Vaginal Exams: Pregnancy & Labor

Are vaginal exams (also called pelvic exams, or cervical checks) necessary during pregnancy and labor? They can certainly be helpful at specific times, such as for being admitted to the hospital or birthing center when you're in labor, if you've gone past your due date, if an induction is needed, if there is a concern about labor progress, or perhaps a question of the baby's position during labor. What about checks during pregnancy, or during labor - when everything seems to be progressing normally, and the mother is fine and the baby is fine? This is your choice to make, based on the pros and cons, your care provider's recommendation, and your feelings, opinions, and intuition. More information on vaginal exams is below, from a few different sources. Read, be informed, and decide for yourself - based on you, not anyone else.

Evidence on Cervical Checks at the End of Pregnancy

Pelvic Exams Near Term: Benefit or Risk?

Vaginal Examinations: A Symptom of a Cervical-centric Birth Culture

Beautiful Birth Photos

These photos are beautiful! Whether it's a home birth, hospital birth, natural birth, cesarean birth, midwife birth, water birth, OB birth, breastfeeding or formula feeding, or it's a first or second or third child... there's no one right way to do it. Take a look here.

The Cesarean Rate Epidemic

This article looks at the current rates, state, and climate of Cesarean Births in the U.S. It provides statistics and rates, reasons for Cesareans, as well as the associated risks. 

“Cesarean delivery may be a safe alternative to vaginal delivery but its use in 1 of 3 women giving birth in the US seems to high.”

— contemporaryobgyn.modernmedicine.com

An excerpt discussing the rising rates and unusual number of Cesarean rates below:

"One possible reason for the rise in the cesarean delivery rate may be that there has simply been a rise in the need for cesarean. The most common indication for a primary cesarean is cephalo-pelvic disproportion, or arrest of progress in labor. It is unlikely that maternal pelvis size has changed over the past 3 decades, but it is possible that birth weight has increased. In fact, evidence suggests that rates of macrosomia have increased over the past 2 decades.8 Other issues that contribute to increasing rates of cesarean delivery, possibly through the mechanism of birth weight, are maternal obesity and gestational weight gain.9,10 Without question, the proportion of obese women has increased over the past decade and higher weight classes are associated with even higher rates of cesarean.11,12 In addition, increased gestational weight gain has been associated with cesarean delivery and is commonly above standard guidelines.13

Another reason for increasing cesarean rates may be a rise in elective cesarean delivery, also known as cesarean delivery by maternal request (CDMR). Because there was no ICD-9 code for CDMR, it is unclear what proportion of cesareans are due to it. One recent study, however, estimated the proportion as high as 4% in the United States.14 Interestingly, CDMR is more common in other countries, such as Brazil, Taiwan, and Chile. A study in Chile comparing women receiving private care (cesarean rate >40%) to women receiving public care (cesarean rate <20%) found that 8% of those receiving private care and 11% of those receiving public care stated a preference for cesarean delivery, with the vast majority preferring to deliver vaginally.15 Thus, even in this setting, it is unclear that maternal preferences are driving the increase in cesarean delivery rate."

Full article can be read here: http://contemporaryobgyn.modernmedicine.com/contemporary-obgyn/news/cesarean-epidemic-are-we-too-quick-cut?cfcache=true

Why delay cord clamping?

Science and Sensibility, the research blog from Lamaze, has an excellently evidence based article on the practice of delayed cord clamping. The article is structured by listing objections, which is a great way to go about learning the benefits, as well as to be prepared to answer to someone's concerns about this practice. Delayed cord clamping is becoming so much better understood and common place. Many Ob and midwife practices in Brooklyn and NYC do this as a matter of protocol. 

Read the full article here. 

What A Doula Does

I adore this blog post written by my dear doula colleague, Yiska Obadia. You can read an excerpt below, and the full article here.

"Doulas are there to serve their clients. You want to birth naturally? I will support you. You want an epidural? I will support you. You want an epidural and to avoid a c-section? I will do my best to help you achieve that. Doulas serve our clients in helping them to achieve the birth THEY want as well as supporting them wholeheartedly with the birth they get."

