Questions for mommies exp w/home-birth

[Gardeninginthefog]

I read an old (ancient actually) thread on things to ask a prospective midwife. There were a lot of great suggestions there of things to ask. I’ve learned a lot since I first started this quest. But I still have a lot of questions, and I am hoping that some of you homebirth mommies can enlighten me. I could tell from questions that there was a lot of stuff I need to learn.

The way the some of the questions were written I could not tell which things were invasive or less invasive practices. I hope that someone will find it in their heart to answer these questions:

I read about strip membranes and it sounded a little unnatural to me. What are the pros and cons for that?

Then there was a question to “ask about vitamin k injections and eye drops,” is that an alternative to some conventional med? Or is it something that it’s a good idea to opt out of?

What is CDP? AROM? What are people’s opinions/ Pros/Cons on vaginal exams (and does that refer to prenatal care or labor), methergine, perenial massage, pitocin, dilatation check?

Also are there any good books, articles or websites that you recommend? I’m interested in homebirth, natural prenatal care, and also preconception nutrition and cleansing.
Thanks for reading my post
Gardeninginthefog

[annakiss]

There are lots of books about preconception nutrition. Nutrition, Cycles, and Fertility is one that I checked out of the library. I'm not really familiar with any others.

Homebirth books - Sheila Kitzinger has a book called Homebirth and her Complete Guide to Pregnancy and Childbirth is a great comprehensive reference book. My favorite book about birth preparation is Birthing from Within By Pam England, which has almost no technical information (as in positioning, dilation, etc.).

Stripping the membranes is a practice common at the end of pregnancy and is said to help urge labor on. It involves the practitioner using their hand to try to seperate the bag of waters from the cervix. It is very uncomfortable and not really necessary if you're willing to wait for labor to begin (which can sometimes be a very long wait). It doesn't necessarily work to stimulate labor either. And it can potentially introduce infection.

Vitamin K injections and eye drops are something that practitioners do to the baby after birth. The eye drops or ointment is an antibiotic administered to help protect the baby from potential unknown gonorrhea in the mother. It can cause inflamation and cloudiness, but has no long term side effects, that I'm aware of. I consider this to be unnecessary personally and simply another thing to cause the child pain.

Vitamin K is an essential component of blood clotting produced by intestinal bacteria. Babies normally have low levels of this vitamin. To prevent a serious bleeding problem called hemorrhagic disease of the newborn (HDN), most babies receive an injection of vitamin K in the upper thigh.

I personally declined Vitamin K as well, though some people do have even a homebirth midwife administer this. I just didn't see the point. Another test that is performed on newborns is the PKU test. It involves a heal stick and extraction of several drops of blood to test for five (I think) very rare diseases. It's usually to comply with state laws, though you can also decline this. If you do have it done, do it in a ped's office or some such place where someone who does them regularly can do it. My mom tried to do DS's and she was not used to doing them and had to stick him several times and it was just awful.

CDP and AROM - I don't know what these acronyms mean. Do you have the thread? Maybe the context could help me figure that out.

Vaginal exams - generally unnecessary and quite uncomfortable. Lots of people have pap smears at the beginning of pregnancy, which I totally just do not understand. The way I look at it is this - introducing germs into the vagina at any point during pregnancy is a bad idea. You're best off to just avoid it. Some midwives are more into doing vaginal checks for dilation during/leading up to labor, but you can decline this unless you really want to know how dialted you are, even though it can have little bearing on where you're at in your labor. I've heard of women who were at 4 cms and then were pushing in the next hour. I've heard of people being completely dilated and then not delivering for several more hours.

Methergine is used to control postpartum hemorage, but I don't know anything else about it. I think that Pitocin is much more commonly used.

Pitocin can be used in a hospital setting to augment labor because it is the synthetic version of the hormone oxytocin which causes contractions. At a home birth, it would be used only postpartum to stimulate contractions to expel the placenta if it is taking a long time or to help control hemorage (which can be caused if the placenta seperates and pieces are left in the womb). Pitocin is a good thing for a midwife to have in an emergency, but some direct entry midwives cannot or choose not to use it because it may be illegal for them to do so since administering it can be "practicing medicine without a license".

Perenial massage is totally up to you. If you don't want a midwife to ever touch you and would rather they only be there in the event of a problem, then that's up to you to opt out of perenial massage. Otherwise, perenial massage or support can be nice or useful. Perenial massage or support involves a midwife touching your perinium during the pushing stage of labor to either help it to stretch using warm oils or merely supporting it with warm wash cloths and/or oil. I had perenial support, but no perenial massage. The benefits of perenial massage are debatable. It is said to help prevent tearing. You can even do perenial massage during pregnancy to help stretch the perenium in preparation for birth. I did not do this and had a minor peri-urethral tear. Some say it's beneficial. Others say it makes no real difference. I think the statisics about perenial massage show that it has little impact. Perenial support with warm washcloths during pushing can be comforting and also helps to catch other bits and goodies that come out (like poo).

Dilation check - I mentioned this when talking about vaginal exams, but since you're wondering, I'm not sure if you need more information about what dilation actually is. During pregnancy, the cervix, which is the opening to the uterus from the vagina is closed tight. Leading up to birth, it begins to soften and slowly open (enfacement - softening and dilation - opening). Contractions of the uterus stimulate this. The cervix will dilate to 10 centimeters for birth. During and even before labor, a practitioner can use their fingers to measure dilation. 1 to 3 cm is considered pre-labor or sometimes early labor (you can be dilated to 3 or even 4 for weeks before birth). 4 to 6 is considered early/active labor (active labor is when labor is HAPPENING). 6 to 10 is active labor and transition. Transition is the stage of labor right before birth. It is the hardest part typically (except for pushing, which can be very painful, or can be a huge relief). Checking dilation is not necessary, but you may want to know where you're at. Some practitioners are more interested than others in performing these checks often.

