| (There is a large difference between having a high-risk pregnancy and having a high-risk birth. You need not necessarily be treated for one simply because you have the other and CF alone is NOT a reason for being regarded as high-risk--ed.) "A child conceived in love should be born in love." from The Home Birth Advantage by Mayer Eisenstein, M.D. (p.246) Vaginal vs. Cesarean Birth Vaginal delivery is preferred for these patients (women with CF) using epidural (if necessary) rather than opiate analgesia or general anesthesia which might compromise respiratory status. Click www.cfpc.ca/cfp/2002/Mar/vol48-mar-clinical-1.asp to view the article in entirety. Cesarean Fact Sheet www.dona.org/PDF/CIMScsec-fact-sheet.pdf C-section delivery is from eight to 26 times more dangerous (for the mother) than natural delivery. Babies over 1500 grams (3.1 pounds) are more likely to die if born by cesarean section than if born vaginally. from The Home Birth Advantage by Mayer Eisenstein, M.D. www.homefirst.com C-sections are not to be taken lightly. Having one raises the risk of complications in later pregnancies. These risks include placenta previa (the placenta covers the cervix) and placenta accreta (the placenta is abnormally attached to the uterine wall). Both can cause hemorrhage. Click www.msnbc.msn.com/id/4724392/ to view the article in entirety. Cesarean births require longer recovery time, so you'll need to be informed about what type of discomfort is normal, and what might be a warning sign of infection or other complications. You should also have a clear understanding of possible risks to you or your baby. Though rare, problems are more common in cesarean birth than regular delivery. Click www.newschannel34.com/guides/health/topic.aspx?content_id=3B6D5934-479B-4CAA-BC86-4CC376D7F169 to view the article in entirety. As part of comprehensive prenatal care, a formal series of prepared childbirth classes conducted by a certified childbirth educator is recommended for all women�These classes can help reduce women�s pain and anxiety as they approach childbirth, making delivery a more pleasant experience and preparing women for what they will face as they give birth. At a minimum, the childbirth classes should include information regarding the physiology of labor and birth, exercises and self-help techniques for labor, the role of support persons, family roles and adjustments, and preferences for care during labor and birth. The classes also should include an opportunity for the mother and her partner to have questions answered about providers, prenatal care, and other relevant issues, as well as to receive information regarding birth settings and cesarean childbirth. Click www.healthypeople.gov/document/HTML/Volume2/16MICH.htm to view the article in entirety (While giving birth is a natural act, it is also a learned skill. Mothers require knowledge and active support in order to give birth in a healthy, natural, fulfilling way--ed.) Cesarean Prevention 1. No use of electronic fetal monitoring, even for epidurals (except for one test strip on admission), thereby necessitating nurse auscultation of the fetal heart rate and one-on-one patient care, both well known to reduce the cesarean rate. 2. No patient admitted to the hospital before 4-5 cm of cervical dilation, also known to lower the cesarean rate. 3. No drugs or epidurals until the woman was 5 cm dilated, also known to reduce the cesarean rate. 4. All births attended by CNMs, which is known to reduce the cesarean rate by one-third of what obstetricians would do. Click www.healing-arts.org/mehl-madrona/mmepidural.htm to view the article in entirety Interventions in Labor and Birth Birth is hard work which is best performed in accordance with the laws of nature. from The Home Birth Advantage by Mayer Eisenstein, M.D. Safety of Interventions Schlenzka�s data from more than 800,000 births show no advantage of the obstetric approach for either low or high risk women. Under no circumstances do the California data for 1989 and 1990 allow the obstetric profession to uphold the claim that for the large majority of low-risk women hospital birth is "safer" with respect to perinatal mortality. Our data also suggest that even for the high-risk levels of our Study Population the natural approach (including transfers) produces the same perinatal mortality outcomes as the obstetric approach. Given no differences in perinatal mortality it must be noted that the natural approach shows significant advantages with respect to lower maternity care cost as well as reduced mortality and morbidity from unnecessary cesareans and other obstetric interventions, and significant benefits from avoiding negative long-term consequences from unnecessary obstetric interventions and procedures. "Midwifery is rooted in the natural approach. Pregnancy and birth are considered fundamentally healthy processes which have many normal variations; it is normal part of life, not a medical condition�Only when complications occur which are beyond the midwife�s expertise, is the woman transferred to obstetric care" "Treating normal labors as though they were complicated can become a self-fulfilling prophecy" Birth in obstetric hospitals was significantly less safe than in general practitioner