Inducing Labor

It's common for many women, especially first-time mothers, to watch their baby's due date come and go without so much as a contraction. The farther away from the expected delivery date (called the EDD) you get, the more anxious you may become. You may start to feel like a ticking time bomb. You may wonder — is this baby ever going to come?

Late pregnancy can be challenging — you may feel large all over, your feet and back may hurt, you might not have the energy to do much of anything, and you're beyond ready to meet the little one you've nurtured all this time. Which is why waiting a little longer than you'd expected can be particularly hard.

Still, being past your due date doesn't guarantee that your doctor (or other health care provider) will do anything to induce (or artificially start) labor — at least not right away.

What Is It?

Labor induction is what doctors use to try to help labor along using medications or other medical techniques. Years ago, some doctors routinely induced labor. But now it's not usually done unless there's a true medical need for it. Labor is typically allowed to take its natural course, with less medical intervention, in most birthing settings today.

Why Is It Done?

Your doctor may suggest an induction if:

• your water broke
• your baby still hasn't arrived by 2 weeks after the due date (when you're considered post-term — more than 42 weeks into your pregnancy)
• you have an infection in the uterus called chorioamnionitis
• you're having a pregnancy with certain risks (i.e., if you have gestational diabetes or high blood pressure, or your baby has growth problems)

Some doctors will perform "elective inductions" — in other words, they will induce labor if the mother wants it for nonmedical reasons. However, this isn't always the best option because inductions do come with risks.

Doctors try to avoid inducing labor early because the due date may be wrong and/or the woman's cervix may not be ready yet.

How Is It Done?

Some methods of induction are less invasive and carry fewer risks than others. Ways that doctors may try to induce labor by getting contractions started include:

• Stripping the membranes. The doctor puts on a glove and inserts a finger into your vagina and through your cervix (the opening that connects the vagina to the uterus). He or she moves the finger back and forth to separate the thin membrane connecting the amniotic sac (which houses the baby and amniotic fluid) to the wall of your uterus. When the membranes are stripped, the body releases hormones called prostaglandins, which help prepare the cervix for delivery and may bring on contractions. This method works for some women, but not all.
• Breaking your water (also called an amniotomy). The doctor ruptures the amniotic sac. During a vaginal exam, he or she uses a little plastic hook to break the membranes. This usually brings on labor in a matter of hours.
• Giving the hormone prostaglandin to help ripen the cervix. A gel or vaginal insert of prostaglandin (often the drug Cervidil) is inserted into the vagina or a tablet is given by mouth. This is typically done overnight in the hospital to make the cervix "ripe" (soft, thinned out, or dilated) for delivery. Administered alone, prostaglandin may induce labor or may be used before giving oxytocin.
• Giving the hormone oxytocin to stimulate contractions. Given continuously through an IV, the drug (often Pitocin) is started in a small dose and then increased until labor is progressing well. After it's administered, the fetus and uterus need to be closely monitored. Oxytocin is also frequently used to spur labor that's going slowly or has stalled.

What Will It Feel Like?

Stripping the membranes can be a little painful or uncomfortable, although it usually only takes a minute or so. You may also have some intense cramps and spotting for the next day or two.

It may also be a little uncomfortable to have your water broken. You may feel a tug followed by a warm trickle or gush of fluid.

With prostaglandin, you may have some strong cramping as well. With oxytocin, contractions are usually more frequent and regular than in a labor that starts naturally.

What Are The Risks?

Inducing labor is not like turning on a faucet. If the body isn't ready, an induction may fail and, after hours or days of trying, a woman may end up having a cesarean delivery (or C-section). This appears to be more likely if the cervix is not yet ripe.

If rupturing the amniotic sac doesn't work, your doctor may need to induce labor a different way. Why? Because there's a risk of infection to both you and your baby if the membranes are ruptured for a long time before the baby is born.

When prostaglandin and/or oxytocin are used, there is a risk of abnormal contractions developing. In that case, the doctor may remove the vaginal insert and turn the oxytocin dose down. While it is rare, there is an increase in the risk of developing a tear in the uterus (uterine rupture) when these medications are used. Some other complications associated with oxytocin use are low blood pressure and low blood sodium (which can cause problems such as seizures).

Another potential risk of inducing labor is giving birth to a late pre-term baby (born between 34 and 36 weeks). Why? Because the due date (also called the expected delivery date, or EDD) may be wrong. Your due date is 40 weeks from the first day of your last menstrual period (LMP). If you deliver on your due date, your baby is actually only about 38 weeks old — that's because your egg didn't become fertilized until about 2 weeks after the start of your last menstrual period. Women who have irregular periods or first trimester bleeding may be mistaken regarding when their last menstrual period was. Although ultrasounds can help to narrow it down, the estimated date of conception may still be off by a couple of weeks.

Babies born late pre-term are generally healthy but may have temporary problems such as jaundice, trouble feeding, problems with breathing, or difficulty maintaining body temperature.

Even though inductions do come with risks, going beyond 42 weeks of pregnancy can be risky, too. Many babies are born "post-term" without any complications, but concerns include:

• A vaginal delivery may become harder as the baby gets bigger.
• The placenta that helps to provide the baby with nourishment is deteriorating.
• The amniotic fluid can become low or contain meconium — the baby's first feces.

Old wives' tales abound about ways to induce labor. One of the oldest involves the use of castor oil. It is not safe to try to artificially start labor yourself by taking castor oil, which can lead to nausea, diarrhea, and dehydration. Breast stimulation can cause uterine contractions by causing the release of oxytocin. However, the safety of this practice has not been well studied. Earlier studies had suggested that the baby might have abnormal heartbeats after breast stimulation. Several recent studies looked at whether having sex in late pregnancy can induce labor, but there is no conclusion on this yet.

