CBE "crash course" - Mothering Forums
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#1 of 7 Old 02-27-2008, 11:36 PM - Thread Starter
 
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I'm teaching one on Saturday. I've had a hard time narrowing down what I normally do over 18 hours into just 6 in one day!

Anyone else do a crash course? What do you cover? It's difficult deciding what's most important.

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#2 of 7 Old 02-28-2008, 01:47 AM
 
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Here's what I cover in one of my prenatals when a client has only had a out of hospital class...a lot to absorb in a couple of hours...but *shrug* better than nothing. We end up talking about oh-so-much more, but this is what I have written down to jog my memory...Sorry, but these are just my notes to myself, so some are more detailed than others!



Childbirth Ed (when only hosp class has been taken):



*Hospital gown (who wears gowns? What does it signal?…body/birth is broken/ill/needs to be fixed)

*Vaginal exams (asking somebody else to tell you that your are in labor, depending on somebody else to tell you whether you’re “progressing” via subjective clues, dr. who developed the “1 cm per hour” rule-Friedman’s curve- has actually recanted it as poor science and as risky and unrealistic)

*Water Breaking (naturally “SROM”…taco; AROM…why???? If allowed to break spontaneously, water generally breaks during the second phase of labor, after full dilation, soon before head crowns…shown to protect baby’s head, make labor easier to bear for mother. Breaking water can lead to being “on the clock” in the hospital, as well as to introducing infection and/or making labor harder for mother/baby to bear…how long can you stay home after water breaks? Spectrum…what do you do if you DO stay home? Baseline temp, vitamin C @ approx 1000 mg /day, ABSOLUTELY NOTHING GOES INTO VAGINA until you feel the urge to push)

*EFM (not an issue in birth center, but if transferred…
-everybody involved tends to watch the monitor rather than the mother.
-Two straps that tend to be tight and rarely get the heart rate consistently for the “required” 20 minute strip in anything that resembles comfortable or safe for mother/baby unit…and protocol does not care.
-Tethers mother to bed, to whatever she can do within a five foot radius of the monitor.
-Only there for safety of the hospital (ie from litigious patients) and its staff.
-proven to be ineffective in “protecting” baby/mother, causing higher unnecessary cesaerean rate, thus putting baby at higher risk of death, and mother at higher risk for infection and death.
-rate of morbidity and mortality actually the same or higher if used, but docs still want a “strip” to show the jury, even if strip doesn’t mean anything!

*IntraUterine Catheter
-Pathway directly into uterus for germs.
-hospital germs nasty!
-amniotic fluid runs DOWN, and germs have been shown to not travel against the flow of fluid. However, inserting catheter allows the germs to travel up the catheter into uterus, allowing germs direct acess to baby/uterus.

*Narcotics
-help in less than half of laboring mothers. For the most part, mothers report feeling pain at same level and being unable to “get a grasp on reality” to DEAL with pain.
-Makes mother feel foggy, as if she were on another planet.
-takes 1.5 hours to WEAR OFF of mom, but doesn’t hit the placenta until about that time. This means that, if given “too late” in labor, it is just hitting baby when baby is born.
-causes babies w/muscle atony, poor oxygen saturation, little breathing reflex, inability to suck…typically low apgars.
-keep narcan on hand to give these babies…this is what docs give HEROIN addicts when they’ve od’d and present at the ER.
-there is a positive correlation to receiving narcotics during labor (fetally) and having drug and alcohol addictions later in life.

*Epidurals
-shown to slow labor
-can cause baby to turn posterior b/c of muscle atony in uterus and abs
-NICU nurses can tell an epidural baby a mile away because they are affected by the drugs, which can cross the blood brain barrier!
-typically cause a drastic drop in blood pressure.
-countered with IV fluids
-IV fluids swell tissues, making breastfeeding properly extremely difficult
-IV fluids can stress kidneys
-causes labor to slow.
-countered with pitocin
-pitocin will cause your body to stop making it’s own oxytocin, which can lead to pp hemorrage
-pitocin can stress baby, causing drop in heart rate (seen as “distress”) and is #1 reason for “emergency c-sections”
-pitocin can cause uterine hyper stimulation, which can cause rupture, hemorrage, and/or loss of uterus.
-epi frequently doesn’t work as promised.
-often there are windows, which are patches that keep on a-hurtin’
-feels like your whole body is “asleep”, ie: pins and needles feeling
-can of course cause infection of spinal fluid/brain, and or other serious side effects.
-sometimes it numbs completely and for an extended period of time
-can cause permanent pain and/or nerve damage (ie: I still can’t feel part of the bottom of my big toe, and for MONTHS couldn’t feel a patch of skin on my right butt cheek after bone marrow harvest's spinal)

*MOST COMMONLY, A WOMAN IS IN TRANSITION WHEN SHE ASKS FOR OUTSIDE PAIN RELIEF.
-as a last resort, ask to be “checked” when you ask for drugs/epidural, and then again JUST as they are going to be administered.
-more stories than birth workers can count about epidurals not taking effect until the mom is in the middle of pushing, and/or babies being born severely blue/sleepy b/c of narcotics b/c drugs epidurals were administered as mother was entering transition.

*Laboring on back/on/in bed:
-Slows labor (body has to work against gravity, effectively causing it to have to lift and move sideways rather than work with gravity and PUSH DOWN)
-deprives baby of oxygen and of ability to practice “cardinal movements (how baby moves to help mom get it down the birth canal)”
-significantly less comfortable for mother to be immobile, and the absolute least comfortable way for mother to labor is on back.

*Reclined/semi reclined birthing/pushing:
-closes off 30% of pelvic space that would otherwise be available to baby to get out.
-mother has to move baby sideways under the pubic bone, with tail bone not moving, because mom is sitting on it.

