I can offer you the exemption forms that I offer to my clients. These include the reasons they are normally administered, along with the risks associated with them.
In addition, this is my normal email about pain medication options, methods of Childbirth Education, and unmedicated pain management options.
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Methods of Natural Childbirth:
Hypnobirthing is: Self-hypnosis by 'distraction (focusing away) for, what you can hope is, a pain-free birth. They teach the physical make-up of labor and birth, and do teach a lot on the postpartum period as well. More 'new age' than Hypnobabies. Only qualms I have with this method are the historical inaccuracies and religous bias/bashing that the founder teaches/believes. I do have great friends, though, that have had great success with this method and found it very cohesive to their MOs. Started by Marie Mongan, a professional hypnotherapist. (check out their website
HERE)
HypnoBABIES is: Again, using self-hypnosis techniques for, what you can hope is, a pain-free birth. Between the two hypno's, this one seems to have more success. Teaches lots of physiology of pregnancy, labor, and birth... not as much postpartum as hypnobirthing but not as much anti-religious themes as them either. Created based on master hypnotist Gerald Klein's teachings for introverted self-hypnosis (focusing IN rather than AWAY). Started by Kerry Tuschhoff, a previous hypnobirthing student/teacher. (check out their website
HERE)
Bradley Method is: A completely different approach than the previous two methods. We start by teaching women to stay healthy and low-risk through diet and exercise, the building blocks to a healthy and low-risk pregnancy. Then we build off of that with the physiological makeup of pregnancy and labor/childbirth. We teach what we consider true natural relaxation techniques (modelled for us through the natural world) by concentration, meditation, and visualization. We do
not teach the 'breathing' (Lamaze). We teach how to be positive consumers and active participants in your healthcare through education of medication and procedures that women are commonly faced with during labor and delivery. Breaking pain/tension cycle by negating fear through education/understanding. We teach S/Os how to help a laboring woman as well as lots of postpartum and b/f education. Founded by Dr. Robert Bradley. (check out their website
HERE)
Birthing From Within is: more of a free-method - taught through the bias of whatever teacher you happen to work with. They 'teach' mainly through dialogues and exercises, not much 'formal education'. Lots of hands on and working through fear/tension cycle. Acceptance and embracing of birth process is a central focus. Lots of creative (drawing, painting, writing) exercises designed to help you through this. They teach breath awareness, mindfulness, self-hypnosis, and visualizations while also being open to the use of drugs and epidurals. The most 'accepting' of drugs beside Lamaze. But, a great thing about this method is they teach
active birthing (moving, yelling, accepting pain, etc...) and good nutrition. Very Very New Age - gleaning from Native American practices a lot. Founded by Pam England. (check out their website
HERE)
These are the four major unmedicated childbirth methods out there presently.
Baby Body Birth is: a newer prenatal education class that has developed a unique set of classes and certifies educators to lead our classes. The founders saw a need to offer more comprehensive and useable information than is commonly available and bring adult-learning principles to the field of prenatal education. The core values include The Pregnancy Cycle™ (a formative period in a woman's life that begins preconception and continues long after the baby is born), birth, breastfeeding and intuitive parenting are all a part of our innate human capabilities, the baby is an active participant in all aspects of the Pregnancy Cycle™ and receives signals from their environment through the mother, it is an honor to attend to a woman during birth, reshaping the language of pregnancy and birth is the most effective way to counteract misinformation and unconstructive influences, the formation of personal ideas about pregnancy, birth and parenting takes place long before becoming pregnant, a mother-centered approach to the Pregnancy Cycle™ can build or restore a new mother's confidence in her innate abilities and instincts, confident parents are equipped with information and trust their own judgment to make the best decisions for their baby and their family. (check out their website
HERE)
Lamaze is: no longer considered 'natural' childbirth by their peers. It is so far from Dr. Ferdinand Lamaze's original design that it no longer resembles his method or teachings. They are the 'mainstream' childbirth class taught in most hospital settings. They teach, though less than they used to, 'the breathing' - which has been deemed by the ACOG to be unsafe in labor as it causes hyperventilation for mom and baby - causing many health problems. Beyond this, they teach anatomy of birth, distraction (by psychoprofilaxis) techniques, and hospital policy. I hate to put it this way, but the method has been changed so far from Dr. Lamaze's teachings in his book "Painless Childbirth" that it is now dubbed the 'obedient patient' class for hospital clients. (check out their website
HERE)
Unmedicated pain management techniques:
Accupressure/puncture: From a medical model, they can be viewed as promoting the release of endorphins, blocking the pain receptors to the brain, dilating the cervix, and increasing the efficiency of the contractions. Examples: C7 pressure - This point has a descending action to aid the first and second stages of labour, and can stimulate uterine contractions. This is an excellent point to use when breastfeeding, it relaxes the shoulder and promotes milk supply. Do not use during pregnancy as it can lead to miscarriage.
