“Breech” is a term describing your baby as head-up rather than the optimal head-down position. Breech position is not uncommon in the middle of pregnancy and most babies turn head down toward the end. Some turn during labour. A baby coming bottom first can have more difficulty being born and while a caesarean birth may be suggested, there are many doctors willing to catch breech babies. For now let’s focus on turning the baby. The best time to turn the baby is around 35 weeks.
Awareness of your baby’s movement is an important and non-invasive assessment of fetal well-being. Basically, activity is reassuring and decrease or cessation is worrisome. “Kick count” is the counting and tracking of fetal movement – kicks, flutters, swishes, jabs or rolls. Mothers learn normal patterns for their baby such as sleep cycles, times of activity and triggers. It’s also a way to bond and connect.
If you’ve been busy or are unsure about movement relax and have a meal, a small glass of juice or some fruit. Palpate your baby to induce movement. Pay attention to the movements. Babies sleep. If your blood sugar is low then so is your baby’s. You should feel at least 10 movements over 2 hours (it usually takes much less time), and at least one movement in the first hour.
Keeping a journal of kick counts beginning at 28 weeks provides valuable information.
- Be properly hydrated and fed.
- Ideally start the kick count at about the same time daily; think of it as a baby-date.
- Rest when you do the kick counts, by sitting or lying on your left side.
- Note the date, start time and the time at which the 10th movement takes place.
- Calculate the total time for 10 movements.
- Keep notes in the same place to see patterns emerge. Any method works. Below is an example of a chart and one of a log.
Contact your midwife, doctor, or go to the birth unit at your local hospital immediately if:
- You have followed the recommendations above and have not felt 10 kicks in 2 hours.
- There’s a significant change in the pattern over the 3 to 4 days.
- Your baby has a significant or sudden change in movements.
- You have concerns.
Example of a Kick Counts Log
Note the date/week of gestation, and start time. Count or jot down a √ or x for 10 movements. Note the finish time, and total time. Keep an eye on patters with the total time.
Mon 9:00 XXXXXXXXXX 9:32 Total: 32 min
Tues 12:00 XXXXXXXXXX 12:45 Total: 45 min
Wed 9:00 XXXXXXXXXX 9:55 Total: 55 min
Thurs 9:00 XXXXXXXXXX 9:45 Total: 45 min
Fri 9:30 XXXXXXXXXX 10:05 Total: 35 min
Sat 9:15 XXXXXXXXXX 10:05 Total: 50 min
Sun 10:00 XXXXXXXXXX 14:15 Total: 4 hr, 15 min
Note the significant change in total time. In this case you would seek medical attention on Sunday.
Prepare Your Home Before 37 weeks:
- Midwife & doula contact info on your fridge; info entered into cell-phones
- Other “Important Phone Numbers” list on your fridge
- Purchase / rent birth pool if applicable, and plan for set-up
- Some cleared surfaces for equipment set-up
- Plan for birth-attendant parking
- Outside lights working, house # visible at night (may require a temporary # to be put up)
- Clear path to door and through halls
- Child-care plan (unless they’re attending birth; MW & doulas can offer tips)
- Pet-care plan – pets with teeth / claws absolutely need to be locked up or sent elsewhere as even the most gentle animal can become over-protective and stressed while mama’s in labour
- If you’d like candles then please use only unscented beeswax or battery-candles
- Get your bed “birth-ready” – make bed in this order (from bare mattress): extra mattress pad, sheets for after the birth, then a plastic sheet, mattress pad (optional but nice), sheets for birth, blankets & pillow cases that can be used for birth. Have pillow cases and blankets for after the birth nearby. Note: if you don’t wish to sleep with plastic in the days/weeks before birth, please have all this ready near bed so someone can quickly make the bed during labour.
- Birth-Kit from MW (if she provides this; otherwise purchase and assemble yourself):
– Package of 10 or more large absorbent under-pads / “blue pads”
– Peri-bottle for postpartum perineal care (one per washroom)
– 4 pair disposable mesh underwear
- If you have a guest-room, it’s nice to have it ready for birth-attendants, just in case
Please prepare in a box, plastic tub or reserved laundry basket.
1) Dryer Items
These items will be warmed in the dryer prior to birth. Place in a separate bag or container (but keep it with Birth Container). Washed and ready for use; will get soiled or stained so consider Thrift Store purchases.
- 6 towels (more for waterbirth!)
- 6 receiving blankets
- 2 hats for baby
- 3 flannel sheets/blankets for mother
2) Other Linen
Washed and ready for use; will get soiled or stained so consider Thrift Store purchases.
- Newborn outfit incl. diaper, undershirt, sleeper, socks, hat and blankets
- Nighty / PJs for mother
- Set of sheets to fit bed
- 6 old washcloths, old diapers, etc. for hot compresses
- 10 washcloths for mother comfort
- 6 towels; make it 12 minimum for waterbirth!
- 10 cloths/rags for clean-up after
3) Other Items
Note: There may be some repeats from the Birth Bag Suggestions list, which you’re encouraged to check out for some great ideas of things you can use at home, hospital or birth centre.
- Large plastic sheet to protect bedding – e.g. drop sheet or plastic shower curtain liner
- 4 large garbage bags (1 for soiled laundry, 1 for garbage, plus 1 replacement each)
- Large saucepan or Crockpot for heating compresses and oils
- (optional) Small unopened bottle of food-grade oil e.g. olive or grape-seed for crowning
- Plastic ice cream pail or other suitable container with lid for placenta
- Flashlight with new batteries
- Large pkg. maxi pads, extra long (the bigger, thicker the pad the better). Avoid pads with a “dry-weave” topping as they can be irritating to your perineum
- Flexible straws
- Cookie sheet or other large firm portable surface
- Bottle of hydrogen peroxide
- Digital thermometer
- Q-tips, in case of care of umbilical cord
Your pool should have come with a supply list. Please ask if you need more info. If you’re lucky enough to have a big comfy built-in tub, the only extra thing you’ll need is a floating thermometer and a small fish-net or sieve.
Think about lots of healthy foods and drinks (Labour-Drinks) you and your family might enjoy during and after labour and birth, and stock up. HINT– birth attendants LOVE tea and snacks too! 😉
Make a few trays of ice-cubes (can keep cubes in a zip-lock).
Below is my list of resources – books, DVDs, CDs – available for clients to borrow, and descriptions. If you have a question please ask, as I have many evidence-based research articles I can share with you.
Ina May’s Guide to Childbirth by Ina May Gaskin
My fave childbirth book ever! First half is filled with empowering birth stories and for many women has totally turned around fears and negated all that societal mis-information about birth. Second half has research based info on what you really need to know about your body and labour – the forgotten, empowering info you don’t hear about in our society unless you really search it out. Most interventions aren’t even discussed which is why I like my clients to pair this with the Dahl book for a balance of a deep knowing of our power and modern day procedures. But if a woman tells me she’ll only read 1 book this is the one.
Birthing From Within by Pam England & Rob Horowitz
What I call the third trilogy in really preparing for birth. Not too much about hospital procedures because it really focuses on the emotional / spiritual preparation for both parents-to-be. This work literally changed the face of birthing in North America. Great info about how our non-physical selves affect the process (>95% in my humble opinion), how to uncover some of our beliefs and work toward really feeling confident. (Pam did The Elk & the Epidural DVD and we get the ice-cube exercise from her teachings.)