Talk to your doctor before doing anything to try to encourage your little one to come out. Inducing labor is best left to medical professionals — you may cause more harm than good.

As frustrating as it can be waiting for your baby to finally decide to arrive, letting nature take its course is often best, unless your doctor tells you otherwise. Before you know it, you'll be too busy to remember your baby was ever late at all!

source from http://kidshealth.org

Epidurals

Gone are the days when women had no choice but to literally scream through labor and delivery without any medications to ease the pain. Now, techniques like epidurals can make an otherwise very painful experience more calm, controlled, and even comfortable.

Of course, many women hope to get through childbirth without having to ask for medications. But once labor starts, it's common — and completely understandable — for a woman to change her mind and request some sort of relief to make things easier or, at least, more bearable. No matter how prepared you are, physically and mentally, giving birth is hard.

Whether you've known from day one that you'd be asking for an epidural or have your heart set on a medicine-free birth, here's the lowdown on epidurals and how they can take some of the pain out of labor and delivery.

What’s an Epidurals?

An epidural (sometimes called an epidural block) is what most women think of when they consider pain medication during labor. Epidurals are a form of regional anesthesia that provide continuous pain relief to the entire body below the belly button (including the vaginal walls) throughout labor and delivery. With an epidural, a woman is comfortable and still fully awake.

How Is It Done?

An epidural involves medication given by an anesthesiologist through a thin, tube-like catheter that's inserted in the woman's lower back and then into the area just outside the membrane covering the spinal cord (called the epidural space). You'll need to sit or lie on your side with your back arched while the doctor inserts the epidural.

The amount of medication can be regulated according to your needs. As your labor progresses and you start to deliver, the anesthesiologist can administer medication as needed through the catheter in your back without having to inject you again.

What Will It Feel Like?

The thought of a big needle going into your back can be downright unnerving. But contrary to what many women may think, getting an epidural doesn't hurt that much at all. The skin is numbed first, so you'll probably feel just a stick or pinch and some pressure. Of course, you may be aware of the catheter in your back, which can be annoying for some women, but it isn't painful or uncomfortable.

Once the epidural is in place, you may still feel the pressure of contractions, although you shouldn't feel the pain. Actually, being aware of your contractions, if even a little, helps once you start to push.

As the doctor adjusts the dosage, your legs may feel a little weak, warm, tingly, numb, or heavy. Unlike some other labor and delivery medications, epidurals don't affect your mind. You'll still feel alert and aware of what's going on.

How Long Will It Take?

It only takes a couple of minutes to insert an epidural. You should start to feel the effects in about 10 to 20 minutes. The epidural catheter will stay in place throughout your labor and delivery.

What Are the Risks?

Epidurals do have some drawbacks. They may:

• make it harder for a woman to push the baby out (although the anesthesiologist can adjust the amount of medication being given if this happens)
• cause the mother's blood pressure to drop
• cause a headache
• cause temporary difficulty with urination, requiring a urinary catheter
• very rarely cause bleeding

Although some studies suggest that epidurals may increase the chances of cesarean deliveries (C-sections) or vaginal deliveries that require forceps or vacuum extractions, others show no correlation. It's not clear if the surgery or assisted delivery were needed because of the epidural or if the epidural and the surgery or assisted delivery were both needed because of some underlying problem.

How Will It Affect My Baby?

Some epidural medication does reach the baby, but it's much less than what the little one would get if the mother is given pain medications through an IV or if she is given general anesthesia. The risks of an epidural to the baby are minimal, but include possible distress (such as a slow heartbeat) caused by the mother's lowered blood pressure.

What Will I Feel Like After the Delivery?

If you have an epidural, you may shiver a little after the baby is born (which is common with or without an epidural). You may also feel some numbness in your legs and tingling as the medication starts to wear off, which may take a little while. That means you may not be able to walk around for at least a few hours after the birth. Even then, ask someone to help you until your legs feel back to normal. If you had a C-section, the doctor may continue the epidural for a while after the delivery to control any pain.

You may also have some soreness in your back for a few days from where the epidural was inserted. Very rarely, women who get epidurals may have bad headaches or difficulty breathing after the birth.

What Other Medications Can Help?

Epidurals aren't the only way medication can help you deal with the pain and stress of labor and delivery.

Also injected into the lower back through a catheter, a spinal block provides faster pain relief, using smaller doses of medication. However, a spinal block only lasts for up to 2 hours, so it may be given during the actual delivery rather than during labor.

Some women may get a combined spinal-epidural (or CSE) block, which is, at its name implies, a combination of a spinal block and epidural that can offer faster pain relief that can then be continued throughout labor. This is often called a "walking epidural" because it allows some women to walk around once it's inserted since it has less of an effect on muscle strength. Walking can be possible with other techniques as well, depending on the medications used.

Another option for pain relief is a nerve block, which is given as an injection and deadens the sensation in specific, smaller areas of the body (such as the vagina and perineum — the area between the vagina and anus).

Analgesics are pain medications that can be administered through an IV or as a shot given as needed. Tranquilizers can be given through an IV to relax anxious women. Tranquilizers do not relieve pain, however, and can have significant side effects. If medications are given through an IV, the baby's going to get those medications, too.

Talk to your doctor about the various medications available and how they could affect you and your baby. If you're interested in getting an epidural, let your doctor know as soon as you decide, and check to see how early and how late in your labor it will be possible for you to get one.