units or home birth�[and] that birth at home and in General Practitioner Units (GPU) was not only safer for low-risk pregnancies, but also for the high-risk cases . "A [recent] meta-analysis of planned home birth vs. planned hospital birth of studies published after 1970 found six studies (from Australia, Netherlands, Switzerland, UK, two from the US) which met the selection criteria and concludes that perinatal mortality was not significantly different in the home and hospital groups in any individual study" (1997). "�in a double blind clinical trial at the Los Angeles County and USC Women�s Hospital (California, USA), 492 low risk women who qualified for the hospital�s Normal Birth Center were randomly assigned to either the midwifery service in the birth center or to the physician service in the maternity ward. While there were no differences in the demographics of the two groups or in neonatal outcome, the physicians had significantly higher intervention rates than the midwives" "The lower rate of interventions in home births meant a lower risk of subsequent complications for the mother." Click www.vbfree.org/docs/meadsum.html to view the article in entirety. Routine Electronic Fetal Monitoring The most significant controlled studies of the effectiveness and safety of electronic fetal monitoring indicated that routine use of the procedure had no measurable effect on death or illness of infants or mothers. �electronic monitoring was associated with a higher rate of Cesarean deliveries, which increases surgical risks to mothers. American College of Obstetricians and Gynecologists [have] endorsed the use of intermittent auscultation (listening with a Doppler, stethoscope or fetoscope) for low-risk pregnant women. Auscultation with stringent evaluation and recording frequency is not feasible under normal labor and delivery room conditions unless 1:1 nursing care is always available. Randomized clinical trials of the past 10 years have compared electronic monitoring to routine periodic auscultation and have consistently failed to demonstrate a statistically significant difference in either the perinatal mortality rate or the outcome of high risk pregnancies. Click www.changesurfer.com/Acad/EFM.html to view the article in entirety. The new study, published in the October issue of the journal Obstetrics and Gynecology, found that electronic monitoring was not measurably better in spotting distress and indicating that intervention was necessary than the traditional practice of intermittent auscultation. With this method, a nurse or midwife closely monitors fetal heart rate with a stethoscope. If a problem is detected, the nurse can reposition the woman to relieve pressure that may be restricting the fetus's oxygen or give extra oxygen to the mother to increase levels in her blood stream. Click www.childbirth.org/articles/efm1.html to view the article in entirety. Labor Induction Fact Sheet www.dona.org/PDF/CIMSinduct-fact-sheet.pdf Epidural Anesthesia More recent forms of epidurals use a lower dose of local anaesthetic, usually combined with an opiate, such as pethidine, morphine or fentanyl (sublimaze). With this low-dose or combination epidural, most women can move around with support; however the chance of a woman being able to give birth without forceps is still low. Sometimes the relief from pain can allow a woman to rest and relax sufficiently to go on and have a good birth experience. However deciding to use an epidural for pain relief can also lead to a "cascade of intervention", where an otherwise normal birth becomes highly medicalised, and a woman feels that she loses her control and autonomy. Often the decision to accept an epidural is made without an awareness of these, and other, significant risks to both mother and baby. Although the drugs used in epidurals are injected around the spinal cord, substantial amounts enter the mother's blood stream, and pass through the placenta into the baby's circulation. Most of the side effects of epidurals are due to these "systemic", or whole-body effects. One of the most commonly recognised side effects is a drop in blood pressure. Up to one woman in 8 will have this side effect to some degree. An epidural will often slow a woman's labour, and she is three times more likely to be given an oxytocin drip to speed things up (see labor induction information above--ed.). The second stage of labour is particularly slowed, leading to a three times increased chance of forceps. Women having their first baby are particularly affected; choosing an epidural can reduce their chance of a normal delivery to less than 50%. When forceps are used, or if there is a concern that the second stage is too long, a woman may be given an episiotomy (see episiotomy information below--ed.). As well as numbing the uterus, an epidural will numb the bladder, and a woman may not be able to pass urine, in which case she will be catheterised. Pruritis, or generalized itching of the skin, is common when opiate drugs are given. It may be more or less intense and affects at least 1/4 of women: morphine or diamorphine are most likely to cause this. Morphine also causes oral herpes in 15% of women. All opiate drugs can cause nausea and vomiting, although this is less likely