From Spinning Babies... The Sacrotuberous Ligament: Key to Unlocking a Long Labor

This article is definitely worth a read if you are pregnant and preparing for labor. And especially if you are interested in anatomy! According to the article, it may be particularly applicable if any of the following are present:

• A long and difficult labor in which normal remedies (Rebozo Sifting, Position Changes, Spinning Babies Maneuvers) are not fully effective

• Persistently malpositioned baby

• Highly athletic mother (especially those who are highly athletic into their pregnancy)

• History of any trauma in which the ligaments of the pelvis could have been affected (accidents, falls, etc.)

• A visible Pelvic Upslip: One (usually left) iliac crest superior to the other, one leg (usually left) functionally shorter than the other.

A secret to a quick and easy childbirth?

There is certainly not one quick and easy solution that's going to work for everyone. I also don't even believe that this is THE way to go, but I have seen scenarios in which women do completely ignore the fact that hey are in labor, whether intentionally or not, and give birth quite smoothly and swiftly. But this is not to discount the women who need to focus and actively think in one way or another. There is no one right way to birth. But I think this article raises some interesting points worth thinking about.

Read the article here:

http://www.dailymail.co.uk/health/article-3147111/The-secret-quick-painless-childbirth-Just-don-t-think-ban-partner-room-leading-doctor-claims.html

Can a midwife administer pain medication?

For a hospital birth, whether or not a midwife can administer pain medication depends on what kind of pain medication we're talking about. For a home birth, it depends on the midwife. Read the article from Choices in Childbirth to get more information:

Can A Midwife Administer Pain Medication? By Barbara Sellers, CNM

Home Birth: The Latest Article with Some Statistics

If you haven't come across it before, Lamaze's blog, Science and Sensibility, is a great way to stay up to date on recent studies and new information in the maternal/perinatal health world. I recently came across this article and wanted to share it.

New Evidence: Give Women More Time in Labor.

This one is so simple, so straight forward. Give women a bit more time to labor and we can reduce the cesarean rate. This is of course assuming that everything points to the mother and the baby being in good health. As long as everyone is doing find, and the mother is game, let's create the space and be encouraging and supporting to women who want to labor just a bit longer and potentially avoid a c-section. This recent study showed that giving mothers just one more hour of time can cut the Cesarean rate in half. That's big. Here's the article you can read to learn more:

http://www.huffingtonpost.com/entry/new-evidence-that-we-just-need-to-give-women-more-time-to-labor_us_56ec4f66e4b084c672203418

Ina May Gaskin Documentary

Looking for a birth-related movie to watch? Here's one: a documentary on the famous Ina May Gaskin, author of Ina May's Guide to Childbirth.

Birth Story Ina May Gaskin and The Farm Midwives ( 2013 )

"Ina May Gaskin and The Farm Midwives captures a spirited group of women who taught themselves how to deliver babies on a 1970s hippie commune. Today as nearly one third of all US babies are born via C-section, they fight to protect their knowledge and to promote respectful, safe maternity practices all over the globe. From the backs of their technicolor school buses, these pioneers rescued American midwifery from extinction, changed the way a generation approached pregnancy, and filmed nearly everything they did. With unprecedented access to the midwives' archival video collection, as well as modern day footage of life at the alternative intentional community where they live, this documentary shows childbirth the way most people have never seen it--unadorned, unabashed, and awe-inspiring."

Midwife Thinking: Birth From the Baby's Perspective

Such a fascinating article! Excerpt below, and definitely head over here to read the article from Midwife Thinking in its entirety, as well as watch the videos.

Here are the bullet points from the article on treating a newborn with respect:

"A humane approach to welcoming a baby to the world

Whilst in some cases it is not possible, I believe that we should aim for all babies to have the opportunity to:

• Make their own way through their mother’s body and into the world (ie. no unnecessary pulling).
• For their first touch to be from the hands of a person who loves them (mother, father, family member, friend).
• To be held immediately by their mother skin-to-skin.
• To be sustained by their placenta until the placenta stops functioning (ie. leaving the cord intact).
• To be left in peace to find their mother’s nipple and latch on.
• To be treated gently and with dignity and respect during any ‘checks’ that their mother chooses to have done."