Although many women want to give birth without any pain medications, it isn't a sign of weakness if you decide to ask for something to ease your pain or anxiety. Childbirth is often one of the hardest, most painful things the human body can go through. Getting a little relief makes you no less of a mother or woman. You know your body better than anyone — only you can be the judge of how much pain you can or can't take.

source from http://kidshealth.org

Cesarean Sections-- C-Sections

Every pregnant woman hopes for a short labor and delivery with no complications — manageable contractions, some pushing, then a beautiful baby — but it doesn't always work out that way.

These days, almost 30% of all babies in the United States are delivered via cesarean section (C-section). In fact, there's a lot of debate and concern about their increasing number, with some health professionals wondering how many are medically necessary. Federal officials have even set a goal of reducing the cesarean rate to 15% by the year 2010.

Still, many C-sections are justified and unavoidable. Even if you're envisioning a traditional vaginal birth, it may help to ease some fears to learn why and how C-sections are performed, just in case everything doesn't go as planned.

What Is a C-Section?

A C-section is the surgical delivery of a baby that involves making incisions in the mother's abdominal wall and uterus. Generally considered safe, C-sections do have more risks than vaginal births. There's far less chance of infection and severe bleeding with a vaginal delivery than with a C-section. Plus, you can come home sooner and recover quicker after a vaginal delivery.

C-sections are worth avoiding, if possible. However, these common surgical deliveries can help women with high-risk pregnancies avoid dangerous delivery-room complications and can save the life of the mother and/or baby in emergency situations.

Who Performs Them?

C-sections are done by obstetricians (doctors who care for pregnant women before, during, and after birth) and some family physicians. Although more and more women are choosing midwives to deliver their babies, midwives of any licensing degree cannot perform C-sections.

Why Are C-Sections Done?

Some C-sections are scheduled if the doctor is aware of certain factors that would make a vaginal birth risky. That means some women know ahead of time that they will be delivering via C-section and are able to schedule their baby's "birth day" well in advance. This allows them to prepare themselves emotionally and mentally for the birth — which can help to lessen the feelings of disappointment that many mothers who are unable to deliver vaginally experience.

So what determines if a woman is scheduled for a C-section? A doctor may schedule one if:

• the baby is in breech (feet- or bottom-first) or transverse (sideways) position in the womb (although some babies can be turned before labor begins or delivered vaginally using forceps and anesthesia)
• the baby has certain birth defects (such as spina bifida)
• the mother has problems with the placenta, such as placenta previa (when the placenta sits too low in the uterus and covers the cervix)
• the mother has a medical condition that could make a vaginal delivery risky for herself or the baby (such as HIV or an active case of genital herpes)
• some multiple pregnancies
• the mother previously had surgery on her uterus or a C-section (although many such women can safely have a vaginal birth after a C-section, called a VBAC)

Some C-sections are unexpected emergency deliveries performed when complications arise with the mother and/or baby during pregnancy or labor. An emergency C-section might be required if:

• labor stops or isn't progressing as it should (and medications aren't helping)
• the placenta separates from the uterine wall too soon (called placental abruption)
• the baby's shoulders are stuck in the birth canal
• the umbilical cord becomes pinched (which could affect the baby's oxygen supply) or enters the birth canal before the baby (called umbilical cord prolapse)
• the baby is in fetal distress — the heart rate drops, doesn't change at all, or is too fast or too slow
• the baby's head or entire body is too big to fit through the birth canal (which is rare)

Of course, each woman's pregnancy is different. If your doctor has recommended a C-section and it's not an emergency, you can ask for a second opinion. In the end, you most often need to rely on the judgment of the doctors.

How Is a C-Section Done?

The thought of having surgery can be unnerving for any woman. Here's a quick look at what usually happens during a scheduled C-section, according to the American College of Obstetricians and Gynecologists (ACOG).

Your labor coach can be right by your side, clad in a surgical mask and gown, during the entire delivery (although partners may not be allowed to stay during emergency C-sections). Before the procedure begins, an anesthesiologist will discuss your options.

To prepare for the delivery, you'll probably have:

• various monitors in place to keep an eye on your heart rate, breathing, and blood pressure
• your mouth and nose covered with an oxygen mask or a tube placed in your nostrils to give you oxygen
• a catheter (a thin tube) inserted into your bladder through your urethra (which may be uncomfortable when it is placed, but should not be painful)
• an IV in your arm or hand
• your belly washed and any hair between the bellybutton and pubic bone shaved
• a privacy screen put around your belly

After being given anesthesia, the doctor makes an incision on the skin of the abdomen — either vertically (from the bellybutton down to the pubic hair line) or horizontally (1-2 inches above the pubic hairline, sometimes called "the bikini cut").

The doctor then gently parts the abdominal muscles to get to the uterus, where he or she will make another incision in the uterus itself. This incision can also be vertical or horizontal. Doctors usually use a horizontal incision, also called transverse, which heals better and makes a VBAC much more possible.

Once the uterine incision is made, the baby is gently pulled out. The doctor suctions the baby's mouth and nose, then clamps and cuts the umbilical cord. As with a vaginal birth, you should be able to see your baby right away. Then, the little one is handed over to the nurses and a pediatrician or other doctor who will be taking care of your newborn for a few minutes (or longer, if there are concerns).

The obstetrician then removes the placenta from the uterus, closes the uterus with dissolvable stitches, and closes the abdominal incision with stitches or surgical staples that are usually removed, painlessly, a few days later.

If the baby is OK, you can hold and/or nurse your newborn in the recovery room by lying on your side (since holding your baby will put too much pressure on your abdomen).

What Will It Feel Like?

You won't feel any pain during the C-section, although you may feel sensations like pulling and pressure. With a planned C-section, the anesthesiologist will give you the option to be unconscious (or "asleep") during the delivery using general anesthesia or awake and simply numbed from the waist down using regional anesthesia (an epidural and/or a spinal block).

