An Honest Doctor

Today I wanted to share a personal note from my doctor's appointment this week. It is so important to know that you can trust your doctor to give you an honest opinion on what to do. I'm tired and really, really ready to meet my baby. On Wednesday, I had my weekly appointment and talking with my doctor about what to do, he said, "I am on call Friday so we could induce you if you wanted but honestly I'm much more comfortable letting nature take it's course than inducing labor."

I was shocked, but remembered this is why I chose him has my primary OB. I said, "Thank you for being honest about what you think is best and not pushing an induction." It was so nice to hear an honest opinion, than him just telling me what he thought I wanted to hear.

This is so important when choosing a care provider. I know there are some places where it is difficult to find doctors like this, and so sometimes you have to go above and beyond to really educate yourself on what is best. But when you have the ability to choose, choose wisely, Sisters. Ask a lot of questions and get recommendation from people who you can trust.

What questions do you ask? What's important to you?

Is An IV Necessary?

This is another common question that I hear frequently that has a simple yet complicated answer. Is an IV necessary?

NO!

However, very few hospitals will allow you to labor and deliver without one, even if you plan to have an un-medicated birth.

Why?

This is a precautionary measure, like not allowing you to eat, in case there is an emergency and you need a c-section or other surgery of some kind. IV access is important in those cases and can be difficult to get if needed quickly. This is why most doctors will require you to have access, known as an INT, a hep-lock or saline lock, if you are delivering at a hospital.

If you plan to be induced or plan to have an epidural, an IV is necessary because of the medicines given for induction, and an IV fluid bolus is necessary for an epidural.

For those who are healthy and have had an uncomplicated pregnancy who are completely opposed to an having an IV, consider a home birth or going to a birth center to avoid an IV.

What is your experience with IVs?

Can I Become Tolerant of Epidurals?

One of my friends who has four children asked me if it's possible for epidurals to become less effective because of becoming tolerant of the medicines in the epidural as hers had become less effective with each birth. I did not know the answer. So at one of my prenatal appointments I asked my doctor about this.

My doctor said that this is not really possible because of the way epidurals work. An epidural is a temporary block on the nerves that is there and then goes away. There is not a way to build up the medicine because it is not metabolized like medicines that you ingest. He said that it could be possible if you were given epidurals every day, but this is not likely for women having babies.

Why then were the epidurals less effective each time? I have no idea and neither did my doctor.

Have you had the experience of epidurals being less effective with each delivery?

When Should I Get An Epidural?

This question is one I get frequently from new moms wanting to make the best decision possible about getting an epidural. This is an easy and tough question all at the same time, so I will share my general guidelines from what I have seen in the hospital.

For first births I recommend waiting as long as possible simply because first births can take awhile so if you get it too early you could end up lying down for hours and prolonging your labor. If you are looking for dilation, I would recommend waiting until you are at least a good 4 cm dilated before getting an epidural for the same reason. If you are able to wait until 6 or 7 cm this is ideal because you will be getting it right around transition, which is the hardest part of labor, but is generally quick compared to the rest.

What if you are having trouble dilating? These recommendations are thrown out the window. If you are having trouble dilating, it is likely that your body is struggling to relax to dilate. In this case, an epidural may be very beneficial in helping you to dilate. This is not a, "I haven't made any progress in an hour" recommendation. This is a, "I have been stuck at 5 cm for a few hours" recommendation, because the first part of labor can be long and slow and can take quite some time to get to 5 or 6 cm, especially if it is your first.

Trouble dilating could also indicate there is some kind of complication, and having an epidural may be a good idea in case a c-section becomes necessary.

If you are being induced, then it does not matter as much when you get an epidural because your labor is being done for you. The question you need to ask yourself is how long to I want to be stuck in bed?

For subsequent births, there is a little more ambiguity. Your first birth will likely give you a good indication of when you should get an epidural with your next.

As with everything else, pray about when the best time to get an epidural is because everyone is different. These are my recommendations based on years of experience. Often times you will know if and when you need it, even with your first.

How did you decide when to get your epidural?

Epidural

What is an epidural?

An epidural is placed in the epidural space in your spine. A needle is used to place a catheter in this space and medicine is giving continuously through the catheter. What is put in the epidural depends on where you are and is typically a combination, for example, fentanyl (an opiod) and bupivacaine (a local anesthetic). Ask your provider what they use in their epidurals.

