http://midwifethinking.com/2011/01/22/the-anterior-cervical-lip-how-to-ruin-a-perfectly-good-birth/

IV Fluids linked to Newborn Weight Loss

Maternal IV Fluids Linked to Newborns' Weight Loss

ScienceDaily (Aug. 15, 2011) — A newborn baby's weight loss is often used to determine how well a baby is breastfeeding, and concern about a baby which loses too much weight may result in supplementing breastfeeding with formula. However, many women receive IV fluids during labor, and new research published in BMC's open access journalInternational Breastfeeding Journal shows that some of a newborn's initial weight loss may be due to the infant regulating its hydration and not related to a lack of breast milk.

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Health & Medicine

• Diet and Weight Loss
• Infant's Health
• Fitness
• Obesity
• Breastfeeding
• Pregnancy and Childbirth

Reference

• Colostrum
• Infant
• Maternal bond
• Childbirth

A group of Canadian researchers looked at relationships among the IV fluids a mother received during labor (or prior to her caesarean section), neonatal output (measured by diaper weight), and newborn weight loss. They found that during the first 24 hours following birth there was a positive association both between the IV fluids given to mothers before birth and neonatal output, and between the neonatal output and newborn weight loss. At 60 hours post birth, the time of the average lowest weight, there was a positive relationship between maternal IV fluids and newborn weight loss.

"Nurses, midwives, lactation consultants, and doctors have long wondered why some babies lose substantially more weight than others even though all babies get small amounts to eat in the beginning," said principal investigator Prof Joy Noel-Weiss from the School of Nursing at the University of Ottawa's Faculty of Health Sciences. "It appears neonates exposed to increased fluids before birth might be born overhydrated, requiring the baby to regulate his or her fluid levels during the first 24 hours after birth."

Prof Noel-Weiss added, "We should reconsider the practice of using birth weight as the baseline when calculating newborn weight loss in the first few days following birth. For mothers and their breastfed babies, accurate assessment of weight loss is important. Although more research is needed, based on our findings, we would recommend using weight measured at 24 hours post birth as a baseline."

Alongside this article, the researchers have provided a standardized method for clinicians to collect and analyze data about newborn weight loss in their own maternity site, in the hope that this protocol will help them to make informed decisions when assessing newborn weight changes.

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by BioMed Central, via EurekAlert!

The Natural Cesarean

The Natural Caesarean is more mom and baby friendly stressing the importance of mom seeing baby born gently, delayed umbilical cord clamping and skin to skin contact immediately following birth. This practise has been used for some time now, lower postpartum depression and more successful breastfeeding are some of the visible benefits. If a c-section is necessary this is the kinder, more compassionate way to birth the baby, resulting in significant less trauma to mother and baby.

The Myth of the Vaginal Exam

Vaginal exams. I don't know a single woman who likes them.

However, there is a myth perpetuated in our society that vaginal exams at the end of pregnancy are beneficial. The common belief is that by doing a vaginal exam one can tell that labor will begin soon. This is not the case.

Most practitioners will do an initial vaginal exam at the beginning of pregnancy to do a pap smear, and other testing. Then they don't do any until about the 36 week mark, unless complications arise that call for further testing or to assess the cervix. If your practitioner wants to do a vaginal exam at every visit, you should probably question them as to why.

Vaginal exams can measure certain things:

• Dilation: How far your cervix has opened. 10 centimeters being the widest.
• Ripeness: The consistency of your cervix. It starts out being firm like the tip of your nose, softening to what your ear lobe feels like and eventually feeling like the inside of your cheek.
• Effacement: This is how thin your cervix is. If you think of your cervix as funnel-like, and measuring about 2 inches, you will see that 50% effaced means that your cervix is now about 1 inch in length. As the cervix softens and dilates the length decreases as well.
• Station: This is the position of the baby in relation to your pelvis, measured in pluses and minuses. A baby who is at 0 station is said to be engaged, while a baby in the negative numbers is said to be floating. The positive numbers are the way out!
• Position of the baby: By feeling the suture lines on the skull of the baby, where the four plates of bone haven't fused yet, one can tell you which direction the baby is facing because the anterior and posterior fontanels (soft spots) are shaped differently.
• Position of the cervix: The cervix will move from being more posterior to anterior. Many women can tell when the cervix begins to move around because when a vaginal exam is performed it no longer feels like the cervix is located near her tonsils.

