BabyGuide

stage 1: three parts: latent (beginning) - the cervix is slowing effacing and dilating until it reaches 3-4 centimeters. active (middle) - the cervix dilates to about 7 centimeters. transition (end) - final stretching of the cervix over the baby's head as the baby moves down into the birth canal. (8-10 centimeters) stage 2: passive stage -- the baby is descending and getting aligned for birth, and contractions may temporarily slow down. expulsive stage -- starts with a strong urge to push and ends with the birth of the baby. (mothers with epi's may not be as aware of the urge). stage 3: contractions following birth until the expulsion of the placenta. stage 4: recovery -- the 24-36 hours following birth as the uterus contracts and shrinks and the mother stabilizes. (these divisions are somewhat arbitrary, and are mostly based on the "friedman curve" from 50 years ago. hopefully, in the future, we'll have more accurate and complex theories for describing the process of birth and recovery that honor the uniqueness of each woman's needs and body, rather than trying to make her fit into our concepts of how it's supposed to "divide up" on paper. agree?) **** edited out advertising signature ****

an amniotomy is a form of labor augmentation, and your patient has the right to informed consent after being told both potential benefits and risks. findings reported in the cochrane library show that this procedure, though simple to do can speed up labor, decrease the use of oxytocin. and reduce abnormal 5-minute apgar scores. but, at the same time, it removes the baby's "water cushion," opens the mother to infection if she doesn't deliver in a reasonable amount of time, and several studies have noted a marked increase in the risk to mothers of cesarean sections. cochrane reviewers have stated: "an association between early amniotomy and cesarean delivery for fetal distress is noted in one large trial. this suggests that amniotomy should be reserved [only] for women with abnormal labour progress." again, your patient will need to be informed what you are planning to do and the potential implications -- both good and bad -- so she and her partner can decide for themselves whether their answer is "yes," or "no." (a informed consent form to sign for this intervention would be useful). **** edited out advertising signature ****

"i would love to hear anything that would help me be a better nurse to families in this situation in the future. like what if anything was said to you that was especially comforting. really, anything you want to share about your situation would be helpful." i recently downloaded an article that was based on a very sensitive swedish study in which parents shared their feelings about losing a baby. it spoke of how parents can be nearly overwhelmed with shock, a sense of loss, guilt and helplessness. it recognized that most mothers have established a relationship with their babies long before birth, but that not all mothers had "instant mother feelings." it spoke of the "ambivalent transition into motherhood" that mothers eperiencing loss undergo that includes "broken expectations when understanding that something was wrong with the fetus or neonate; total confusion when confronting the fact that the neonate would die; 'reality awareness' when facing the actuality of the neonate's dying and death; 'consious leave-taking' when encountering the dead infant; and 'elusive grief' when adapting to the death of the infant." although most women found that holding and caring for their babies after death helped them with their transitions, some didn't want to hold or take care of them, preferring to keep the memory of a "living infant." "almost all women had a great fear of forgetting what had happened because they were in a state of shock. they could not comprehend all that had taken place in such a short time." the article concludes: "for health care professionals, it is important to 'be there." i downloaded the full text article from cinahl. hopefully, you can access it with help from your medical library. here's the citation: lundqvist, anita, nilstun, tore, and dykes, anna-karin. experiencing neonatal death: an ambivalent transition into motherhood. pediatric nursing. 2003. nov-dec, vol. 28 (6), pages 621-25. **** edited out advertising signature ****

it's great that evidence is now revealing the best practices for helping women with second stage labor! a really helpful, evidence-based clinical practice guideline for managing women's second stage of labor was issued in 2000 by the association of women's health, obstetric and neonatal nurses (awhonn). it is based on the highest-quality research and expert recommentations. here's a quote from the summary: "women should be encouraged to push for 4 to 6 seconds with a slight exhale for approximately five to six pushes per contraction or as tolerated by the woman and fetus. traditional breath holding for 10 seconds should be discouraged (thomson, 1995: evidence rating: i) (roberts & woolley, 1996: evidence rating: iii)...women will be encouraged to use exhalatory open glottis pushing versus forced pushing or valsalva maneuver and discouraged from using prolonged closed glottis pushing (mayberry, hammer et al., 1999: evidence rating: i) (parnell et al., 1993: evidence rating: ii) (sampselle & hines, 1999: evidence rating: iii)." it also suggests that women be allowed to rest as needed, rather than being required to push with every contraction. title: "evidence-based clinical practice guideline. nursing management of the second stage of labor." (monograph). washington (dc): association of women's health, obstetric and neonatal nurses (awhonn), 2000 jan. 27. the complete guideline can be ordered from awhonn (www.awhonn.org): you can take a look at the summary of its recommendations ---> www.guideline.gov/summary/summary.aspx?doc_id=2926 **** edited out advertising signature ****

