Fear of Childbirth Increases Likelihood of C-Section, Study Suggests

Source: Science Daily

ScienceDaily (Sep. 23, 2011) — A new study published in the international journal Acta Obstetricia et Gynecologica Scandinavica (AOGS) reveals that fear of childbirth is a predisposing factor for emergency and elective cesarean sections, even after psychological counseling. This may mean a negative experience that lasts a lifetime among the approximately 3% of women who in this study were estimated to suffer from excessive fear of childbirth.

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• Menopause

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• Stillbirth
• Childbirth
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Led by Professor Gunilla Sydsjo of the Department of Obstetrics and Gynecology at the University Hospital in Linköping, Central Sweden, researchers analyzed the antenatal and delivery records of 353 women who were referred to a unit for psychosocial obstetrics and gynecology because of fear of childbirth, and 579 women without fear of childbirth.

The researchers found that fear of childbirth affected obstetric outcomes and increased the frequency of emergency and elective cesarean sections. Induction of delivery was more common among the women with fear of childbirth (16.5%) as compared to the women without this problem (9.6%). Women with fear of childbirth who were scheduled for vaginal delivery were more often delivered by emergency cesareans and they also more often requested elective cesarean delivery.

"Maximal effort is necessary to avoid traumatizing deliveries, ensure early recognition of women with traumatic birth experiences, and provide psychological treatment for fear of childbirth," Sydsjo concludes.

How Dilated Am I? Assessing Dilation in Labor WITHOUT an Internal Exam.

Source: Sarah Vine

It’s the magic question weighing on most laboring mothers’ minds: (as well as the minds of her partner or birth attendants!) How much longer? Is there any way to tell how far along I am in the birthing process? I’ve seen mothers beg for an internal exam and then be gutted about the answer (What? ONLY 4cm STILL!?) and suddenly *poof* she looses her resolve. It’s akin to having a test and finding out you’ve failed it, in front of your loved ones as well as complete strangers. Everyone knows this feeling is not conducive to labor – suddenly doubt and fear slide in and the laboring mother feels tense. Her oxytocin levels (our body’s natural pain-killer and labor inducer) take a nose dive and immediately she feels much more pain and she starts to run away from the contractions.

Happily, there are a number of external cues that can help you and birth partners get clued in to how much labor is advancing. Some are more subtle than others, but if you are ignoring the clock and keeping focused on staying in tune with your body, you will see them. Listen, embrace, wait.  Enjoy the way it responds! It is amazing what it can do, this body that God gave you.

1. Sound. The way you talk changes from stage to stage in labor. With the first contractions, you can speak during them if you try, or if something surprises you, or if someone says something you strongly disagree with. You may be getting into breathing and moving and ignoring people – but if you really want to you can raise your head and speak in a normal voice. When the contraction disappears you can chat and laugh at people’s jokes and move about getting preparations done. During established labor, There is very little you can do to speak during a contraction. You feel like resting in between, you are not bothered what people are doing around you. As you near transition and birth, you seem to go to ‘another’ level of awareness – it’s almost like a spiritual hideaway. You may share this with someone else, staring into their eyes with each surge, or you may close them and go into yourself. In between surges you stay in this place. It is imperative for birth assistants and partners to stay quiet and support the sanctity of this space: there are no more jokes, and should be as little small talk as possible. Suddenly, the sounds start to change involuntarily: you may have been vocalizing before (moaning, talking and expressing your discomfort, singing, etc) or you may have been silent. Listen – there are deep gutteral sounds along with everything you have heard before, just slipping in there. You are about to start pushing.

Melatonin’s role in labor progress

Source: Birth Faith

In February of last year, I heard about a study that reaffirms what our mammal cousins have known instinctively for thousands of years… birth should happen in a dark, comfortable place. It also helps explain why most women go into labor in the middle of the night. And why so many labors slow down or stall in a hospital setting.