What this equation leaves to be desired is something that is not always tangible. Many people try to use the information that is gathered from a vaginal exam to predict things like when labor will begin or if the baby will fit through the pelvis. A vaginal exam simply cannot measure these things.

Labor is not simply about a cervix that has dilated, softened or anything else. A woman can be very dilated and not have her baby before her due date or even near her due date. I've personally had women who were 6 centimeters dilated for weeks. Then there is the sad woman who calls me to say that her cervix is high and tight, she's been told that this baby isn't coming for awhile, only to be at her side as she gives birth within 24 hours. Vaginal exams are just not good predictors of when labor will start.

Using a vaginal exam to predict advisability for a vaginal birth is usually not very accurate, for several reasons. First of all it leaves out the factor of labor and positioning. During labor it's natural for the baby's head to mold and the mother's pelvis to move. If done in early pregnancy it also removes the knowledge of what hormones like Relaxin will do to help make the pelvis, a moveable structure, be flexible. The only real exception to this is in the case of a very oddly structured pelvis. For example, a mother who was in a car accident and suffered a shattered pelvis or someone who might have a specific bone problem, which is more commonly seen where there is improper nutrition during the growing years.

During labor vaginal exams can't tell you exactly how close you are either, so keeping them to a minimum then is also a good idea, particularly if your membranes have ruptured.

Okay, so there's not really a great reason to have a vaginal in exam done routinely for most women. So are there any reasons not to have vaginal exams? There sure are.

Vaginal exams can increase the risks of infection, even when done carefully and with sterile gloves, etc. It pushes the normal bacteria found in the vagina upwards towards the cervix. There is also increased risk of rupturing the membranes. Some practitioners routinely do what is called stripping the membranes, which simply separates the bag of waters from the cervix. The thought behind this is that it will stimulate the production of prostaglandins to help labor begin and irritate the cervix causing it to contract. This has not been shown to be effective for everyone and does have the aforementioned risks.

In the end only you and your practitioner can decide what is right for your care in pregnancy. Some women refuse vaginal exams altogether, so request to have them done only after 40 weeks, or every other week or whatever she feels comfortable with.

Healthy Babies Are Worth the Wait

June 10, 2011 By Cara Terreri 1 Comment

Source: PRNewswire-USNewswire

Every week of pregnancy is crucial to a newborn’s health, and today, the March of Dimes unveiled a new public education campaign to raise awareness about the important development that occurs during those last few weeks.

The campaign, called “Healthy Babies Are Worth the Wait,” encourages women to allow labor to begin on its own if their pregnancy is healthy. It aims to dispel the myth that it’s safe to schedule a delivery before 39 weeks of pregnancy without a medical need.  

Babies born after 37 weeks of pregnancy are full-term. However, new research has shown that a baby’s brain nearly doubles in weight in the last few weeks of pregnancy. Also, important lung and other organ development occur at this time. And, although the overall risk of death is small, it is double for infants born at 37 weeks of pregnancy, when compared to babies born at 40 weeks, for all races and ethnicities.

“Some women mistakenly think that the only thing a baby does during the last weeks of pregnancy is gain weight, making labor and delivery more difficult,” said Judith Nolte, a member of the March of Dimes national Board of Trustees and former editor-in-chief of American Baby Magazine Group, who worked with the March of Dimes to develop the new awareness campaign. “When the moms in our focus groups learned about the important brain and organ development that occurs, they were more than willing to put up with their own discomfort so their baby could get a healthy start in life.”

Only 25 percent of women know a full-term pregnancy should last at least 39 weeks, according to research published in the December 2009 issue of Obstetrics and Gynecology.

“Women may feel worried, anxious, or simply uncomfortable near the end of their pregnancy.  But unless there are medical complications, the healthiest and safest place for that developing infant is in the womb,” said Eve M. Lackritz, M.D., chief of the Maternal and Infant Health Branch, Division of Reproductive Health, Centers for Disease Control and Prevention, who outlined the health consequences of an early birth. “Term labor and delivery are not just normal and natural – they’re the healthiest alternative for both the mother and the infant.”

Information about the new Healthy Babies Are Worth the Wait educational campaign can be found at marchofdimes.com/39weeks.