Pregnancy & Childbirth Secrets by Gail Dahl
A best-seller to help you prepare for a positive childbirth in any setting. Kind of like a non-scary, empowering version of What to Expect. (That book scared the crap out of me while pregnant!) Laid out month-by-month. Packed full of info and includes sections on preparing for birth, every pregnancy issue and intervention I can think of, extensive sections on breastfeeding and baby-care. An example of some of the top secrets for childbirth: Go in with a plan for pain. There is much more to know than breathing. Her book lists over thirty methods to help reduce pain during labor.
Smart Medicine for a Healthier Child by Zand & Rountree
It’s the best kid-health book I know of from infancy right to teen years, and the only one you’ll need unless you plan to specialize in some aspect of kid-health. There are short sections on basic safety, nutrition, health etc. The bulk of the book is an alphabetical listing of specific illnesses and conditions – what it is, signs & symptoms, many ways to treat allopathically (i.e. Western medical style) and holistically (i.e. outside the medical model). Each illness has a “when to seek medical advice” paragraph, which I found quite reassuring as a new mom.
DVDs & CDs
Birth Day (DVD) by Naoli Vinaver Lopez (10min)
Natural home water birth, empowering, short, non-graphic; good one to show siblings-to-be. Naolí’s birth takes place at home with her husband and two children. It’s a touching and intimate account of natural birth, waterbirth and close family dynamics. The love and support Naolí receives gives her courage to labor uninhibited. Her children are present to receive their sister and be part of the process. She provides narration about what she was feeling and thinking during labor.
Birth with Gloria LeMay (DVD)
- 9 Homebirths without narration
- Same 9 Homebirths with commentary
- 30 min intact PSA featuring Dr. Dean Edell
- 25 min The Prepuce presentation by Doctors Opposing Circumcision. This is a film for medical students on the importance and function of the male foreskin.
It’s My Body, My Baby, My Birth (DVD) (27min)
An educational DVD that tells the story of 7 mothers and their emotional journeys to natural childbirth. Partners express their fears and concerns, ultimately transforming as well.
The story is enhanced with footage of partners and the roles of various professional birth workers.
Pregnant in America¬ (DVD) by Steve Buonaugurio (106min) – (may be on Netflix)
A story about the institutionalization of birth in North America – kind of like Business of Being Born but more fun to watch; follows a couple from pregnancy to birth. Shocked by the greed of U.S. hospitals, insurance companies and medical organizations, Steve and his wife Mandy set out to create a natural home birth in a world where everything is anything but natural. The film is educational and entertaining and prepares excepting parent for their uncertain journey of being pregnant and having their baby.
The Birth of Sabine (DVD) by Andaluz Waterbirth Center (10min)
Sabine’s video shows the excitement and anticipation of a first pregnancy. Follow a couple from the positive pregnancy test, prenatal visits, to the unexpected surprise of her water breaking days before labor begins. They are shown making decisions and using natural methods of induction up until the day they are (gratefully!) in labor. Dad helps catch baby as she is born into the water and placed immediately on mamas chest.
What Babies Want (DVD) by Debby Takikawa and Noah Wyle (58min)
Mind blowing info about infant’s experience of pregnancy, birth and early childhood. This info changed my life. An award winning documentary that explores the profoundly important and sacred opportunity we have in bringing children into the world. Filled with captivating stories and infused with Noah Wyle’s warmth as narrator, the film demonstrates how life patterns are established at birth and before. It includes information on early development as well as appearances by experts: babies and families.
The Elk and the Epidural (DVD) by Pam England of Birthing From Within (15min)
Discusses pros and cons, when use is appropriate, and how to support a family if epidurals are used. Candid info not presented by mainstream medicine, research based. Illustrates the truthful and typical experience of labor with an epidural. Parents learn about the advantages, disadvantages, and the cascade of medical support that accompanies epidurals. The message to parents is to develop and maintain a solution-focused, non-judgmental mindset, so that if an epidural (or any medical support) becomes necessary, they can stay present emotionally and spiritually for the birth of their child.
Gentle Birth Choices (DVD) by Barbara Harper (55min)
Blends interviews of midwives and physicians with footage of six different birth experiences–including a home birth, waterbirths, vaginal birth after a prior Cesarean section, and birth with other children present. The DVD vividly demonstrates the strength of women during childbirth and the healthy and happy outcome of women exercising gentle birth choices. It is a moving and powerful instructional tool, not only for expectant parents, but also for midwives, hospitals, birth centers, and doctors. This remarkable production combines art, education, and politics.
Giving Birth (DVD) by Susanne Arms (35min)
Lots of info about how nature equips us to handle labour and have a safe birth. Lots of great info about how hormones work in labour – every woman should know this. NOTE: Research done on Giving Birth proved that this film is effective in lowering the level of fear of birth in men as well as women.
It shows the model for normal birth and why it is important for mothers and babies. It contrasts the two different models for birth ~ the medical model vs. the midwifery model and explains the risks of routine obstetric practices. You will learn what scientific evidence has discovered about birth and hear it from three obstetricians a labor and delivery nurse, and a doula. You will learn why doulas are important if you birth in a hospital. You will also hear from a mother post-Caesarean and watch two (non-graphic) births. You will experience a woman giving birth in her own home, attended by a midwife, and see images of a water birth. This video explores common misconceptions about pain in labor, epidural anesthesia, cesarean, and many routine hospital procedures. Giving Birth presents what midwifery care is all about.
Birth As We Know It (DVD) by Elena Tonetti-Vladimirova (75min)
Variety of births clips in a variety of settings; watch as many or as few as you wish. This movie features eleven natural births, including home birth, water birth, twins, breech delivery and self-birth. Also featured are informative interviews on topics rarely discussed, such as the Sexuality of Childbirth, Circumcision and Limbic Imprinting, and conveys its message in a non-intrusive way.
Giving Birth & Being Born (DVD) (20min)
Shows 4 natural births in a European birth centre, in variety of positions. The women use a variety of equipment, including birth ball, wall mounted ladder, rope, stool and mats to increase their comfort, with their partners offering support and encouragement. There is no commentary, just simple music to underpin the visuals and a very few sub titles to explain what is being said by the midwives and women. Bonus (36 minutes) offers an explanation of the basics of the birth process, using video animation and short clips from Part 1 to illustrate the various topics.
Business of Being Born (DVD) by Ricki Lake & Abby Epstein – (May be on NETFLIX)
A documentary story about the institutionalization and financial business of birth in North America. This film interlaces intimate birth stories with surprising historical, political and scientific insights and disturbing statistics about the U.S. maternity care system. When director Epstein discovers she is pregnant during the making of the film, the journey becomes even more personal. The filmmakers ask: Should most births be viewed as a natural life process, or should every delivery be treated as a potentially catastrophic medical emergency?
Orgasmic Birth (DVD)
Yup – just like it sounds. A documentary about medicalization of births and how well women can cope in the right circumstances. Examines the intimate nature of birth and the powerful role it plays in women’s lives when they are permitted to experience it fully. This documentary asks viewers to re-examine everything they thought they knew about giving birth and the potential it holds. Undisturbed birth is revealed as an integral part of women’s sexuality and a widely neglected human right. Couples share their birth experiences, discussing their fears and how they found the support, nurturing, and ultimately the power and strength within themselves to labor and birth their babies in a beautiful, loving, and ecstatic way.
Relaxation, Rhythm, Ritual: The 3 Rs of Childbirth (DVD) by Penny Simkin (15min)
Penny shares 23 “scenes” from the labors and births of 10 women, illustrating with moving examples what she often refers to as “The 3 Rs of Childbirth: Relaxation, Rhythm, and Ritual.” Watching these different women and their unique responses to contractions as they progress from early labor to birth will inspire women looking forward to birth.