Many women want to be awake to see and hear their baby being born. A curtain will be over your abdomen during the surgery, but you can take a peek as your baby is being delivered from your belly.

However, women who need to have an emergency C-section occasionally require general anesthesia, so they're unconscious during the delivery and won't remember anything or feel any pain.

What Are the Risks?

C-sections today are, in general, safe for both mother and baby. However, there are risks with any kind of surgery. Potential C-section risks include:

• increased bleeding (that could, though rarely, result in a blood transfusion)
• infection (antibiotics are usually given to help prevent infection)
• bladder or bowel injury
• reactions to medications
• blood clots
• death (very rare)
• possible injury to the baby

Some of the regional anesthetic used during a C-section does reach the baby, but it's much less than what the newborn would get if the mother received general anesthesia (which sedates the baby as well as the mother). Babies born by C-section sometimes have breathing problems (transient tachypnea of the newborn) after birth since labor hasn't jump-started the clearance of fluid from their lungs. This usually gets better on its own within the first day or two of life.

Having a C-section may — or may not — affect future pregnancies and deliveries. Many women can have a successful and safe vaginal birth after cesarean but, in some cases, future births may have to be C-sections, especially if the incision on the uterus was vertical rather than horizontal. A C-section can also put a woman at increased risk of possible problems with the placenta during future pregnancies.

In the case of emergency C-sections, the benefits usually far outweigh the risks. A C-section could save your life or your baby's.

What Will I Feel Like Afterwards?

As with any surgery, there's usually some degree of pain and discomfort after a C-section. The recovery period is also a little longer than for vaginal births. Women who've had C-sections usually remain in the hospital for about 3 or 4 days and need to stay in bed for at least a day after the delivery.

Right after, you may feel itchy, sick to your stomach, and sore — these are all normal reactions to the anesthesia and surgery. If you needed general anesthesia for an emergency C-section, you may feel groggy, confused, chilly, scared, alarmed, or even sad. Your doctor can give you medications to ease any discomfort or pain.

For the first few days and even weeks, you might:

• feel tired
• have soreness around the incision (the doctor can prescribe medications and/or recommend over-the-counter pain relievers that are safe to take if you're breastfeeding.)
• be constipated and gassy
• have a hard time getting around and/or lifting your baby

After about 6 to 8 weeks, the uterus is usually healed and you can probably get back to your normal routine. In the meantime, you'll need to avoid driving or lifting anything heavy so that you don't put any unnecessary pressure on your incision. And as with a vaginal delivery, you should refrain from having sex until about 6 weeks after delivery and your doctor has given you the go-ahead.

Frequent walking may help ease some post-cesarean pains and discomfort. Among other things, it can help prevent blood clots and keep your bowels moving. But don't push yourself — take it easy and have someone help you get around, especially up and down stairs. Enlist friends, family, and neighbors to lend a helping hand with meals and housework for a while, especially if you have other children.

Although breastfeeding may also be a little painful at first, lying on your side to nurse or using the clutch (or football) hold can take the pressure off your abdomen.

Also, C-sections scars fade over time. They'll start to decrease in size and become a natural skin color in the weeks and months after delivery. And because incisions are often made in the "bikini" area, many C-section scars aren't even noticeable.

Call your doctor if you have:

• fever
• signs of infection around your incision (swelling, redness, warmth, or pus)
• pain around your incision or in your abdomen that comes on suddenly or gets worse
• foul-smelling vaginal discharge
• heavy vaginal bleeding
• leg pains
• difficulty breathing or chest pain
• feelings of depression

Emotionally, you may feel a little disappointed if you'd been hoping for a vaginal birth or had gone through labor that ended in a C-section. Although it can be disheartening when the traditional way doesn't work for your delivery, having a C-section does not make the birth of your baby any less special or your efforts any less amazing. After all, you went through major surgery to deliver your baby! It might not be the birth experience you'd imagined, but you can finally meet the little one you've been nurturing all this time!

source from http://kidshealth.org

Birthing Classes

If you are having a child for the first time, it is easy to feel overwhelmed by questions, fears, and just not knowing what to expect. Many new parents find that birthing classes can really help calm their worries and answer many questions.

These classes cover all kinds of issues surrounding childbirth including breathing techniques, pain management, vaginal labor, and cesarean labor. They can help prepare you for many aspects of childbirth: for the changes that pregnancy brings, for labor and delivery, and for parenting once your baby is born.

Typically, new parents take birthing classes around the third trimester of the pregnancy, when the mother is about 6 months pregnant. But there are a variety of different kinds of classes which begin both sooner and later than that. It's a good idea to talk with your doctor about the different kinds of classes that are offered in your community.

Benefits of Taking a Childbirth Class

A childbirth class can provide you with a great forum to ask lots of questions and can help you make informed decisions about the key issues surrounding your baby's birth. Some of the information you can find out from a birthing class includes:

• how your baby is developing
• healthy developments in your pregnancy
• warning signs that something is wrong
• how to make your pregnancy, labor, and delivery more comfortable
• breathing and relaxation techniques
• how to write a birth plan
• how to tell when you are in labor
• pain relief options during labor
• the role of the coach or labor partner

Many classes also address what to expect after the baby is born, including breastfeeding, baby care, and dealing with the emotional changes of new parenthood.

You might also find support from other expectant couples at a childbirth class. Who would better understand the ups and downs of pregnancy than couples who are going through them, too? Many people find friends in their childbirth class who last long past the birth of their child.

If your birth coach is also the baby’s father, taking a class together can mean his increased involvement in the pregnancy. Like the mother, the father can also benefit from knowing what to expect when the mother goes into labor - and how to assist in that process. Some classes have one session just for fathers, where men can discuss their own concerns about pregnancy and birth. There are also classes geared just for new fathers. Some classes even offer a special session for new grandparents, which is a great way to get them involved in the process and to make sure they're up on the latest in baby care techniques and safety.

