor
  • Interventions
  • C-sections and VBAC
  • Neonatal care (newborn baby care)
  • Breastfeeding

Even second-time mommies can benefit from classes.  It helps you to have a better / safer birth to review information.

Childbirth Educators can assist in labor, in a much similar way that a Doula would.  They can answer your questions and assist after the baby is born.

 Part 3: Midwifery

Culture Part II

Cultural Perspectives on Childbirth

Achomawi mother and childMulti-cultural Beliefs (Continued)

Last week I ended with discussion about the Lakota belief in a spiritual being who assists the souls of the unborn in their journey to human existence. It is thought she “marks” them before entry into this world.  This “mark” is what the medical field calls a “Mongolian” mark.

Because of the spiritual forces in play, many indigenous cultures had and still practice rituals at the birth of a child. This is due to the understanding that childbearing and childbirth are a sacred act.

This may not necessarily be understood by present-day women within the culture, but in their soul and spirit the women do recognize that modern medicine’s “managed care” works against the traditions and ageless wisdom of their tribe. This is true whether they have a traditional spiritually based upbringing in their lives or they have adopted non-traditional religious practice. Their sense of “knowing” from their soul, speaks out against what is not natural and spiritual in the birthing process.

Western culture encourages reading and the attendance of Childbirth Education classes, along with other strategies for birthing. In traditional cultures women “…prepare more symbolically. They avoid all actions and thoughts that have anything to do with ‘getting stuck’ or ‘closing up’ and ‘letting go’…  In traditional societies, women often go to midwives to confirm the pregnancy and then again only if there are special problems… (145)” prior to childbirth.

Another aspect is that most women within many traditional cultures would have been directly involved in the childbearing and child birthing aspects from a young age. Her mother or aunts and grandmother would have taught her about the processes of childbearing and childbirth during childhood and/or adolescent years. The concepts would have “…been integrated into her maturity into adulthood (Ibid.)”. It would have come from her experiential life and stories told to her instead of a class or books.

Unfortunately, much of this kind of experiential life and tradition has been lost or no longer practiced today by local tribal women. Some of the other women will talk about this or that grandma who was a midwife, and who may have been allowed at IHS for a birth. When I have asked women, they mostly talk about a more negative experience for their childbirth if they speak up at all.

Traditionally, the birth of a baby was in the home, not a hospital. Some cultures used “a special hut [that] is constructed for that purpose ;…(Ibid)”. But today in the local area, birthing mostly takes place in a hospital setting, here on the reservation. Locally, there is the IHS. There also is Winner Regional, in Winner South Dakota (45 minutes from Mission, SD) or Cherry County Hospital in Valentine, NE.

Due to past experiences with IHS (the “Eugenics Project” of the 60s and 70s, for one), many women may opt to not have their babies unless there is an emergency. Both Winner and Valentine have doctors that have demonstrated certain biases against native women. Without midwives to deliver locally, this is what women on the Rosebud (Sicangu Oyate) Reservation face today (with the exception of one community).

Each of these three hospitals has their own regulations as to who may attend the birth. They also decide on whether a woman can have assisted births (Nurse-midwives/doulas/etc.).  My attempts to discover these policies, and the reasons for them, have been futile.

– Next week will be “Part 1 – The issues that affect Lakota Native women during pregnancy and childbirth in regards to: Racism, Sexism, and Oppression”

 

Vices in Pregnancy – Part 1

woman pregnant smoking

Caffeine

Caffeinated beverages do not seem to cause birth defects or preterm labor and delivery in people…but there are other risks. Such as: fetal growth retardation, miscarriage, and low birth weight.

Woman who drink more than 300mg of caffeine are at the highest risk. That would be about three, five ounce cups. Those that both smoke and drink caffeine are at even a higher risk for babies with stunted growth.

Coffee (5 oz. cup) 60-180 mg
Tea (5 oz. steeped 4 minutes) 38-77 mg.
Cocoa (5 oz. cup) 2-20 mg.
Chocolate milk (8 oz.) 2-7 mg.
Cola drinks (Jolt, Mr. Pibb, Mountain Dew, etc.) 36-72 mg.
Non-prescription drugs (Excedrin, Anacin, etc.) 30-65 mg.


Tobacco

Cigarette smoke is full of chemicals. Many of these migrate to the sperm cells when they fertilize the ovum, and then continue to bombard the fetus when the mother smokes or is exposed to tobacco smoke.

