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Discussion about UC birth - Page 8

post #141 of 238
Did your baby need resuscitation?
post #142 of 238
well this thread has given me a lot to think about. i'm not planning to ttc for another year anyway but i've been processing my last birth for almost a year now.

my 1st was a standard hospital/ob/induction
my 2nd most recent was a natural hospital birth attended by a cnm

next time i am leaning towards homebirth or maybe a birthcenter

but i am lurking in the uc forum too because uc seems so empowering. i think that is what attracts me too the idea the most is the sense of empowerment i hear in those birth stories.

i do feel like i would need to do a great deal more reading than i have. which is a good deal more than a typical mom i think but probably less than most mdc moms. (or maybe just the low end of average for around here)

anyway i'd want to have a lot of textbook knowledge at the ready even knowing that i'd likely use more intuitive knowledge.

birthing from with in is on my reading list for next time b/c i don't have a lot of confidence in my intuition. also hypnobabies. (i flipped through it last time but didn't really absorb it ykwim?)

its not an option i'm ready to rule out yet.
post #143 of 238
Quote:
Originally Posted by ~~Mama2B~~ View Post
I don't want an ugly hospital experience to lead me to a UC, even if it would provide experience. I want ALL of my birth memories to be spiritual and comfortable and in a place I want to birth. Saying that a woman should not UC with her first is reenforcing the idea that women are not capable of getting through birth without firsthand knowledge of what the almighty doctors/midwives are doing so that we can mimic them. I find this an offensive notion.
:

I am a first-time mom, having a UP, planning a UC. I have known for many years that my births would not be in a hospital, but at home. It wasn't until DH and I began ttc (Aug05) that I first began reading about UC. It was a really simple choice for us.

I know myself, truly know myself, and I know that with anyone else at the birth I would be negatively hindered. I have even had to tell my mother that no, she is not welcome in the house during the birth, because I know her nervous and fearful energy would transfer itself to me.

In a big way, I think my lack of practical experience in giving birth is going to be an asset to me during my UC. I have no bad experiences clouding my thinking and interfering with my instincts.

It has been (and will be, until the birth, I am sure) difficult to find that balance between reading enough and learning enough to be prepared for any situation that may arise, and reading so much (negative) that I am unnecessarily fearful.
post #144 of 238
Quote:
i am lurking in the uc forum too because uc seems so empowering. i think that is what attracts me too the idea the most is the sense of empowerment i hear in those birth stories.
this empowerment extends beyond the place of birth. a woman can be empowered to and in her birth in any location, with any number of attendants.

to me, the optimal empowerment is that process of being empowered to choose and choosing to do whatever is right and necessary. this may mean doing something that doesn't including having or "achieving" (for lack of a better word) a UC. For example, a transfer that is determined through an empowered, intuitive thought process is a 'successful' "uc" in my book because it comes from that central place of empowerment.

an empowered woman who chooses a midwife, goes to a birth center, or even chooses an elective c-section--if done form a place of empowerment, deep knowing, and the desire to offer one's child the best care, fulfills what UC is striving to achieve in part: the empowerment of women.

the other aspect UC is trying to achieve is safe homebirths for healthy babies and mothers, as interventions can increase risks to babies and mothers and actually cause the need for more interventions to 'save' them.
post #145 of 238
Quote:
Originally Posted by erin_brycesmom View Post
The baby had already started descending when my water broke. My water broke while I was pushing.
What I meant to imply was that the meconium would not have gotten into the forewaters (bulging in front of his head) if his head was already in the birth canal when he began to experience the distress that caused the release of meconium, because your tissues would have been taut around his head, creating a forewaters and hindwaters. So that the meconium was there indicates that the distress occured before his head was descending.
post #146 of 238
Quote:
What I was trying to get accross is that my son had a blue/purple face and the rest of his body looked much better. I can even see in the picture that his face was purple before the cord was cut.
Not to keep arguing with you, but as mwherbs said, a blue/purple head is not considered an emergency in itself.

