If you are expecting again and want to try and go for a VBAC, consult with your doctor. You may be a good candidate for a VBAC. The only way to know for certain, is to speak with your doctor about your options. Your doctor will monitor your pregnancy closely so they will be able to advise what is best for you and your baby. Talk through all of the positive and negative aspects of a VBAC with your doctor when deciding to chose this option.

How does a VBAC differ from a normal vaginal delivery?

The main difference is how often and how closely your labour will be monitored. You’ll be offered continuous electronic fetal monitoring. You will need to measure your baby’s heart rate and your contractions at all times.

Many women have a successful VBAC without any complications at all. But there is a very small risk that the scar from your previous caesarean could tear. This is called uterine rupture.

A uterine rupture is a tear in the wall of the uterus, most often at the site of a previous c-section incision. In a complete rupture, the tear goes through all layers of the uterine wall and the consequences can be dire for mother and baby.

As scary and risky as this all sounds, fortunately these ruptures are relatively uncommon. Although the risk is small, your medical team will want to monitor you for it. During a VBAC you can have an epidural for pain relief if you want one.
What are the risks of VBAC?

The most serious risk of a VBAC is that a C-section scar could come open during labor, although this is very rare. But when it does happen, it can be very serious for both the mother and the baby. VBAC is often only offered by hospitals that can do a rapid emergency C-section.

What’s the alternative to a VBAC?

The other option when you’ve had a caesarean is to have an elective caesarean. This is usually booked one to two weeks before your due date, unless your baby needs to be born sooner for a medical reason.

What are the advantages of a VBAC?

• The main advantage is that you have a vaginal birth and avoid the risks of caesarean birth.
• Less pain after delivery.
• Fewer days in the hospital and a shorter recovery at home.
• A more active role for you and your birthing partner in the birth of your child.

What are the disadvantages of a VBAC?

The disadvantages of VBAC are generally the same as with any vaginal birth.

• Pain from bruising
• Pain from possibly having an episiotomy.
• In the long term, vaginal birth may slightly increase the risk of your uterus slipping into your vagina (prolapse).
• Pregnancy itself can weaken your pelvic floor. This can lead to problems such as incontinence in later life.

Take time to decide about the birth. It’s a highly individual decision. Talk to your doctor about your previous birth or births. This will help you come to a decision about how to have your baby this time around.

All the best.

Stem Cells are the body’s master cells, which have the ability to differentiate and specialize into all cells that make up the human body (skin, tissue, blood, organs, muscle, bones, nerves etc).

Where are stem cells found?

After conception, a sperm and egg fuse to form on single human cell. This cell then begins to divide to form a group of cells known as stem cells as all the organs of the body will stem from them. These stem cells are classified as embryonic stem cells and research on these cells is what has made stem cells so controversial … the termination of a potential life to obtain stem cells in the interests of medical and scientific research. Netcells is not involved in any form of embroyonic stem cell research or therapies.

Stem cells are also abundant in the umbilical cord and placenta, which makes the collection of umbilical cord

blood at birth a once-in-a-lifetime opportunity, free of moral, ethical or religious concerns considering that the umbilical cord and placenta would otherwise be discarded.

Stem cells are also found in adults in peripheral blood, bone marrow and adipose (fat) tissue. Stem cells are active in maintaining and repairing our tissues. Traditionally, bone marrow has been utilized for transplants in life-threatening illnesses such as leukaemia. The problem with a bone marrow donor, is that it is extremely difficult to find a suitable HLA-type match (1 in 40,000). There is also a risk of rejection even where a match is found.

Stem cells collected from the umbilical cord provide an exciting solution, considering they are autologous (from your own body) and there is no chance of rejection.

What illnesses can stem cells treat?

The main use so far has been for blood related diseases, such as blood cancer like leukaemia and lymphoma; blood disorders like aplastic anaemia, Thalassemia, sickle cell anaemia, Fanconi’s anemia; disorders of the immune system and metabolic disorders. Significant research is being undertaken worldwide in stem cell therapies, such as in the treatment of spinal cord injuries, heart tissue regeneration, corneal reconstruction, diabetes, multiple sclerosis, Parkinson’s disease, etc, although none of this is yet clinically proven or commercially available.