The study’s abstract says this in conclusion: “[Melatonin] synergizes with [oxytocin] to promote [uterine smooth muscle] contractions and to facilitate gap junction activity [in a controlled testing environment]. Such a synergy in [a living human] would promote coordinated and forceful contractions of the late term pregnant uterus necessary for [childbirth]” (Sharkey, Puttaramu, Word and Olcese, “Melatonin Synergizes with Oxytocin to Enhance Contractility of Human Myometrial Smooth Muscle Cells“).

I was absolutely stoked and fascinated when I read this. It makes complete sense! Melatonin is the hormone responsible for inducing sleep. Our bodies increase production of melatonin in darkness, and most humans’ melatonin levels peak in the wee hours of the morning. Daylight and artificial light reduce melatonin production.

In my excited melatonin frenzy, I did some quick internet browsing and discovered thatmeditation increases melatonin production. Some of the most effective coping strategies for labor are akin to meditation–progressive relaxation, hypnobirthing, visualization, breathing techniques–so it makes sense why they’re so helpful.

So… let’s just be logical here… if melatonin and oxytocin synergize to produce labor contractions, wouldn’t it make sense to do everything possible to keep melatonin levels high during childbirth?

And, let’s just be logical again… how well do you think a woman can “meditate” or use coping techniques when she’s…

1) In a sterile, cold, artificially bright, unfamiliar setting?

2) Having an IV inserted, being given forms to sign, or being asked irritating questions about her social security number mid-contraction?

3) Being relentlessly interrupted by hospital staff coming in and out, sticking their fingers inside of her?

Unfortunately, just about everything about a hospital makes it one of the worst possible places to facilitate childbirth progress. If you really want to facilitate the birth process, take a lesson from your pet cat. Turn off the lights! Get to a comfortable place. Do whatever you can to relax and get into a sleep-like meditative state. Let your body do what it already knows how to do. If/When it’s time to leave your dark/comfortable nest, take along some sunglasses and someone who can protect your birthing space from unnecessary distractions and interruptions.  Keep those melatonin levels high!

I love it when science discovers that nature was right all along.

Hospital staff quizzed over deaths of women after giving birth

Source: Arab News

By ARAB NEWS

Published: Sep 15, 2011 23:36 Updated: Sep 15, 2011 23:36

JEDDAH: A five-member panel set up by Health Minister Dr. Abdullah Al-Rabeeah is questioning 16 doctors, nurses and technicians at a government maternity and children’s hospital in Jeddah for allegedly causing the deaths of two Saudi women soon after they gave birth.

Relatives of the two women accused the hospital staff of negligence and urged authorities to take action against them. According to informed sources, one woman died because she was prescribed the wrong medicine while the other due to a blood infection.

Hospital authorities had handed over the women’s bodies to their relatives without informing them of the real reasons for their deaths. Foreign doctors involved in the case have been banned from traveling abroad until investigations are completed.

Majed Al-Sulami, husband of one victim, said the death of his wife, who is mother of two girls, has turned his life upside down. “I took her to hospital last month when she had labor pains and doctors told me that she would have a natural delivery. After a few hours they gave me the good news that a baby boy had been born. Half an hour later, they asked me to sign a paper authorizing an emergency surgery to remove her uterus because of internal bleeding,” he said. But her condition went from bad to worse after the operation.

UK 'has too many hospital births'

Source: BBC

Maternity services across the UK need a radical rethink, the Royal College of Obstetricians and Gynaecologists says.

Dr Anthony Falconer: 'We all have a moral responsibility to create the best services we can'

It wants the number of hospital units cut to ensure 24-hour access to care from senior doctors and says more midwife-led units are needed for women with low-risk pregnancies.

The National Childbirth Trust welcomed the report but says the proposals do not go far enough.
NHS managers said maternity care desperately needed to be reorganised.

Proposal To Build 3 Hospitals For Expats Residing In Kuwait Govt To Present New Health Insurance Draft

Source: Arab Times

KUWAIT CITY, Aug 10: The government will soon present a new health insurance draft bill to improve medical services in the country, reports Al-Watan Arabic daily quoting informed sources.