New Birth Plan Template

Many of my birth doula clients - whether they are planning a natural birth in a hospital or birthing center, or birth with medication, or a home birth - want to create a birth plan. One hospital in NYC (NYU) provides a fairly succinct birth plan template, which is great, however I don't know many other hospitals that do provide a template. You can find some templates online, some simple and some that are pages and pages long (which I don't recommend). The image above is of a new one that I came across and thought I'd share - link below. Enjoy!

https://thebestseasonofmylife.wordpress.com/2015/08/20/a-downloadable-visual-birth-plan/

Birth Matters.

I love this article! Read the full text here.

Excerpt below:

"The problem with saying “It doesn’t matter how you give birth” is that if women take that to heart, they may not take the time to educate themselves on their choices or vet potential providers to find the right fit since the birth process doesn’t really matter anyway. Empowerment starts with women educating themselves on the childbirth process and understanding that they are the drivers of that process. Birth attendants are primarily experienced navigators who know what to do if inclement weather hits or if the car breaks down. They should not take the wheel unless there is truly no other choice.

Childbirth is the likely the hardest, most overwhelming thing a woman will ever do, so of course those experiences matter. If you walk away from your birth feeling powerless, that’s important. No matter how your baby ultimately enters the world, how you experience birth and how empowered you feel throughout the process does matter. Let’s stop telling women that it doesn’t."

Placenta: Essential Resuscitation Equipment

When people hear "placenta" these days, they may tend towards thinking about placenta encapsulation. What about the placenta's role and potential as the baby is born? This is fascinating article on the placenta, delayed cord clamping, and newborn resuscitation. It's a little bit birth-nerdy, but if you are interested in cord clamping and your newborn's transition to breathing on her/his own, please have a read!

Read the full article here from Midwife Thinking.

The Truth About Your Due Date

Get some perspectives on your due date, or "EDD" (estimated due date), as well like to call it. Read what a midwife, a doula, an OB, a labor nurse, an acupuncturist, and a pediatrician have to say about. it And in case you didn't know already, only about 5% of women give birth on their due date. The rest of us tend to naturally go somewhere from week 37 (full term) to week 42. There are exceptions to this, of course - as always, with birth. My best advice on the "due date" situation is to consider it your due month, and when people ask you when you are due, you give them the month, not the date :)

Read the article on due dates from Well Rounded NY here.

The Forgotten Art of Untucking The Tail

Very interesting as it relates to birthing a human...

“Modern birthing science has placed a large burden on secreted hormones (like relaxin) to prepare the body for needed mobility.” Katy Bowman says. Yes, hormonal relaxin is useful in letting the body open up for the birth, but it’s not enough, unless we have strong muscles that can fully contract, but also fully release. But then, strong isolated muscles are not enough either. In order to have smooth births we need to have a whole-body endurance. A great way to develop endurance is to walk as much as you can. “The woman who wants to go about a birthing process naturally can follow the lead other “natural” processes women have been doing for millennia — walking 5–6 total miles per day, and squatting to bathroom multiple times daily” — she adds.

Read the full article here.

Using a Mother’s Microbes to Protect Cesarean Babies

"The first germs to colonize a newborn delivered vaginally come almost exclusively from its mother. But the first to reach an infant born by cesarean section come mostly from the environment — particularly bacteria from inaccessible or less-scrubbed areas like lamps and walls, and skin cells from everyone else in the delivery room.

That difference, some experts believe, could influence a child’s lifelong health. Now, in the first study of its kind, researchers on Monday confirmed that a mother’s beneficial microbes can be transferred, at least partially, from her vagina to her baby after a C-section."

Read the full article from the NYT Well Blog here.

Home Birth in the News

Fox News covering home birth!

Watch the video here.

Evidence Based Care for Pregnant Women

Ever wonder what evidence-based care is? This great free video series by Rebecca Dekker, PhD of Evidence Based Birth does an excellent job of explaining what evidence-based care is and how to get it. A must watch video series for expecting parents - even if you are not pregnant yet! In fact, the sooner parents-to-be have access to this kind of information, the better. Whether you are interested in a natural birth, home birth, hospital birth, cesarean birth, birth with a doula, or birth without a doula, midwifery care or medical care model, this video series is for you! There's also a great video on the evidence for birth plans. Very enlightening. Enjoy!

Click here to watch the Evidence Based Birth video series: Do Birth Plans Really Work?