Women who smoke are more likely to experience pre-eclampsia during pregnancy, preterm labor, premature rupture of the membranes, and premature delivery. The baby born to a smoking woman tends to be lower in birth weight, and more likely to die soon after birth than those who do not smoke.

The damage to the baby can persist into later life. They are at more risk for cancer as an adult, susceptible to middle-ear infections, asthma, chronic bronchitis, and wheezing.

If raised in a household where smoking is allowed children are more likely to develop hypertension, as well as neurological and behavioral problems such as attention deficit disorder. They also tend to score lower in intelligence tests later in life.

Men who smoke have a considerable higher risk of having children with birth defects and childhood cancer. This is probably due to the lowering of vitamin C levels in seminal fluids and sperm. Not even the best of nutrition can make up for the damage done by smoking!

Woman smoking and alcohol

Alcohol

Alcohol freely enters the placenta and directly exposes the developing baby to its toxic effects. It travels in the baby’s blood stream at the same concentration as that of the mother. If mother is “buzzed”, so is the baby!

Some babies born develop a condition called “Fetal Alcohol Syndrome” or FAS. They are shorter in length, lighter in weight, than other babies. They do not “catch up” eve with special postnatal care. They also have abnormally small heads, irregularity in their faces, limb abnormalities, heart defects, and poor coordination. Many are mentally retarded and may develop behavioral problems as they grow up (such as hyperactivity). Another condition, which is similar, is called “Fetal Alcohol Effect” or FAE.

No one knows how much alcohol it would take to damage a baby. Since it causes permanent physical and mental birth defects and no “safe” amount is known, the best bet is to abstain from alcohol.

Be aware of the alcohol that may be in certain foods. Such as: Irish Coffee, wine coolers, rum in fruit cakes, liquor-laced desserts, and cough medicines.

 

 

Pre-Natal Tests

What are the Different Prenatal Tests Women are Offered?

The following discussion is about tests conducted,
beyond the usual blood panel and vaginal cultures…

ptg02629155

DOPPLER OR ULTRASOUND

As with EFM, there have been questions raised regarding the use of Ultrasound, as to whether it is actually useful and if it is safe. Just like EFM it was in use before the safety of Ultrasound was confirmed. Now it is commonly used, expected by pregnant mothers.

With its use, are three ways in which women are exposed to ultrasound. First, the Doptone used in listening to the fetal heartbeat. Secondly when doctors order its use during exams, in order to check the fetal position and its growth along with the placenta (and take a picture of the baby within the womb). Third, Electronic Fetal Monitoring uses ultrasound to detect the fetal heartbeat.

So is it SAFE? Well, no one really knows for sure. The “problem lies in what happens when energy-containing sound waves strike growing fetal tissues (Sears & Sears, 82).” It is uncertain if the delicate tissues become damaged on a subtle level.

What happens is the sound-waves bombard the tissues, shaking up molecules causing heat. The heating up of the molecules cause gas bubbles of a microscopic size in the cell which are called cavitation. It is uncertain whether the heat or the bumbles damages the cells.

Not like EFM, Ultrasound has improved the practice of Obstetrics. Since it seems to be safer than X-rays, it can be used to give a more precise dating of gestational age of the fetal in early pregnancy. It also is helpful to determine if the placenta has any abnormalities, whether there is more than one fetus, and if there are abnormalities with the fetus.

Unfortunately, no study has been conducted to confirm whether there is an improvement in the outcome of mothers and their babies. Most likely, there never will be any studies, either.

Maternal Serum Alpha-Fetoprotein (MSAFP) Testing
(also known as: Alpha-Feto Protein (AFP) Screen)

The best time for this test is between 15 to 18 weeks gestation. This time frame seems to be best because the results are the most accurate.
(AFT) Alpha-fetoprotein is a substance that is produced by the liver of a fetus. It enters the bloodstream of the mother by way of amniotic fluid and placenta. It is found in the mother’s bloodstream in minute quantities. In pregnancy the level of AFP raises in progression with the duration of pregnancy. An abnormal low or high level is an indication of fetal anomalies.

MSAFP test does not harm a pregnant woman. It does seem to have an unusually high rate of false positives. If a woman has a very high level she may be referred for amniocentesis. She could be subjected to more tests that have higher risks for both herself and baby.

  • AFP increases as the baby grows.
  • It reads as “elevated” for multiples and for neural tube defects.
  • It reads low when the baby has Down’s Syndrome
  • If baby is found to have anomalies then the choices are: abortion, or keep the baby.