with an epidural (around 30%) than when these drugs are given into the muscle or bloodstream, where larger doses are needed. Up to 1/3 of women with an epidural will experience shivering, which is related to effects on the bodies heat- regulating system. For women giving birth by caesarean section, epidurals are certainly a great alternative to general anaesthetic, allowing women to see their baby being born, and to hold and breastfeed at an early stage: however their use as a part of a normal vaginal birth is more questionable. Epidurals interfere with the release of oxytocin which, as well as causing the let-down effect in breastfeeding, encourages bonding between a mother and her young. Other studies have shown that, after an epidural, mothers spent less time with their newborn babies, and described their babies at one month as more difficult to care for. Click www.birthinternational.com/articles/sarah02.html to view the article in entirety A general estimate of the overall complication rate of epidural anesthesia is 23%. The incidence of cesarean section for dystocia was significantly greater in the epidural group (10.3%) than in the nonepidural group (3.8%). There remained a significantly increased incidence of cesarean section for dystocia in the epidural group after selection bias was corrected . Frequently the epidural is so effective that it eliminates uterine contractions. The nerves which tell the uterus to contract are all anesthetized. The uterus becomes quiet and must be driven artifically with the hormone oxytocin (Pitocin or Syntocinon). After controlling for potentially confounding variables Adashek, et al found that epidural anesthesia was an independent risk factor for cesarean birth among women over age 35. Epidurals prolonged the first stage of labor and increased the incidence of oxytocin administration. Fever developed in more women during epidural anesthesia. Click www.healing-arts.org/mehl-madrona/mmepidural.htm to view the article in entirety Epidurals increase the need for episiotomy. They also increase the probability of instrumental delivery. Instrumental delivery increases both the odds of episiotomy and deep tears. Click www.efn.org/~djz/birth/obmyth/epis.html to view the article in entirety EPIDURAL EFFECTS ON BABY Possible problems, such as rapid breathing in the first few hours and vulnerability to low blood sugar suggest that these drugs have measurable effects on the newborn baby. As well as these effects, babies can suffer from the interventions associated with epidural use. Several studies have found subtle but definite changes in the behaviour of newborn babies after epidural with one study showing that behavioural abnormalities persisted for at least six weeks. Click www.birthinternational.com/articles/sarah02.html to view the article in entirety Epidural: List of Side Effects and Prevention www.kimjames.net/epidural_risks_and_side_effects.htm www.oyston.com/anaes/local/muir.html Episiotomy The perineum, or tissues between the vaginal entrance and anus, are cut to enlarge the outlet and hurry the birth. Stitches are needed and it may be painful to sit until the episiotomy has healed, in 2 to 4 weeks. Click www.birthinternational.com/articles/sarah02.html to view the article in entirety Routine or prophylactic episiotomy (as opposed to episiotomy for specific indication such as fetal distress) is the quintessential example of an obstetrical procedure that persists despite a total lack of evidence for it and a considerable body of evidence against it. Episiotomies: - do not prevent tears into or through the anal sphincter or vaginal tears. In fact, deep tears almost never occur in the absence of an episiotomy. - do not prevent relaxation of the pelvic floor musculature. Therefore, they do not prevent urinary incontinence or improve sexual satisfaction. - are not easier to repair than tears. - do not heal better than tears. - are not less painful than tears. They may cause prolonged problems with pain, especially pain during intercourse. - do not prevent birth injuries or fetal brain damage. - increase blood loss. As with any other surgical procedure, episiotomies may lead to infection, including fatal infections. Click www.efn.org/~djz/birth/obmyth/epis.html to view the article in entirety The following have been reported as side effects of the episiotomy: � Infection � Increased Pain � Increase in 3rd and 4th degree vaginal lacerations (euphemistically called extensions) � Longer healing times � Increased discomfort when intercourse is resumed There is little evidence to support routine use of episiotomy. This procedure may well increase the incidence of third- and fourth-degree lacerations. There are few data to support the premise that this procedure prevents pelvic relaxation. from "Episiotomy: Can its routine use be defended?" by Dr. JM Thorp as referenced on pregnancy.about.com/cs/episiotomy/a/aa042897.htm EPISIOTOMY PREVENTION Some techniques for reducing perineal trauma that have been evaluated and found effective are: prenatal perineal massage, slow delivery of the head, supporting the perineum, keeping the head flexed, delivering the shoulders one at a time, and doing instrumental deliveries without episiotomy. (Others, such as perineal