Reducing Infant Mortality and Improving the Health of Babies (DVD) (17min)
Free viewing at http://www.reducinginfantmortality.com/ Listen to Obstetricians, Doulas, Neonatologists, Midwives, Psychologists, Pediatricians, and other Physicians explain how our health care system is failing babies and mothers and what we can do about it. This film is a tool for everyone to use to draw attention to infant mortality and infant and maternal health issues as national health care policy is debated on Capitol Hill.
First Hour of Life (DVD) by Marshall Klaus (33min)
Dr. Marshall Klaus has studied infant bonding and newborns for over forty years. He, along with John Kennell, introduced the Doula concept into mainstream US medical practice. Now, filmmakers from Italy have combined an interview with Dr. Klaus and footage from four (Italian) home births in a profound and simple video which should be required viewing for all parents, obstetricians, nurses, and childbirth educators.
Kangaroo Mother Care I & II (DVD) by Nils Bergman, MD
KMC I – Rediscover the natural way to care for your newborn baby (26min)
This video summarizes the latest research to prove that the newborn thrives best on his mother’s chest, where the temperature is perfectly controlled all the time. How to wrap the baby to mother’s chest is also shown. Kangaroo Care is for all newborn babies, but especially premature ones. Dads can do it too! This is the “How-To” video. Kangaroo Mother Care enables the baby to relax, and improve the heart rate and the body temperature. Breastfeeding is an essential and natural part of Kangaroo Care.
KMC II – Restoring the original paradigm for infant care and breastfeeding (52min)
This comprehensive, expanded video is instruction for health professionals who support the maternal/newborn dyad. Dr. Bergman clearly and simply presents what happens to a human newborn when separated from the mother. His own research plus >200 studies shows many benefits to the newborn in skin to skin care.
Dr. Jack Newman’s Visual Guide to Breastfeeding (DVD) (45min)
Simple reassuring info about breastfeeding. This is a no-nonsense approach to baby-led breastfeeding. It illustrates the numerous benefits of breastfeeding for both mother and baby, including detailed reviews on the importance of colostrum, proper latching techniques, latching the baby who does not yet latch, and how to treat the colicky baby by changing milk flow.
- How to know if baby is getting enough milk
- Breast compressions
- Avoiding sore nipples
- How to get a baby to latch
- Colicky babies
- How to increase baby’s intake of breastmilk
- Risks of formula
- Using a lactation aid
Baby-Led Breastfeeding (DVD) by Christina Smillie (16min)
This film shows mothers learning to breastfeed naturally, by letting their babies show them how. Human babies are already hardwired to seek out and find the breast at birth and this film shows babies instinctively finding the nipple. The film includes babies of various ages with a variety of breastfeeding challenges. In this video we see just how babies can do it, when we get out of the babies’ way.
Prenatal Yoga (DVD) by Shiva Rea
Learn poses for each trimester. DVD includes:
- Calming meditation and deep breathing
- Gentle workout with seated poses, standing poses and floor work
- Guided relaxation
Postnatal Yoga (DVD) by Shiva Rea Reconnect with your strength, your energy and your pre-pregnancy shape and lifestyle through warmth, guidance and inspiration of instructor Shiva Rea. Post-pregnancy is a most important time for a woman to regain her physical strength and stamina. This gentle program focuses on moves and exercises that help alleviate the stress incurred by giving birth.
Happiest Baby on the Block (DVD) by Dr. Harvey Karp (128min)
Note: I haven’t watched this yet so can’t share an opinion. It was donated by a client who highly recommends it. Aimed to help soothe most of baby’s cries in seconds…plus add 1-3 hours to tot’s sleep! Parents master these fun tips best by watching. Then, after they you get good at switching-on your baby’s amazing calming reflex, Dr. Harvey Karp, noted pediatrician and child development expert, reveals the amazing secret reflux that literally is ‘THE OFF SWITCH” for baby’s crying! Learn the 5 simple ways to turn on the calming reflex (the 5S’s).
Babies Know… Seven Principles of Prenatal and Perinatal Psychology (DVD) (20 min)
Seven Principles of Pre- and Perinatal Psychology is all about infant consciousness from the moment of conception through birth, and the significance of our first experiences after birth on development. Becoming aware of this level of consciousness can have a profound impact on our babies being born today, as well as people of any age investigating how experiences from within the womb and birth have impacted the overall experience of being human.
Trauma, Brain & Relationship – Helping Children Heal (DVD) (30min)
This documentary is an overview to help those who care about children recognize, prevent and heal psychological trauma. Internationally and nationally recognized authorities who work with children and teenagers in the field of emotional trauma offer insight and information about the origins of relationship/developmental problems, as well as problems associated with PTSD later in life. A central message of the documentary is that even though psychological trauma often goes unrecognized in children, emotional trauma is very responsive to relational repair. It clarifies such points as the difference between emotional trauma and emotional stress.
Your Body, Your Birth (CD) by Lynn Griesemer (78min)
Inspires, encourages and reveals secrets for a rewarding birth experience – one you can cherish for the rest of your life. This CD is about taking charge of your birth and your life. Topics include: exploitation in pregnancy and delivery; medical aspects of birth (drugs, safety, myths, technology); natural childbirth (definition, advantages, why we should avoid drugs at birth, why more people don’t aspire to natural childbirth); tips for a successful pregnancy and birth; how to make birth-related decisions that you feel comfortable with; goal setting; imagination; body image; human needs; what obstetricians will do for you; strategies for a satisfying birth.
Wondrous Beginnings (CD) by Wendy Anne McCarty (49min)
This audio CD is part of the What Babies Want Audio Lecture Series about the consciousness of infants. This CD offers insights into our spiritual nature, right from the beginning of life.
Dr. McCarty intertwines amazing new theories and findings with heart-warming healing stories of families who have come to her for guidance. This CD is especially encouraging and supportive of pregnant families and families with young children. Wendy leads us on an amazing journey through a new understanding of the consciousness of the infant. Her emphasis on scientific research does not contradict her deep spiritual understanding of what it is to be human. She presents ideas and stories pertaining to the process of coming into the world from preconception through early childhood.
Ancient Encoded Wisdom (CD) by Joseph Chilton Pearce (45min)
This audio CD is part of the What Babies Want Audio Lecture Series about the consciousness of infants. This CD offers insight into our birthing culture. Joseph Chilton Pearce offers us a clear, no-holds-barred look at the developmental needs of babies and children, and clearly spells out for us the roots of violence inherent in our birthing and parenting practices. He also offers simple and concise choices that we can make for positive change.
Some little-known gold nuggets for breastfeeding in the first days (you may wish to print this and stick it on the fridge or by your feeding-nest):
- Breastfeeding may take practise but is designed to work
- Watch for feeding cues* and offer breast. Crying is considered a late sign of a stressed babe.
- Offer one cue, then pause to let babe work it out. E.g. nipple to baby’s lips, then pause for 5 seconds to allow babe to sort out latch. If she needs another cue, then give on, pause, and repeat if needed. Baby is learning too.
- Babies rest/pause with eyes closed. If babe stops sucking but stays on breast, let him rest and resume feeding. He’s likely not actually sleeping, so don’t take him off. (Sleep test – lift and drop arm. Sleeping baby’s arm will fall; wake baby’s arm will respond.)
- You should feel a tug or pull, but no pinching. Avoid the temptation to feed through a bad latch, no matter how demanding baby is. Not even once!! Break the seal (insert pinkie into babe’s mouth) and start again. Even if it takes 10 tries.
- Don’t hold baby’s head while feeding. It may be sore from birth. Sore or not, the stimulation causes baby to pull back from breast. Hold head by putting hand on bones at top of neck if necessary.
