Posts Tagged ‘second stage’

Calling all bloggers! 5th Healthy Birth Blog Carnival: Get up, stand up!

March 25th, 2010 by avatar

It’s been a while since our last Healthy Birth Blog Carnival.  I thought I’d give everyone a break since there was plenty of blog fodder, what with the NIH VBAC Consensus Conference, an Amnesty International Report on U.S. maternal mortality, and the release of appalling cesarean section statistics from the National Center for Health Statistics.  But when I posted a Fit Pregnancy article about coached versus spontaneous pushing on the Science & Sensibility Facebook page yesterday, it was met with a flurry of comments and was shared widely. It occurred to me that bloggers may be looking forward to something other than cesareans and VBACs to write about.  And readers may be looking forward to something other than cesareans and VBACs to read about.  So without further ado, I hereby announce the 5th Healthy Birth Blog Carnival on none other than the 5th Lamaze Healthy Birth Practice:

Avoid giving birth on your back and follow your body’s urges to push

Anything about the second stage of labor is welcome. Here are some resources from Lamaze to get you thinking.

Participation in the Healthy Birth Blog Carnival is easy:

1. If you are a blogger, write a blog post on the Carnival theme (Avoid giving birth on your back and follow your body’s urges to push). Post it on your blog by Wednesday, April 7. Make sure the post links back to this blog post, to the Healthy Birth Practice Paper, or to the video above. You may also submit a previously written post, as long as the information is still current.

2. Send an email with a link to your post to amyromano [at] lamaze dot org.

3. If you do not have a blog but would like to participate, you may submit a guest post for consideration by emailing it to me.

4. I will compile and post the Blog Carnival here at Science & Sensibility.

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Home Birth: The rest of the story

September 11th, 2009 by avatar

As most readers of this blog are probably already aware, The Today Show ran an inflammatory piece about home birth this morning that parroted ACOG’s long-standing scare tactics and anti-midwife rhetoric.

Since I just wrote a post on the safety of home birth, I thought that rather than repeating the same old story that home birth is safe for healthy women with qualified attendants and access to referral, I would share with readers some other thoughts, culled from this blog, the rest of Lamaze.org, and other trustworthy resources.

One of the first posts I wrote for Science & Sensibility (actually written as a guest post at the Giving Birth with Confidence Blog while this site was getting up and running) was titled, “Why the Largest Study of Planned Home Births Won’t Sway ACOG.” ACOG prefers to hold home birth to a standard of evidence to which hospital birth was never held.  Even while actively compiling the lowest form of evidence on the supposed “perils” of home birth in a membership survey, ACOG repeatedly calls for a randomized controlled trial comparing perinatal death rates in the two settings, fully aware that such a trial is literally guaranteed never to happen. I discuss some of the reasons why in my post, concluding that we face much more urgent research priorities for the study of planned home birth than a full-scale clinical trial.

We need more and better research on home birth. We can use data from the Netherlands to determine the safety of home birth in systems that support and integrate home birth midwifery. After all, it is the only place left with a maternity care system that lends itself to home birth safety research, and national registers to conduct that research soundly. In the U.S., we must study how we can reform our maternity care system to provide access to midwife-led care in all settings, and best practices for caring for the women who rightly and inevitably will continue to desire birth at home.

Why exactly do women desire to birth at home? It’s is not because they are hedonistic or selfish, as ACOG likes to suggest. Judith Lothian, PhD, RN, LCCE, wrote recently about the qualitative research she will present at next month’s Lamaze Conference. (Rixa Freeze, PhD, Lamaze International’s 2009 Media Award recipient, has conducted similar research.) Judith asked women themselves why they planned to give birth at home, and then observed them doing so. Their responses describe motivations far from reckless desire and hedonism. She writes:

I was surprised that all of the women described themselves as “mainstream”. They all wanted a natural birth. All the women came to believe that “intervention intensive” maternity care increased risk for them and their babies. They valued the personal relationship with their midwife and believed that this relationship increased safety. They believed they could manage the work of labor more easily and more safely in their own homes. They all expressed confidence that a hospital and skilled physician care were available if needed. ‘Being Safe’ emerged as the theme that captured the essence of women’s decision to plan a home birth. In stark contrast to the current thinking, that birth is safer in hospitals under the care of an obstetrician, these women believe that giving birth at home is safer for them and their babies.