Sources disclosed the government will submit the bill to the National Assembly in the next legislative round for review and approval. Sources explained the proposal is aimed at regulating treatment procedures in private hospitals abroad or in Kuwait. Sources said the government will pay installments of the proposed health insurance through the establishment of joint stock companies, in which 50 percent of the shares will be offered to the citizens and the remaining portion to specialized local and foreign corporations. Sources added the joint stock companies will construct hospitals, hire medical experts and purchase the necessary equipment to better serve the citizens.

Sources confirmed the proposal includes a social insurance scheme for expatriates, in addition to the construction of three hospitals exclusive for foreigners residing in Kuwait. Sources said these hospitals will be established in Jahra, Farwaniya and Ahmadi. Sources clarified the bill also states that the existing public hospitals will serve only the Kuwaitis and citizens of other Gulf countries upon completion of the hospitals for expatriates.

Miracle of baby boy born full term despite his mother's waters breaking at just 16 WEEKS

Source: Daily Mail UK

By ANDREW LEVY

Last updated at 12:19 AM on 9th August 2011

When Laura Hill’s waters broke after only 16 weeks of pregnancy, doctors advised her to seek a termination.

Not only was her own health at risk but the baby had only a one per cent chance of survival. Even then he would probably have devastating problems such as brain damage.

But certain she had already felt his first kicks, Miss Hill defied the doctors’ advice.

Thrilled: Laura Hill's son Charlie was born on her own birthday. He had been given a one per cent chance of survival

‘I said one per cent is still a chance he could live and I didn’t want to give up on my baby,’ she said.

She gave birth to Charlie after a pregnancy that almost lasted a full term, and five months later he is in perfect health. ‘I was determined to hold on to him,’ said Miss Hill, 20, from Norwich. ‘I just wanted to keep him safe.’

Water births come to UAE (Khaleej Times)

Source: Khaleej Times

Olivia Olarte

26 July 2011, 10:46 PM

An age-old birthing practice that is proven to reduce pain but a novel concept in the Arab 
world is coming to the UAE and is aining interest from women across the emirates.

The water birth method will be operational in the region for the first time in the Al Ain 
Cromwell Women and Children Hospital in Al Ain next month when the hospital opens
up its in-patient services.

According to Sandi Blankenship, head midwife at the hospital, water birth is very
popular in the UK and the US, and it is common for hospitals with the facility to offer
it for women to labour into if not to deliver.

“Typically between 50-70 per cent of women in the US would choose to at least
labour in the water,” said Blankenship, who have attended around 700 water births.

Citing its advantages, Blankenship said labouring in water can shorten the length of 

labour and reduces the pain between 60–70 per cent, due to the warm water 

temperature (between 35 degree Celsius and 37.5 degree Celsius) which has a

soothing  effect.

“Because they are in a warm safe environment, they have less fear, and when you have

less fear you have less pain,” she explained. In the water birth tub, the woman also has 

the opportunity to float and she can be in any position she’s comfortable in to labour

and deliver.

“It’s really about the woman’s comfort level. You want the baby to come out in an

 environment he/she used to be in, by coming out into water,” said Blankenship.

Expert highlights advantage of human milk bank in UAE

Breast milk is the best nutrition for the newborn and exclusive breastfeeding of the infant is recommended up to 6 month of age by WHO . However, sometimes breastfeeding is difficult, like in cases of premature babies or babies born with certain diseases. Then, it can be replaced with breast milk from donor/ donors so baby can reap all benefits. 

In State of Kuwait we have available these breastfeeding resources:

HM4HB- Kuwait Human Milk for Human Babies Kuwait : Facebook group

LLL Kuwait La Leche League Kuwait

Gulf Today informs us about initiative to establish Human Milk Bank in Dubai, UAE 

DUBAI: As mothers in the UAE are becoming more aware of the benefits of breast milk, some may be unable to give the nourishment to their babies for various reasons.

A possible solution is the establishment of at least one human milk bank (HMB) in the country.

The concept was recently introduced to 750 pregnant and new mothers at a breastfeeding and child nutrition symposium in Dubai.