- Don’t “pet”, rub, stroke babe while feeding. Holding and feeding baby is an act of big love in and of itself. (Imagine if you were trying to enjoy a fine meal, and someone was petting and rubbing you all over. Ok that might be fun, but not conducive to eating.)
- After 3-6 weeks the effort of breastfeeding becomes way less than the effort of formula. Keep going – it gets easier and is worth the early efforts.
Best Start has an excellent 1 page chart for the first days – feeding guidelines, newborn stomach size, diapers and other info. Print this!
* Here’s a great graphic to help you identify visual feeding cues.
Natural physiologic birth leads to a safer and gentler birth for both mother and baby. Labour hormones (including higher levels of pain-killing endorphins) work optimally when a labouring woman feels safe, private, unobserved, and uninterrupted. Labour proceeds faster, with more efficient contractions, less pain perceived, and fewer complications (Buckley, 2004). Women can relax, surrender and sink deeper into labour. This results in fewer interventions. Water birth helps facilitate an environment of privacy, calm, and quiet. Several studies of labour in water vs. land report positive findings. Others found no differences but also reported no adverse outcomes, no increase in interventions, nor poorer outcomes.
Easier, faster labour:
- More support: mother isn’t left alone and partner can get in pool to provide close support.
- Reduced inhibition as mother feels supported and less exposed.
- Buoyancy allows for easier mobility and relaxed muscles. Less work is used for support and upright positions. This especially helps women with a physical disability, injury, body-pain or mobility issues to assume positions they may not be able to hold or achieve on land.
- Fewer vaginal-exams and other interventions.
- Less back-labour.
- Easier delivery. Greater pelvic diameters; low back and pelvis aren’t compressed.
- Fewer & less severe tears with natural counter-pressure on perineum.
- Less fear & pain with birth.
- Warmth and skin-contact of water may close the “pain gate” (Wall, 1962).
- Endorphin (natural pain killer) levels increase after 20-30 min of immersion (Frye, 2004).
- A 2000 study in the UK (Balaskis, 2004, p51) determined waterbirth is an effective method of pain relief. A dramatic reduction of narcotic pain meds was seen (eg 3% vs 60% for pethidine).
- As with any position changes or new environments, it’s important to wait several contractions or ½ hr before determining the full effect of water on pain.
Gentle transition. Babies born in water are more settled, alert, and less stressed.
Birth in Water
The mother or father can bring the baby out of the water over 5-7 seconds. Over-stimulation should be avoided so baby doesn’t gasp for breath while submerged. If the cord is pulsing then the baby’s getting oxygenated blood. Midwives report that water-born babies are calmer and slower to transition so might not appear to breath as quickly as land-babies. First breaths are often smaller and slower.
Special Conditions that Benefit from Water Birth
It’s essential to find a practitioner comfortable and experienced with these conditions in water. Enning (2004) lists the following as benefiting from waterbirth:
- Pre-eclampsia- darkness, privacy, water at proper temperature lower blood pressure.
- VBAC (vaginal birth after Caesarean) – decreased risk of uterine rupture.
- Big baby, small mama (rare) – waterbirth practices and dynamics create optimal space in pelvis.
- Malpositioned baby – water allows baby to maneuver in a manner to allow easier birth of head.
When to Get In
Michel Odent (1997) reports that contractions can be boosted or inhibited, depending on how long a woman spends in water. There’s an initial decrease in stress hormones upon immersion, resulting in higher oxytocin levels and hence stronger contractions. After a couple of hours the effects can wear off and labour may slow. The “oxytocin wave” usually carries through to birth if a woman gets in during active labour. Women who get in earlier often have to get out before transition due to labour slowing. Birth attendants around the world report the same thing. Eriksson et al (1997) found that women who entered the pool early had more interventions and longer labour than those who entered after 5cm. Although laboring upright on land often re-establishes labour, oxytocin augmentation may be required.
When to Get Out
Medical reasons to assist mother out of the tub include significant labour slows or stalls, non-reassuring vital signs in mother or baby, postpartum hemorrhage, suturing, and anytime the baby must be born quickly. It’s important to rehearse a plan and be prepared for a necessary or quick exit from the pool.
When to get out after a healthy birth is a contentious issue. Getting out in first hour may interrupt sacred bonding time or decrease maximum oxytocin released during this stage. However, current recommendations are that mother leave (with the cord intact) to birth the placenta. In any case, someone must hold baby as mother leaves the pool in case of dizziness, light-headedness, slipping or difficulty getting mother out of pool. Besides, wet babies are very slippery.
Ideal Temperatures for Waterbirth
The general rule in North America is 32-36C for labour and 36-37.5C for delivery (Wheatly, 2008; Balaskis, 2004). Cornelia Enning has done extensive research on waterbirth physiology. She generally recommends lower temperatures and different temperatures for different stages, positions and multiple births (Frye, 2004, p471-3). She found that babies born in cooler water are more active and vigorous. If a woman feels the need to be in a tub for early labour (pain management etc) the pool should be 35-37C, although Enning’s findings agree with Odent (1997) that submersion in early labour can slow or stall the process.
In 2002 Geissbeuhler et al. conducted research where women chose their water temperature and time in the pool. Despite ranges of 23-38.9C and 28-364 minutes, maternal and infant body temperatures all stayed within normal range. Women intuitively know what’s best for them and their babies!
Depth of Water
When kneeling, the water should cover mother’s belly, just below her breasts. When sitting the water covers her breasts but not shoulders to allow heat-loss. When holding her baby she can choose a position to keep the head out of water but body submerged enough to keep warm.
Equipment for Water Birth
Waterbirth equipment includes extra towels, a kettle to boil water, equipment to maintain pool, a floating thermometer, and strainer & container (for debris in pool). See Homebirth Supplies for a detailed list.
Possible Risks / Common Fears about Water-Birth
Infant inhaling pool water is the number one risk and fear. An innate, physiological and powerful “Dive Reflex” protects healthy fetuses from inhaling water (Johnson, 1996). However if a baby is deprived of oxygen the dive reflex may be over-ridden in favour of gasping for air immediately upon birth. Oxygen-deprived babies almost always show signs of stress during labour such as meconium or heart-rate abnormalities. In this case birth should take place on land. With careful monitoring the risk of a stressed baby aspirating water is decreased. A baby with reassuring heart tones all the way through labour is highly unlikely to develop last minute hypoxia; however it’s a rare possibility.
Normal newborn breathing pattern:
- Intact cord and placenta help inhibit breathing due to high levels of prostaglandin. If cord is clamped or cut while baby’s under water it can initiate breathing under water.
- Babies won’t breathe in body temperature water. The main breathing stimulant is exposure of cheeks, nose and mouth to air at least 1° cooler than body temperature.
- Newborn babies may be stimulated to breath with too much handling.
- When baby tastes fluids the larynx (in throat) automatically closes. This also prevents babies from aspirating breast milk during feeding.
Assessment of mother & baby may be more difficult. However, birth attendants who are educated and practiced in water-birth can do accurate assessments. If unsure the mother is asked to leave the tub.
Dehydration of mother is a risk of waterbirth but can easily be prevented by diligent birth-attendants who hydrate mom and maintain water temperature.
Water embolism: Some believe it’s possible for water to enter mother’s bloodstream via the uterine placental site. Others believe it’s impossible as the cervix is swollen and closes after birth, which prevents water from entering. Balaskis (2004) states there are no known reports.