Who can use the stem cells?

Stem cells represent a perfect match for the baby whose cord blood stem cells have been collected. There is also an excellent possibility that the stem cells will be a suitable match for a sibling (1 in 4) or a parent (1 in 8). In fact, the majority of stem cell transplants to date have been used for siblings.

What are the chances of you needing the stem cells?

The chances of needing the stem cells are not high and hopefully you will never need them. With all the current research being undertaken, it is likely that retrievals will increase in the future, as more diseases become treatable through stem cell therapy.

Reasons to consider in deciding whether to store your baby’s stem cells

This is primarily a question of affordability and should be seen as an extra form of medical insurance.

However, you should strongly consider storage,

• If your family has a history of certain diseases, especially hematological cancers and;
• Families of ethnic minorities or mixed race marriages, who are seriously underrepresented in public banks.

Collection procedure

Parents are provided with a collection kit prior to the birth, which is taken to the bedside during delivery. After the birth, once the baby has been safely delivered, the physician clamps the umbilical cord (with the placenta in utero or delivered), places a needle into the umbilical cord vein and the blood is drained by gravity into a sterile collection bag. It is a completely painless procedure and only takes a couple of minutes.

The blood is then couriered in a special temperature controlled kit to the laboratory in Midrand, Gauteng. The laboratory complies with international accreditation guidelines of the American Association of Blood Banks.

On receipt, the laboratory processes the blood and the stem cells are separated out and cryogenically stored in bags in vapour liquid nitrogen at -196°C.

Cord Tissue Collection

The tissue of the umbilical cord can also be preserved. It has been documented that the jelly like substance, contained in the centre of the umbilical cord, is also rich in stem cells. These stem cells are known as Mesenchymal stem cells and are able to differentiate into many cells of the body (nerve, skin, blood, bone, cartilage, fat, muscle, skeleton, heart, kidney, endothelium, liver, and pancreas cells).Therefore, they are able to be used in the treatment of many different diseases.

A piece of about 15cm of umbilical cord is sent to the laboratory with the cord blood. The cord is processed and frozen, just like the cord blood, and will be kept for use at a later stage.

Article and images courtesy of Dr Yvonne Holt from Netcells

Home birth for a new generation

As far as natural birth goes, you can’t get more authentic than home birth. After all, women have been bringing their babies into the world within the comforting confines of their own homes since the dawn of time.

With the advance of medicine and technology, it is almost an automatic choice these days to deliver a baby in a hospital setting. After all, everyone else does it… right? With that said, home birth has regained popularity as new-generation, low-risk women rediscover the joys of completely natural, grassroots-style childbirth.

There’s no place like home

What to expect when you’re having your baby at home

The vast majority of doctors and ob-gyns won’t consider a home delivery, both in terms of viewpoint and logistics, so a midwife is your best bet if you’re interested in a home birth.

Your midwife will guide you through the various stages of your pregnancy, preparing you all the way along for what comes next and what your birthing options are. Her role in a home birth is much the same as it would be in a conventional birth, but the home lends itself to a much more intimate and relaxed setting.

Midwifery has not always been given the credit that it’s due, but in the 21st century, society has thankfully started to recognise the value of these experienced, skilled, empathetic and highly knowledgeable childbirth mavens.

Far from being inferior to obstetricians, midwives are qualified nurses who have furthered their studies by attaining a diploma in midwifery and are trained to handle even the most harrowing of emergency situations.  You can rest assured that your midwife will be able to identify any possible warning signs and will call for emergency assistance should it be required.

Furthermore, they are likely to have delivered just as many – if not more – bouncy babies than the average ob-gyn. So when it comes to childbirth, you (and your newborn) couldn’t be in safer hands.

East, West, Home is Best

The many advantages of home birth

Statistics show that the majority of women who have had a planned home birth have described it at as a positive experience, and would choose to go the same route for subsequent births. Here’s why:

Comfort

Giving birth in your own home can provide comfort on both physical and emotional levels. Going through this life-changing experience in a cold, sterile, noisy hospital room just cannot compare to having your own pillows, teacups, friends, aromatherapy candles or television nearby.