Hydrotherapy: aka Water birthing. Showers work 3 fold through hydrotherapy, massage, and heat. Tubs work because of the equalization of pressure, weighlessness/boyancy, heat, and nipple stimulation. Hydrotherapy has long been known to be extremely effective when used properly. Benefits include: easing labor discomforts, more freedom of mobility, less stress on the joints, heat therapy, more effective contractions, more pliable tissue for stretching. Hydrotherapy injections have been shown to be useful when a laboring woman has persistant back labor. A small amount of sterile water is injected directly under the epidermis of the lower back to alleviate the pressure caused by baby's decent by offering direct counterpressure.
Vocalization: using tonality for ease of discomfort and creating more effective contractions. Not all noise is the same. In order for vocalization to work as a way to promote relaxation and more rapid dilation, the noise must be conducive to relaxing and dilation. Screaming, screeching, or any high-pitched noise does not come from a relaxed body, nor does it create a relaxing environment for the mother. The type of noise to use in labor is low-toned moans, groans, humming, deep breathing, chanting or sighing. Low-toned nioses are made from a relaxed throat, neck and chest with the mouth and jaw relaxed. You cannot make low-toned noises without being relaxed. Open jaw and relaxed throat also promote the cervix to open and relax as well, allowing for more rapid dilation and less stress = less discomfort. Helping a vocalizer: Pay particular attention to the noise the mother makes. If her voice gets high-pitched or she begins to scream, tell her to open her mouth and take a deep breath. Just opening her mouth should get her to relax her jaw and will bring the tone lower. If the mother is really struggling through a contraction, you may find that you need to make noise for her. Start making a low-toned noise near her face while you try to get her attention. Most mothers will begin to imitate the noise you are making.
Massage: Deep tissue massage throughout labor can aid in assisting the body to completely relax through contractions, allowing the mother to 'get out of the way' of her laboring uterus. Deep tissue massage can easily be combined with hydrotherapy, or accupressure. The sacral points, coccyx, pudendal nerve, and others can be massaged deeply to promote opening of the pelvis, facilitating a more rapid, easier labor. Light massage, such as stroking, jiggling (of the thighs or buttocks), and effleurage can encourage a woman to relax deeper and to concentrate on the movements upon her body. As with all massage, it also aids with circulation and keeps major muscle groups functioning to their utmost without causing additional stress for lack of oxygen.
Hypnosis: An artificially induced altered state of consciousness, characterized by heightened suggestibility and receptivity to direction. One can practice hypnosis by either directing their focus inward or outward (introspection vs. distraction). Inward hypnosis has been proven to facilitate more rapid dilation and shorter labors while also, potentially, making labor near painless. Outward hypnosis can make labor near painless, but has been shown to be not as effective at rapid dilation... thus, labor is not shortened but can be more comfortable. In order for hypnosis to be effective, one must master self-hypnosis by rigid discipline and practice during pregnancy.
Relaxation therapy: all of the above help to promote relaxation. There are three parts to relaxation: mental, emotional, and physical. Many women have had difficult labors until they can effectively let go of mental inhibitions about their bodies or their labors. Many other women have had to work through traumatic memories or thoughts, which effect emotions, regarding their relationships with ppl close to the pregnancy, childbirth itself, or parenting, before the labor can become it's utmost in effective. Fear can make labor much more difficult than it has to be. Finally, physical relaxation: the more physically relaxed one is able to become, the more effectively the uterus can do it's job without the inhibition of stress on other muscles.