From Special Delivery by Rahima Baldwin:

Quote:
The first view you will have of your baby is usually the top of its head. As it starts to appear to the vaginal opening, you may wonder how anything so wrinkled, gnarled and bluish-grey can relate to a baby. [...] As the baby slips out, you may be amazed by his bluish color and the slippery, shimmery energy surrounding him. [...] [Primary apnea is] characterized by: a blue color, indicating adequate circulation of unoxygenated blood; [...] a baby who is not breathing, but is blue, shows fairly good muscle tone, and responds to stimulation, will start to breathe on his own. [...] If the baby is blue and his breathing efforts are not successful, it means his circulation is good and the baby just needs mouth-to-mouth resusitation.
A blue baby is of course not a fully oxygenated baby, so it's important that the cord still be attached so that there is no break between oxygen being received by the cord and oxygen being received through the nose and mouth. If there is a break, the baby will be less likely to start breathing spontaneously. Many babies in the hospital have to have help getting started breathing because their cords are cut before they've started breathing spontaneously.

So, going back aways,
Quote:
If the cord is tight around the babies neck, you can just unwrap it once the head is out. However, in my cases, I have never really worried about it. The cord is usually plenty long enough and it is also stretchy and strong. So most of the time, you would never have to do anything at all.
Quote:
I had my last ds in the hospital and he had a very tight double nuchal cord. The OB said it was too tight and she had to cut it off before I finished pushing him out. He was limp and not breathing. His head was very blue compared to his body and he had to be resuscitated.
Okay. Perhaps the problem here is that, as could be inferred in the first quote (although I'm sure she didn't mean that) the doctor believes like so many people that the cord needs to be loosened from around the neck before the baby ican be born. This is standard I think in most hospitals and many midwives do this as well, but there is no evidence that it is necessary and the argument can be made that it creates problems, as increased exposure to air and stimulation of the cord can cause it to begin shutting down, and the fooling around with the mother at that stage can also inhibit her body from spontaneously pushing the rest of the baby out quickly. So, while the doctor probably sees lots of blue-ish babies, if she assumes that the cord *must* come off before the baby is born and can't get it off and sees this in conjunction with a blue scalp, she may assume further that the cord is choking the baby or being compressed. The meconium wouldn't have helped keep it from feeling like an emergency situation, even though (like I said before) the meconium was more than likely not due to cord compression. So the cord "must" be cut, and the baby needs help breathing due to that.

Of course, all this is speculation. But theoretically it's as much a possibility as the explanation your doctor presented to you.
post #147 of 238
Thread Starter 
I don't ever check for cords or loosen cords before birth.

Certainly cutting off a baby's oxygen supply before the birth (cutting the cord) will autotmatically put baby in need of resuscitation. It more than likely wasn't the cord that necessitated the resuscitation - it was the cutting off of your baby's oxygen supply before it was ready. Will do it every time. No amount of slight pressure from a cord around the neck will do the same serious insult that cutting the cord before the first breath will do. It's a very, very SERIOUS intervention.
post #148 of 238
Quote:
Not to keep arguing with you, but as mwherbs said, a blue/purple head is not considered an emergency in itself.
I see what you are saying. HOwever I did not say that it was considered an emergency in itself. It *was* an emergency but for other reasons as well.

Quote:
a baby who is not breathing, but is blue, shows fairly good muscle tone, and responds to stimulation, will start to breathe on his own.
yeah, he wasn't doing those things.

I don't think it is totally "normal" for a baby to have a blue/purple head and the rest of his body looks fairly normal in color (normal for a just born babe). Surely it could happen for a variety of reasons but I think given the variety of other things going on it is a pretty safe assumption in my son's delivery that the tight nuchal cord had something to do with it.