What are some pros of an epidural? 

• If placed well there is complete pain relief with the ability to feel pressure when it's time to push (yes feeling this pressure is a good thing)
• Ability to sleep/rest during your labor
• If you have been in labor for a long time with out progressing it can help speed up dilation
• If a c-section is needed you already have it in place

What are some cons of an epidural?

• Can cause your blood pressure to drastically decrease- If too low can lead to distress with the baby
• Unable to get out of bed in most places
• Cannot eat or drink (ice chips only)
• Can slow down labor process- (if this happens you may be given pitocin)
• May not be able to feel to push
• Catheter is needed to empty your bladder
• Other unforeseen complications

When needed, epidurals are great tools to have. Again I encourage you to pray over whether or not this is the best option for you. 

What have been your experiences with epidurals?

Updated from "Epidurals" posted on February 19, 2014

Ways to Help Naturally Induce Labor

You are past your due date and your provider is talking about induction and yet you do not want to induce if possible. The question that comes after this talk: is there anything I can do to start labor on my own? There is a lot of question about this as some things work well for some people while others have no success. With my first I tried a lot to make myself go into labor, but nothing worked. I have talked to others that the first thing they tried helped them go into labor. Ultimately, only God can start your labor and sometimes He allows your efforts to push you on over.

With that being said, here are some things that may or may not help you go into labor.

First I suggest you pray, because God is the one who will make labor happen!

Walking- This one is completely up in the air as to whether or not it helps, hinders or has no effect at all on labor. Do not walk until exhaustion, but feel free to try walking as it will not hurt you.

Sex- Sex is one of the best options as long as you are healthy for a few reasons. Semen has prostaglandins in it that help prepare the cervix for labor and can then kick you into labor. It also helps with intimacy and preparing you together for what's to come. There are other techniques I will mention that can be implemented during your time together.

Nipple stimulation- This can be very effective as it releases oxytocin, which is the natural form of pitocin, into your body. You must pay very close attention to your body so you do not over stimulate your uterus leading to contractions that are too long or too frequent. This site has a good basic process to follow.

Acupressure- This can actually feel really nice as it is more of a massage technique. There are 2 primary places to use: 1) The webbing between the thumb and forefinger and 2) 4 fingers above the ankle on the inside of your leg. The spot on your leg is really nice for helping to relax while someone massages your ankles. See this link to learn the process.

Food- There are some foods that may help you go into labor. Some that are out there include: pineapple, spicy food, eggplant parmesan, date fruit, curry, Chinese food and licorice. There is no definitive research to back up any of these, but it can't hurt to try.

Blue or Black Cohash- These are herbs and need to be handled with great care. Please consult your healthcare provider before trying one of these.

Castor Oil- This is another method that should be used with great care. You drink castor oil  or add it to your food causing the bowels to be stimulated, which stimulates the uterus. I have talked to many women who have had success with this. It can cause severe diarrhea. There is also some question as to whether or not it can cause the baby to have a bowel movement in utero. Ask your care provider before using it and use wisdom.

These are just a few well known options. Again pray for wisdom and for God to bring out labor. If you are unsure of anything ask your health care provider.

Have you tried to induce labor naturally? What did you use? Was it successful?

Updated from "Are There Ways To Induce Naturally" on February 18, 2014

Inductions Updated

What is induction of labor? 

This is when medical interventions are taken to cause a woman to go into labor.

When are inductions necessary?

There is certainly some subjectivity to this question, but some cases that may need an induction of labor would include developing pre-eclampsia or pregnancy induced hypertenstion (PIH), low or high amniotic fluid, the baby being too big or too small, and going far over your due date. This is not an exhaustive list but more of the common reasons why induction may be considered.

What medicines are used to induce labor?

Depending on the circumstances different medicines may be used.

Cervidil is used to help prepare the cervix for labor. It is put inside of the woman behind the cervix and left in for up to 12 hours.

Cytotec is also used to prepare the cervix for labor as well. It can be put behind the cervix and absorbed or taken orally. This can be given every 4 hours minimum, depending on contractions.

Pitocin is a synthetic form of the hormone secreted by women to cause labor. It is given through an IV and the dose depends on the provider and how labor is progressing.

A balloon catheter is another device used for induction that does not involve medicine but can be used in conjunction with pitocin to aid in inducing labor. A balloon catheter is inserted by a doctor or midwife into the cervix so that the balloon that is inflated puts pressure on the cervix to aid it in opening.