Being in a familiar, private setting can enhance the overall experience and make you much more positive and relaxed. These happy vibes will prompt the release of the feel-good, pain-relieving hormones known as endorphins as well as the hormone oxytocin, which is the hormone responsible for the triggering of labour.

Control

Modern women aren’t pushovers on any other day, so why should that be any different during the Big Push? Hospitals do have a certain ‘our way or the highway’ vibe about them and can render an otherwise sassy, strong-willed woman suddenly subservient. The beauty of the home birth is that the mom in question can have a Crème Soda float if and when she likes, or take a stroll around the garden, read a magazine, or even watch a Chuck Norris DVD, if it will help! This freedom to do it your way will again release all those helpful hormones and get that sweet little baby homeward bound in no time at all.

Lower incidence of intervention

Studies show that home births result in fewer complications and less intervention such as labour induction, shaving and episiotomies. Apprehension caused by birthing in an intimidating hospital setting can cause the release of adrenaline, which in turn inhibits the above hormones, endorphins and oxytocin. When this happens, hospital staff will generally administer labour-inducing drugs, which can cause foetal distress, leading to a cycle of otherwise unnecessary interventions. Another cause of intervention is that, due to the frantic nature of a hospital, medical professionals overseeing the labour will often offer interventions as a matter of efficiency. In a home birth, neither of these scenarios is relevant, and labour is allowed to progress the way nature intended.

Less risk of complications

Even better news is that the lower incidence of intervention results in a far lower risk of complications such as tearing, post-partum haemmorhage and postnatal depression. Babies who are born in la casa are less colicky and have fewer sleeping and feeding problems too. Bonus!

As always, our advice is to talk things through with your partner, research the risks and benefits and discuss your options with your doctor or midwife. Wishing you the very best for the happiest of births!

REFERENCES

www.thinkbaby.co.uk
www.pregnancy-info.net
www.gynob.com
www.midwiferytoday.com
www.babyexpert.com
www.childbirthsolutions.com
www.homebirth.org.uk

For most people, the word “hypnosis” conjures up visions of a suspicious-looking therapist dangling a watch in the face of a dazed and intimidated patient. We have Hollywood to thank for this misconception and, thankfully, the field of hypnotherapy has traversed this comical stereotype due to the fantastic results that it can offer the willing patient.

For the pregnant woman determined to go the natural route, hypnotherapy is an incredibly powerful form of pain relief. At its most basic level, hypnotherapy is the practice of applying hypnotism as a remedy to achieve various therapeutic results. Growing rapidly in popularity amongst women preparing for childbirth, this ancient form of mind control offers heaps of benefits.

Read on as we demystify the subject of hypnotherapy as a birthing tool.

Neither dazed nor confused
How hypnotherapy works

Although hypnotherapy has been used during pregnancy and childbirth for centuries, it has experienced a massive resurgence in the past three decades. Various practitioners have perfected and registered specific techniques, which are now employed by hypnotherapists around the world.

Most notably, Marie Mongan pioneered HypnoBirthing® (also known as the Mongan Method) after employing the techniques advocated by Dr Grantly Dick-Read, the British obstetrician who is widely thought to have been the father of the natural childbirth movement. HypnoBirthing® practitioners are now found in almost every main centre worldwide, although many other therapists offer different techniques with very positive results.

No matter which specific type of hypnotherapy is employed, the concept and techniques of hypnobirthing remains the same

• Improved prenatal health and sleep patterns
• Reduced morning sickness
• A relaxed and calm state
• Heightened energy and awareness
• Control over the labour process
• Shorter labour
• Decreased anxiety, fear and shock
• Less discomfort and tension
• Well-practised mothers can use their skills to turn breech and posterior babies
• Less likelihood of medication and intervention
• An exhilarating, pain-free birth
• Positive feelings and memories of pregnancy and childbirth
• Faster postnatal recovery
• Lower risk of postnatal depression
• Strong mother-child bond
• Calmer, happier babies who sleep and nurse well

Staying in for a spell
The benefits of hypnotherapy-assisted childbirth

The birth of her baby is one of the most significant events in a woman’s life. All too often, though, this special moment can be lost in a haze of pain and drug-induced confusion. Hypnotherapy offers the ultimate objective: to experience the entire miracle of the birth, without pain, anxiety or trauma.