*Induction
-Cytotec
-cervidil
-pitocin
-breaking water (releases prostiglanons…why there are better ways to do this)…only works in half the cases, and you’re ALWAYS “on the clock” when AROM occurs
-natural methods
-Evening Primrose Oil
-sex (3 e’s equivalent to a dose of cervidil)
-accupuncture, acupressure
-homeopathy
-waiting until BABY RELEASES hormones that signal that it’s done cooking. Why rush things? What will happen if you don’t show up for an induction? Car breaks down, sick with the flu, death in the family, etc. Can’t fire you…can’t refuse you when you’re in labor.
-other methods (ie: castor oil, black/blue cohosh…not proven to be effective, can be dangerous[studies could be considered inconclusive in support of and against using]<can be cause of hypertension in mother/baby> or uncomfortable/downright messy)



-Episiotomy…automatic 2-3rd degree tear (goes into muscle) and more likely to cause WORSE tears than tearing alone. Tear heals more quickly, more comfortably, tear less likely to “re-tear” down same site at subsequent births.
-Vaccuum extraction ask parents to do research and come to conclusion
-Forceps assisted birth “



*Water as pain relief (shower equiv. to 50ccs Demerol, tub equiv to 500ccs Demerol)
*birth ball (useful to open pelvis, useful in back labor for pressure, or to lean over/onto from knees, great in shower)
*aroma therapy (moves faster than pain to receptors, can “flood” brain with outside stimulus to trick it into forgetting pain
*hot/cold therapy (ie, suck popsicle, have cold cloth on neck/forehead while in bath/shower) same as above…moves faster than pain does up nerves, so you’ll “flood” pain receptors with other stimulus.
*TENS unit
*sterile water injections for back labor (stings like the dickens to have it done, but can give us time to get posterior baby anterior in a “pain free” environment)
*simply being upright and mobile…walking, dancing, moving however you feel the need to move during contractions. This helps the baby move down more easily, applies it‘s head to your cervix more firmly, and makes labor MUCH more comfortable for the mother in many cases.
*music. If you have music that already helps you to relax, it can be very helpful to stimulate you to relax during a stressful situation(listen to it every day during the “together” relaxation practice)
*practice relaxation together so that mom is accustomed to hearing dads voice as a comforting and relaxing thing when she’s under stress of labor.



*relaxation: YOU SHOULD BE PRACTICING THIS EVERY SINGLE DAY, AT LEAST ONCE A DAY, IN ALL TYPES OF SITUATIONS.
-practice while standing, dancing, squatting, sitting on ball, in tub, in shower, in crowded and bright rooms.
-practice progressive relaxation, practice “immediate relaxation” where you tense up entire body and then MELT into floor/surface.
-practice belly breathing…slow deep breathing, to counts of twenty, or as high as you can, but make them equal, so you don’t hyperventilate. Relax even more on the exhales.
-practice envisioning discomfort as a color (choose this color now). Make this color a fog in your body, and on your inhale, ball the fog together, on the exhale, blow it out of your body.
-practice imagining your cervix opening. Different people do it different ways, some using flower imagery (ie: rose blossom slowly opening), some people imagine a tiny plate slowly getting bigger, until it’s the size of the inside of a dinner plate, which is the size your cervix will be before you feel the urge to push.
-practice imagining the baby moving down your birth canal, and out. Encouraging your body to allow the baby to move down helps the proper muscles do their work. You’ll use this during transition and then until the baby is born.

*Homework: -read articles I left you (BOTH OF YOU!)
-Practice relaxation minimum of once a day (together) and as often as you get a break (mom alone) for a few minutes during the day.
-Exercise daily. (provided a normal healthy pregnancy, start slow, but should be up to 45 min a day by due date)
-Practice squats. (keep heels flat, can be helpful to use door knobs)
-Sit on birthing ball rather than chair and/or couch from now on.

Mama to two awesome kids. Wife to a wonderful, attached, loving husband. I love my job-- I'm a Midwife, Doula and Childbirth Educator, Classes forming now!

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#3 of 7 Old 02-28-2008, 04:04 AM - Thread Starter
 
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That's a lot to cover in about 2 hr?

I'm planning on doing stages of labor and what can be done for pain relief, natural and med. Communicating with doctor before and during labor. Cascade of interventions and what they are. Breastfeeding.

Most of the couples in the crash course come from out of country just to birth their baby and have had no CBE or even have a birth book. I give a handouts packeage covering the basics and then some. Lots on breastfeeding, etc.

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#4 of 7 Old 03-09-2008, 08:53 PM
 
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Nah, I do it in about 2.5 usually, because there's conversation interspersed. This IS my crash course, my actual CBE course lasts 8 weeks!...this is for people who have already had a "hospital" class, and I need to give them info that they DIDN'T get at the hospital.

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#5 of 7 Old 03-09-2008, 08:56 PM
 
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AND...I like them to be able to make informed decisions, as these are things that WILL be presented to most women laboring in a hospital...and informed consent can make all the difference as to the outlook the mother has on the outcome of the birth. Even if it wasn't the way she thought it would be...if she made the choices, she will usually be more content with the outcome than if the interventions were "forced" on her because of lack of information or incorrect information, you know?

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#6 of 7 Old 03-10-2008, 10:06 AM
 
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thanks courtenay, thats really great!

labor & postpartum doula, mom to sky & ben
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#7 of 7 Old 03-10-2008, 11:43 AM
 
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Wow Courtenay!!!! May I print that???






Jen Burnett, DEM
Homeschooling mom to my 3 kids (10, 9 and 8)
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