Three of my births thus far have been inductions and were completely different experiences. I so desired not to be induced, but God taught me so much through them. From my personal experience I definitely would not recommend having an elective induction as my recoveries were a lot easier when I was not induced. Whether or not you should be induced should be a matter of prayer, seeking God's wisdom.

What is your experience with induction?

Updated from Inductions posted on February 17, 2014

Megan's Pregnancy and Simon's Birth

    I was not a fan of pregnancy. I know there are a lot of women who love being pregnant, who thrive while they are with child, I however was not one of them. I had a very unique and complicated pregnancy, which added to the typical discomforts of a “normal” pregnancy (if there is such a thing). 

    A little background history… I was born with Biliary Atresia. I was the 1 out of every 15,000 children born with it. What is Biliary Atresia? Well, long story short I was born without any bile ducts connecting from my liver to my small intestine. This left the bile with nowhere to go. Most Biliary Atresia children are born with blocked ducts but I was one of the babies who didn’t have any. This is where my hero Dr. Nagaraj stepped in and performed the Kasai procedure (attaching a piece of my small intestine to my liver) on my fragile 9 day old body, which would give me roughly another 2 years of life, if I even lived through the surgery. The chances of my body returning to a normal state were less than 30%. Back then this wasn’t a procedure done that often and well, here I am 29 years later, off the transplant list, no sign of my disease, and still baffling doctors. Really the only difference in me is that I have a very low platelet count. This means my blood doesn’t clot as fast as most peoples. The normal platelet count for a person is roughly 150,000-400,000. Mine hold pretty steady somewhere between 60,000 and 80,000. 

    Back to the pregnancy. When I first told my OB about my medical history she freaked. I mean, people with this disease don’t typically live to a reproductive stage, let alone have babies. I was immediately under the microscope of all my doctors, and let me tell you they did NOT take this lightly. I can really tell that they THRIVE on cases like mine! I was very closely monitored by my OB, my gastrointerologist, and my hematologist. I mean, with a platelet count as low as mine the chances of my bleeding internally or bleeding out during delivery were pretty great. My GI doctor kept a close watch on my liver, which meant getting a few scopes done, as well as seeing him bi-weekly, my Hematologist kept a close eye on my blood count bi-weekly, and my OB saw me bi-weekly. Basically I LIVED at the hospital. When cases like mine come through they always prepare for the worst, and they also prepare YOU for the worst. You know, it’s really scary when you are told the chances of your survival rate during delivery. Those 9 months were the most trying 9 months of my life physically, spiritually, and mentally. How do you stay excited or joyous when people are preparing you for some scary truths? Every time I heard the statistics I felt like I was walking towards the gates of death. 

    After a group meeting with my OB doctors every thing became a blur. It was a unanimous decision that I needed to deliver cesarean, but not only cesarean, I would need to be put to sleep. And not only cesarean and knocked out, I would be sent downtown to deliver with doctors that I had never met before. This was all decided roughly a month before my due date. The next week i went downtown for routine ultrasounds and was told I needed to deliver early at 37 weeks, which was NEXT WEEK. I knew the name of the doctor who would be deliver my sweet boy but I still had never met her. 

    Fast forward to next week, my husband and I are walking into the hospital at 8:00am on Halloween morning knowing that at 10:30am our lives would be different. I am immediately swept so that the show can begin. When you have a million doctors around you poking you, giving you instructions, sharing the details of what they are doing, asking for blood transfusion permission, making you sign a ton of papers, you really can’t do anything but silently panic. But let me tell you, there was one person there who I really felt was sent there by the Lord to be with me during all this. It was my anesthesiologist. I never would have thought that a person like him would be my rock. My husband was not allowed to be with me during any of my prep or any of my delivery and I know that the Lord knew I needed someone. I hate that I cannot remember his name but this man is responsible for keeping me together. He took the initiative to stay with me not only for emotional support but he did more prep on me than any of the nurses put together. Did I mention that I still hadn’t met my delivery doctor?

