The Birth Experience

The Birth Experience Every Birth is Different.  The Goal is the Same. 
What to Expect in Natural Births, C-Sections, VBACs and preventing Preterm births.
By Michelle Brown-Echerd, ND and provisional doula ICTC
Natural Births:
Natural birth is a process of delivering vaginally without any interventions.  This can occur in a variety of situations, including in hospitals, at homes or in birthing centers and unfortunately, but not the end of the world, sometimes occurs in cars, while people are on the way to the hospital or stuck in traffic.
There are various types of birth workers around the world including doctors (MD/ND), midwives, nurses, doulas, perinatologists, neonatologist, lactation consultants, massage therapists and other practitioners that have special training in birth related treatment including chiropractors, counselors and Reike practitioners.

• Naturopathic (ND) midwives are naturopathic physicians who have an additional certificate and midwifery.  In the state of Oregon, a separate licensing exam is given and licensure is granted after all requirements are met; which includes attending at least 50 births of which, the student midwife needs to have medical hands on, at; at least 40 births.

• ND midwives can deliver in homes and birthing centers in Oregon.

• ND midwives are eligible to take the NARM exam in Washington state and become certified Licensed midwives (other rules for naturopaths vary by state/providence).

• ND midwives can prescribe prescription medications, botanical medicine, homeopathics, suppositories and more.

• ND midwives can administer IV medications; including for dehydration and for positive group B strep; in which antibiotics are given every 4 hours, while in the home or birth center.

• ND midwives can use oxygen as needed for births.

• ND midwives can use Pitocin only after the birth; to reduce bleeding.  Other medications can be used at home as well; as needed.

• ND midwives are certified in Neonatal resuscitation and carry equipment to each birth

• ND midwives do not have admitting or hospital privileges but in the event for a need to transport; will call ahead to hospitals to see if they have space or find out recommendations if the hospital is on divert.   NDs often call ND friendly physicians and midwives to discuss the transport plan.  NDs will call the hospital in advance to let them know that the patient is coming and what the situation is; the chart notes; including all lab testing results will be brought to the hospital as a valuable resource for hospital staff to review.  The ND and student will meet the family at the hospital and stay for the birth and often several hours immediate post-partum and will follow up with additional post-partum care after hospital stay.

• Other practitioners can deliver in homes, birth centers and hospitals and the criteria and regulations vary state to state and country to country. 

C -sections:

• Cesarean sections are performed in hospitals. 

• Many are planned in advance for “high risk” births and women may be given this route as the “only” option.

• Dr. Barfield, African American Medical doctor/neonatologist; of the CDC states that 2013 rates in the US 32.7% and in 2009 32.9%4

• Women are choosing elective C-sections prior to 39 weeks gestation; some convenience knowing due dates and when to take maternity leave.

• Risks include:

• Preterm babies

• Retained fetal lung fluid

• Respiratory distress

• C-sections can be a life saver in urgent situations and extenuating circumstances.

VBACS:

• Vaginal birth after C-section

• These can be done by midwives at home births.  Many hospitals will tell women who have C-Sections that they cannot ever have an out of hospital birth.

• Uterine rupture is a risk after C-Section or transmyometrial surgery.1

• Signs and symptoms include:

• Abnormal heart rate tracing

• Uterine tenderness

• Vaginal bleeding

• Shock

• Peritoneal irritation

• Fetal death

• If you are a mother or supporting a mother who is having her first vaginal births, be informed on signs of labor and be prepared for how to cope with uterine contractions.

 
Preventing preterm labor and births:

• Premature is “Born or manifest before full development has been achieved” 5

• < 37 weeks gestation

• Normal is 40 weeks; not exact date known

• </= 2500 g or 5.5 lb.

• Crown heel </= 47 cm (crown rump </= 32 cm) diameter occipital femoral </= 11.5 cm

• Head ratio thorax < 93%

• Preemies in US

• 7.1% white live born

• 13.4% non-white live born </+ 2500 g

• Socioeconomic status educated 16+ years of school vs. </= 9 years5

• Prematurity a leading cause of death for neonates (<2500 g 17 x higher mortality rate)

• Immediate Risks:5

• Abnormal pulmonary ventilation (can be given steroids)

• Infection

• Intracranial hemorrhage

• Abnormal blood conditions

• Congenital anomalies

• Physiologic and anatomic limitations:

• Weak suckling/swallowing reflex

• Small stomach

• Renal function impairment

• Incomplete lung capillary development

• Immature alveoli of lungs

• Weak cough and gag reflexes

• Weakness of the thoracic cage muscles and other respiratory muscles

• Inadequate regulation of the body temperature

• See your healthcare provider regularly during pregnancy

• If there are any concerns; do not hesitate to contact your provider, you will not be bothering them.  It is okay to get support from your doula.  The doula can give you information and encourage you to contact your provider with confidence in listening to your instincts.

• In some “high-risk” situations; delivering pre-term may be “lifesaving” –i.e. pre-eclampsia, eclampsia, twins/multiples, infection, insufficient placenta, large for gestational age, Marfans, connective tissue disorders, severe trauma and more.

• Intra-amniotic infection is common after premature rupture of fetal membranes. 

• Signs and symptoms:

• Abdominal pain

• Maternal and fetal tachycardia

• Uterine contractions

• Uterine tenderness

• fever

• Differential diagnosis- includes acute cholecystitis which would often present with pain in the RUQ region instead of the uterine area and the membranes would likely still be intact.1

• In hospitals, options include cervical cerclage if the cervix ripens (shortens and dilating prematurely); in which stitches are used to close the cervix.3

• Work with a well-educated health care provider on options for VBACs, risks and prevention of uterine rupture or other complications.

 
Sources:

1. UpToDate:  Gallstones in pregnancy.  David C Brooks, MD
2.  Personal knowledge, Michelle Brown-Echerd, ND; from education and experience.
3. www.mayoclinic.org/tests-procedures/cervical-cerclage/basics/definition
4. Medscape –Reducing the C-Section Rate Aug 24, 2014.  Wanda D Barfield, MD MPH
5. Tabors Medical

This blog post is for entertainment and educational purposes only.  It is not intended to take the place of medical care and is not intended to diagnose, treat, cure any disease or condition.  See your healthcare provider for health related issues.