Of course, some people get more out of childbirth classes than others do. But even if you find the techniques you're taught don't work for you when you finally go into labor, you may get other benefits from the class. The common goal of all birthing classes is to provide you with the knowledge and confidence you need to give birth and make informed decisions. This includes reducing your anxiety about the birth experience, as well as providing you with a variety of coping techniques to aid in pain management. Remember that the ultimate goal is to have a healthy mom and healthy baby.

What Types of Classes Are Available?

Many childbirth classes embrace a particular philosophy about pregnancy and birth. The two most common methods of childbirth breathing, relaxation, and exercise in the United States are the Lamaze technique and the Bradley method.

The Lamaze technique is the most widely used method in the United States. The Lamaze philosophy holds that birth is a normal, natural, and healthy process and that women should be empowered through education and support to approach it with confidence. The goal of Lamaze is to explore all the ways women can find strength and comfort during labor and birth. Classes focus on relaxation techniques, but they also encourage the mother to condition her body's response to pain through training and practice (this is called psychoprophylaxis). This conditioning is meant to teach expectant mothers constructive responses to the pain and stress of labor (for example, controlled breathing patterns) as opposed to counterproductive responses (such as holding the breath or tensing up). Other techniques, such as distraction (a woman might be encouraged to focus on a special object from home or a photo, for example) or massage by a supportive coach, are also used to decrease a woman's perception of pain.

Lamaze courses don't advocate for or against the use of drugs and routine medical interventions during labor and delivery, but instead educate mothers about their options so they can make informed decisions when the time comes.

The Bradley method (also called "Husband-Coached Birth") places an emphasis on a natural approach to birth and on the active participation of the baby's father as the birth coach. A major goal of this method is the avoidance of medications unless absolutely necessary.

Other topics stressed include the importance of good nutrition and exercise during pregnancy, relaxation techniques (such as deep breathing and concentration on body signals) as a method of coping with labor, and the empowerment of parents to trust their instincts and become active, informed participants in the birth process. The course is traditionally offered in 12 sessions.

Although Bradley emphasizes a birth experience without pain medication, the classes do prepare parents for unexpected complications or situations, like emergency cesarean sections. After the birth, immediate breast-feeding and constant contact between parents and baby is stressed. Bradley is the method of choice for many women who give birth at home or in other nonhospital settings.

There are several other types of birthing classes available. Some include information from the two previously mentioned techniques, and some are offshoots that explore one particular area. Two options that might be available in your area are active birth classes that teach yoga techniques to prepare for labor and "hypnobirthing" courses, which use hypnosis as a relaxation technique.

When Should I Start Taking a Birthing Class?

In addition to offering many techniques and curricula, birthing classes also vary greatly in terms of duration. You'll find classes that begin during the first trimester and focus on all the changes that pregnancy brings; 5- to 8-week courses offered late in pregnancy aimed at educating parents mostly about labor, delivery, and postpartum issues; and one-time-only refresher courses for repeat parents. Most parents opt for a course that meets about six or seven times in the last trimester for 1 1/2 to 2 hours per session, or for full-day versions that take place over one or two weekends. What's important to remember is that a variety of options are often offered, so be sure and find one that fits your needs.

Choosing a Birthing Class

The type of class that's right for you depends on your personality and beliefs, as well as those of your labor partner. There is no one correct method. If you're the kind of person who likes to share and is eager to meet people, you might like a smaller, more intimate class designed for couples to swap stories and support each other. If you don't like the idea of sharing in a small group, you might want a larger class, where the teacher does most of the talking.

Of course, the community you live in may limit your choices - expectant parents in rural areas often have fewer choices than those in large cities. You may find childbirth classes offered by:

• hospitals
• private teachers
• health care providers (through their practices)
• community health organizations
• midwives
• national childbirth education organizations
• videos and DVDs

Before you sign up for a class, it's a good idea to ask what the curriculum includes and what philosophy it is based upon. You can also request to see the course outline. A good class will cover a range of topics and prepare you for the many possible scenarios of labor and delivery. Classes should include information about vaginal births and cesarean sections; natural childbirth techniques as well as the use of pain medication during labor; tips on pre- and postnatal care; and postpartum adjustment.

If something you wanted or expected to see isn't included in the outline, ask about it - if your teacher doesn't seem flexible or his or her philosophy doesn't match yours, you may want to look elsewhere.

You should also feel free to contact the teacher or childbirth class coordinator with questions, such as:

• What's your background and how were you trained?
• Do you have certification from a nationally recognized organization?
• What is your philosophy? Do you teach a particular method?
• How does the class time break down between lecture, discussion, and practicing techniques?
• How many people are in the class?

Whatever course or method you choose, you'll want to begin exploring your options early - some classes fill up well in advance of the start date.

Finding a Birthing Class

There are a variety of ways you can find out about your birthing class options. A good place to start is with your obstetrician, family doctor, or midwife, followed by friends or acquaintances who have had babies in your area. Your local hospital or birthing center should also be able to provide you with a list of classes.

You can also contact national organizations that certify childbirth educators. The International Childbirth Education Association supports families and trains childbirth educators - you can contact them to find out what certified courses are offered in your area. Lamaze International can give you information on where the Lamaze technique is taught in your area; for information on the Bradley method, contact the American Academy of Husband-Coached Childbirth.

