2003 study in the Journal of Maternal-Fetal & Neonatal Medicine, "doctors are incorrect about determining the baby's head position almost 70 percent of the time." (p. 126)
Caput - in labor, the skin on a baby's head undergoes some normal swelling (p. 127)
"Studies show that women who are admitted to the hospital early are subject to more interventions, including more cesareans." (p. 128)
"Cesarean rates are at an all-time high of over 31 percent in the United States, and over 23 percent in nations including Australia, Canada, and the U.K. The U.S. has one of the highest cesarean rates in the world--with these surgeries mostly being performed on healthy mothers and healthy babies--yet ranks nearly last in preventing infant mortaliy among developed nations. Hence the controversy about how commonly they are being used." (p. 129-130)
2005 ACOG "estimated that 60 percent of cesareans are based on a diagnosis of failure to progress." (p. 131)
"In natural labors, contractions and dilation normally speed up, slow down, plateau, stop, and speed up again. And while it may seem that the use of Pitocin would result in shorter births than natural labor, studies have shown that the presence of a doula, or preserving the mother's freedom to sit up and walk around, may result in shorter labors than those with Pitocin." (p. 132)
"Researchers estimate 30 to 50 percent of slow labors may be due to a cervix that is more firm or rigid, not due to 'inadequate contractions' that need Pitocin." (p. 132)
Reasons for a firmer cervix:
birth control pills
scarring on the cervix resulting from
"1. Removal of tissue after a miscarriage (D&C)
2. Previous births in which the cervix sustained tiny tears during pushing
3. Abortion
4. Insertion of an IUD
5. Treatments for abnormal pap smears or genital warts, such as cryosurgery (freezing)
6. Taking a biopsy from the cervix or inside the uterus
7. Removal of polyps
*Not all women with scars will necessarily have longer labors, though." (p. 132-133)
April 2004...journal Obstetrics & Gynecology...University of Liverpool.."Sometimes a buildup of lactic acid in the body can happen during birth...this can temporarily slow labor...woman's body needs to rest. Once lactic acid clears from the system, labor will usually naturally resume." (p. 134)
Contractions rated in units called millimeters of mercury or mm Hg. Getting mom upright can increase contractions by 35 mm Hg. (p. 135)
2004 Journal of Obstetrics, Gynecologic, & Neonatal Nursing..."women pushed safely for up to eight hours." (p. 137)
" a healthy second stage can take much longer, lasting as many as ten to twenty hours." (p. 137)
Signs of progress
1. Changes in Contractions
2. The Height of the Belly
3. Bloody Show
4. "The Bottom Lin"
5. Descent of the Baby
6. The Baby's Heartbeat (For a fun way to see progress, a pen can be used to mark the belly with an X each time the heartbeat moves lower.)
7. Bag of Waters Breaking
8. Ultrasound
9. Rectal Pressure
10. Involuntarily Having a Bowel Movement
11. "Opening the Back"
12. Seeing the Head (p. 138-140)
"With three vaginal exams, the risk of infection doubled; with nine exams, the risk of infection soared five times higher. Scientists also conclude that risk of infection increases based on hours between the first vaginal exam and delivery (not between water breaking and delivery)." (p. 142)
"However, even the presence of GBS is a much lower risk factor than having multiple vaginal exams in labor!" (p.143)
World Health Organization says, "infection might be caused by vaginal exams not only in labor but during prenatal appointments with your midwife or doctor; if you are GBS positive, you may want to avoid exams during pregnancy or inserting anything else into your vagina (e.g., use lovemaking options that don't involve penetration). (p. 143)
Bag of Waters
pH strip to test fluid if thinking water has broken. (p. 143)
feel and see periodic gushes of clear fluid (p. 144)
check for baby's umbilical cord did not slip out when water broke, "listening to the baby's heartbeat can reveal the condition of the cord instead." (p. 144)
signs of infection: fever in the mother, rapid heartbeat of mother or baby, foul-smelling vaginal discharge, tenderness in the belly (p. 144)
"Cochrane Collaboration, 70 percent of women have contractions within twenty-four hours, 90 percent by forty-eight hours, and it can be safe for women who take longer if they're watched by their providers." (p. 144)
Epidural fevers "not caused by an infection." (p. 146)
"During pushing...posterior or misaligned...technique is known as digital or manual rotation...By using this technique, in a pilot study in the March 2007 European Journal of Obstetrics, Gynecology and Reproductive Biology, the cesarean rate for malpositioned babies was reduced from 23 percent to zero." (p. 148)
"Cochrane Collaboration, 70 to 90 percent of the time when brain damage occurs in newborns it is not caused by events in labor and cannot be stopped by the birth provider. And while cesareans for fetal distress have increased, the rate of cerebral palsy has not changed, as reported in the Journal of the American Medical Association. (p. 150)
fetal scalp blood sampling should be used to check for fetal distress. This is a test that allows baby's pH to be checked for acidity (p. 150)
Cochrane Collaboration..."the increase in cesarean section rate is much greater when scalp pH estimates are not available." (p. 150)
"A full-term baby's normal baseline rate is 110-160 beats per minute...a change of more than five beats per minute is normal variability, while variability of less than five beats is cause for concern...provider looks for accelerations and decelerations...Williams Obstetrics states, '...epidurals and Pitocin cause the most decels...'...It is considered acceptable for the baby's heartbeat to go as low as seventy beats per minute before it is seen as worrisome, as long as this does not happen repeatedly or for long periods of time." (p. 150-151)
Obstetrics & Gynecology journal, "women who had sexual intercourse an average of four times in the ninth month of pregnancy gave birth sooner and were half as likely to be induced as women who did not have sex." (p. 152)
"The Cochrane Collaboration reports that breast stimulation is as successful as Pitocin for starting labor within three days." (p. 153)
Pitocin tips:
"Request a low dose of Pitocin that is increased more slowly (a.k.a. a "whiff" of Pitocin). (p. 153)
"Ask for a portable wireless monitor" (p. 154)
"Once contractions are two to three minutes apart ask to have Pitocin turned off (p. 154)
"Watch for extremely long contractions that go on for more than ninety second each, or contractions that seem to have only a tiny break of a few seconds between them. Pitocin needs to be turned down or off in these situations for safety, and although providers should be checking on this, studies and doulas report that they don't always notice." (p. 154)
"British Medical Journal..women with 'stalled' labors got into a tub for up to four hours, one in three mothers who would have gotten Pitocin didn't have to." (p. 155)
Pitocin time to work..."According to scholar and doula Henci Goer, research shows that women who are given only two hours on Pitocin to achieve increased dilation receive three times as many cesareans, compared to women allowed to continue laboring for four hours or longer with Pitocin.
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