Quote:
This is standard I think in most hospitals and many midwives do this as well, but there is no evidence that it is necessary
This could definitely be true. I didn't get that impression from her at the time but it could be. I didn't get the feeling that she thought it needed to be cut for any other reason than the tightness of it. I don't think it is standard in most hospitals though. I think that might just be your impression. When researching the matter I didn't find it to be more common for the cord to be cut in those cases nor did I find the recomendations to be for cutting (unless the cord was very taut). The problem is the situation is rare but you do not know if there is a short cord going on. I have started to suspect that *that* is what she was thinking, but who knows for sure. I think you are right about the mec effecting her viewing of the situation being more emergent. That is unfortunate but I'm not sure she was too off in her thinking. My gut (and common sense) tells met that the mec probably was from distress from the cord compression. I hate telling people that my first son who was 18 days past edd and induced with the works did not have mec but my son who I refused induction with and allowed to go naturally with NO drugs of any kind was the one who had mec. Purely anecdote but still increased risk of mec is just another little reason to avoid pit.
post #149 of 238
Quote:
Certainly cutting off a baby's oxygen supply before the birth (cutting the cord) will autotmatically put baby in need of resuscitation. It more than likely wasn't the cord that necessitated the resuscitation - it was the cutting off of your baby's oxygen supply before it was ready. Will do it every time.
interseting view, someone else said that earlier in this thread. However I have actually heard of several babies who had early cord cutting NOT requiring resuscitation. I just tried a google search and found some cases where it was not needed.

Quote:
No amount of slight pressure from a cord around the neck will do the same serious insult that cutting the cord before the first breath will do. It's a very, very SERIOUS intervention
yeah I don't think it was slight pressure but rather strong pressure. That can in fact cause serious insult above and beyond cutting the cord before the first breath such as death or serious brain injury.
post #150 of 238
hopping in, then subscribing to catch up..

I grew up in an area of almost no midwife access. I cannot tell you how many friends i had that UC's simply because they refused to go to the local crappy hospital with a 98% episiotomy / 60% C sec rate to have a baby and be treated like crap.

they often had babies at home, with husbands, friends, and other moms.

Was it always safe?? No..I have heard some stories of babies...babies blue/white, cord tied in 3 knots and wrapped around the neck...who were only resuscitated after a lot of work and prayer.

however....those families also couldnt afford to pay the fee of the one operating midwife in the state at the time. They were just poor.

So their reasons for UCing were valid i suppose.

Fast forward to me...I have had one midwife attended birth center birth. And one unplanned UC. with just my husband and I. It was an amazing experience, and I would do it again in a heartbeat.

I do feel its sad when moms feel like they HAVE to do it b/c they have no other choice.
post #151 of 238
Pamamidwife - I must disagree from experience that cutting a nuchal cord does NOT automatically mean resuscitation.
I performed one that I wish I had not during my training (I just wish she had shown me how to wait for babe to somersault - hurts me when I think of it now). - thrice wrapped nuchal cord (it was a LONG cord!) that incidentally was loose enough to easily get the clamps onto - should have been loose enough to somersault baby out - anyway needless to say baby did not need resuscitation.
It was a completely unecessary invasion but was not dire.
post #152 of 238
Quote:
Originally Posted by erin_brycesmom View Post
I don't think it is standard in most hospitals though. I think that might just be your impression. When researching the matter I didn't find it to be more common for the cord to be cut in those cases nor did I find the recomendations to be for cutting (unless the cord was very taut).
Checking for the cord is standard, agreed? And what's the point of doing that unless you're planning to do something about it if it's not loose?

Anyway, perhaps you could share your sources. I've had trouble finding any that refer specifically to cord-clamping on the perineum.

ETA: if you haven't already seen this you might find it helpful: http://www.gentlebirth.org/archives/nuchlcrd.html (It's titled "somersault maneuver" but there's also general discussion on cord issues. And it's from a non-UC perspective, if that helps. )

Quote:
Originally Posted by erin_brycesmom
interseting view, someone else said that earlier in this thread. However I have actually heard of several babies who had early cord cutting NOT requiring resuscitation. I just tried a google search and found some cases where it was not needed.
Are we talking about all early cord-cutting, or cutting the cord while most of the baby is still in the uterus? I'm going to assume Pam was referring to the latter and exaggerating for emphasis... there are of course exceptions to nearly every rule. In any case, we can probably all agree that cutting the cord before the baby is born increases respiratory difficulty. If we can't agree on that, perhaps a new thread should be started to hash it out and provide sources, because this is getting a bit away from the subject of UC.

Quote:
Originally Posted by erin_brycesmom
it is a pretty safe assumption in my son's delivery that the tight nuchal cord had something to do with it.
In that case, it's pointless to continue on examining it, so let's get back to your original question: What would you do in that situation? Would you not have cut the cord off before fully birthing him?