Whether it's a healthier pregnancy, increased knowledge, reduced anxiety, or a greater closeness with your labor partner, there are many benefits to taking a birthing class.

source from http://kidshealth.org

Birthing Centers and Hospital Maternity Services

There are plenty of decisions to consider during pregnancy. Opting for prenatal testing, selecting a doctor for your baby, and deciding who will be present during your baby's birth are among the more challenging decisions you'll need to make. But where you choose to give birth - whether in a hospital or in a birth center setting - is one of the most important decisions you'll make before delivery.

Hospitals

Many women fear that a typical hospital setting will be a cold and clinical environment, but that's not necessarily always the case. But a hospital setting can accommodate a variety of birth experiences.

Traditional hospital births (in which the mother-to-be moves from a labor room to a delivery room and then, after the birth, to a semiprivate room) are still the most common option. In a traditional hospital birth, doctors "manage" the delivery with their patients. In many cases, women in labor are not allowed to eat or drink (possibly due to anesthesia or for other medical reasons), and they may be required to deliver in a certain position. Pain medications are available during labor and delivery (if the woman chooses); labor may be induced, if necessary; and the fetus is usually electronically monitored throughout the labor. Of course, a birth plan can help a woman communicate her preferences about these issues, and most doctors will be as accomodating as possible.

In response to a push for more "natural" birth events, many hospitals now offer more modern options for low-risk births, often known as family-centered care. These may include private rooms with baths (known as birthing suites) where women can labor, deliver, and recover in one place without having to be moved. Although a doctor and medical staff are still present, the rooms are usually set up to create a nurturing environment, with warm, soothing colors and amenities that try to simulate a home-like atmosphere that may be very comforting for some new mothers. Rooming in - when the baby stays with the mother most of the time instead of in the infant nursery - may also be available.

In addition, many hospitals offer a variety of childbirth and prenatal education classes to prepare parents for the birth experience, as well as parenting classes after birth.

The number of people allowed to attend the birth varies from hospital to hospital. In more traditional settings, as many as three support people are permitted to be with the mother during a vaginal birth. In a family-centered approach, more family members, friends, and sometimes even children may be allowed. During a routine or nonemergency cesarean section, the number of support people is usually limited to one.

If you decide to give birth in a hospital, you will encounter a variety of health professionals.

Obstetrician/gynecologists (OB/GYNs) are doctors with at least 4 additional years of training after medical school in women's health and reproduction, including both surgical and medical care. They can handle complicated pregnancies and can also perform cesarean sections.

Look for obstetricians who are board-certified, meaning they have passed an examination by the American Board of Obstetrics and Gynecology. Some board-certified obstetricians go on to then receive further training in high-risk pregnancies. These physicians are called maternal-fetal specialists or perinatologists.

If you deliver in a hospital, you may also be able to use a certified nurse-midwife (CNM). CNMs are registered nurses who have a graduate degree in midwifery, meaning they are trained to handle normal, low-risk pregnancies and deliveries. Most CNMs deliver babies in hospitals or birth centers, although some do home births.

In addition to obstetricians and CNMs, registered nurses are typically present during a birth to take care of the mother and baby. If you give birth in a teaching hospital, medical students or residents may also be present during the birth. Some family doctors also offer prenatal care and deliver babies.

While you are in the hospital, if you choose or if it's necessary for you to receive anesthesia, it will be administered by a trained anesthesiologist. A variety of pain control measures, including pain medication and local, epidural, and general anesthesia, are also available in the hospital setting.

Birth Centers

Women who experience delivery in a birth center are usually those who have already given birth without any problems and whose current pregnancies are considered low risk (meaning they are in good health and are the least likely to develop complications). A woman who's giving birth to multiples, who has certain medical conditions such as gestational diabetes or high blood pressure, or whose baby is in the breech position would be considered higher risk and should not deliver in a birth center. Women are carefully screened early in pregnancy and are given prenatal care at the birth center to monitor their health throughout their pregnancy.

Natural childbirth is the focus in a birth center. Since epidural anesthesia is not typically offered, women are free to move around in labor, get in positions that are most comfortable to them, spend time in the jacuzzi; in other words, deal with the labor in a proactive manner. The baby is monitored frequently in labor typically with a handheld Doppler. Comfort measures such as hydrotherapy, massage, warm and cold compresses, and visualization and relaxation techniques are often used. The woman is free to eat and drink as she chooses.

A variety of health care professionals operate in the birth center setting. A birth center may employ registered nurses, CNMs, and doulas (professionally trained providers of labor support and/or postpartum care). Although a doctor is seldom present and medical interventions are rarely done, birth centers may work with a variety of obstetric and pediatric consultants. The professionals affiliated with a birth center work closely together as a team, with the nurse-midwives present and the OB/GYN consultants being available if a woman develops a complication during pregnancy or labor that puts her into a higher risk category.

Birth centers typically do have medical equipment available, including intravenous lines and fluids, oxygen for the mother and the infant, infant resuscitators, infant warmers, local anesthesia to repair tears and episiotomies (although these are seldom performed), and oxytocin to control postpartum bleeding. A birth center can provide natural pain control and pain control with mild narcotic medications, but if a woman decides she wants an epidural, or if complications develop, she must be taken to the hospital.

Birth centers often provide a homey birth experience for the mother, baby, and extended family. In most cases, birth centers are freestanding buildings, although they may be attached to a hospital. Birth centers may be located in residential areas and generally include amenities such as private rooms with soft lighting, showers, and whirlpool tubs. A kitchen may be available for the family to use.

Look for a birth centers that is accredited by the Commission for the Accreditation of Birth Centers (CABC). Some states regulate birth centers, so you may want to find out whether the birth center you choose has all the proper credentials.

Which One Is Right For You?

How do you decide whether a hospital or a birth center is the right choice for you? If you've chosen a particular health care provider, he or she may only practice at a particular hospital or birth center, so you should discuss your decision with him or her. You should also verify your choice with your health insurance carrier to make sure that your prospective hospital or birth center is covered. In many cases, accredited birth centers as well as hospitals are covered by major insurance companies.