Cord snapping: Gilbert (1999) cited a possible link to waterbirth and increased cord-snapping but there is no significant evidence to support this. In any birth the cord and mama-baby should be treated in a way to minimize or eliminate cord-tension. Incidence and treatment is the same for water or land.
Polycythaemia (too many red blood cells) has been suggested as a risk (Austin, 1997) but there’s no evidence that water caused it. Practitioners don’t seem to consider this a risk (Balaskis, 2004).
Contamination of pool water: Floating debris is removed by birth attendants. If water gets too messy, mother will leave the pool so it can be drained, cleaned and refilled.
Infection transmission: Parents’ “germs” generally don’t pose a threat to baby. Infection rates are very low (Balaskis, 2004). If baby’s father is in the pool there are no hygiene concerns, as he and mother share the same bacterial environment that baby will share. Mother’s friendly bacteria are protective to baby.
Waterbirth provides a wonderful and gentle birth experience for both mother and baby. Often shorter labours with fewer complications are seen. This in turn leads to a better experience for dads. Mothers rate high satisfaction with waterbirth experiences, as do fathers and birth attendants.
Austin T, Bridges N et al. (1997). Severe neonatal polycythaemia after third stage of labour under water. The Lancet, 50, 1445-47.
Balaskis, Janet. (2004). The waterbirth book. London: Thorsons.
Buckley, S.J., Dr. (2005). Gentle birth, gentle mothering. Brisbane: One Moon.
Enning, Cornelia. (2004). Lecture notes from 2004 International Waterbirth Congress, Chicago, IL.
Eriksson M, Mattsson L-A and Ladfors L. (1997). Early or late bath during first stage of labour: a randomized study of 200 women. Midwifery, 13, 146-148.
Frye, Anne. (2004). Holistic midwifery: A comprehensive textbook for midwives in homebirth practice, vol 2. Portland: Labrys.
Geissbeuhler V et al. (2002). Waterbirth: water temperature and bathing time – mother knows best! J Perinat Med, 30(5), 371-378.
Gilbert, Ruth E; Tookey, Pat A. (1999). Perinatal mortality and morbidity among babies delivered in water: surveillance study and postal survey. BMJ, 319, 483-487.
Johnson, Paul. (1996). Birth under water – To breathe or not to breathe. BJOG: An International Journal of Obstetrics & Gynaecology. 103(3), vii-vii.
Odent, M., Dr. (1997). Can water immersion stop labour? Journal of Nurse-Midwifery, 42(5).
Wall P.D., Melzack R. (1962). On nature of cutaneous sensory mechanisms. Brain, 85, 331.
Wheatley, Lainna. (2008). Midwife’s Assistant Orientation class notes. SLC: Midwives College of Utah.
A baby’s nutrition in the first year has life-long effects. Inadequate nutrition is responsible for more than 35% of child-deaths, and higher rates of illness and developmental delays (World Health Organization, 2009). Even in affluent North America babies and children are malnourished, often due to misinformation and poor food choices.
Health Canada (2012): Breastfeeding – exclusively for the first six months, and sustained for two years or longer with appropriate complementary feeding – is important for the nutrition, immunologic protection, growth, and development of infants and toddlers. Several international health organizations such as UNICEF, WHO, and the American Academy of Pediatrics make the same recommendation.
Birth to 6 months
Babies should be exclusively breastfed until at least 6 months of age. There are no nutritional benefits to early complimentary feeding, only risks. Babies who are only partially breastfed (i.e. supplemented with formula or other liquids or solids) in the first 6 months are healthier than those who are not breastfed at all, but risks are significantly higher than in exclusively breastfed babies.
If you think your baby is ready for solids before 6 months then please see section below regarding signs.
Benefits of breastfeeding, i.e. why formula should be used only as medicine
Human breastmilk is uniquely designed for human babies and contains all the required nutrients. It’s the only thing an infant’s gut is designed to digest and assimilate until at least 6 months of age. Breastmilk contains substances that augment the immature immune system, and aid in digestion and absorption of nutrients. Anything else is likely to ferment, lead to gas, colic, poor nutrient absorption (malnourishment), illness and food-allergies.
Babies who are breastfed:
- Decreased risk of SIDS, less likely to die of other causes in first months
- Lower rates and severity of diarrhea and pneumonia
- Lower rates and severity of ear-aches, flu, meningitis, bladder infections, respiratory illness, and other acute infections
- Decreased risk of childhood leukemia
- Decreased risk of long term chronic illness such as asthma, diabetes, gastro-intestinal disease (celiac, ulcerative colitis, Crohn’s), cardiovascular disease, obesity
- Higher cognitive function / greater intelligence
Benefits of breastfeeding to mother include decreased risk of post-partum hemorrhage, breast and ovarian cancers, late-onset diabetes, and heart disease; faster loss of weight gained in pregnancy, and delayed return of fertility (although this is not necessarily a birth-control method).
6 to 12 months
Baby’s weight / size has nothing to do with readiness for solids. At 6 months a baby’s digestive & immune systems have developed enough to introduce solids. Earlier is correlated with allergies, digestive problems, immune problems, and obesity. After 6-8 months caloric and nutrient needs exceed those provided by exclusive breastfeeding. Further delay of complementary foods may stunt growth. Start with breastmilk then finish with solids from 6-12 months. Do encourage – but do not force nor coerce – the baby to eat.
STEP-1: 6 months, or whenever baby shows interest in food (whichever is later)
Offer breast-milk first then finish the meal with solids. Introduce 1 food at a time for a few days, in small amounts, and then try another. This helps the caregiver be aware of allergies or intolerances. Simple, natural, pureed, unprocessed, organic – whole foods, like they came from earth. There’s no need to buy special baby food – healthy family food, properly prepared, is just fine.
- 200 kcal/day (in addition to about 400 kcal breastmilk) of mushy or runny foods
- Offer 30-45 ml (2-3 tbsp) food per feed, at 2-3 meals daily
- Pureed, raw or lightly cooked, non-citrus fruits e.g. apples, pears, bananas, blueberries
- Cooked & pureed veggies – start with avocados, roots (carrots, yams, beets) and squashes
- Cooked whole gluten-free grains (rice, quinoa) or oatmeal
- Egg -yolks (yolks are usually not an allergen; whites may be)
STEP-2: 7-8 months, or 1 month after beginning step-1 (which-ever is later)
Continue with step-1. Increase portions gradually up to 125-250 ml (1/2-1 cup) per meal and the following:
- As child grows used to solids can also offer 1-2 snacks daily
- Organic meats, pureed
- Other cooked, pureed veggies
- Can start combining foods that are tolerated
STEP-3: 8-10 months, or 1 month after beginning step-2 (which-ever is later)
Continue with step-2 and add:
- 300 kcal/day (in addition to about 400 kcal breastmilk) of mashed food or finely chopped that baby can pick up
- Offer 125-250 ml (1/2-1 cup) per feed at 3-4 meals daily, and 1-2 snacks if needed
- Whole eggs
- More variety
12 months and beyond … or 2 months after beginning step-3 (whichever is later)
- See general recommendations below
- Baby can eat regular family foods but watch for allergy or sensitivity
- 550 kcal daily (in addition to about 350 kcal breastmilk)
- 175-250 ml (3/4-1 cup) per meal for 3-4 meals daily and 1-2 snacks
- Continue to breastfeed until 2 years of age
Signs that baby’s ready to start complimentary feeding
Solids can be introduced when baby shows signs of being ready, but only after 6 months of age. Some babies take longer than 6 months but most are ready for solids by 8 months.