My first reaction when reading your story was, what in the environment was contributing to a constipated second stage? Forgive me, I know this is going to raise some ire among non-UCers and many will not approve, but I don't have concern about cord compression issues because I have no reason to not expect a normal second stage in an unhindered environment. If second stage is spontaneous and instinctive, it will be quick, and there will be no time for the baby to languish on the perineum, so no need for fiddling with the cord (which as we know carries its own risks.)
post #153 of 238
just subbing, very interested in this conversation
post #154 of 238
Thread Starter 
Loved, I definitely respect your experience and feel like you were lucky that the baby didn't need resuscitation. Likely the baby came right after the cutting, right?

Anytime we totally and completely cut off a baby's oxygen supply, we're not exerting some stress on the baby, it's much worse than that. It's done - there is not a "reduction" in oxygen...it's just not there at all.

I recently read a birth story here at MDC of a mom whose mw cut the cord on the perineum and then had issues getting the baby out! Another reason to NEVER do this! Surely if it looks like the cord is holding the baby up, it could also be a shoulder dystocia. These have to be considered - is the baby rotating? head turtled in? In the end, everyone was grateful for the resus equipment of the mw when in fact, it was her that caused the need for the resuscitation! A baby with a TRUE shoulder dystocia needs all the oxygen it can get from the cord. Cutting it before the baby is born is essentially slitting its throat! I know that sounds harsh, but it's so true. You can cut the cord, but you better be sure that baby is going to slide out RIGHT THEN or you're in for a mess.

I agree that there could be a small percentage of cases in which babies do not need resuscitation, but on the whole, they will and do. Physiologically, it forces them to transition faster and harder before they're even ready to. Most cannot make that huge, quick adaptation!

The whole "cord around the neck" myth / urban legend telling really is interesting to me. I'm glad Fourlittlebirds started the other thread.
post #155 of 238
Speaking of nuchal cords & knots!

Two months ago I birthed my 13 pounder, in water, on hands & knees.....and she had a TIGHT nuchal cord (just once round her neck) & a true knot!!!!!!!! It was amazing.

What happened was: I birthed her in the water, turned around, went to pick her up out of the water, & realized her cord was so short I'd have to get myself out of the water some to bring her up to the surface. When I did, I immediately saw the tight nuchal cord.....and was amazed at how it didn't just come off all that quickly. I had to really maneuver myself to remove it. Later, after I pulled the placenta out of the water, I saw the knot....and the cord itself was weirdly flat & straight in many places, particularly on either side of the knot.

All that I did happened very instinctually...there was no stress involved and it was like time stood still.

She breathed immediately and I had to hunch over to nurse her in order to not cut the cord!! I cut the cord about 3 hours after she was born.
post #156 of 238
Thread Starter 
Surely you lie, Mama! That can't be! a 13lb baby with a nuchal cord and true knot? you didn't need a cesarean?? and you had no midwife to protect your perineum???

[/sarcasm]

post #157 of 238
subbing to read this later. falling asleep at the keyboard...
post #158 of 238
fourlittlebirds - at this point I think we are really going in circles. You are asking me about a link that i have already been shown and addressed in this thread already. Here is a quote from your link:

Quote:
c. If the cord is too tight to slip back over the shoulders, but has a little give to it, somersault the baby out, as follows:
bold is my emphasis. Not sure how much more clear I can be. I think you and some others are trying to argue the point of standard nuchal cord checks, standard cutting, etc. I am not saying that. What I have said all along is that basically ever single piece of evidence I have read gives exception to the rare situation where cutting the cord on the perinium is the right thing to do. Do I think that all double nuchal cords should be cut? No as I've already said it is a shame that my son's was cut when he needed it delayed more than most.

My last pregnancy was an amazing journey for me. After the birth of my first I felt totally broken and didn't know if i could ever go into labor on my own. For 10 months I researched childbirth for hours every single night. I got in touch with myself and my body to a point I never knew was possible. I enjoyed the birth instead of feeling pain I felt incredible. Almost 14 months later I am still on a high from it. My life will never be the same, I have found my calling.