Benefits of hypnotherapy include:

• Improved prenatal health and sleep patterns
• Reduced morning sickness
• A relaxed and calm state
• Heightened energy and awareness
• Control over the labour process
• Shorter labour
• Decreased anxiety, fear and shock
• Less discomfort and tension
• Well-practised mothers can use their skills to turn breech and posterior babies
• Less likelihood of medication and intervention
• An exhilarating, pain-free birth
• Positive feelings and memories of pregnancy and childbirth
• Faster postnatal recovery
• Lower risk of postnatal depression
• Strong mother-child bond
• Calmer, happier babies who sleep and nurse well

Zoning in
Is hypnotherapy for you?

Offering many advantages and few drawbacks, hypnotherapy is an exciting option when weighing up pain-control options during pregnancy and childbirth. But, because we’re all individuals, what works for one woman may not work for another.

Before you make any further decisions, we suggest you:

• Talk to your partner
• Do further research on hypnotherapy
• Make a list of your expectations
• Talk to your doctor or midwife about hypnotherapy
• Find a local registered therapist and discuss your options

We’re sure that you’ll be utterly entranced by the experience.
Good luck!

Click here to submit your personal Hypnobirthing story.

References:
www.mebmd.comwww.brisbanehypnosis.com.au
www.babyexpert.com
www.childbirthsolutions.com
www.hypnobirthing.com
www.posihd.com
www.homebirth.org.uk
www.hypnotherapy.co.za

An increasingly popular choice for expectant mothers who want to go the natural route, water birth is a refreshing alternative to conventional birthing options.

Gaining popularity worldwide, the concept of water birth is simple: assisted by a midwife or doctor, the mom-to-be delivers her baby while immersed in a bath or small pool of tepid water. Having been practiced around the world for centuries, this birthing method is now offered in clinics throughout South Africa, and is also favoured by women who choose to have their baby at home.

Water birth offers many advantages, on physical, psychological and practical levels. Perfect for low-risk pregnancies, it is worth considering if you envisage a warm, nurturing and unstressed birth experience. If such a thing as chilled-out childbirth exists, this is it!

Photo courtesy of Xanthe Roxburgh: life, laughter, love

A whale of a time
What to expect from the water birth experience

If you are interested in having a water birth, speak to your doctor or midwife about your options. Many local clinics and hospitals have a dedicated birthing tub or pool. The tub is usually in a well-appointed, homely room which makes for a peaceful and welcoming setting. Alternatively, you can buy or hire a pool to use at home if you wish to have a home birth.

Naturally, every labour and birthing experience is different. However, the water birth guidelines and procedures are fairly standard:

• Water temperature in the small pool or tub is maintained at around 36°C
• The mom-in-waiting enters the water when she is around 5cm dilated
• The midwife or doctor remains outside the tub, while the mother’s partner can join her in the water
• Should contractions slow down, the mom is encouraged to step out of the water for a while
• All examinations are carried out in the water
• When baby is born, he is given to his mom and encouraged to breastfeed straight away
• Babies have inbuilt mechanisms that prevent them from inhaling water during the birth
• Sometimes mom is offered the choice of ‘catching’ her baby after the last contraction

Untroubled waters
The benefits and joys of water birth

Mothers who have previously experienced a water birth and midwives alike sing the praises of this childbirth option. Benefits far outweigh possible concerns and drawbacks, and include:

