View Full Version : Preparing for labour?
Hi, i had a c-section almost 12mnths ago, and am due on the 12th Jan with no 2 (although doc is sure i'll go early, bub 1 was 3 weeks early too).
The c-section was due to bub going into distress after 30 hrs of labour and failure to progress.
This time i am going to try for a natural birth and seeing as it is getting so close i want to know of ways i can prepare my body so i will be sucessful.
I have been going for regular walks, and started taking raspberry leaf tablets.
What else can i do?
Also, is evening primrose meant to help prepare you for labour or help induce? I have heard conflicting stories on this.
Any help would be greatly appreciated.
Take a doula to the hospy with you! That reduces c-secs by a huge amount!
You don't say what drugs/positions you were in for your labour or if you ate and drank as all those things have significantly impacts on how we birth. If you want to avoid the same outcome, avoiding anything like that would make a big difference this time.
Ultimately while it's always better to be fitter than not (like life really LOL) really what happens in birth is a result of our careprovider. So to avoid another c-sec, be really clear with your CP about what you will and won't accept. Induction with VBAC leads to uterine rupture, and yet women are often pressured to accept some form of intervention to start their labour when if left alone, they would labour spontaneously and birth a healthy baby who's ready for the world. What is your Ob's VBAC rate? It should be over 70% to be an effective CP. Independent MWs have rates well over 90% and they treat mamas with previous surgery exactly the same as mamas without surgery.
What plans and preparations have you made to manage your labour? Epidurals will stop you moving around and being in full control of what position you're in, thus making a c-sec more likely. If you can get access to water in the hospital that might just prove to be your best friend. If your Ob wants you to have EFM, that too will tie you down and we know it increases the likelihood of c-sec and doesn't improve outcomes for babies so make sure your birth attendants just use a doppler now and then. It's really important that you find out what policies your Ob/hospy have to manage your labour as we know that the less active management which occurs, the safer birth is and the less likely you are to have a c-sec.
Your body is perfect and you were made to birth. You just need to support your body's natural desire to birth, and your baby's natural desire to be born.
Feel free to PM me. I hope you have beautiful birth! :)
Keep your fitness up, it helped me beyond anything for my second labour.
My first was 27 hours long and just awful. My second was 8 hours, still painful, but I was 100% fitter than before and in 7 pushes (instead of 4 hours of pushing) he was out.
I had GD with my second pregnancy and did a lot of exercise including 3-4km walk every night.
Remember though if you need extra help during your birth don't be afraid to ask for it. That's what the professionals are there for.
Thanks, JanetF i have read a few posts on here about Doulas. How would i go about finding one? and is it expensive? I replied to a post on here about a trainee doula looking for preg women in Brisbane.
I couldn't tell you the success rate of my ob cos i don't really have one. I'm in the public hosp and see whoever is on at the time. They really haven't discussed anything about the birth with me. I have an appt with a doc there at 36weeks so will ask any questions i can think of then.
When you say did i eat/drink during labour, will that help? I drank heaps and was walking/rocking and using gas for the first 15hrs with no1, then had an epidural and slept for a few hrs, then had c-section.
Should i try and drink heaps again?
I really haven't made any plans for this labour. I'm hoping to go without an epidural this time, i made it soo long without last time, so if i have a quick enough
labour i know i can do it. Thats why i want info on how to prepare for the labour and hopefully make it faster (doesn't have to be 2-3hrs or anything, but would really like less than 15! lol).
Also, can you answer my question about evening primrose? Can it help make an easier labour?
Thanks for your help.
I'm thrilled to hear you don't have an Ob. You're a lot more likely to have a vaginal birth without one regardless of previous surgery. But you can still ask your hospital what %age of women achieve VBACs in their care. Most hospitals have ****poor VBAC rates which is why you MUST have a doula to achive one. You are much much less likely to want pain relief and that is one of the big causes of fetal distress, labour slowing down and then c-sec. Also, make sure you understand what they want to do to manage your VBAC labour - commonly ARM at 3cm, constant EFM, reduced time for dilation and pushing. None of it is evidence based unfortunately which is why hospitals have low VBAC rates and private MWs very high VBAC rates.