    Once prepped, i was wheeled into the delivery room. If I thought I was scared before, wow, I had no idea. There’s nothing like florescent lights, a million doctors, and a laying naked on a stainless steel table, and the thought of never waking up, to get the tears flowing. There she was, my doctor. She was very sweet and I knew she was good at this. I was sent specifically to her. Everything was so fast paced, I was shaking horribly, everything hurt, I was strapped down, naked, and freezing. But that’s when my anesthesiologist gently grabbed my head and started whispering in my ear that I was going to be okay and that he was going to take care of me. Then he told me to keep my eyes on him while the doctors did their work. I kind of felt like I was in a factory. I was the product and they were the assembly line. Anybody been there? Next thing I know he tells me I will soon be asleep, which I am glad for but also scared to death that maybe I wouldn’t wake up. I have been put to sleep more times than probably most people and it has never bothered me. If anything I find it very peaceful. This however, was different. But you can’t just not go to sleep so off I went, to dream land…

    Guess what! 1 hour later I woke up and was immediately holding a beautiful baby boy in my arms. The love i felt for him outweighed any fear of death. It was worth it. He was worth it, and I will do it again with the Lord’s blessing. Recovery was super painful and definitely the worst part of my experience. Just when I think it couldn’t get any worse! I was in the hospital for I think 4 days? I longed for daylight. I longed for no pain. I longed to be able to walk down the hall by myself. I am not one that likes to sit around, let alone lay around in a super uncomfortable hospital bed! But you know what, at the end of the day God was glorified through my pregnancy, He showed himself to the doctors, to me, He used my circumstance to glorify himself and I am honored I could be a part of it. I have never publicly shared this story because it’s not always what people wanna read when they are pregnant. I am also very private person. I never think people want to know the details of my life. I always think pregnant women want to laugh about all the silly food cravings, giggle over the belly kicks, relate to all the back pains and swollen ankles. My story is different. It’s not something most people relate to. But here I am and I hope this was in some way encouraging. Pregnancy is beautiful and it looks so different to so many people. Thank you for letting me share my experience. 

~Shared by Megan B.

Advocating for Yourself in Labor

I want to delve a little more into advocating for yourself. Today I want to discuss advocating for yourself during labor.

First off to be able to advocate for yourself you need to be educated. You need to know generally what you want and be familiar with things that can go different as planned. Clearly you cannot know everything, but basic information and prayer can help you prepare.

There are times you may end up with a nurse or a provider that may not agree with your decisions and possibly pressure you into making a decision you are not comfortable with. There are clearly times when things need to be different, but I'm talking about when you are pressured to get medication or have interventions taken or might even be refused medication for some reason.

I want to be clear, you are the only one who can give consent to have medical treatment done unless it is a life or death situation. You are your own advocate. You can have others there to help you make decisions, but only you can make the call. Again, be polite and gracious, but do not be afraid to be firm in your decisions.

You can refuse medications and interventions.
You can ask for medications and interventions.
You can ask to be checked.
You can ask to be left alone.

This can be difficult in labor, but it is still your job. So pray, be prepared, have a plan, make sure your husband is on board with your plan and be ready to stand on your decision no matter what pressures come.

Have you had to advocate for yourself? Did your plans ever have to change?

How Do You Advocate For Yourself?

This question came from one of my friends that I wanted to answer on here. The question relates specifically to going to labor and delivery when not in labor as discussed yesterday.

So, you are having pain that is unexplained and is not seeming to go away, you cannot get to the doctor's office and you are concerned, so you head over to the hospital to see if you can get some answers. What do you do from there?

They will put you on the monitor to check the baby and see if you are having contractions, but sometimes that is all that will happen if there is nothing evident. Throughout pregnancy there are weird pains and twinges that are often unexplainable, and usually if everything looks good there will be no need to do more. It is also possible that the doctor may not come by if everything looks normal.

If you are not comfortable with this and and wish for further evaluation, ask. Remember to be polite and gracious, knowing that sometimes things maybe refused or you may have to wait awhile to see the doctor on call. If your nurse is not working with you, you can ask to speak with the charge nurse, but please only do this in extreme circumstances.

The biggest thing is to not be afraid to ask. You can ask to see your doctor. If you are far enough along and are unsure if what your feeling could be labor related, you can asked to be checked. You can ask for medication. You can ask for anything. Again, be polite and gracious and be willing to listen in case they must refuse your request. This is the best way to advocate for yourself. Also pray for wisdom and peace throughout this time. God is the One ultimately in control and He knows what is going on.

Can I Go To The Hospital For Problems When Not In Labor?