A Look at the Research: The Link Between Epidural Analgesia and Breastfeeding

Science & sensibility by Lamaze is bringing us a review of latest research on use of epidural analgesia with possible link to breastfeeding difficulties after the delivery. 

It’s probably fair to say that most women who decide to have an epidural during labor don’t consider its possible impact on breastfeeding. Perhaps this is because no thought is given generally to any possible links between drugs and breastfeeding success (or otherwise). Instead, both pregnant (or laboring) women and caregivers usually assume that breastfeeding is a separate issue. Evidence from early research certainly doesn’t seem to support that view and a little common sense would also lead us to challenge it further…

Posttraumatic Stress Disorder in New Mothers: Results from a Two-Stage U.S. National Survey

1. Posttraumatic Stress Disorder in New Mothers: Results from Two-Stage U.S. National Survey 

Article first published online: 20 MAY 2011 
DOI: 10.1111/j.1523-536X.2011.00475.x

1. AUTHORS: Cheryl Tatano Beck DNSc, CNM, FAAN,
2. Robert K. Gable EdD, 
3. Carol Sakala PhD, MSPH, 
4. Eugene R. Declercq PhD, MBA

MIDWIFE`S NOTES:

Pregnancy and labour may be diffucult and painful expirience for some women,  leaving permanent impact on the life of the woman and her baby. This study identified main factors in onset of posttraumatic stress disorder. 
- low partner support
- elevated postpartum depressive symptoms
- more physical problems since birth
- less health-promoting behaviors
- eight variables significantly differentiated women who had elevated posttraumatic stress symptom levels from those who did not: no private health insurance, unplanned pregnancy, pressure to have an induction and epidural analgesia, planned cesarean birth, not breastfeeding as long as wanted, not exclusively breastfeeding at 1 month, and consulting with a clinician about mental well-being since birth. 

Too Many C-Sections: Docs Rethink Induced Labor

Time analyses birthing culture in USA.
The rise in cesarean-section deliveries in recent years has been characterized by some as a key indication of the overmedicalization of childbirth. While the procedure undoubtedly saves lives and leads to better health outcomes for mothers and infants who face problems during pregnancy and labor, many experts say the procedure is being performed too often, and in many cases for nonmedical reasons, putting healthy women and babies at undue risk of complications of major surgery.

The rate of C-sections has reached more than 31% in the U.S., a historical high, according to 2007 data from the American College of Obstetricians and Gynecologists (ACOG). The reasons for the increase are many and have been widely discussed: the rising rate of multiple births, more obesity in pregnant women, the older age of women giving birth. In fact, C-sections have become so common that many women may have an inflated sense of safety about them. "For the most part, moms and babies go through the process healthy and come out healthy, so maybe there's this sense that we're invincible," says Dr. Caroline Signore of the Eunice Kennedy Shriver National Institute for Child Health and Human Development.

C-section not best option for breech birth (Research)

The Globe and mail informs us about a new guidelines for birthing breech positioned baby.

Physicians should no longer automatically opt to perform a cesarean section in the case of a breech birth, according to new guidelines by the Society of Obstetricians and Gynecologists of Canada.

Released yesterday, the guidelines are a response to new evidence that shows many women are safely able to vaginally deliver babies who enter the birth canal with the buttocks or feet first. Normally, the infant descends head first.

Trolley saves lives of newborn

The Advertiser informs us about new life-saving equipment: bedside trolley for newborns. It can be used for resuscitation of newborns who need life-saving procedures while connected to the mother via umbilical cord as per WHO recomendations about cord clamping.

"Changing the timing of cord clamping and cutting from immediately after delivery of the baby to 1–3 minutes after delivery of the baby improves the iron status of the infant. Potential adverse effects on the infant of delayed cord clamping and cutting, such as jaundice requiring phototherapy, should be considered, especially in under-resourced settings."

A RETIRED North-East hospital consultant has helped to design an award-winning resuscitation trolley for newborn babies.

Former Darlington Memorial Hospital consultant obstetrician David Hutchon believes the bedside trolley could save babies’ lives if it becomes a standard piece of equipment in the NHS.