Doulas cost a range of different prices dependant on experience and you can often get student doulas for free as they need to attend a certain number of births to achieve certification.
I also STRONGLY RECOMMEND a book called "Birthing From Within" (Pam England) to you. It's probably THE BEST birth preparation book ever produced and it's by a woman who had a c-sec first time and a HBAC second time. It really gives you and your dp fantastic info and help on dealing with the hospy.
EPO is thought by many people to be a good cervical ripener but remember, your body is not broken. You don't really need anything to improve how your body works, just a lot of support and good understanding of birth, how hospitals function and ways to manage your labour. Some women insert the EPO as pessaries, some swallow it as well. But basically, you *will* go into labour because everyone can, our society is just obsessed with induction. Ever seen anyone enrolling their belly at primary school? No? That's because ALL babies come out :D
Eating and drinking in labour reduces caesarean rates because not even marathon runners are expected to go hours and hours without food! Your epidural and lying down, plus a timetable for progressing is probably what led to your c-sec. Many people call the so-called "failure to progress" "failure to wait". Hospitals expect women to dilate much faster than most women do, especially first time mothers for whom 24 hours is a normal labour. So staying upright, even if it's draped over a beanbag and avoiding that epidural is vital to you. You need to be able to move instinctively, driven by your body and your baby, to birth. If you are undrugged, in a dimly lit room and not being pestered by strangers, you'll get into your zone and birth beautifully.
Just to give you an idea, this is a common hospy VBAC protocol.
Everything covered by studies below is marked **
VBAC - Vaginal Birth after Caesarean: Intrapartum Management
**Registrar to be informed on admission to Delivery Suite of all women who have a uterine scar. The registrar must make an appropriate management plan.
Anaesthetist and theatre to be notified of any patient for planned VBAC in Delivery Suites and in labour.
**IV access with 16G cannula from onset of labour.
Blood to be taken for
Group and Save
**ARM to be performed once the cervix is
3cm dilated, &
applied to the presenting part
**Continuous Electronic Fetal Monitoring throughout the labour
**Aim to deliver within 12 hours of onset of active labour
**Vaginal Examination by RMO / Registrar every 4 hrs until 7cm dilated, and 2-hourly thereafter. RMO to notify Registrar of findings at each assessment.
**Progress: anticipate 1 cm dilatation / hour (after achieving 3cm). Discuss progress with obstetric consultant if less.
**Augmentation: not contraindicated, but use MUST be discussed with the consultant prior to commencement of a Syntocinon infusion.
**Epidural may be used as indicated.
Registrar to be notified when patient assessed / considered to be fully dilated.
Length should not exceed 2 hours: 1 hour to allow for Passive descent, but no more than 1 hour of Active pushing (or 30 minutes if the woman has had a prior vaginal delivery).
The option of any mid-cavity assisted vaginal delivery MUST be discussed with the consultant
No midcavity assisted delivery to be performed without the consultant being present, and then to be performed in the operating theatre.
Digital examination of the scar is not required
Here's a great article about how EFM increases the likelihood of surgery.
Here's a quote.
Most hospitals require you to have an IV and an external or internal fetal monitor. These inhibit mobility, and make you feel like there's something wrong just by their being there. Obstetricians believe that these monitors provide a more accurate record of the baby's heart rate, thus guaranteeing safer outcomes by providing the opportunity for quicker intervention. The monitors do provide very detailed information, but machines can and do malfunction, showing distress where there is none. A. Prentice and T. Lind surveyed monitoring trials and reported their conclusions in the journal Lancet in 1987. They found that "many mothers will have operative deliveries for "distressed" babies who show no such distress at birth" (Korte and Scaer 111). These researchers also noted that Van den Berg et al. reported that 71-95% of babies diagnosed as distressed during labor show no distress at birth. In other words, the monitor provides a "false positive" up to 95% of the time, and ! ! mothers undergo all the risks of surgery for nothing (111).