A friend recently asked me about this after a frustrating experience. She had been experiencing some intense pain and with it being the weekend it was not an option to go to the doctor's office to be looked at and was advised to go to labor and delivery.

If you are uncertain as to what is going on and you are concerned that something could be wrong, call your doctor's office and tell them the situation. In an after hour situation it is quite legitimate to go to labor and delivery at the hospital to be checked out, and the nurse adviser, doctor or midwife can tell you if this is best. 

If you are bleeding a lot or are having intense abdominal pain, go to the hospital ASAP and call your provider on the way. These can be emergencies that need to be addressed immediately!

Labor and delivery is there to help you, so do not be afraid to use them if you are really uncertain as to what is going on and you are concerned. 

Circumcision

I am well aware of how controversial and sensitive the discussion of circumcision can be. That being said I want to simply give an overview of circumcision and the ways they perform circumcision.

Circumcision is when the foreskin is loosened from the head of the penis and then removed. This is a very quick procedure in newborns and generally has no major side effects as long as everything goes well. There are 3 major ways they perform circumcisions: Mogen Clamp, Gomco Glamp and Plastibell.

Mogen Clamp

The Mogen clamp is a metal hinge shaped device. Using this device does not require a cut in the foreskin before using it. The foreskin is pulled through the hinge of the clamp. The clamp is then closed and locked for about 90 seconds to crush the foreskin, which helps to decrease bleeding. The foreskin is then surgically removed.

The Advantages of this device are that it takes less time than the other two and it is the least likely to lead to infection, excessive bleeding and/or swelling.

The Disadvantages are that there is a greater potential to accidentally remove the tip of the penis and fewer doctors know how to use it or are less comfortable with it.

Gomco Clamp

The Gomco Clamp is a metal device that is shaped like a bell that fits over the end of the penis. The baby's foreskin is stretched over the bell and the clamp tightened. If the foreskin is not retractable I cut in the foreskin will be made. Once the clamp is tightened the foreskin is then surgically removed.

The Advantages of the Gomco are that it allows for easy removal of foreskin and tissue, has good cosmetic results and many doctors are familiar with it.

The Disadvantages of it are that it is more complex than other circumcision procedures, more likely to cause excessive bleeding and more likely to remove too much skin from the shaft of the penis.

Plastibell Device

The Plastibell Devise is a plastic device slipped between the foreskin and the penis. A cut in the foreskin is usually required to place the device properly. A sterile string is tied around the device and over the foreskin to cut off the blood supply. Foreskin tissue is trimmed and the device removed leaving the string in place. The tissue under the string dies and falls off about 10-12 days after the procedure.

The Advantages to this device are different sized bells allow for custom fit to each baby, has good cosmetic results and many doctors are familiar with it.

The Disadvantages of this are an increased risk of excessive bleeding than the Mogen and infection is more likely.

I hope this is helpful in giving an overview. Please feel free to ask additional questions. Also please share your experience. I ask you be sensitive in sharing your opinion on any of this.

Other Newborn Care

About 24 hours after birth other newborn care options come in to play. Here is a brief description of them.

Hepatitis B Vaccine

If you are planning to start the hepatitis vaccine with your newborn the first dose is given in the hospital around 24 hours old. Hepatitis B is contracted through body fluids and unless you are infected or at risk for contracting Hepatitis B your baby is not likely at high risk. It is considered safe by the CDC, but has the risk of side effects as with all vaccines. This is a matter of prayer and decision to be made between your spouse and you.

PKU Screening

The PKU screening is done between 24 and 72 hours old for best results. This is done by pricking the baby's heel to draw blood. This tests for PKU as well as other metabolic disorders. PKU is very serious and needs to be caught early to prevent serious complications or death. You can refuse this screening, however I would not recommend this. The risks of doing a heel stick clearly outweigh the benefits from knowing if your child has a metabolic disorder so you can properly care for their needs.

Circumcision

Circumcision is very controversial in our culture, but is still an option, to be done around 24 hours old by your OB/GYN. This entails removing the foreskin from the penis. It is considered a cosmetic surgery and can be refused. If you do not want your son circumcised, make sure it is clearly marked on your baby's chart.

CCHD

This is a new screening to determine if there is a possibility of congenital heart defects in the baby. This is done by putting a pulse oximeter on two of the baby's extremities to see if the readings are equal. A positive screen would require an echocariogram to follow up.

