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?
Showing posts with label Medical. Show all posts
Showing posts with label Medical. Show all posts
Thursday, July 30, 2015
Thursday, July 16, 2015
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?
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?
Tuesday, July 14, 2015
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?
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
Updated from "Epidurals" posted on February 19, 2014
Monday, April 7, 2014
Is Vaginal Pain and Pressure Something to Be Concerned About?
This question comes from a friend who was experiencing this.
There are a lot of new feelings and sensations that can come from being pregnant. It is not unusual to have twinges of pain or pressure in the vagina throughout pregnancy. Toward the end of pregnancy pressure will increase as the baby puts more pressure into vaginal canal, especially as the baby drops. Often being up on your feet all day can also increase the amount of pressure you feel and can even cause sharp pains. Try lying down. If it begins to subside it is normal. As the baby moves pains can come as the baby hits different areas, particularly the cervix. When the baby hits the cervix it often feels like a sharp stab that lasts for only a moment. All of this is normal and is not anything to be concerned about.
If vaginal pain is accompanied by bleeding call your doctor immediately and get checked out. If pain is not resolved after lying down I also recommend calling your doctor and get their recommendation. If it is not during office hours and you are concerned you can go to the hospital to get evaluated.
Have you experienced vaginal pain or pressure?
There are a lot of new feelings and sensations that can come from being pregnant. It is not unusual to have twinges of pain or pressure in the vagina throughout pregnancy. Toward the end of pregnancy pressure will increase as the baby puts more pressure into vaginal canal, especially as the baby drops. Often being up on your feet all day can also increase the amount of pressure you feel and can even cause sharp pains. Try lying down. If it begins to subside it is normal. As the baby moves pains can come as the baby hits different areas, particularly the cervix. When the baby hits the cervix it often feels like a sharp stab that lasts for only a moment. All of this is normal and is not anything to be concerned about.
If vaginal pain is accompanied by bleeding call your doctor immediately and get checked out. If pain is not resolved after lying down I also recommend calling your doctor and get their recommendation. If it is not during office hours and you are concerned you can go to the hospital to get evaluated.
Have you experienced vaginal pain or pressure?
Wednesday, March 12, 2014
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.
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.
Tuesday, March 11, 2014
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?
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?
Monday, March 10, 2014
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?
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?
Friday, March 7, 2014
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?
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?
Thursday, March 6, 2014
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!
Wednesday, March 5, 2014
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!
Tuesday, March 4, 2014
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.
Monday, March 3, 2014
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?
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?
Wednesday, February 26, 2014
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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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?
Tuesday, February 25, 2014
C-Section, No Question
Yesterday we talked about c-sections covering what they are. I concluded that they are great when they are needed. Today I want to share situations when a c-section would be absolutely necessary, no questions asked. Some of the information may be a little scary, but I believe it is important for us to be informed about these situations so if it arises during our pregnancies or births, we know that it is necessary for the baby's health and ours and not simply doctors attempting to control a situation.
- Placenta Previa- A previa is when the placenta is covering all or part of the cervix. A complete previa covers the cervix completely, a partial means it is over part of the cervix. Clearly if the previa is complete, there is no way for the baby to come out vaginally and a c-section is required. With a partial there is still a high bleeding risk involved and will still require a c-section. Often times previas will move. The placenta need to be at least 2 cm away from the cervix for a vaginal delivery.
- Placental Abruption- This occurs when part of the placenta begins to tear away from the uterine wall before the delivery of a baby. Typically it comes on very suddenly and there is a lot of bleeding and pain. Due to the blood loss the baby needs to be delivered quickly for the health of both mom and baby.
- Prolapsed cord- This occurs when the umbilical cord comes down before the baby's head. This is an emergency and the baby needs to be delivered ASAP!
- Non-reassuring heart tones- This includes prolonged decelerations or persistent late decelerations that do not stop with intervention. A prolonged deceleration in the baby's heart rate is an emergency and you will be running back for a c-section. Late decelerations (slight decrease in heart rate that occurs after the contraction) is not an immediate emergency, but are a sign that there is a problem with the oxygen supply to the baby. Other interventions would be attempted before a c-section, but if there is no improvement a c-section will be needed.
- Breech or Transverse Presentation- I mention these here because there are not many providers who will deliver a breech presentation vaginally and transverse presentation cannot be delivered vaginally.
- Medical Conditions- There are certain medical conditions that will not allow for a vaginal delivery such as certain heart conditions, previous uterine surgery and active herpes legion. These will be discussed with your provider ahead of time.
These are the primary reasons I can think of for immediate c-sections. Have you had any experience with these?
Monday, February 24, 2014
What Is A C-Section?
A c-section is a surgical procedure that is done to take the baby out of the uterus when a vaginal delivery may not be possible. The procedure is done by cutting a horizontal incision in the pelvic region of the skin and typically a horizontal incision in the uterus. The abdominal muscles are also cut during this procedure. On occasion, if there is an emergency a vertical incision may be done on the skin and/or uterus. The type of incision on the uterus will determine if you will be able to attempt a VBAC in the future. After the baby and placenta have been delivered the uterus, muscles and skin are then sewn back together with sutures that absorb. Sometime staples are used on the skin.