In a groundbreaking study done by Dr. Albert Haverkamp to assess the worth of external fetal monitoring, the results of a study group of 483 mothers showed that among those who had an external fetal monitor, the cesarean section rate was 2 1/2 times as high as it was in the group which had auscultation. However, there was no corresponding increase in the rate of problems for the monitored babies (Jones 15-16). These results surprised Haverkamp. Several other studies have verified this outcome. The EFM does not make your baby safer; it simply increases your risk of having surgery, which in turn, greatly increases your risk of injury or death, as described above. Another EFM study even found that the monitor did not improve neurological health outcomes for premature babies (Korte and Scaer 111), who certainly fit the definition of high risk, which is what the monitor was designed for originally!
And excellent info on how epidurals increase the risk of caesarean.
Read the rest of the article. It's very thorough and well evidenced.
Overall complications rates for epidural anesthesia
A general estimate of the overall complication rate of epidural anesthesia is 23%.2
1. Effects of epidurals on cesarean rate:
When the dose is too large or when it sinks down into the sacral ("tailbone") region of the body, the perineum and the vagina are anesthetized. Anesthetic is intentionally injected into this area late in labor to deaden all sensation. When it "accidentally" happens earlier in labor, the muscles of the pelvic floor are prematurely relaxed, thereby interfering with the normal flexion and rotation of the baby's head as it passes through the birth canal. This interference can lead to abnormal presentations which are more dangerous for the baby or to what is called "failure to descend," an indication for Cesarean birth.
Thorp, et al3 studied 711 consecutive nulliparous women at term, with cephalic fetal presentations and spontaneous onset of labor. They compared 447 patients who received epidural analgesia in labor with 264 patients who received either narcotics or no analgesia.
The incidence of cesarean section for dystocia was significantly greater (p < 0.005) in the epidural group (10.3%) than in the nonepidural group (3.8%). There remained a significantly increased incidence (p < 0.005) of cesarean section for dystocia in the epidural group after selection bias was corrected and the following confounding variables were controlled by multivariate analysis: maternal age, race, gestational age, cervical dilatation on admission, use of oxytocin, duration of oxytocin use, maximum infusion rate of oxytocin, duration of labor, presence of meconium, and birth weight.
The incidence of cesarean section for fetal distress was similar (p > 0.20) in both groups. There were no clinically significant differences in frequency of low Apgar scores at 5 minutes or cord arterial and venous blood gas parameters between the two groups. They concluded that epidural analgesia in labor increases the incidence of cesarean section for dystocia in nulliparous women.
Frequently the epidural is so effective that it eliminates uterine contractions. The nerves which tell the uterus to contract are all anesthetized. The uterus becomes quiet and must be driven artifically with the hormone oxytocin (Pitocin or Syntocinon).
As the cervix becomes fully dilated and the head descends, the woman (in a normal birth) feels pain and pressure in the lower pelvis and rectum. The last injection of anesthetic during the process of epidural anesthesia occurs after the head has rotated and come down onto the perineum. Higher concentrations of anesthetic are used to assure perineal relaxation. Sometimes the mother is sat upright or at least at a 45 degree angle to be certain that the anesthetic will descend to the sacral nerve roots. When the sacral nerve roots are blocked, the woman looses the urge to push.
After controlling for potentially confounding variables with multiple logistic regression analysis, Adashek, et al4 found that epidural anesthesia was an independent risk factor for cesarean birth among women over age 35 (R = 0.195, p < 0.001).
Here is a few studies demonstrating the Friedman Curve to be pointless and actually dangerous since it means women are forced into using Syntocinon, a drug specifically contraindicated in women with previous uterine surgery. The Friedman Curve states that women must dilate 1cm per hour in labour.
Am J Obstet Gynecol. 2002 Oct;187(4):824-8.
Reassessing the labour curve in nulliparous women.
Zhang J, Troendle JF, Yancey MK.