Medicated Pain Management - Analgesics:
Pudendal Block: An injection of narcotic medication (usually buvidicaine) is given through the vaginal wall and into the pudendal nerve in the pelvis, numbing the perineum.
Pros: given shortly before delivery so less medication reaches baby, quick acting and short term (2-4 hours), alleviates pain associated with the second stage of labor
Cons: does not relieve the discomfort of contractions, short window of time that it can be administered, may cause residual to permanent nerve damage, can puncture fetus, can puncture uterus or arteries of mother.
Paracervical block: An injection of narcotic medication into the tissues around the cervix. A form of local anesthesia.
Pros: decreases contraction and dilation discomfort, short term (1 to 2 hours)
Cons: can puncture uterus causing infection, can puncture placenta causing hemorrhage, can puncture baby,
Stadol: an analgesic (works on whole nervous system instead of one area) which is administered via IV. It is an opiate derivative (narcotic) with an additive to combate the dysphoriate reaction to narcotics.
Pros: near instant relief, takes the ‘edge off’ of hard labors, moderate (2-4 hours) spanning.
Cons: loopy or high feeling, hallucinations, nausea, depressed respiration in mother and baby, decreased cardiac output, decreased oxygen in blood in mother and baby, fetal heart rate deceleration, and/or epidura hematoma (bleeding on the brain) can occur. Roughly 20% of women have a sensitivity or allergy to the narcotic Stadol.
Demerol: a narcotic analgesic which is administered via IV sometime in the early-late phase of first stage. Very closely related to Stadol.
Pros: near instant relief, makes one ‘too high’ to care about pains of labor, moderate (2-4 hours) spanning.
Cons: loopy or high feeling, nausea, irreconcilable fatigue, depressed respiration in mother and baby, decreased cardiac output, decreased oxygen in blood in mother and baby, fetal heart rate deceleration, and/or epidura hematoma (bleeding on the brain) can occur.
Nubain: another narcotic analgesic, administered via IV throughout the first stage of labor.
Pros: Near instant effectiveness, moderately spanning, similar reactions as marijuana
Cons: abdominal cramps, nausea and vomiting, rhinorrhea, lacrimation, restlessness, anxiety, elevated temperature, respiratory depression in the neonate, and death. Roughly 20% of women have a sensitivity or allergy to the narcotic Nubain.
Medicated Pain Management - Anesthesia:
Spinal (saddle block, intrathecal): an injection of opiates between the vertebrae of the low-mid back, through the epidura, and just beyond the dura – before the spinal cord. This injection is directly into the spinal fluid.
Pros: near instantaneous relief, less medication than epidural, less chance of infection as there is no running line, should completely numb in the uterine area. Should still be able to feel the tightening of the contractions.
Cons: Cons: can be ineffective (either completely or in ‘windows’), readministration means another needle, cause fever, maternal drop in bp, fetal respiratory depression, arresting of labor, inability to push, urinary incontinence, decreased cardiac output of either mother or neonate, increase risk of jaundice, fetal bradycardia (decreasing heartrate with or without contractions), improper engagment (head or presenting part not moving through the pelvis correctly), breastfeeding problems, fetal death, maternal death, or cardiac arrest. Long term consequences can include chronic lower back pain, spinal headache, ruptured discs, or permanent nerve damage.
Epidural: a cocktail of various opiates and narcotic anesthetics placed into a catheter (thin tubing). The catheter is fed between the vertebrae of the low-mid back and into the epidura space before the dura/spinal cord; hence the term ‘epidural’.
Pros: can be given in varying doses, works quickly (within 5-10 minutes), easy to re-administer if it runs out, easy to increase the dose if necessary for a c-section, should completely numb from the uterus to the toes.