Hope that helps. You can feel free to ask any additional or more specific questions.

[jessitron]

AROM - artificial rupture of membranes. This is when a doctor or midwife deliberately breaks the bag of water to speed up labor. This intervention can lead to cord prolapse (the umbilical cord is squished between the baby's head and the cervix, cutting off oxygen to the baby - very bad) if done too early. It can also wedge the baby in a bad position if done too early. There's no good reason to do this at all, as far as I can tell.

[gottaknit]

AROM = Artificial Rupture of Membranes (when the practioner breaks the bag of waters to "get things moving" in labor)

CPD = Cephalopelvic Disproportion (when a mother has a baby with a head too big to fit through her pelvis. Extremely rare, unless you have rickets.... which is also extremely rare in this day and age.)

[Patchfire]

My midwife gave us some information on increasing my vitamin K in the weeks before and after the birth so that the baby would indirectly benefit, in lieu of eyedrops. I think - I'd have to look - it was specifically about nettles.

A book I absolutely love is Aviva Jill Romm's The Natural Pregnancy Book (well, all her books are great!). It doesn't go into great detail about birth, but covers the prenatal period really well.

Stripping the membranes... you're right, it is somewhat invasive. The 'pro' to it is that it's not going to bring on labor unless you're already very close to it anyway. I did choose to have the midwife strip my membranes with dd because I was coming up on having to go back to school (college, but I couldn't take her to class at all) with a baby less than 2 weeks old, and ultimately I decided it was more important to me, personally, to have breastfeeding well-established than to go into labor completely without interference. I think it's also something to consider in lieu of more invasive (pitocin, cervical ripening) medical induction. I doubt it comes up very often in most homebirth situations.

I've never been able to find the reference again, but I do recall reading something during dd's pregnancy suggesting that prenatal (not during labor) perineal massage was unnecessary and perhaps just another way of not trusting our bodies. The article did suggest that perineal support during labor itself was important. I wish I could find it, because it made a real impact on me, the reasoning they used. So I didn't practice perineal massage with dd, didn't really have all that much perineal support (medwife), and still just had a small 'skid,' which I'm certain was positional. (This was in a hospital.) I fully anticipate that with better perineal support and better positioning, my chances of even that will decline. We'll see.

HTH!

[pamamidwife]

Kash, as a midwife, I don't do much perineal support. I think the benefits of having someone's hands on your vagina during pushing is a bit overrated, really. I usually will offer some rectal counterpressure with a warm washcloth during out-of-water births, but no reaming of the tissues or special hand maneuvers.

I encourage women to support their own bodies as much as they can. I don't think it means that a midwife is a medwife if she doesn't do much perineal support - on the contrary, I think many midwives believe they need to stretch and massage the vagina during pushing and I think this is actually more harmful than beneficial. In terms of having someone's hands on you during the actual birth, I find that the invasiveness of my hands on a woman's body is not always welcome.

Here's a small blurb I wrote about preventing perineal tears, though it's not written very well: http://magazine.motherspassion.com/tears.html

And, a great article from a UK midwife on whether or not small perineal tears are a bad thing and something to be "prevented": http://www.withwoman.co.uk/contents/info/perineal.html

I think the main idea is that we, as midwives, are not going to protect the vaginal tissues by what we do - but more by what we DON'T do.

[Patchfire]

Heh, well, I call her a medwife because I saw her exactly *twice* during my labor - once when she threatened AROM, and once when I was pushing. I think what I mean by perineal support is that I didn't feel like I was guided as to when to push and when to just let her head ease out - there was no way I could see it myself and the room was just such chaos at that point. I really *would* have appreciated just one voice, gently giving me some perspective on the whole matter. As it was, I just kept pushing, thinking that, well, the burning sensation had to go away once I got her out! :LOL

(And just to completely hijack this thread, I think the idea of rectal counterpressure sounds lovely, in retrospect!)

[pamamidwife]

ah, I getcha. Just wanted to clarify that a bit - I agree that pushing is the one time that chaos seems to rule during birth. As if there isn't ENOUGH chaos in your head!

[Jemper]

This website (http://www.maternitywise.org/mw/topi...iver/tips.html) has a great list of questions to run by your m/w.

http://www.nchomebirth.com/QandA.html is another good list of questions about homebirth.

Ina May Gaskin's latest book (Ina May's Guide to Childbirth) is an excellent read as well.

Good luck!

[Jemper]

Lots of ELV to all you 40-wkers!

[Gardeninginthefog]

Thank you, thank you!!!

Thank you all for your help, and thanks for all the great resources. I'm very excited to know that there is so much help out there. I've read over all of the websites suggested, and will check out the books as well.

I feel like I've really learned a lot so that I can make a much more educated choice. I'm not pregnant yet-- but I am searching this early because I thought I might need help getting my body into good condition so that everything will go smoothly when I am.

I'm not sickly or anything, but I am not in the greatest of health-- so I think I need to get it in gear so that I can have a nice easy homebirth exp.

DH and I are both pretty excited, but committed to waiting until I'm healthier, (and to getting me that way as soon as possible). Anyhow thanks again for all the help, and I'll let you know how the interview process goes.

Also if anyone has reccomendations of good reading material on the subject or know any preconception health tips I'd be ever so pleased to hear them
Gardeninginthefog

[Electra375]

Vit K, drink Alfalfa tea (or mix alfalfa in your regular pregancy herbal tea)
Eye drops (goop) only if you have Gonorreah or Clamidia, that is what it is for, to prevent blindness cause by STDs.
Books:
The Thinking Woman's Guide to a Better Birth by Henci Goer
Ian May's Guide to Natural Childbirth by Ian May Gaskin