massage during labor or hot compresses have yet to be studied.) The lithotomy position increases the need for episiotomy, probably because the perineum is tightly stretched. The birth attendant's philosophy, technique, skill, and experience are the major determinants of perineal outcome. Click www.efn.org/~djz/birth/obmyth/epis.html to view the article in entirety Some preventative measures are: � Good nutrition (Healthy skin stretches more easily) � Kegels (exercise for your pelvic floor muscles) � Prenatal discussion with your care provider about episiotomy � Prenatal Perineal massage � A slowed second stage (controlled pushing) � Warm compresses, perineal massage and support during delivery (The last two of these suggestions are arguably the most effective in preventing not only a need for episiotomy, but a naturally occurring tear. Good perineal support and massage combined with allowing your body to push out the baby's head and shoulders slowly and without voluntary pushing and alternative positions during the second stage can result in a completely intact perineum and a speedier, more comfortable recovery for you--ed.) Click pregnancy.about.com/cs/episiotomy/a/aa042897.htm to view the article in entirety Withholding Food and Drink Risks and Reasons www.acnm.org/prof/display.cfm?id=115 www.thelaboroflove.com/forum/dorinda/1.html normalbirth.lamaze.org/institute/CarePractices/NoRoutineInterventions.asp (The practice of withholding food and drink during labor can be particularly risky for women with CF who have higher caloric needs, greater predisposition to dehydration and expend more energy per task than women without CF--ed.) Natural and Gentle Birth Choices Labor and Birthing Positions www.seasonsindia.com/pregnancy/birthposition_sea.htm (Knowledge of and availablitiy to use alternative birthing positions can be vital to a successful vaginal birth, especially for women with CF. Upright birthing positions allow more room between your pelvis and diaphram for you to breathe more efficiently and for your baby to move more easily. Optimum positioning can also help your pushing phase be more efficient so that you are not working against gravity, help reposition a malpositioned baby [as it did in my case] and maximize circulation for both mother and baby--ed.) Water Birth waterbirth.org Episiotomies can be avoided, as the water softens the tissues surrounding the perineum, making them more pliable and able to stretch. And labor itself could be shortened. Some laboring positions (are) easier in the water. The women who had tried it had consistently and unanimously reported that their contractions were far less painful while laboring in the water. Click www.naturalchild.com/guest/lakshmi_bertram.html to view the article in entirety. Water births can reduce the need for augmentation (such as breaking the waters or giving oxytocin) and other forms of obstetric intervention in women with slow or difficult labour. Compared to women given standard augmentation, those who laboured in water had a lower rate of epidural analgesia and fewer required augmentation. The authors believe that water births can increase satisfaction, reduce pain, and optimise use of resources. BMJ 2004;328.7435.0-a Summary from the Journal of Chinese Medicine (Water has been used for centuries for pain relief and relaxation. It is particularly helpful in labor and birth for women with CF as the bouyancy makes breathing easier, helps allieviate strain and weight, makes upright positioning easier, which can help conserve your energy--ed.) Home Birth www.homefirst.com There is no convincing or compelling evidence that hospitals give a better guarantee of the safety of the majority of mother and babies. It is possible that the contrary may be the case. from "Why Home Birth?" Vol.II No.2, Homefirst News [A] mother's chances [of giving birth naturally] are diminished greatly by the very act of walking into a hospital. [In the home birth setting] husband's don't have to have their guard up...everyone's energy can go into the birth. Women laboring at home actually enjoy giving birth. Under any circumstances labor time is doubled in the hospital...Many interventions such as drugs, intravenous fluids, electronic fetal monitoring and forceps come in the hours of labor that wouldn't have existed at home. from The Home Birth Advantage by Mayer Eisenstein, M.D. Birth Support Labor and Birth Support The best coaches for labor are women who have had children of their own... [Fathers] have a very important role. Women most want their husband's presence in the room...and the unique support husband's have to give. Ideally the laboring woman also can have the support of another woman who knows how labor feels and how to make [her] comfortable during this time. (Husbands usually appreciate an experienced mother's presence as well--ed.) from The Home Birth Advantage by Mayer Eisenstein, M.D. (p.89) The Benefits of Having a Doula: � Reduced chances of getting a C-section � Reduced epidural or other painkiller use � Reduced use of oxytocin (Pitocin) � Reduced duration of labor � Reduced use of forceps � Reduced use of vacuum extraction � Reduced chances of health complications and hospitalizations of baby � Reduced chances of maternal fever