Division of Epidemiology, Statistics, and Prevention Research, National Institute of Child Health and Human Development/NIH, Building 6100, Room 7B03, Bethesda, MD 20892, USA. firstname.lastname@example.org
OBJECTIVES: Our purpose was to examine the pattern of labor progression in nulliparous parturients in contemporary obstetric practice. STUDY DESIGN: We extracted detailed labor data from 1329 nulliparous parturients with a term, singleton, vertex fetus of normal birth weight after spontaneous onset of labor. Cesarean deliveries were excluded. We used a repeated-measures regression with a 10th-order polynomial function to discover the average labor curve under contemporary practice. With use of an interval-censored regression with a log normal distribution, we also computed the expected time interval of the cervix to reach the next centimeter, the expected rate of cervical dilation at each phase of labor, and the duration of labor for fetal descent at various stations. RESULTS: Our average labor curve differs markedly from the Friedman curve. The cervix dilated substantially slower in the active phase. It took approximately 5.5 hours from 4 cm to 10 cm, compared with 2.5 hours under the Friedman curve. We observed no deceleration phase. Before 7 cm, no perceivable change in cervical dilation for more than 2 hour was not uncommon. The 5th percentiles of rate of cervical dilation were all below 1 cm per hour. The 95th percentile of time interval for fetal descent from station +1/3 to +2/3 was 3 hours at the second stage. CONCLUSION: Our results suggest that the pattern of labor progression in contemporary practice differs significantly from the Friedman curve. The diagnostic criteria for protraction and arrest disorders of labor may be too stringent in nulliparous women.
PMID: 12388957 [PubMed - indexed for MEDLINE]
Here’s a comment on the above study.
The Friedman Curve: An Obsolete Approach to Labor Assessment
The Friedman curve, the gold standard for rates of cervical dilation and fetal descent during active labor, was developed almost 50 years ago. To define a modern curve for normal labor, these researchers evaluated data on 1329 nulliparous, full-term women with spontaneous labors and vertex presentations who gave birth to singletons of normal birth weight from 1992 to 1996.
Dilation in the active phase was much slower on the modern curve than on the Friedman curve (mean time from 4 cm to complete dilation, 5.5 vs. 2.5 hours). Among the current study's patients, labor lasting more than 2 hours without apparent change was not uncommon before 7 cm of dilation. Friedman described 3 stages in the active phase: acceleration, maximal slope, and deceleration. No deceleration stage was noted in the contemporary curve.
Comment: The Friedman curve for normal active labor is one of the first pieces of knowledge that most obstetric students acquire. Comparison of Friedman's population with the current study's population shows marked differences: Anesthesia and augmentation are much more common now than in the past, and birth and maternal weights have increased substantially. The authors suggest that in addition to the discrepancies between the 2 groups of parturients, methodologic differences also might explain the differences between the curves. For example, Friedman actually plotted 500 individual curves and then synthesized them into 1 curve, whereas the current researchers used repeated-measures analysis with 10th-order polynomial function.
The authors conclude that the Friedman curve likely represents an ideal, rather than an average, curve. Although this study has limitations (e.g., assessment of cervical dilation is somewhat subjective), practitioners who base their diagnoses of protraction and arrest solely on the Friedman curve might need to reconsider their approach to labor assessment.
— Ann J. Davis, MD
Published in Journal Watch Women's Health February 19, 2003
Reevaluation of Friedman’s Labor Curve: A Pilot Study
Sandra K. Cesario
Sandra K. Cesario, RNC, PhD, is the director of research and assistant professor in the College of Nursing, Texas Woman’s University–Houston Center.
Address for correspondence: Sandra Cesario, RNC, PhD, College of Nursing, Texas Woman’s University, 1130 John Freeman Blvd., Houston, TX 77030. E-mail: email@example.com .
Objective: To reevaluate the average length of each phase/stage of labor for multiparous and primiparous women in North America who received no regional anesthesia or oxytocin augmentation or induction, to describe a range of labor lengths associated with good childbirth outcomes, and to determine if there is a consensus among labor and delivery nurse managers responding to the survey regarding the need to revise Friedman’s Labor Curve.