- 6 to 8 months of age
- Can sit unsupported
- Doesn’t automatically push solids out of mouth with tongue (a reflex present until at least 6m in most babies)
- Willing and able to chew
- Can pinch or pick up food or other objects between thumb and forefinger
- Eager to participate in mealtime
- Shows interest in food – e.g. reaches for food at mealtime, crawls to dog’s dish to steal food
- Long-term increased need to nurse, unrelated to illness, teething pain, stress or growth spurt
Note: this is only an indication if other signs are present; not a sign on its own
If baby shows signs before 6 months
Eagerness to engage in mealtimes doesn’t mean ready for solids. It’s likely a social behaviour rather than a physiological one. Baby can be included in family mealtimes without eating solid foods.
- Join the family at mealtime in a lap, booster seat or high chair
- Give a sippy-cup containing some expressed milk (if baby is more interested in playing with the cup than drinking the contents, you may wish to use water instead of valuable pumped milk)
- Provide baby-safe cutlery and dishes to play with
- Give baby an ice cube (baby-safe size & shape) or ice chips to play with
- Offer a cube, popsicle or slushy frozen breastmilk to eat with a spoon
Food intolerance or sensitivity, allergy
Common allergens include soy, wheat, dairy, peanuts, egg-whites, food colouring, corn, citrus, strawberries, raspberries, kiwis, pork and shellfish.
The following correlate with food intolerance or allergy: mucous conditions, ear infections, runny nose, rashes (including diaper rash), colic, green stools, digestive issues (diarrhea, constipation, gas, vomiting), undigested food in diaper, asthma, wheezing, and /or behavioural changes after eating given food.
- Proper food storage and handling
- Foods that are choking hazards; can block or wedge into wind-pipe
- Hard and small sized, smooth / sticky solids g. popcorn, meat chunks meat, hard pieces of fruit / veggies, candies, hot dogs (unless cut lengthwise and cubed), gum, whole nuts and seeds, fruit-pits or seeds, cough drops, raisins, fish-bones, food on toothpicks or skewers.
- Thick creamy texture e.g. a blob of nut-butter
- Always supervise infants when they eat or drink
- Mealtime supervisor should be familiar with baby’s chewing and swallowing abilities
- Upright and secured position
- Do not allow baby to eat while laying, running, walking, distracted, nor eat in the car
- Avoid sharp objects
- Take an infant / child choking & CPR class to be prepared in case of choking
- Organic, whole foods i.e. how they come from nature e.g. baked potato rather than French-fries
- Purified water, if water is used
- If juice is used, then fresh & home-made
- Baby stomach is about the size of her/his fist – portion accordingly, considering breastmilk
- Take time for eating patiently – meal time should be enjoyable
- Feed infants directly and assist older children when they feed themselves
- Feed slowly and patiently, and encourage children to eat, but do not force them
- Variety of foods
- Iron fortified food or easily digestible supplement (e.g. Floradix) in case of immediate cord clamping or anemia
- Whole spectrum salt – Himalayan, Celtic
- The Kidco Food Mill is a brilliant device for creating baby food on the fly. It’s affordable, simple to use and easy to clean.
- Ice-cube trays make perfect infant-sized meals – nice to have on hand for child-care or those busy days that run away from us. Puree a few foods and freeze for later use. Best for 1-3 months in fridge-freezer, and 6 months in chest-freezer.
- Foods that are choking hazards; can block or wedge into wind-pipe (see “Safety”)
- Common allergens (see intolerance section), foods with family history or allergies, or that baby reacted to in mother’s breastmilk
- Processed foods – fried, unhealthy fats, high-sugar e.g. chips, crackers, French-fries
- Chemical additives
- Fluoridated water, artificial colours & flavours, MSG, aspartame & derivatives
- Unpasteurized honey, as it may contain spores that can be life-threatening to baby (after 1 year these have no effect on a mature digestive system)
- Sugary drinks – pop, store-bought fruit-juices
- Caffeine – coffee, tea, chocolate
- Under-feeding – babies let us know when they’re hungry (crying, fussing, listless); avoid portion-control as needs change e.g. growth-spurt, immune system fighting a bug
- Rushing through eating
- Avoid distractions
- Strong tastes – spicy, salty, overly sweet
- No store-bought goat/cow milk until 8-10m of age, and only if child has no sensitivities (but it’s best to avoid non-human milk at all stages of life)
In the rare case that a mother is not able to breastfeed her baby, the following options can be considered. They’re listed in order of healthiest to least.
- Pumped mother’s milk, if inability to breastfeed is due to a “mechanical problem” e.g. cleft-palate
- Fresh donor milk e.g. close relative, friend in the community (not recommended by public health due to worries about disease transmission)
- Frozen human milk from milk-bank
- Home-made formula (this is not recommended by public health regions) with added high quality probiotics and fish-oil / ω-3 EFA
- Organic formula from a reputable company with added high quality probiotics and fish-oil / ω-3 EFA
- Regular store-bought formula with added high quality probiotics and fish-oil / ω-3 EFA
Note: if the inability to breastfeed happens after 6m (e.g. medical problem) then it’s preferable to start on real food and purified water rather than store bought formula (World Health Organization, 2009).
Gaskin, I. M. (2009). Ina May’s guide to breastfeeding. New York: Bantam Books.
Hass, E. M. (2006). Staying healthy with nutrition. Toronto: Celestial Arts.
Health Canada. (2012). Infant feeding. Retrieved from Health Canada (Government of Canada): http://www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/index-eng.php
KellyMom. (2011). Is my baby ready for solid foods? Retrieved from Kelly Mom Parenting & Breastfeeding: http://kellymom.com/nutrition/starting-solids/solids-when/
La Leche Leage International. (2010). The womanly art of breastfeeding. Ballantine Books: New York.
Ochoa, S., & Kline, A. (2011). BIOL404 Chemistry & nutrition student syllabus. SLC: Midwives College of Utah.
Stuebe, A. (2009). The risks of not breastfeeding for mothers and infants. Reviews in Obstetrics & Gynecology , 2 (4), 222-231.
World Health Organization. (2009). Infant and young child feeding – Model Chapter for textbooks for medical students and allied health professionals. Geneva: WHO Press.
This paper was published in Midwifery Today, Issue 102, Summer 2012
Click here for video of webinar presented to students at Midwives College of Utah based on this paper.
This paper investigates neonatal resuscitation with the umbilical cord intact. Research confirms numerous immediate and long-term benefits to leaving the cord intact while performing neonatal resuscitation in both term and preterm neonates, while doing no harm. Current neonatal resuscitation guidelines from around the world are discussed with respect to the cord. Methods for incorporating an intact cord into standard resuscitation procedures are explored.
Neonatal Resuscitation with Intact Umbilical Cord
In many birth places, including birth centres, hospitals and home, neonatal resuscitation equipment is set up out of the way of the birth area. In hospitals, assessment and resuscitation of newborns almost always occurs on a large table across the room and far from mother. Obviously this requires severing the umbilical cord. In addition to the physiological advantages of leaving the cord intact, keeping the baby close to mother reduces maternal stress (and surely infant fear too (Strange, 2009)) and helps facilitate bonding (Wright, 2011). We can do better. Term and preterm neonates are safer and healthier when neonatal resuscitation includes delayed cord clamping.