Cons: can be ineffective (either completely or in ‘windows’), cause fever, maternal drop in bp, fetal respiratory depression, breastfeeding problems, increase risk of jaundice, fetal bradycardia (decreasing heartrate with or without contractions), improper engagment (head or presenting part not moving through the pelvis correctly), arresting of labor, inability to push, urinary incontinence, fetal death, maternal death, or cardiac arrest. Long term consequences can include chronic lower back pain and ruptured disc.
Walking Epidural: a combination of the epidural and the spinal. An initial injection into the spinal fluid, then a catheter line running continuous low-dose narcotics and opiates to the epidural space of the spinal column.
Pros: quick acting, again can be given in varying doses. easy to re-administer if it runs out, easy to increase the dose if necessary for a c-section, should completely numb in the uterine area while still allowing movement of the legs.
Cons: all of both the epidural and the spinal. In addition, though it is called a walking epidural, a mother does not have full use of her legs and will still be, most likely, confined to bed or sitting in a chair.
Surgical Delivery Options:
Cesarean Section by General Anesthesia: a surgical procedure when a surgeon removes the neonate by incision, through the abdominal wall. In order to get to the uterus, the surgeon must cut through the abdominal wall, the interior membrane, the muscular layer, removing (putting aside) the little intestine, and cutting through the uterine wall. This is done while mother is under general anesthesia - meaning that she is unconscious throughout the operation via IV medication.
Pros: Quick delivery, can save lives of mother or baby.
Cons: major surgery, can mean repeat c-sections for all other deliveries, increase chance of placental retention/abruption/previa in subsequent pregnancies, can lead to hysterectomy, death, hemmorhage, depressed respiration in both mother and baby, major breastfeeding problems, cardiac arrest, decreased cardiac output, infection, intestinal failure, and/or hernia of the abdominal wall.
Cesarean Section by Regional Anesthesia: Usually done with an epidural or combination of a heavy epidural and spinal.
Pros: Quick delivery, can save lives of mother or baby, can be scheduled for convenience, remain awake, less medication gets to baby.
Cons: all of the same risks of epidurals as well as being major surgery, can mean repeat c-sections for all other deliveries, increase chance of placental retention/abruption/previa in subsequent pregnancies, can lead to hysterectomy, death, hemmorhage, depressed respiration in both mother and baby, cardiac arrest, decreased cardiac output, infection, intestinal failure, and/or hernia of the abdominal wall.
In Cesarean Sections, there are two types of incisions and three types of suturing:
Classic Incision: a high risk incision which runs longitudinal. Usually between 3-5 inch incision running from below the belly button to the pubic bone. Generally done in extreme emergencies.
Pros: larger space to work with, faster than a low transverse incision.
Cons: No known successful chance of VBAC, more blood loss, harder recovery, more noticable, higher incidence of suture rupture.
Low Transverse Incision: definitely the incision of choice. It is a smaller incision, below the pubic hair line, from left to right. It is between 2-3 inches long. Done when there is no emergent situation.
Pros: smaller incision, smaller scar, less noticable place, easier recovery, less blood loss, better odds of successful VBAC, lower incidence of suture rupture.
Cons: higher incidence of infection.
Single Layer Suturing: The sutures are used to pull the edges of the incision together and then individual, smaller sutures are used to stop any continued bleeding or pull together areas that aren’t well opposed.
Pros: faster than double layer, less incidences of inflammation, less infection, less endometritis, and less hemorrhage.
Cons: higher incidence of uterine rupture, infection, and placental abnormalities: namely placenta accreta.
Lower Layer Suturing with External Staples: The same as the single layer suturing.. only instead of dissolvable sutures for the initial suturing, they use staples and only 'patch' with dissolvables.
Pros: faster than single layer, less incidences of inflammation, less infection, less endometritis, and less hemorrhage.
Cons: More painful, need of manual removal of staples, higher incidence (than double layer) of uterine rupture, infection, and placental abnormalities; namely placenta accreta.
Double Layer Suturing: The first layer of sutures pulls the cut edges together and then the second, called an “imbricating pattern” pulls uncut tissue together, on top of the first suture layer.
Pros: less chance of placental abnormalities
Cons: increase risk of inflammation, infection, endometritis, and hemorrhage.
Hope that was fun reading for you all!
Quote:
Goin' for it!