If you have any conditions that would classify your pregnancy as higher risk (such as being older than 35, carrying multiple fetuses, or having gestational diabetes or high blood pressure, to name a few), your health care provider may advise you to have your child in a hospital where you and your baby can receive the required medical treatment, if necessary. In fact, you may be ineligible to deliver in a birth center because of your risk factors.

If you desire interventions such as an epidural or continuous fetal monitoring, a hospital is probably the better choice for you.

For a woman without significant problems in her medical history and whose pregnancy has been classified as low risk, a birth center might be an option. Someone who desires a natural birth with minimal medical intervention or pain control may feel more comfortable in a birth center. Because the number of labor and support people you can choose to be present is less limited, if you want to have your entire family participate in the birthing experience, you might consider a birth center.

Choosing a Hospital or Birth Center

Once you've decided on either a hospital or a birth center, you may still have to choose which hospital or which birth center. Before you make a choice, you'll have to verify if your health care provider, whether he or she is a doctor or a CNM, will only deliver at certain facilities. In addition, it's a good idea to get a tour of the hospital or birth center so you can determine for yourself if the staff is friendly and the atmosphere is one in which you will feel relaxed.

Before your labor pains start, get answers to the following questions.

Choosing a Hospital: Questions to Ask

• Is the hospital easy to get to?
• How is it equipped to handle emergencies?
• What level nursery is available? (Nurseries are rated I, II, or III - a level III neonatal intensive care unit [NICU] is equipped to handle any neonatal emergency. A lower rating may require transportation to a level III NICU.)
• How many deliveries take place at the hospital each year? (A higher number means the hospital has more experience with various birth scenarios.)
• What is the nurse-to-patient ratio? (A ratio of 1:2 is considered good during low-risk labor; a 1:1 ratio is best in complicated cases or during the pushing stage.)
• What are the hospital's statistics for cesarean sections, episiotomies, and mortality? (Keep in mind, though, that these numbers include high-risk and complicated deliveries.)
• How many labor and support people may be present for the birth?
• What procedures are followed after your baby's birth? Can you breastfeed immediately if desired? Is rooming in available?
• How long is the typical postpartum stay for vaginal deliveries? For cesarean sections?
• Can the baby and the father stay with you in your room around the clock, if you desire?

Choosing a Birth Center: Questions to Ask

• Is the birth center accredited by the Commission for the Accreditation of Birth Centers?
• Is the birth center easy to get to?
• What situations during labor would lead to a transfer to a hospital? How are transfers handled? What emergencies are the transfer facilities able to handle?
• What professionals (such as midwives, doctors, and nurses) are available on staff? On a consulting basis? Are they licensed?
• What childbirth and prenatal education classes are offered?
• What are the center's statistics for hospital transfers, episiotomies, and mortality?
• What procedures are followed after your baby's birth? How long is the typical postpartum stay and how will your baby be examined?

Choosing where to deliver your baby is a complicated decision and one you'll want to decide

upon as early in your pregnancy as possible. That way, if complications do arise, you'll be well informed and you can concentrate on your health and the health of your baby instead of making last-minute decisions.

source from http://kidshealth.org

Donating Your Baby's Cord Blood

What is cord blood donation?

Cord blood donation is a way for you to preserve the potentially lifesaving stem cells found in the blood of your newborn's umbilical cord and placenta in a public cord blood bank for the public good — in other words, for anyone who needs it. (To preserve your child's cord blood for your own family's use, you can pay to store it in a private bank.)

Cord blood stem cells can be used as an alternative to bone marrow to treat some cancers, blood diseases, and inherited disorders such as sickle cell anemia. Donated cord blood is also sold for research. To learn more about its medical uses, see Cord Blood Banking: An Overview.

Donating cord blood to a public bank is free, safe, and painless for you and your child because it's collected after your baby's born and the umbilical cord is cut. And there's a network of public cord stem blood banks that can take your donation.

If your baby's cord blood meets certain requirements, it's placed on a registry where it can be accessed by transplant surgeons to treat patients who need a stem cell transplant and are deemed a good match with your baby's blood. Cord blood that doesn't meet the requirements for transplant is used for medical research.

Why don't more families donate their newborn's cord blood?
It's a combination of the high cost of processing and storing donated blood at public cord blood banks and a lack of awareness about cord blood donation among parents-to-be

It costs a public bank about $1,000 to collect, rigorously test, freeze, and store a single unit of cord blood. With a price tag that high, and the public need for cord blood still relatively low, routine collection of cord blood has been a low priority. .

That's starting to change. A federal law passed in late 2005 set aside $79 million to expand cord blood collection and storage, establish a public cord bank network, and make it easier for doctors to access cord blood units for their patients. And several states are considering legislation to promote cord blood donations.

For the time being, however, "most public banks operate on a shoestring budget," says Mary Halet, cord blood program manager of the National Marrow Donor Program, a nonprofit organization that maintains the largest public listing of umbilical cord blood units available for transplantation in the United States.

"With 4 million births annually, the current system would be overburdened if even one-quarter opted for donation." As a result, most public banks work with a select group of collecting hospitals, so they can manage the volume, Halet says.

That doesn't mean the NMDP, which has facilitated more than 25,000 marrow and blood stem-cell transplants between unrelated people since 1987, doesn't welcome donations. But it can only accept them from participating banks and hospitals. The NMDP is particularly interested in cord blood donations from families whose children are not Caucasian.