During pregnancy, the umbilical cord provides oxygen and transfers blood between the placenta and the baby. Nature has perfectly designed a placental transfusion to carry the blood through the cord and into the newborn baby. If the cord is intact, then oxygenation continues after birth until the newborn lungs have transitioned to air, a process that takes 30 to 90 seconds in a full-term infant. If a newborn isn’t breathing independently then the placenta is nature’s neonatal life-support system. Newborns are not simply tiny adults. The newborn heart can beat for 20 minutes or longer despite anoxia and the brain can tolerate lack of oxygen for this duration of time (Resuscitation Council (UK), 2001; Frye, 2004; World Health Organization, 1999). Newborns cope well with hypoxia but struggle with hypovolemia. At the moment of birth 30 to 50% of the baby’s blood volume is in the placenta. Immediate clamping deprives the baby of that blood. Adults are in perilous danger of hypovolemic shock and receive blood transfusions at 15 to 30% blood-loss.
The benefits of delayed clamping are well documented. Immediate cord clamping is now being compared with blood-letting. However neonates who are compromised or require resuscitation and desperately need all their blood almost always get their cord severed immediately. In spite of research saying otherwise, it’s still common practise at most births, usually due to outdated theories or habit. As more parents request delayed clamping, newborns are more likely to receive their full volume of blood.
As delayed clamping becomes a hot topic there are some aspects that need clarification: time interval, milking the cord, gravity and the myth of causing harm. “Delayed” isn’t a long time: the rate of transfusion is about half the blood in 1 minute and nearly 100% over the next 2 to 5 minutes. What about cord stripping? Parents-to-be may be told that if the cord can’t be left intact then it will be “milked,” implying the benefits are the same. It’s the time interval of delayed clamping that has clinical benefits, not whether the cord is milked (Fogelson, 2011).
During the first 45 to 60 seconds of life, arterial pressure pumps blood into the neonate, so the height differential between the placenta and baby doesn’t matter. After that, veins drain blood into the neonate and height matters more. Full placental transfusion occurs with the baby from 10 centimeters above to 40 centimeters below placenta, which is about the position of baby on mother’s abdomen or lap (Yao & Lind, 1969).
Leaving the umbilical cord intact does not lead to pathological jaundice. The naturally occurring physiological newborn jaundice has no clinical significance. Many practitioners believe leaving the cord intact leads to other adverse effects such as tachypnea, grunting, hyperbilirubinemia, polycythemia and hyperviscosity. If transient these are often not clinically significant issues but rather a normal part of physiological compensation during newborn transition (Tolosa et al., 2010).
Babies with delayed clamping fare better. They have 40% more blood volume, a 45% increased hematocrit, a 50% increase in red blood cell counts and ferritin is up to 50% higher (Fogelson, 2011). The benefits are greater in SGA or preterm infants and those born to mothers with low ferritin at birth. The effects of delayed clamping can be seen well past the newborn period. Term infants are protected from anaemia and iron deficiency for at least 6 months (Chaparro, Neufeld, Alavez, Cedillo & Dewey, 2006). This is vital where infant and pediatric anaemia is common, such as impoverished areas.
Mercer et al. (2006) compared data from premature infants that had a 30 to 45 second delay in clamping and intubation, and from those who were immediately clamped and intubated. There was no statistically significant difference in mortality rates. The delayed clamping group fared better in common premie health issues, with lower rates of necrotizing enterocolitis, bronchopulmonary dysplasia, intraventricular haemorrhage (IVH) (14% versus 36%) and sepsis (3% versus 22%). In addition to the higher rates of IVH, cases were more severe in the early clamping group. Preterm neonates with delayed cord clamping are less likely to require blood transfusion, ventilation and oxygen therapy, and have lower rates of anaemia at 6 months. They have more stable blood pressures and thrive better (Asfour & Bewley, 2011). A 1-minute delay in cord clamping resulted in remarkably elevated red blood cell volume and weekly haematocrit compared to early clamping in neonates of 30 to 36 weeks gestation (Tolosa, Park, Eve, Klasko, Borlongan & Sanberg, 2010).
Of course, if a baby is born flat with a limp, non-pulsing cord then the cord is no longer working. This is the rare case when immediate clamping and aggressive resuscitation is warranted.
Neonatal resuscitation guidelines in Canada, Australia, Europe and the United Kingdom recommend delayed clamping for a minimum time range from 1 minute to when the cord stops pulsing in healthy neonates. These same guidelines cite insufficient evidence to recommend an optimal time of clamping the cord of infants requiring resuscitation. Not one of them recommends immediate clamping and cutting as part of care, including the American guidelines which say nothing about timing of cord clamping. The UK and Australian guidelines go so far as to advise waiting 3 minutes in healthy preterm infants for “increased blood pressure during stabilisation, a lower incidence of IVH and fewer blood transfusions” (Resuscitation Council (UK), 2010; Australian Resuscitation Council, 2010). The UK guidelines also speculate that cord clamping with resuscitation could be delayed until the baby has started breathing. WHO (1999) advises it’s unnecessary to clamp the cord before beginning resuscitation and to not waste time moving to a special place, as mother’s bed is usually warm and suitable.
The requirements of medicalized neonatal resuscitation are warmth, a firm surface, suction and access to the umbilicus. Other priorities include comfortable position for staff and the ability to draw umbilical blood for cord-gas analysis. A warm firm surface can be the bed or surface where baby is born. In this author’s 2011 poll of 34 midwives from around the world, most reported that they perform resuscitation with the cord intact using the bed, side of a pool designed for water-birth, part of an adult human body (mother or midwife) or a portable board with a warm-pack.
Suction can be from a main hospital line, resuscitation machine or a portable unit such as those used at homebirths. The umbilicus is accessed to provide drugs and fluids. If the cord is left intact, then fluids are already being provided. Drugs are rarely required for resuscitation, and it’s likely they would be required far less often if cords were intact. Since extensive resuscitation is rarely required can we not be uncomfortable once in awhile, bending over the baby rather than performing resuscitation at our standing height? Even if one requires cord-gases for medical reasons rather than protection from litigation, they can wait. Cord-gas results don’t change significantly if taken immediately after birth or after 2 minutes of delayed clamping (De Paco, Florido, Garrido, Prados & Navarrete, 2011; Asfour & Bewley, 2011).
If one prefers a newborn resuscitation table, then there are alternatives to what’s currently being used in most hospitals. Dr. Andrew Weeks and a team at University of Liverpool designed the award-winning BASICS (Bedside Assessment, Stabilisation and Initial Cardiorespiratory Support) Trolley, a smaller portable neonatal resuscitation table that can be used alongside the mother, even for caesarean birth (University of Liverpool, 2011). It includes oxygen, suction and heat. Dr. Weeks says, “It is crazy that the most vulnerable babies are born and whisked off and surrounded by a scrum of doctors” (Wright, 2011).
Many midwives are already doing the good work of leaving cords intact, even for resuscitation. As further research is available and better equipment is implemented in hospitals, neonatal resuscitation may include nature’s life-line — the full placental transfusion.
About the author: Angie Evans, BSc(Hon), MH is an herbalist, doula and prenatal educator currently enrolled in a Bachelor of Midwifery program. She’s passionate about the parents’ and baby’s experience of birth and believes good care includes more than simply physical health. angie@AngieEvans.ca
AAP/AHA/CPS. (2006). Neonatal resuscitation textbook (5th ed.). Ottawa: Canadian Paediatric Society.
Alberta Health Services. (2007). Maximum blood draw protocol for pediatric patients.
American Heart Association. (2005, Nov). 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care – Part 13: Neonatal Resuscitation Guidelines. Retrieved Jan 2012, from American Heart Association Journals: http://circ.ahajournals.org/content/112/24_suppl/IV-188.full
Asfour, V., & Bewley, S. (2011). Cord clamping practice could affect the ratio of placental weight to birthweight and perinatal outcomes. BJOG: An International Journal of Obstetrics & Gynaecology, 118 (12), 1539-40.