The March of Dimes is the leading nonprofit organization for pregnancy and baby health.  With chapters nationwide, the March of Dimes works to improve the health of babies by preventing birth defects, premature birth and infant mortality.  For the latest resources and information, visit marchofdimes.com ornacersano.org. For free access to national, state, county and city-level maternal and infant health data, visit PeriStats, at marchofdimes.com/PeriStats.

Low Amniotic Fluid???

Low Amniotic Fluid. . . I don’t think so

Posted on November 28, 2008 by gloria

What will it take to stop the inductions for too little amniotic fluid?  This is largely a wrong diagnosis based on ultrasound.  Women are having their births wrecked by midwives and doctors who believe that Biophysical Profile is a valid testing method.  We need to go back to clinical palpation skills and stop depending on sound wave fuzzy pictures to assess the amount of fluid at full term.

 Here is where the problem begins:

Many North American women are being told at the very end of their pregnancies to go to an ultrasound clinic and have a biophysical profile done. Most are impressed by the thoroughness of their practitioner and have no idea what this test involves or what sort of harm could follow from consenting to this diagnostic procedure. They will probably not be told that there is no scientific basis for having faith in the test results and that no improvement in health has been proved from large numbers of fetuses being “profiled.” Certainly, no one will mention that the only benefits of the procedure are: 1) the ultrasound clinic will earn $275; and 2) the medical practitioner will be able to cover themselves legally in the very rare instance that a baby might die in utero.Until recently, physicians and midwives would tell women who were carrying their babies beyond 41 weeks gestational age to do “kick counts.” If the baby has 10 distinct movements between the hours of 9 a.m. and 3 p.m., it is widely accepted that the baby is thriving under the mother’s heart. In a culture that loves technology and with the push to expand the commercial use of ultrasound, it was inevitable that someone would come up with a more complex strategy to provide reassurance of the baby’s wellbeing in late pregnancy. Thus the biophysical profile (BPP) was born. Here is the content of the testing, as it appears on the Family Practice Notebook Web site (www.fpnotebook.com/OB44.htm):

1. Cost: $275
2. Criteria (2 points for each)
   1. Fetal Breathing
      1. Thirty seconds sustained breathing in 30 minutes
   2. Fetal Tone
      1. Episode extremity extension and flexion
   3. Body Movement
      1. Three episodes body movement over 30 minutes
   4. Amniotic Fluid Volume
      1. More than 1 pocket amniotic fluid 2 cm in depth
   5. Non-Stress Test
      1. Reactive
3. Scoring
   1. Give 2 points for each positive above
4. Interpretation
   1. Biophysical Profile: 8-10
      1. Low risk or Normal result
      2. Repeat Biophysical Profile weekly
      3. Indications to repeat Biophysical Profile biweekly
         1. Gestational Diabetes
         2. Gestational age 42 weeks
   2. Biophysical Profile: 8
      1. Delivery Indications: Oligohydramnios
   3. Biophysical Profile: 6
      1. Suspect asphyxia
      2. Repeat Biophysical Profile in 24 hours
      3. Delivery Indications
         1. Repeat Biophysical Profile less than or equal to 6
   4. Biophysical Profile: 4
      1. Suspect asphyxia
      2. Delivery Indications
         1. Gestational age 36 weeks
         2. Lung Maturity Tests positive (L/S Ratio 2)
   5. Biophysical Profile: 0-2
      1. Likely asphyxia
      2. Continue monitoring for 2 hours
      3. Delivery Indications
         1. Biophysical Profile ‹ 4

“Breathing” above refers to movements in the lungs that show activity of the lungs in preparation for life outside the womb. The baby’s oxygen supply in utero comes via the placenta and umbilical cord while in the mother’s womb.

In the past year, I have had a number of letters and phone calls from doulas, midwives and childbirth educators about a flaw in this testing method. An unusually large number of diagnoses seem to be made that “there is not enough amniotic fluid.” This seems to be the factor in this outline that is most often used as an excuse for induction. It is important for parents to know that this is likely an inaccurate assessment. What the ultrasound technician is doing could be compared to viewing an adult in a see-through plexiglass bathtub from below the tub. In such a scenario, it would be difficult to assess how much water is in the tub above the body that is resting on the bottom of the tub. You might be able to get an idea of the water volume by measuring how much water was showing below the elbows and around the knees, but if the elbows were down at the bottom of the tub, too, you might think there was very little water. This is what the technician is trying to do in late pregnancy—find pockets of amniotic fluid in little spaces around the relatively large body of an 8 lb. baby who is stuffed tightly into an organ that is about the size of a watermelon (the uterus). If most of the amniotic fluid is near the side of the uterus closest to the woman’s spine, it can not be seen or measured. This diagnosis of low amniotic fluid frightens the parents-to-be into acquiescing to an induction of labour. Even though the official BPP guidelines do not require immediate induction for a finding of low amniotic fluid, in practise, the parents are pressured to induce. Stories abound of mothers who are induced for this indication and then report having abundant fluid when the membranes released in the birth process. The risks of induction, which can be catastrophic, and the resulting increase in the need for pain relief medication and cesarean section are usually not discussed with the parents prior to embarking on induction of the birth. Be warned that this latest suspect diagnosis using ultrasound is increasing in frequency and causing increased harm to mothers and unborn babies through aggressive use of induction.