Now I am planning a homebirth for my third child and my husband has reservations. Yes I know I can have a homebirth without my husband approval and he respects that but I also know that by knowing my husband is uncomfortable with it, that will hinder me in the birth process. I won't be fully comfortable knowing that the person with me (hopefully) is very uncomfortable with the situation. His main concerns center around the cord incident with our 2nd and how that would be handled at home and believe me I wanted nothing more than to come to him with evidence to show him that what the OB did by cutting our cord was totally unnecessary and caused all of the problems. Looking at the evidence without bias, I am not able to do that. Was it necessary or at least appropriate given the circumstances? I'm not so sure that it was, but I have concluded that there are rare times when it is necessary and all I can really do is focus on how to handle it at home (possibly UC) should the situation ever arise so that we can get past this issue..

Quote:
In any case, we can probably all agree that cutting the cord before the baby is born increases respiratory difficulty. If we can't agree on that, perhaps a new thread should be started to hash it out and provide sources, because this is getting a bit away from the subject of UC.
Yes of course I agree that cutting increases respiratory difficulty. I think this is getting so far off subject because of misconceptions of my view on this matter.

Quote:
My first reaction when reading your story was, what in the environment was contributing to a constipated second stage?
Thank you for trying to answer my original question. That is a valid concern and I'm sure that the enviornment after the head was out did effect how long that stage of labor lasted. But I also think it would be foolish for me to think that the only time a tight nuchal cord can effect the baby is if the enviornment constipates the situation or that an enviornment can not be constipated in a UC.
post #159 of 238
Quote:
you didn't need a cesarean?? and you had no midwife to protect your perineum???
:

The funny thing is, my big girl was really not much different getting out than my tiny little first born at 9 & 1/2 pounds! All the hooplah over big babies is just ......well, not true! That is, I think when they are born in an environment where mama is left to her own devices.
post #160 of 238
Quote:
Originally Posted by erin_brycesmom
I think you and some others are trying to argue the point of standard nuchal cord checks, standard cutting, etc.
No, and I apologize for not being more clear about what I found relevant there. The part that I thought might be helpful was:

Quote:
Our major concern should be to avoid pulling on a taut cord. We don’t want to increase the tension already there. This is done one of two ways: 1) by cutting the cord from around the neck – the standard medical view; or 2) by keeping the baby close to the uterus as it is born, delivering through the loops or else using the “somersault maneuver.” [...]

As for the second part of the question, it shouldn’t make a difference how hard mom pushes, since the cord is not holding back the baby. One other possible factor to consider: if a tight or short cord is slowing labor, then can the cord “stretch” to allow descent? Theory says it could and that this is more likely than pulling the placenta off. Tight cords can cause fetal distress, of course, and that’s what practitioners should be watching for. If mild stress is present but the baby is coming quickly, then the baby will be better off if the midwife can keep the cord intact after birth. He’s the kid who will really NEED an intact cord to help him recover. But if we follow the advice of cutting the cord around the neck, we will be putting the baby through a good deal of additional stress! [...]

I can’t say there won’t be the very rare case of a baby who really needs his cord cut after the birth of the head. I will say I’ve seen more than a few who would have been cut following the old rule, but who were born through the loops or somersaulted out and were fine, vigorous babies.
The reasons I thought it might be helpful: one, because she acknowledges that there might be rare cases in which the cord needs to be cut on the perineum while still questioning under what circumstances this makes sense, so that it is a relatively unbiased opinion (as opposed to, say, someone who believes that the cutting of a tight cord is always indicated, as with one of the previous -- and more traditionally medical -- opinions on that same page.) Two (and this is probably the most relevant part of it at this point,) because she talks about the fundus following the baby, which I thought was interesting regarding the fear of short cords. You had written earlier, "The problem is the situation is rare but you do not know if there is a short cord going on. I have started to suspect that *that* is what she was thinking, but who knows for sure." Third, she explains in yet another way why she feels that cutting a tight cord for a mildly distressed baby (which was the indication in your case, as the head was blue/purple on the perineum) does not make sense, which supports my own opinion of how it would be handled in the event of a UC (my UC, I should be clear,) which is what you were asking for.
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