Australian Resuscitation Council. (2010). Introduction to resuscitation of the newborn infant. Retrieved Feb 2012, from The Australian Resuscitation Council Online: http://www.resus.org.au/
Barret, L. (2008). Resuscitation of the newborn. Retrieved from Homebirth: A Midwife Mutiny: http://www.homebirth.net.au/2008/04/resuscitation-of-newborn.html
Buckley, D. S. (2005). Gentle birth,gentle mothering. Brisbane: One Moon.
Canadian NRP Steering Committee. (2010). Addendum to the NRP provider textbook 6th edition: Recommendations for specific treatment modifications in the Canadian context. Ottawa: Canadian Paediatric Society.
Chaparro, C. M., Neufeld, L. M., Alavez, G. T., Cedillo, R. E.-L., & Dewey, K. G. (2006). Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial. The Lancet , 367 (9527), 1997-2004.
Crews, C. (2007). Clamping of the umbilical cord – Immediate or delayed. Is this really an issue? Retrieved Feb 2012, from Midwifery Services of South Texas: http://www.midwiferyservices.org/umbilical_cord_clamping.htm
CRYO-CELL International Inc. (2011). Cord blood collection instructions . Florida.
De Paco, C., Florido, J., Garrido, M., Prados, S., & Navarrete, L. (2011). Umbilical cord blood acid-base and gas analysis after early versus delayed cord clamping in neonates at term. Arch Gynecol Obstet , 283 (5), 1011-4.
Fogelson, D. N. (2011). Delayed Cord Clamping Grand Rounds. USC School of Medicine, A.P. Dept. Obstetrics and Gynecology. South Carolina: Palmetto Health Grand Rounds.
Frye, A. (2004). Holistic midwifery, Vol 2, Care during labour and birth. Portland: Labrys.
Greene, A. (2008). How much blood is too much guideline. Retrieved from Dr Greene: http://www.drgreene.com/article/how-much-blood-too-much-guideline
Kattwinkel, et al. (2010). Special Report Neonatal Resuscitation: 2010 AmericanHeart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics , 126 (5), 1400-1413.
Mercer, J. S., Vohr, B. R., McGrath, M. M., Padbury, J. F., Wallach, M., & Oh, W. (2006). Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemmorhage and late onset sepsis; A randomized, controlled trial. Pediatrics , 117 (4), 1235-1242.
Morley, D. G. (2011, July). Neonatal resuscitation: Life that failed. Retrieved Jan 2012, from UBM Medica: http://hcp.obgyn.net/fetal-monitoring/content/article/1760982/1911275
Reed, R. (2011). Cord blood collection: confessions of a vampire-midwife. Retrieved from Midwife Thinking: http://midwifethinking.com/2011/02/10/cord-blood-collection-confessions-of-a-vampire-midwife/
Resuscitation Council (UK). (2010). Newborn life support guidelines. London: Resuscitation Council (UK).
Resuscitation Council (UK). (2001). RESUSCITATION AT BIRTH, The Newborn Life Support Provider Course Manual (2nd ed.). London, UK: Resuscitation Council (UK).
Richmond, S., & Wyllie, J. (2010, Aug). European Resuscitation Council guidelines for resuscitation 2010. Section 7. Resuscitation of babies at birth. J. Resuscitation , 1389-1399.
SOGC. (2012, Feb). Clinical Practice Guidelines. Retrieved Feb 2012, from SOGC (Society of Obstetricians and Gynaecologists of Canada): http://www.sogc.org/guidelines/index_e.asp
Strange, K. (2009, Jan). NRP for midwives certification class. Seattle, WA.
Tolosa, J. N., Park, D.-H., Eve, D. J., Klasko, S. K., Borlongan, C. V., & Sanberg, P. R. (2010). Mankind’s first natural stem cell transplant. J. Cell. Mol. Med. , 14 (3), 488-95.
University of Liverpool. (2011, June). City experts develop life-saving trolley for newborn babies. Retrieved Nov 2011, from University of Liverpool University News: https://news.liv.ac.uk/2011/06/17/city-experts-develop-life-saving-trolley-for-newborn-babies/
Usher, R., Shephard, M., & Lind, J. (1963). The blood volume of the newborn infant and placental transfusion. Acta Paediatrica – Nurturing the Child , 52 (5), 497-512.
Weaver, P., & Evans, S. (2007). Practical skills guide for midwifery (4th ed.). Wasilla, AK: Morningstar
WHO. (1999). Basic newborn resuscitation practical guide – Revision. Geneva: World health Organization Safe Motherhood Unit.
Wright, A. (2011, June). BASICS: Bedside Assessment, Stabilisation and Initial Cardiorespiratory Support. Retrieved Feb 2012, from Liverpool Women’s NHS Foundation Trust: http://www.lw.nhs.uk/Library/news_centre/Life_Saving_Trolley_Basics_Case_Study.pdf
Yao, A., & Lind, J. (1969, Sep). Effect of gravity on placental transfusion. The Lancet .
 Clamping refers to clamping and/or cutting the umbilical cord. Clamping, whether cut or not, immediately halts placental transfusion. Clients who ask for delayed cord-cutting could be counselled to request delayed clamping.
(There is a connection – stay with me here!)
Cytotec (misoprostol) is a drug for stomach ulcers. However, it is used “off-label” in the USA, (and has recently been approved in Canada too) to induce labour, per obstetrical guidelines. It’s not approved by the FDA for such use. In fact the manufacturer issued a written warning against use of Cytotec for labour induction as it can cause hyper-contraction of the uterus, which can lead to uterine rupture, which can obviously lead to death.
So, when Cytotec is used as directed by the ACOG (American Congress of Obstetricians and Gynecologists), a well documented, possible side effect is uterine rupture.
Ina May Gaskin started a quilt project in which each square represents a woman who died in childbirth. Many of these squares are dedicated to women who received Cytotec induction.
This issue was raised by some classmates today. Many good points were made; the most obvious being, why are Cytotec inductions allowed, despite ample evidence to show it’s a dangerous practice. It was suggested that this demonstrates the extent of disregard for women and their bodies. My friend and classmate, Kelly Graham, a passionate advocate for women’s health, speculated, “I wonder how many (of these same) doctors would prescribe Viagra if a side effect was penis explosion.” Or – another analogy – would we use a drug to help asthma if a possible side effect was ruptured lungs?
Want to explore further?
- Ina May Safe Motherhood Quilt Project:
- Ina May Gaskin article, Induced and Seduced: The Dangers of Cytotec
- ACOG Induction Guideline
- A comparison of the American and UK guidelines for induction
- RCOG Induction Guidelines (UK), which recommend: “Misoprostol should only be offered as a method of induction of labour to women who have intrauterine fetal death or in the context of a clinical trial.”
- Canadian Induction Guidelines (discussion of Misoprostol starts at the bottom of p4)
- Cytotec Pharmaceutical Insert, which begins with an all-caps warning enclosed in a text-box: “CYTOTEC (MISOPROSTOL) ADMINISTRATION TO WOMEN WHO ARE PREGNANT CAN CAUSE ABORTION, PREMATURE BIRTH, OR BIRTH DEFECTS. UTERINE RUPTURE HAS BEEN REPORTED WHEN CYTOTEC WAS ADMINISTERED IN PREGNANT WOMEN TO INDUCE LABOR OR TO INDUCE ABORTION BEYOND THE EIGHTH WEEK OF PREGNANCY.”
- Warning sent to physicians from Searle, the Cytotec manufacturer
- Henci Goer’s blog, ACOG’s 2009 Induction Guidelines: Spin Doctoring Misoprostol (Cytotec)