Question of the day (QOTD) 2/23/12

If someone gave you good advice on how to prepare for labor and birth, what would it be?

Lotsa reading......

I have been so super busy with lots of reading and writing assignments for midwifery school.

This week in intrapartum, we're reading, discussing and synthesizing multiple aspects of fetal monitoring in labor. Did you know that in low risk women, continuous EFM is no better than intermittent auscultation in labor, as it relates to reducing rates of cerebral palsy? In fact, rates of CP have been unchanged since EFM was first introduced in the early 1970's? Continuous EFM in low risk women actually increases the likelihood of a cesarean section.

Does this mean that I am an uber crunchy granola student midwife who has been brainwashed into believing that continuous EFM (or any EFM!) has no place in birth? WRONG-O!

I have had a belief for many years now that EFM has a time and a place in birth. I feel it's more than appropriate, for a low risk laboring woman to have a baseline fetal monitor strip on admission to labor and delivery to determine adequate fetal oxygenation AT THAT MOMENT IN TIME (admission). After that, I feel that intermittent auscultation, at the appropriate intervals during labor, is best for the low risk pregnant woman and her fetus. If, however, at any point in time that things change from low risk to potentially a higher risk, I don't hesitate to put the fetal monitor back on to reassess the fetus. And yes (GULP!) I believe that interventions are sometimes needed. All on a case by case, moment by moment basis.

Labor and birth is not a cookie cutter process, nor is it an assembly line.

What would you do?

Hypothetical situation:

Your first pregnancy was normal. GBS screen was negative at 37 weeks. However, after you have an uncomplicated labor and birth, your baby develops early onset GBS infection. Your baby has a prolonged stay in the NICU with overwhelming sepsis, but eventually recovers fully and is discharged home.

You're pregnant again. You're 37 weeks along. You plan on having your baby in the same hospital as the first pregnancy. You are not in labor at the moment.

Do you:
1. Do the GBS swab?
Positive results - treat with antibiotics in labor.
Negative results - no treatment in labor.
Negative results - treat with antibiotics in labor despite the negative result.

or do you........

2. Decline the GBS swab and opt to have antibiotic coverage in labor?

Remember, your first pregnancy you were tested GBS negative, yet your baby ended up with an overwhelming GBS infection.

Just another personal choice/moral situation for you to ponder.

Getting in position -- making changes to shake, rattle, and roll

I cannot emphasize how important it is to be as mobile as possible in labor and during the pushing stage. There are such an abundance of different positions to assume in labor, even with an epidural. Maternal position changes will help the baby move into optimal position for the birth process.

Many times, I have women who are laboring with 'back labor'. Back labor is when there is (obviously) pain in the lower back with contractions, and often times, also in between the contractions. This can be quite painful, in addition to the pain felt across the uterus and in the front low pelvic area. It can simply feel unrelenting. (Can you tell that I've been there, done that, bought the t-shirt?) The root cause of the back pain is usually a posterior lying baby, or even an asynclitic lying baby (cock-eyed, off to the side).

I often wonder, why so many posterior babies? Simply put - we're a reclining society. We sit back in our recliners, couches, office chairs, dining room chairs, rocking chairs and more. Our babies get into these funky positions from us lying back.

This is why it is so very important to get up and move in labor. No lying back on the hospital bed if you possibly can! Lying in the bed just lets the baby stay in a sub-optimal position for birth, leading to back labor, long labors, 'failure to progress' and yes, even some c-sections. I cannot tell you just how many c-sections I have witnessed for 'failure to progress' and the baby is in a posterior or asynclitic lie.

Up. Move. Lean forward. Lie on your far left or right side. Squat. Walk. Dance. Hands and knees. Modified lunges. Sway from side to side.

Even with an epidural -- yes, you can do many different position changes! Left lateral, right lateral, squatting with support, squatting with no support (light epidurals, when you can bear your weight on your legs), knee chest, sitting straight up with the foot of the bed lowered.

I am a huge fan of position changes. If one position doesn't work, or doesn't feel right -- MOVE! Change it!

Good bye persistent lithotomy or supine position.

Hello position changes!!

(I need a t-shirt to wear at work that says "L&D Nurses Do It In Every Position")