AMNIOCENTESIS

How the test is done:

The doctor inserts a long, sterile needle through the abdominal wall and the uterine wall, into the amniotic fluid. The test is conducted with an ultrasound, so that the fetus and placenta can be viewed.

What does the collected Amniotic fluid tell the Doctor?

The fluid contains cells from the fetus that would indicate certain birth defects. Such as: Down’s syndrome, hemolytic anemia (the destruction of red blood cells due to an Rh disease)metabolism disorders, Cystic Fibrosis, and many other diseases. It can tell the doctor the maturity of the lungs if an early labor or Cesarean is indicated.

What are the risks?

Puncture of other areas of the uterine area, such as the umbilical cord, placenta, or another area of the uterus. It can cause infection or miscarriages.

Not only that, but if an inadequate amount of fluid is collected, or the cells of the fetus do not grow in the culture, another test will be necessary.

What Happens then?

  • If the baby is found to have a disorder, then the mother needs to choose what to do next. Does she keep or abort the baby?
  • Is the test able to screen for all disorders of the fetus?No it does not. In fact it can damage the fetus.


CHORIONIC VILLI SAMPLING (CVS)

How is it done?

Tissues are removed from what will develop into the placenta. These tissues are gathered by one of two ways: either through the abdomen or the cervix, using an instrument to collect tissue while looking at the area.

At what point in the pregnancy is the test conducted?

The test is done at the nine to eleven weeks’ gestational point.

What would it indicate?

It would indicate whether there are any chromosomal abnormalities in the fetus. It is not able to detect all the abnormalities that can be seen in an Amniocentesis.

What are the risks of taking this test?

The risks include possible damage to the embryo, damage to the uterus, infection, hemorrhage, and miscarriage. It should not be conducted when an infection is already present, if there is a known Rh factor, or multiple gestations. It has a high false positive rate.


GLUCOSE TOLERANCE TEST (GTT)

This test is conducted around 24-28 weeks of pregnancy, and then repeated again at around 32-34 weeks for high risk mothers.

How is the test done?
A sweet liquid called glucola is given to her and then the blood sugar is checked an hour later. If positive, the doctor may then order the 3 hour test, which is more accurate. Only 15% of the women with abnormal results from the 1 hour test will have the same results in the 3 hour test.

Why would the test be important?

The hormones of pregnancy normally suppress insulin release, allowing more glucose to be released for the developing baby. Occasionally the blood sugar is too high (2-10% of pregnant women) causing blood sugar levels to be raised. This is condition called gestational glucose intolerance or gestational diabetes.

  • A lengthy exposure to the high blood sugar in pregnancy causes the infant to grow exceptionally large.
  • Babies of women with blood sugar issues also tend to be born prematurely and have respiratory problems.
  • The baby may manufacture too much of his / her own insulin instead. The manufacture of too much insulin would cause the baby’s blood sugar to drop quickly and dangerously once born.

Who would be at risk?

High blood sugar during pregnancy is more common in obese women, older women, and those who have a family history of diabetes, or in women who have delivered a baby weighing more than 9 pounds previously. If discovered early in pregnancy, by being tested, the pregnant woman can alter her diet to alleviate the issue of high blood glucose.


X-RAY PELVIMETRY AND / OR FETAL INDEX X-RAY (prelabor or labor)

How is it Done and why?

A series of x-rays are done in which the radiologist measures various dimensions of the pelvic passage in order to determine if it large enough for the baby to pass through safely. These measurements are compared to tables of “normals”.

  • The test is done on a mother whose baby is failing to descend during labor.
  • If delivery is contemplated for a breech birth
  • Or if there is a previous history of a difficult birth because of a presumed cephalopelvic disproportion (CPD)*

What Problems Can it Potentially Create?

The X Ray Pelvimetry is being used less often because of concerns over safety and accuracy. Studies have linked X Ray exposure of the fetus to higher odds of childhood cancers. This correlation is not determined accurate because of conflicting study results.

Considerations Regarding the Pelvic Opening:

What is not considered is that the process of labor is an amazing one, that changes of position such as using squatting, can increase the pelvic outlet by as much as 20%. This test also only considers the outlet, not the size of the baby itself.

A newer technique using measurements of the pelvis by X ray and the size of the baby by ultrasound, called the Fetal Pelvic Index (FPI). It considers the size of the whole baby, not just the head. It is useful for those mothers considering VBAC who have had a previous diagnosis of CPD based upon X rays.

 

* To be discussed in a future blog.  Next topic coming up: Teen Pregnancy and Nutrition