episiotomies ("cutting into the connective tissues and muscles in the area between the lady parts and the orifice to widen the birth canal in order to ease the baby out") were once routine procedures for childbirth. it was widely believed that the cut would ease a woman's delivery and avoid the deep, jagged tears that might happen. it was also thought to prevent urinary incontinence, and that it would keep a woman's pelvic floor from becoming too lax, and even prevent a prolaped (dropped) uterus. recent research now shows that having an episiotomy actually increases a woman's chance of severe tearing, excessive bleeding, infection, and swelling. the procedure has also been implicated in anal incontinence. as some of us know from first-hand experience, it can cause severe discomfort afterward and make sex painful. surprisingly, the 2002 edition of gabbe, et. al's "obstetrics: normal and problem pregnancies" (one of the basic obstetrics textbooks for doctors-in-training) states episiotomies are stil performed "in 50 percent of lady partsl deliveries in the united states" -- but my sense is that the practice is dropping off as doctors become more aware of research to the contrary. the texbook then states on the next page: '"median episiotomies [cuts between the base of the lady parts and the rectum] are associated with an increased incidence of third- and fourth-degree lacerations. such injuries are associated with a high incidence of long-term incontinence and pelvic prolapse." a newer technique adopted from europe cuts at the side of the lady partsl wall, but the textbook states that such cuts are longer and require a more lengthy repair and states "the side to which the episiotomy is performed is usually dictated by the dominant hand of the practitioner." doctors and midwives routinely don't give their patients "informed consent" on this procedure. that is, they don't explain the risks to the mother. rather, they just announce (usually while the mother's compellingly in the midst of her pushing), "i'm going to make a 'little' cut to make things easier," or somesuch. and even if she says "no," they may go ahead anyway. that's why it's important to talk about this before labor. below are two places to start studying up about the procedure so that you can be more informed: http://www.cochrane.org/cochrane/revabstr/ab000081.htm http://www.choicesinchildbirth.com/articles,%20research.htm#episiotomy **** edited out advertising signature ****

i'm wondering if there are any "physiologic" things you can do that would help to bring you some easement? i'm also wondering if your baby's head is really pressing down on you, and causing something akin to your "ferguson's reflex" -- firing some neurons down there. would periodically spending some time on your hands and knees, as in "the scrub woman pose" help to briefly take some pressure off your cervix and lower body as your baby settles more to the front of your belly? perhaps do it on the bed so you wouldn't have so much pressure on your knees, or actually scrub the kitchen floor with your knees resting on a pad or folded towel. while you're at it, try doing the "cat pose" by arching and then lowering your back and belly a few times to help strengthen and "de-stiffen" the muscles that line your spine and those that help to hold your lower abdomen up. also, would taking a soaky bath in comfortably warm (but not hot) water (with help getting in and out) "float" you a little and ease your muscular strain? or, reclining in a hammock that keeps your chest and head high, but also lifts your legs. i'd also suggest trying to not stay on the toilet for very long. (no magazine reading! but for moms with small kids it's the only time you get a break, right?) i'm wondering, too, if anyone has tried those fabric pregnancy braces? i'm not sure that they're very good because they probably cut off circulation with their pressure, but then again, it might help to support the belly and position the baby up just a little to relieve some of the pressure? i'm not a physical therapist, so please take all this with a big grain of salt! * **** edited out advertising signature ****

what a huge, comprehensive article. it's really great. i'm so glad you took the time to point it out to us. **** edited out advertising signature ****