and infection � Reduced maternal bleeding following birth � Increased chances of successful breastfeeding � Reduced incidence of post-partum depression � Reduced levels of anxiety � Found to be superior to Lamaze � Result in a more positive birth experience � Mothers feel more in control � Increased chance of spontaneous vaginal birth � Mothers have higher regard and increased sensitivity towards babies � Mothers feel more secure Quotes from some of the studies: The father-to-be's presence during labor and delivery is important to the mother and father, but it is the presence of the doula that results in significant benefits in outcome. ... doula support is an essential component of childbirth. A thorough reorganization of current birth practices is in order to ensure that every woman has access to continuous emotional and physical support during labor. Certainly, having loved ones such as a spouse with the mother does provide some added comfort and support. However, as the published literature continues to show, it is the support of a trained and experienced woman (usually) that results in the greatest benefits. So the small cost of a doula, which can range anywhere from $200 to $800, depending on location. However, according to Kathie Lindrom, price should not be an obstacle. "For the most part - no one is denied doula services because of an inability to pay. The vision of DONA is that there would be a doula for any woman that desired one," she states. Click www.mercola.com/2000/oct/1/doula.htm to view the article in entirety. DONA Position Paper on Doulas (Doulas of North America) www.dona.org/PDF/BDPositionPaper.pdf DONA (Doulas of North America) contains links for care providers in US and Canada www.dona.org Searchable International Directory of Doulas www.doulaworld.com Natural and Home Birth Attendants The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes. The Midwives Model of Care includes: - Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle - Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support - Minimizing technological interventions - Identifying and referring women who require obstetrical attention The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section. Click www.cfmidwifery.org/mmoc/define.aspx to view the article in entirety ACNM (American College of Nurse Midwives) Fact Sheets www.acnm.org/prof/factsheet.cfm Midwifery, Pregnancy & Breastfeeding Information www.moonlily.com/obc Searchable International Directory of Midwives www.doulaworld.com Australian Midwives www.pregnancy.com.au/australian_websites.htm www.australiansocietyofindependentmidwives.com International links www.tarayoga.net/links-p.html Canadian Links www.kidalog.com/midwives.html (Each country or state has it's own legislation concerning whom and under what circumstances a midwife may serve as the sole or primary attendant to a birth. But, in my own research I found no legislation barring a woman with CF from birthing in the care of a midwife either in a hospital, birth center or at home. The specific diagnosis of CF is not a contraindication, nor did I find any listing that marked my symptoms as contraindication for midwifery services or homebirth--ed.) Childbirth Educators Bradley Method www.bradleybirth.com (The primary methods of coping here are knowledge and relaxation. Bradley is the method we used for a successful natural, vaginal birth. It has the highest success rates of the many natural childbirth methods. It also is comprehensive in that is teaches nutrition and pregnancy health as well as childbirth preparation--ed.) Lamaze Method www.lamaze.org (The primary methods of coping here is distraction. This method has helped many parents (including my own), but currently has lower success rates for natural birth, especially in a hospital setting--ed.) HypnoBirth www.uncommon-knowledge.co.uk/hypnosis/childbirth/relaxation.html (The primary method of coping here is relaxation through hypnosis. This is a younger technique and few statistics, if any, are available for the success rates of this method--ed.) Searchable International Directory of Childbirth Educators www.doulaworld.com Suggested Resources and Reading A comprehensive site of informed birth choices and information www.rslnetwork.com/midwifery A Thinking Woman's Guide to a Better Birth and Obstetric Myths Versus Research Realities by Henci Goer The Birth Book by William Sears, M.D. and Martha Sears, R.N. Natural Childbirth the Bradley Way by Susan McCutcheon Gentle Birth Choices by Barbara Harper Mothering the Mother: How a Doula Can Help You Have a Shorter, Easier, Healthier Birth by Marshall H. Klaus Immaculate Deception II by Suzanne Arms (A great book for understanding how and how far we've come to the modern Western model of birth care--ed.) |
| Excerpts from various sources on issues of health, safety and options in childbirth for women with CF |
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| But You are He who took Me out of the womb; You made Me trust when I was on My mother's breasts. I was cast upon You from birth. From My mother's womb You have been My God. Psalm 22:9-10 Nevertheless she sill be saved in childbearing if they continue in faith, love, and holiness, with self-control. 1 Timothy 2:15 |