Design: This pilot study used a descriptive and anonymous cross-sectional survey design. Surveys were mailed to 500 maternity care agencies in the United States, Canada, and Mexico with a return rate of 17.8% (n = 89). Each participating agency was asked to submit five patient cases to be included in the analysis.
Sample and Setting: The sample of patient cases (n = 419) was drawn from randomly selected maternity care agencies throughout North America representing all sizes of agencies and geographic locations. The cases submitted for analysis represented women 14 to 44 years of age with varying ethnicities who received no regional anesthesia or oxytocin augmentation or induction. Twenty-three percent of the women in the sample (n = 97) were primigravidas.
Results: The average length of labor for primiparous and multiparous women today is similar to the average length of labor described by Friedman in 1954. However, a wider range of "normal" was found in cases included in the current study. Primiparous women remained in the first stage of labor for up to 26 hours and the second stage of labor up to 8 hours with no adverse effects to mother or infant. Multiparous women remained in the first stage of labor for up to 23 hours and the second stage of labor for up to 4.5 hours with good birth outcomes. In addition, 87.6% of nurse managers responding to the survey believed that Friedman’s Labor Curve should be revised to meet the needs of current patient populations, technological advances, and nursing responsibilities.
Conclusions: This study suggests that the parameters to determine if a labor is progressing satisfactorily may need to be expanded. With the availability of technology to assess maternal and fetal well-being, labor should be allowed to progress past the rigid 2-hour time limit for the second stage of labor artificially imposed on women in some childbirth settings. More emphasis should be placed on the nursing assessment techniques used to reassure the family and health care practitioners that labor is progressing safely and the nursing interventions that may have an impact on the length of each stage of labor.
This is a thorough list of who should and shouldn't receive Syntocinon. I've made the particularly relevant parts obvious to the eye. This is from the manufacturer of Syntocinon.
Hypersensitivity to the drug
Hypertonic uterine contractions, foetal distress when delivery is not imminent.
Any condition in which, for foetal or maternal reasons, spontaneous labour is unadvisable and/or vaginal delivery is contraindicated: e.g. significant cephalopelvic disproportion, foetal malpresentation; placenta praevia and vasa praevia, placental abruption, cord presentation or prolapse; overdistension or impaired resistance of the uterus to rupture as in multiple pregnancy, polyhydramnios, grand multiparity and in the presence of a uterine scar resulting from major surgery including classical caesarean section.Syntocinon should not be used for prolonged periods in patients with oxytocin-resistant uterine inertia, severe pre-eclamptic toxaemia or severe cardiovascular disorders.
Special Warnings and Special Precautions for Use
The induction of labour by means of oxytocin should be attempted only when strictly indicated for medical reasons rather than for convenience. Administration should only be under hospital conditions and qualified medical supervision. When given for induction and enhancement of labour, Syntocinon must only be administered as an i.v. infusion, and never by s.c., i.m. or i.v. bolus injection. Careful monitoring of foetal heart rate and uterine motility (frequency, strength, and duration of contractions) is essential, so that the dosage may be adjusted to individual response.
When Syntocinon is given for induction or enhancement of labour, particular caution is required in the presence of borderline cephalopelvic disproportion, secondary uterine inertia, mild or moderate degrees of pregnancy-induced hypertension or cardiac disease and in patients above 35 years of age or with a history of lower-uterine-segment caesarean section.In the case of foetal death in utero, and/or in the presence of meconium-stained amniotic fluid, tumultuous labour must be avoided, as it may cause amniotic fluid embolism.