Typically they will use epidural anesthesia for a c-section unless it is a true emergency or you are unable to have an epidural for medical reasons. If you are unable to have an epidural, they will put you under general anesthesia. Typically those who have epidural anesthesia have a quicker recovery due to the nature of epidural vs general anesthesia, so if you know you are having a c-section then if at all possible you would want an epidural.
We are blessed that we have the ability to do these easily when they are needed, but c-sections are major surgery and should be considered very carefully in healthy women. Know your providers c-section rate. Know if they are quick to do c-sections for non-emergent reasons. Know what they are and when they are necessary. Ask a lot of questions, especially if you are hoping to avoid a c-section.
Typically they will use epidural anesthesia for a c-section unless it is a true emergency or you are unable to have an epidural for medical reasons. If you are unable to have an epidural, they will put you under general anesthesia. Typically those who have epidural anesthesia have a quicker recovery due to the nature of epidural vs general anesthesia, so if you know you are having a c-section then if at all possible you would want an epidural.
We are blessed that we have the ability to do these easily when they are needed, but c-sections are major surgery and should be considered very carefully in healthy women. Know your providers c-section rate. Know if they are quick to do c-sections for non-emergent reasons. Know what they are and when they are necessary. Ask a lot of questions, especially if you are hoping to avoid a c-section.
Friday, February 21, 2014
Episiotomy
What is an episiotomy?
An episiotomy is when a cut is made in the perineum. There are 2 types: median and midline.
Midline is a cut made straight down the middle of the perineum.
Median is made at an angle to the right or left.
Are episiotomies necessary?
Generally speaking they are not necessary. Some providers use them as an alternative to tearing.
In the case of a emergent situation they can be necessary. For example, the baby is almost out at the vaginal opening, but the heart rate is dropping drastically. An episiotomy may be performed to help the baby get out quickly instead of doing a c-section.
Is an episiotomy better than tearing?
This question is clearly up for debate and you can find research supporting both views. From my personal understanding and experience I believe it is better to tear for healing purposes. The reason for this is it's a natural process and the tear fits back together upon repair like a puzzle. When there is a clean cut this does not happen. Also, with a cut it becomes easier to rip like when you cut a piece of paper.
Have you had an episiotomy? What are your thoughts on them?
An episiotomy is when a cut is made in the perineum. There are 2 types: median and midline.
Midline is a cut made straight down the middle of the perineum.
Median is made at an angle to the right or left.
Are episiotomies necessary?
Generally speaking they are not necessary. Some providers use them as an alternative to tearing.
In the case of a emergent situation they can be necessary. For example, the baby is almost out at the vaginal opening, but the heart rate is dropping drastically. An episiotomy may be performed to help the baby get out quickly instead of doing a c-section.
Is an episiotomy better than tearing?
This question is clearly up for debate and you can find research supporting both views. From my personal understanding and experience I believe it is better to tear for healing purposes. The reason for this is it's a natural process and the tear fits back together upon repair like a puzzle. When there is a clean cut this does not happen. Also, with a cut it becomes easier to rip like when you cut a piece of paper.
Have you had an episiotomy? What are your thoughts on them?
Thursday, February 20, 2014
Pain Medication
What pain medications are available during labor?
There are a few that are used in labor and it depends on the provider what they generally use. It also depends on the stage of labor you are in what they might use.
If early in labor or being induced overnight, they are more likely to give you something longer lasting, while in active labor they are more likely to give you a short acting drug.
Some of the drugs that might be used include stadol, fentanyl, morphine, dilaudid, and demerol.
Are there risks involved with these drugs?
Like with all medication, there are risks. They give temporary relief, but they have the possibility of suppressing the baby's breathing upon birth. This can lead to needed interventions when they are born. Generally speaking this is not severe, but can be.
When can these be given?
Each provider and hospital have there different policies, but once you are dilated to about 7 cm or so, they will not give these for the risk above. Up until then they can be given every 2 to 6 hours depending on the drug.
Have you had any of these drugs during labor? What was your experience?
There are a few that are used in labor and it depends on the provider what they generally use. It also depends on the stage of labor you are in what they might use.
If early in labor or being induced overnight, they are more likely to give you something longer lasting, while in active labor they are more likely to give you a short acting drug.
Some of the drugs that might be used include stadol, fentanyl, morphine, dilaudid, and demerol.
Are there risks involved with these drugs?
Like with all medication, there are risks. They give temporary relief, but they have the possibility of suppressing the baby's breathing upon birth. This can lead to needed interventions when they are born. Generally speaking this is not severe, but can be.
When can these be given?
Each provider and hospital have there different policies, but once you are dilated to about 7 cm or so, they will not give these for the risk above. Up until then they can be given every 2 to 6 hours depending on the drug.
Have you had any of these drugs during labor? What was your experience?
Wednesday, February 19, 2014
Epidurals
What is an epidural?
An epidural is placed in the epidural space in your back. I 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. Ask your provider what they use in their epidurals.
What are some pros of an epidural?
An epidural is placed in the epidural space in your back. I 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. 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
- 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
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?
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