Hearing Screen

The hearing screen is done by stimulating the ear drum or brain stem to verify there is a response. This is a non-invasive procedure that allows you to know if your baby may have hearing loss.

What are your experiences with these?

Afterbirth Newborn Care

One of my friends asked me to talk about some of the interventions done with newborns in the hospital after birth. Here is a basic overview of those done in the delivery room.

Cord Clamping

There is much debate about when the cord should be clamped. On the natural side people argue that you should wait for the cord to stop pulsating before cutting. On the medical side you have people saying it doesn't matter when you cut it. The truth is probably somewhere in the middle and dependent on each child. Generally speaking there is no harm in waiting to cut the cord and there could be some harm in cutting to early, though not likely.
The reasons for waiting include increasing the blood supply, increasing levels of vitamin K and helping the circulatory system as it transforms.
This is a matter for you to pray over and discuss with your spouse and provider.

Vitamin K Shot

After birth newborns are given a shot of Vitamin K to help with blood clotting. This is to prevent possible bleeding, especially in the brain that can happen due to birth trauma. Thankfully, this is not very likely, especially in an unassisted birth. There is some evidence to show that if you delay in clamping the cord, there may be less of a need, if any at all for the Vitamin K shot.
This is again a matter to pray over and discuss with your spouse and provider to decide what is best for your baby.
These first two are closely related and should be considered together

Eye Antibiotic

After birth, newborns are given erythromycin ointment in their eyes to prevent infection. The infections that typically cause issues are STDs such as chlamydia and gonorrhea, therefore if you do not have a known infection the antibiotics are not necessary.

What are your thoughts on these interventions?

VBAC

What is a VBAC?

A VBAC is a vaginal birth after Cesarean (c-section).

Can I have a VBAC?

Generally speaking most women can have VBACs and is a safe option. There are factors to consider, such as how many c-sections have you had and why was the first c-section done, which should be discussed with your provider and prayed over at great length.

What are the benefits to having a VBAC?

• Avoiding more scarring on your uterus 
• Usually less painful recovery
• Shorter recovery period
• Decreased risk of infection
• Being active in the birth of your child

What are the risks of a VBAC?

• Uterine rupture- the previous incision may come open due to the pressure of labor
• Other risks associated with C-sections: increased infection, increase in bleeding, 

When is it not possible to attempt a VBAC?

If you have a vertical incision on the uterus instead of the common horizontal incision providers will not allow you to attempt a VBAC due to the much higher risk of uterine rupture with this type of incision. Also if you have had 3 or move previous c-sections, it is not likely you will be permitted to attempt a VBAC.

Have you had or attempted to have a VBAC? What was your experience? 

Prolonged Labor

Prolonged labor can sometimes be used as a reason to do a c-section, in spite of everything else going well. What is prolonged labor? That is hard to say. Every woman is different and every labor is different. Medically speaking it is greater than 24 hours in a first time labor and greater than 16 hours in subsequent labors. However some can last even longer if there early labor takes a while. 

If you are wanting to avoid a c-section or other medical interventions if at all possible, stay home as long as possible. Doctors will watch the clock and time closely. If things seem to be going well and you are comfortable at home, wait until labor becomes more intense before going in to the hospital, generally speaking. Again pray the whole time and seek God's wisdom in knowing when to go to the hospital, if that's what your choosing. 

Prolonged labor can put added stress on the baby. Again, ask for wisdom throughout. Labors can take 36 to 48 hours if you are slow moving. This does not necessarily mean that anything is wrong, but it could be a sign of complication. 

Have you had long, drawn out labors? Did you have interventions? Share your experience!

Breaking Your Water

What is involved with my provider breaking my water for me?

The provider will do a pelvic exam, locating the cervix and amniotic sac, and use a tool called an amniohook to break a hole in the amniotic sac.

Should I let my provider break my water?

This is something that must be bathed in prayer. From a professional standpoint, I think it generally unwise if done too early in labor, especially with first births. The reason for this is I saw this happen to many people who ended up with infections, c-sections that could have been avoided or both. 

For some, breaking the water really speeds up labor and it is a good idea. For others it has no effect in the labor process. With a first delivery you do not know how your body will respond to the water breaking so pray for lots of wisdom on whether or not you should allow this. If you have been in labor for a long time and are desiring to see if it will help speed up the process, I recommend waiting until at least 5 cm if not 7 cm dilated, as those are the 2 numbers people seem to stall out at. Again this is based on my experience. 