It seems likely that women believe that home birth is safer than hospital birth because word is getting out that hospitals routinely deprive women of the style of care that is proven to produce the safest, healthiest outcomes. Just last week, Lamaze released the third revision of the Healthy Birth Practice Papers, a collection of evidence-based articles about the care practices that ease and facilitate labor, prevent complications, and protect breastfeeding and early mother-infant attachment:

1. Let labor begin on its own

2. Walk, move around, and change positions throughout labor

3. Bring a loved one, friend, or doula for continuous support

4. Avoid interventions that are not medically necessary

5. Avoid giving birth on the back and follow the body’s urges to push

6. Keep mother and baby together – it’s best for mother, baby, and breastfeeding

The 2006 U.S. Listening to Mothers II Survey revealed what anyone who advocates for home birth could tell you even without the data: almost no one who births in a hospital actually experiences these care practices. The survey found that fewer than 2% of women had all 5 of the care practices that the survey measured. (The practice they were unable to measure was “no routine interventions”. Since interventions are routine and rampant in hospitals, this likely means that the proportion of hospital birthing women who experienced all six care practices was effectively zero.)  Instead, the authors of the survey tell us what is happening in current, hospital-based maternity care:

The data show many mothers and babies experienced inappropriate care that does not reflect the best evidence, as well as other undesirable circumstances and adverse outcomes. This sounds alarm bells…Few healthy, low-risk mothers require technology-intensive care when given good support for physiologic labor. Yet, the survey shows that the typical childbirth experience has been transformed into a morass of wires, tubes, machines and medications that leave healthy women immobilized, vulnerable to high levels of surgery and burdened with physical and emotional health concerns while caring for their newborns.
– Maureen Corry, Executive Director of Childbirth Connection.

In fact, ACOG themselves acknowledged in a press release today that the current style of obstetric practice (high-tech defensive medicine) “ultimately hurts patients“.

I continue to believe that if hospitals provided the Six Healthy Birth Practices as the standard of care and offered evidence-based treatments for women and babies experiencing complications, hospital birth would be safer and so would home birth. That’s because midwives would initiate transfers with more confidence that it would improve the outcome, women would transfer more willingly, and care at the receiving facility would be safe and effective. What’s not to like about that plan, ACOG? Now, let’s make it happen!

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Revised and Updated! The Six Lamaze Healthy Birth Practices (aka, the “Care Practice Papers”)

September 3rd, 2009 by avatar

Lamaze International

Launched in 2004 to summarize the evidence for a healthy, safe, and natural approach to labor and birth care, Lamaze’s Care Practice Papers, have just undergone their second update. Now referred to as  The Six Lamaze Healthy Birth Practices, the latest update incorporates current evidence as well as more clear language that we know will resonate with women more effectively. These papers supplement the video series and handouts launched earlier this summer in partnership with InJoy Birth & Parenting Videos, and are trustworthy resources for women as well as childbirth educators and other birth professionals.

Each of the Healthy Birth Practices is supported by decades of high quality research. I like to think of the practices as “the basic needs of childbearing women.” Some women will need high tech monitoring and intervention to birth safely, but the standard should be care that supports and facilitates the normal physiologic processes, intervening with the safest, most effective, and least disruptive approach only when a medical need arises and with fully informed consent.

Routinely depriving women of The Healthy Birth Practices makes birth unnecesarily difficult, and complications more likely.  Got it? Good.