Because oxytocin possesses slight antidiuretic activity, its prolonged i.v. administration at high doses in conjunction with large volumes of fluid, as may be the case in the treatment of inevitable or missed abortion, or in the management of postpartum haemorrhage, may cause water intoxication associated with hyponatraemia. To avoid this rare complication, the following precautions must be observed whenever high doses of oxytocin are administered over a long time: an electrolyte-containing diluent must be used (not dextrose); the volume of infused fluid should be kept low (by infusing oxytocin at a higher concentration than recommended for the induction or enhancement of labour at term); fluid intake by mouth must be restricted; a fluid balance chart should be kept and serum electrolytes should be measured when electrolyte imbalance is suspected.
When Syntocinon is used for prevention or treatment of uterine haemorrhage, rapid i.v. injection should be avoided, as it may cause an acute short-lasting drop in blood pressure.
Interactions with Other Medicaments and Other Forms of Interaction
Prostaglandins may potentiate the uterotonic effect of oxytocin and vice versa; therefore, concomitant administration requires very careful monitoring.
Some inhalation anaesthetics, e.g. cyclopropane or halothane, may enhance the hypotensive effect of oxytocin and reduce its oxytocic action. Their concurrent use with oxytocin has also been reported to cause cardiac rhythm disturbances.
When given during or after caudal block anaesthesia, oxytocin may potentiate the pressor effect of sympathomimetic vasoconstrictor agents.
When oxytocin is used by i.v. infusion for the induction or enhancement of labour, its administration at too high doses results in uterine overstimulation which may cause foetal distress, asphyxia and death, or may lead to hypertonicity, tetanic contractions or rupture of the uterus.
Water intoxication associated with maternal and neonatal hyponatraemia has been reported in cases where high doses of oxytocin together with large amounts of electrolyte-free fluid have been administered over a prolonged period of time (see 'Special Warnings and Special Precautions').
Rapid i.v. bolus injection of oxytocin at doses amounting to several IU may result in acute short-lasting hypotension accompanied with flushing and reflex tachycardia.
With either mode of administration, oxytocin may occasionally cause nausea, vomiting or cardiac arrhythmias. In a few cases, skin rashes and anaphylactoid reactions associated with dyspnoea, hypotension or shock have been reported.
The symptoms and consequences of overdosage are those mentioned under 'Adverse effects'. In addition, placental abruption and/or amniotic fluid embolism as a result of uterine overstimulation have been reported.
Treatment: When signs or symptoms of overdosage occur during continuous i.v. administration of Syntocinon, the infusion must be discontinued at once and oxygen should be given to the mother. In the event of water intoxication, it is essential to restrict fluid intake, promote diuresis, correct electrolyte imbalance; and control possible convulsions by judicious use of diazepam.
Do vaginal exams really help us? Especially if performed hoping to see the discredited Friedman Curve in action?
. Vaginal Examinations
• Many women find vaginal examinations painful and sometimes traumatic (Menage 1996); sensitivity to this issue, privacy and continuity of midwife will make them less so.
• Vaginal examinations measure of the progress of labour imprecisely when performed by different examiners (Clement 1994). Where possible therefore, they should be carried out by the same midwife.
• Examinations should not be routine or prescriptive but carried out only where there is clinical necessity and after discussion with the woman.
• Midwives should give weight to their other skills in determining the progress of labour (McKay and Roberts 1990).
• "Repeated vaginal examinations are an invasive intervention of as yet unproven value" (Enkin 1992).
I have posted this site before, but go and have a look. There are heaps of papers on a lot of different Obstetrics & Gynecology topics. They reflect results form both sides of the coin.
The articles I posted are written by Obs, and mostly published in OBGYN journals. Check the titles. It's mostly Obs who have the captive population to do research into this stuff.
You posted this earlier on this thread...
or if you ate and drank as all those things have significantly impacts on how we birth. If you want to avoid the same outcome, avoiding anything like that would make a big difference this time.
What do you mean? I ate and drank like an absolute pig when I was in labour with Jesse (which resulted in an emergency c/s) I just couldn't help myself - I felt famished and constantly needed water - how does it impact on how you give birth?
You've answered my question - I skipped over a couple of posts to write my question and then went back to read it - and there it was!!!!
It was freaky how much food and water I put away in those hours - my body took charge and I was just along for the ride!
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