Your water breaking puts you on a clock as well. Generally speaking providers like for you to be delivered within 24 hours of your water breaking. If you are not delivered by 24 hours it makes most providers nervous. It also increases likelihood of infection and antibiotics may be started to hopefully prevent infection.

I cannot emphasize enough, pray for guidance in this. Allowing them to break your water can be of great benefit, but it can also cause issues. God knows, so ask Him!

CPD Myth or Fact?

It's been said that a woman will not grow a baby she cannot physically birth. In a perfect world this would be true. However, sometimes a woman has a poorly shaped pelvis or a small pelvis that does not allow for a vaginal delivery. This is known as cephalopelvic disproportion or CPD. Thankfully this is not common but many times you will not know if this is true for you until you are in labor. This can also vary from pregnancy to pregnancy. Because one baby cannot be born vaginally does not mean others cannot in the future.

Therefore CPD is a fact, however it is not as common as people think it is. 

Fetal Heart Rate Monitoring

Is Fetal Heart Rate (FHR) Monitoring Necessary?

From a research standpoint, there is nothing to indicate that FHR monitoring is needed nor does it improve the outcomes of moms and babies. There is some thought that FHR monitoring can catch problems early, and it can, but it can also lead to more c-sections. If you are in a hospital you will have at least external monitoring some of the time.

What does the monitor show?

The monitor reads the baby's heart rate along with a monitor to show the contractions. They are looking for how the baby's heart rate reacts to the contractions. The reaction shows generally how the baby is doing. Throughout the labor process we want to see accelerations in heart rate, as this is healthy.

There are also decelerations that indicate different things. An early deceleration occurs as the head is compressed, typically as you near the time to deliver. This is considered normal. A late deceleration happens after the contraction and indicates a problem with placental profusion. This can happen for a number of reasons including cord compression or placenta issues.

With labor there is also the risk of prolonged deceleration. This was mentioned in our discussion of c-sections as it is quite serious. It can indicate that the baby is ready to be born, but if it's not then usually there is a more serious issue and you may be heading for an emergency c-section.

Should I use FHR monitoring in labor?

If you are laboring at a hospital you will have some monitoring without question. How much depends on your doctor. If you are wanting to have as little monitoring as possible, talk to your provider early to find out what their thoughts and policies are as well as the policy of the hospital you will be delivering at. If you are being induced you will have to have continuous monitoring. Like everything else this is a matter of prayer as God is the only one who knows how your labor will go.

What is your experience with FHR monitoring? What do you think about it?

Other Reasons for C-sections

There are other considerations for having a c-section than the reasons mentioned yesterday that may not be known until labor or you have more of an option as to whether or not you will have a c-section.

1. Previous c-section- This one is tricky as the research goes "back and forth" as to the phrase "once a c-section, always a c-section" is really best. Having a previous c-section is something that must be considered, but does not mean you must have another c-section. Ask your provider where they stand.
2. Multiple Pregnancy- When pregnant with more than one baby it may be recommended that you have a c-section, especially if one or more babies is not positioned ideally. Providers will consider allowing you to labor with twins, but typically if there are more than twins, they are unlikely to allow you to labor. 
3. CPD- This is an abbreviation that means the baby's head does not fit in your pelvis. This is something that will likely not be known until you are actually in labor and may not discover until you have been laboring a while. Occasionally you may know if you have an oddly shaped pelvis ahead of time, giving you a heads up that this could be an issue, but many times this is not known until later. 
4. Labor being too long- This, of course, you cannot know ahead of time. Having a long labor is not indicative of needing a c-section, but often times, especially if you are in a hospital laboring, this will give providers "concern" and you can end up with a c-section.
5. Prolonged Rupture of Membranes- This, too, would not be known ahead of time. Once your water has broken you are "on the clock" in the hospital setting. They like the baby to be delivered by 24 hours after this happening. At the 24 hour mark it is likely they will begin talking about a c-section, especially if progress is slow. 
6. Placenta accreta- This occurs when the placenta is implanted to deeply and firmly into the uterine wall. If it is caught ahead of time a c-section may be scheduled in the hopes of saving the uterus. 

There might be other reasons, but these are the common ones that happen fairly often. Have you had experience with these? Are there other reasons you can think of?