So here they are! Drumroll, please…

1. Let labor begin on its own – lead author Debby Amis, RN, BSN, CD(DONA), LCCE, FACCE

2. Walk, move around, and change positions throughout labor – lead author Teri Shilling, MS, CD(DONA), IBCLC, LCCE, FACCE

3. Bring a loved one, friend, or doula for continuous support – lead authors Jeanne Green, MT, CD(DONA), LCCE, FACCE, and Barbara A. Hotelling, MSN, CD(DONA), LCCE, FACCE

4. Avoid interventions that are not medically necessary – lead author Judith A. Lothian, RN, PhD, LCCE, FACCE

5. Avoid giving birth on the back and follow the body’s urges to push – lead author Joyce DiFranco, RN, BSN, LCCE, FACCE

6. Keep mother and baby together – it’s best for mother, baby, and breastfeeding – lead author Jeannette Crenshaw, MSN, RN, NEA-BC, IBCLC, LCCE, FACCE

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From the Research Summaries Archives: Care in Second Stage

August 26th, 2009 by avatar

Lamaze International’s popular series, Research Summaries for Normal Birth, was discontinued in 2008 after four years of quarterly round-ups so that we could move to the blog format and launch Science & Sensibility. In order to bring all of our research resources together in one place, we are adding the Research Summaries archive to Science & Sensibility.

This week we are presenting the archive of summaries of research on care in the second stage of labor. Don’t forget that you can find all second stage Science & Sensibility posts (including this archive) by clicking on “second stage” in the tag cloud.

The articles summarized in this archive are listed here. Please click on the extended post to read the summaries.

  1. Digital Rotation When the Baby is OP Decreases Need for Cesarean Section and Instrumental Vaginal Delivery
    Reichman, O., Gdansky, E., Latinsky, B., Labi, S., & Samueloff, A. (2007). Digital rotation from occipito-posterior to occipito-anterior decreases the need for cesarean section. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 10.1016/j.ejogrb.2006.12.025.
  2. Coached Pushing Offers No Benefit to Moms or Babies and May Be Harmful
    Bloom, S. L., Casey, B. M., Schaffer, J. I., McIntire, D. D., Leveno, K. J. (2006). A randomized trial of coached versus uncoached maternal pushing during the second stage of labor. American Journal of Obstetrics and Gynecology, 194, 10-3.
  3. Upright Positions in Second Stage May Decrease Instrumental Deliveries in Women with Epidural Analgesia
    Roberts, C. L., Algert, C. S., Cameron, C. A., & Torvaldsen, S. (2005). A meta-analysis of upright positions in the second stage to reduce instrumental deliveries in women with epidural analgesia. Acta Obstetricia et Gynecologica Scandinavica, 84(8), 794-798.
  4. Delayed, “Physiologic” Pushing Improves Fetal Oxygenation in Women Using Epidural Analgesia
    JSimpson, K. R., & James, D. C. (2005). Effects of immediate versus delayed pushing during second-stage labor on fetal well-being: a randomized clinical trial. Nursing Research, 54(3), 149-157.

Read more…

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Nursing Care and Management of the Second Stage of Labor: AWHONN Webinar on August 4

July 31st, 2009 by avatar

The Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) has been leading the fight for physiologic care in the second stage of labor. Next week AWHONN will host a webinar for nurses, presented by one of the leading second stage care researchers, Joyce Roberts, CNM, PhD, FACNM, FAAN. Here’s the information.

No Directed Pushing - AWHONN

Register now for this 75-minute educational webinar focused on current evidence-based information about the benefits of upright positioning and delayed and non-directed pushing. Strategies for implementation of these techniques, including preparation and education of the mother for the second stage of labor also will be presented.

Webinar: Nursing Care and Management of the Second Stage of Labor

When:  August 4, 2009 1 PM ET

Presented by: AWHONN and Joyce Roberts, CNM, PhD, FACNM, FAAN. Dr. Roberts is a former Professor of Nursing in the School of Medicine, Dept of OB/GYN at the University of Michigan and former President of the American College of Nurse Midwives.

Register Now!
Book a conference room with a computer and Internet connection and invite your registered and advanced practice perinatal nurses, OBs and family practice physicians to enhance their expertise. Pay just one connection fee, regardless of how many attend. One contact hour of CNE will be available to attendees of the live event. A live Q&A will follow the presentation. Handouts will be provided.

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