It is already in use at Darlington Memorial Hospital and two other hospitals in the UK.

The Basics (Bedside Assessment, Stabilisation and Initial Cardiorespiratory Support) Trolley won a Medical Futures Innovation Award in London last night.

The bedside trolley has a built-in resuscitator, water supply and heater.

It allows doctors and nurses to check for vital life-signs while the baby is safely connected to its mother via the umbilical cord.

Hospital restricts free formula baby milk for newborns to encourage mothers to breastfeed

By DAILY MAIL REPORTER

Last updated at 3:29 AM on 2nd June 2011

Breast is best: Mothers in Hull and East Yorkshire who insist on using formula milk will be provided with just one bottle after giving birth

An NHS trust has stopped providing free formula milk for new babies in an attempt to encourage more mothers to breastfeed.

Those who do not will be expected to take their own formula milk to hospital or send out a relative to buy some. Maternity staff will only have access to a ‘small emergency stock’.

Mothers who insist on using formula milk will be provided with just one bottle after giving birth.

The decision by Hull and East Yorkshire Hospitals NHS Trust backs up the Government’s ‘breast is best’ campaign which recommends that babies have breast milk for at least six months.

Eight in ten women in England start the natural way, but by six weeks fewer than half are still breastfeeding.

Liz Mason, the Hull Trust’s infant feeding co-ordinator, said babies who are bottle-fed formula milk are at a higher risk of obesity and childhood diabetes.

Despite sustained publicity about the health benefits, the UK has one of the lowest breastfeeding rates in Europe, with around 20 per cent of new mothers never making any attempt.

Read more: http://www.dailymail.co.uk/news/article-1393353/Hospital-restricts-free-formula-baby-milk-newborns-encourage-mothers-breastfeed.html#ixzz1OW5XJIkz

Lawyer died after doctors gave 16 times correct dose of labour drug

RIP Suzanne Ballantyne, who died last year from drug overdose during labor in UK as reported by London Evening Standard .

NOTE: Drug Misoprostol is one of the drugs which are used for induction of labor(forcing labor to start) which was in this situation medically indicated, because of intrauterine death of the baby ( baby died in womb). Misoprostol use has certain risks, like overstimulation of uterus ( womb will contract very strongly which can cause rupture). Kindly scroll to the bottom of this article, where you will find adviced management. 

The family of a lawyer who died after being given 16 times the recommended dose of a labour-inducing drug could sue after a coroner voiced "grave concerns".

Suzanne Ballantyne, 47, was given 800 micrograms of misoprostol at St George's Hospital in Tooting to bring on delivery after her baby, a girl, died in the womb.

Mrs Ballantyne suffered multiple ruptures to her womb, causing vital organs to fail.
Four days previously, the Royal College of Obstetricians and Gynaecologists had recommend doses no higher than 50 micrograms - though at the time of Mrs Ballantyne's death there were no official guidelines from the Government's drug rationing watchdog, the National Institute for Clinical Excellence.

Various Birthing Positions

I came across this article on Science& Sensibility Blog from Lamaze International. The article discuses various birthing positions and their pros/cons.  

"If we limit the discussion of birthing positions to those that can be easily described, classified,  sketched and/or photographed we have quite an array at our disposal:

standing

Sitting variants

Side-lying

Kneeling

Squatting variants (including lap squatting)

Asymmetrical upright positions (standing, sitting or kneeling)

"With so many options available to birthing women why then continue to use a lithotomy / supine /horizontal position?

I highly encourage you to look  for your own answers and do your research. Make your choices which will be best for your and your baby`s  health.

Recomendations for OB in Kuwait

Dear Friends,

I` ve got a question from reader and would like to ask for your recomendations for good Obstetritian in Kuwait.

"I am curious to find out which hospitals here in Kuwait will promote Natural Childbirth (following C-Section) and which Dr.’s are also “onboard” ? "

OB should support natural birth: that is hands off policy- minimum exams, alternative birthing positions, no medication, early initiation of breastfeeding.

Looking forward to hear your opinions.

Thank you very much!