Patients who need a stem cell transplant are more likely to find a matched cord blood unit in their own ethnic group, but not enough cord blood units have been collected from people in racial minority groups, says the NMDP. According to July 2003 figures, a Caucasian patient has an 88 percent chance of finding a matching donor on the NMDP registry, while an African American's chance is only 58 percent.

I want to donate my cord blood — how do I get started?
Ideally you're no more than 34 weeks pregnant — before 34 weeks is when most public cord blood banks and hospitals like to begin working with expectant moms. They need several weeks before your baby's due to process your paperwork and arrange for collection and processing of your cord blood.

If you're past 34 weeks and there's a public bank or collecting hospital in your area, call to discuss your specific case and options. You should also discuss your desire to collect and donate your baby's cord blood with your healthcare provider, and make sure that provider knows how to harvest cord blood.

Next, check to see whether the hospital where you plan to deliver your baby is on the NMDP list of affiliated collecting hospitals. If it is, call the public bank that serves it (the contact number is listed beside the hospital name) to begin the process.

You can also check the NMDP's list of nonparticipating banks. These banks maintain their own cord blood registries rather than listing their units on the NMDP national list, and they have a wider network of collecting hospitals.

If one of these banks is in your area, contact it to find out whether you can make a donation. This list includes prestigious organizations such as the New York Blood Center, which has provided nearly a third of the core blood units used for transplants worldwide.

Finally, if you can't find a facility serving your city in these databases, call the NMDP at (800) 627-7692 to see if any new options exist in your area. You can also try local university hospitals to see if they'll accept your donation.

Keep in mind that donating your cord blood to a public bank doesn't guarantee that the blood will be used for transplants. Ask the public bank you're considering whether it sells any cord blood units for research purposes. See below for more information on for-profit public banks.

Will I be screened before I can donate?
Yes, the public cord blood bank will ask you to complete a consent form and a health questionnaire. You'll also need to provide a small sample of your blood to be screened for infectious diseases.

Under certain conditions, you won't be able to donate your baby's cord blood. If you're expecting twins, for instance, most public banks will reject you because typically not enough stem cells are recovered from twin pregnancies to facilitate a successful transplant.

Other conditions that are likely to keep you from donating include most cancers, most cases of medication-dependent diabetes (but not necessarily gestational diabetes), hepatitis or a history of hepatitis, HIV/AIDS, and being the recipient of an organ or tissue transplant. If you're at risk for HIV/AIDS or have had a tattoo in the last 12 months, you'll also be rejected.

Public cord blood banks also evaluate any history of sexually transmitted infections and the circumstances and timing of any ear, skin, or body piercings. You'll be required to take an HIV test.

How is the blood collected, and what happens to it afterward?
Your baby's umbilical cord blood is collected shortly after you deliver. Your doctor or nurse clamps the umbilical cord and cuts it (your partner can do the cutting if you prefer), and then drains the blood from the cord and placenta into a storage bag or vials. (See a slide show of a collection procedure provided by LifebankUSA, a private cord blood bank.)

Most umbilical cords yield 3 to 5 ounces of blood. If your baby's cord produces less than that, the blood may be used for research purposes.

Next, the blood goes to a lab, where it's tested to see how many cells it contains and for its HLA-tissue type. This is a set of six antigens (substances that cause immune responses in the body) used to match your cord blood with patients needing transplants. The cord blood is also tested for bacterial or fungal contamination.

As required by U.S. law, donated blood is tested for certain infectious diseases such as AIDS — and depending on the bank, other tests may be performed as well. The details should be spelled out in the paperwork you sign. But in any case, be sure to inquire about confidentiality and find out exactly what the bank that's receiving your donation will test for and how you'll be informed (and who else will be informed) if the tests uncover anything that's unusual or might affect your child's health.

Once testing is complete and the cord blood meets the bank's criteria, it's stored in a liquid nitrogen freezer until someone needs a transplant. The storage life of cord blood is still unknown, but a 2003 study showed that 90 percent of the stem cells recovered from cord blood stored for 15 years (the oldest blood available) were still viable.

Should I avoid for-profit public banks, and how can I spot one?
If you're donating your child's cord blood in the hope that a sick child will receive it for a transplant, you might want to avoid these types of banks, says Frances Verter, an independent volunteer researcher of cord blood facilities and a founding board member of the Umbilical Cord Blood Education Alliance. But if your main goal is to donate the blood for the general public good, including medical research, this may not be a problem.

Like nonprofit public cord blood banks, for-profit banks accept donations for free, says Verter. Both types of banks also sell cord blood for research purposes. What's different is that for-profit banks expect to make a profit from these sales, while nonprofit banks aim to cover their operating expenses. Selling cord blood to researchers for a profit is not illegal in the United States.

It can be tough to spot a for-profit public cord blood bank. Ask if the company operating the bank is registered as a nonprofit or for-profit organization and read a copy of the informed consent form provided by the public bank. This form should stipulate whether cord blood units can be sold for research.

If I donate my baby's cord blood and I change my mind, can I get it back?
If the cord blood hasn't been used for a transplant or research, the answer is "probably." According to the Cord Blood Donor Foundation in San Bruno, California, if you requested your child's cord blood for someone in your family, or if your child developed one of the conditions that can be treated with cord blood, the foundation would try to locate it. If the unit turned out to be a good match for the person needing the transplant, the foundation would release it and charge the cost to the patient's health insurer.

StemCyte, a cord blood bank with both a public and a private division, has a similar policy. "If the cord blood you donated is the optimal one for a given transplant, it will be available to you unless it has already been used by another person. The likelihood of it having been used is low since only about 1 to 5 percent of banked units are used," says Lawrence D. Petz, StemCyte's chief medical officer.

It's always a good idea to ask the public cord blood bank you're considering about its retrieval policy.

source from http://www.babycenter.com