After I published the above explanation in Midwifery Today Magazine in 2004, I received  posts from women who had experienced being induced for this diagnosis. Here’s an example:

Thanks for writing this article, Gloria.  It was the one that made me fully realize that my induction (at 41w1d – due to “low” amniotic fluid) & subsequent c/s due to failed induction were almost certainly unnecessary when I first read it in 2004.  Everything you wrote happened to me.  The BPP was perfect besides the fluid measurements.  And then I did have “abundant fluid when the membranes released in the birth process”.

Cathleen in MA

——————

DS 5/03

DD 2/06 (HBAC!)

Here are some medical studies that confirm my alarm over using Amniotic Fluid Index as the reason to do an induction:

Low Levels of Amniotic Fluid No Risk To Normal Birth (2004)

Doctors may not have to deliver a baby early if it has low levels of amniotic fluid surrounding it, Johns Hopkins obstetricians report.

In a study to be presented Feb. 7 at the annual meeting of the Society for Maternal-Fetal Medicine in San Francisco, researchers show that babies born under such conditions fared similarly to those born to women whose wombs held normal amounts of amniotic fluid. No significant differences were found in the babies’ birth weights, levels of acid in the umbilical cord blood, or lengths of stay in the hospital.

Typically, doctors have been concerned about women with low levels of amniotic fluid during the third trimester – a condition called oligohydramnios – because too little fluid can be associated with incomplete development of the lungs, poor fetal growth and complications with delivery. Amniotic fluid is measured by depth in centimeters. Normal amounts range from 5 to 25 centimeters; any amount less than 5 centimeters is considered low.

“These study results are very surprising – they go against the conventional wisdom,” says Ernest M. Graham, M.D., senior author of the study and assistant professor of gynecology and obstetrics. “Amniotic fluid stems from the baby’s urine, and the urine results from good blood flow, so if we see low fluid we assume there probably is not good blood flow and the fetus is compromised. This study shows the fluid test is not as good as we thought, and there is most likely no reason to deliver the baby early if other tests are normal.”

The researchers studied 262 women (131 with oligohydramnios and 131 with normal amounts of amniotic fluid) who gave birth at The Johns Hopkins Hospital between November 1999 and July 2002, comparing the babies’ health at birth. Patients with oligohydramnios were delivered sooner, but were less likely to need Caesarian sections. Babies born to moms with isolated low amniotic fluid were normal size and were at no increased risk of respiratory problems, immature intestines or brain disorders.

Study co-authors were Rita Driggers, Karin Blakemore and Cynthia Holcroft.

Abstract # 318: Driggers, R. et al,

“Are Neonatal Outcomes Worse in Deliveries Prompted by Oligohydramnios?”

Related Web sites: Related Web sites:

http://www.nature.com/jp/journal/v24/n2/abs/7211034a.html
Journal of Perinatology (2004) 24, 72–76. doi:10.1038/sj.jp.7211034 Published online 22 January 2004

An Amniotic Fluid Index 5 cm Within 7 Days of Delivery in the Third Trimester Is Not Associated with Decreasing Umbilical Arterial pH and Base Excess

Rita W Driggers MD¹, Cynthia J Holcroft MD¹, Karin J Blakemore MD¹ and Ernest M Graham MD¹¹Division of Maternal-Fetal Medicine, Department of Gyn-Ob, Johns Hopkins University School of Medicine, Baltimore, MD, USA.Correspondence: Ernest M. Graham, MD, Johns Hopkins Hospital, Department of Gyn-Ob, Phipps 228, 600 N. Wolfe Street, Baltimore, MD 21287-1228, USA.