• Relaxation and comfort
  Every woman knows that a warm soak can be incredibly soothing, and this is especially true while in labour. In the case of water birth, water acts as a powerful relaxant, inhibiting stress hormones which can interfere with a smooth labour, instead encouraging the release of endorphins, which offer natural pain relief and a positive outlook
• Buoyancy and mobility
  Women who experience labour while immersed in water have an advantage over those who have a conventional labour due to the fact that the buoyancy afforded by the water allows her to instinctively and easily move into positions that offer her more comfort, which allows for an active birth. This movement opens up the pelvis, allowing the baby to descend
• Pain relief (less medication)
  Apart from the release of pain-reducing and feel-good hormones, water has a pain-relieving effect. Research shows that women who have water births request epidurals less often. The need for caesarean-sections is also far less likely
• Shorter labour
  Experts believe, due to the comfort that water immersion provides, that water birth can often result in a shorter, less stressful labour than conventional methods
• Less tearing
  Water softens the perineum, reducing both perineal trauma and the likelihood of an episiotomy
• Peaceful entry in the world for baby
  Babies are in a watery environment for 9 months, so it makes sense that the journey from womb to warm water is much gentler than being suddenly yanked into bright, dry air. Midwives encourage mom and baby to stay in the water for up to an hour, which promotes early bonding
• Special, private experience
  The water birth room, whether at a clinic or at home, is generally much more serene than a typical room in a hospital or maternity ward. Often dimly-lit with soothing music playing in the background, this peaceful setting can add a great deal to both the birthing experience and the mother’s memories of this special event. The value of happy recollections of the birth of a child cannot be understated

No sitting duck
Know the risks and ask the right questions

If you are considering a water birth as your chosen labour method, you will no doubt have a hundred questions for your midwife or doctor. Our advice is this: write a list, then get answers to each and every query and concern. Ensure that your medical caregiver is experienced in water birth and that your and your baby’s safety is their first priority. And, most importantly, rely on your instincts. If something doesn’t feel right, it probably isn’t!

“To witness the birth of a child is our best opportunity to experience the meaning
of the word miracle.” – Paul Carvel

References:
www.earthbabies.co.za
www.givingbirthnatuarlly.com
www.waterbirthinfo.com
www.waterbirth.org
www.findarticles.com

Hospital costs
Depending on which hospital you go to, there might be a deposit you need to pay when booking your bed. There are usually two packages to choose from: a standard package that includes your bed only, and a more exclusive package that includes your baby’s name registration and a photo of your newborn and his birth information on their website (available at Netcare hospitals nationwide). This will get published shortly after the birth and allows relatives to get a sneak preview.

Your hospital costs will be determined by the quality and duration of your stay. Most medical aids cover your stay in a standard room while you will have to pay the difference if you prefer the luxury of a private room. The extra charge for a private room is payable on admission. The best way to do it is to get the exact options and costs from the hospital of your choice before you make a booking.

Average hospital costs should you go private (medical aids will cover most of this, depending on your medical aid scheme and plan) are:

• Caesarean: R25 000 (average as of April 2010)
• Natural birth: R18 500 (average as of April 2010)

Gynae costs
A gynaecologist has a standard fee for a natural and a caesarean birth.

If you booked an elective Caesar and your water breaks in the early morning hours, or if there is an emergency which means prolonged theatre time, chances are that he will add an emergency fee to his account.

You might have to pay in a substantial percentage of the gynae’s fee as medical aids don’t often cover 100% of the specialist’s costs (again, this depends on your specific medical aid plan). This fee is usually due within 30 days after the birth. Do your homework and ask a medical aid consultant what percentage will be covered – this way you won’t have to deal with a nasty surprise when you need it the least.

• Average gynae cost for a caesarean and natural birth: R7 250 (as of April 2010)
• Average gynae emergency cost (depending on time spent in theatre): R500 – R750 (as of April 2010)

Paediatrician
When drawing up a childbirth cost plan, remember to add the cost of the paediatrician as his presence is compulsory. He is there to do an Apgar score and check on your little one to make sure that everything is working the way it should be. A great source of comfort, he is!

• Average cost for the paediatrician being present when baby is being born: R1 500 (as of April 2010)
• R550 per day thereafter – to do his daily rounds and check on baby until she is discharged (as of April 2010)

If your paediatrician charges medical aid rates, this will be covered fully. If not, you will have to pay in a percentage, depending on your medical aid plan.

• Anaesthetist
  If you have a c-section or an epidural it means that you will receive an account from the anaethetist. Ask your gynae for the anaesthetist’s contact details to get an idea of the costs involved.
• Maternity leave
  There will be a lack of income, with or without UIF. If you are employed, ask the HR manager about the company’s policy with regards to maternity leave.
• Adding your baby to your medical aid scheme
  This needs to be done immediately after birth and means you’ll now pay a higher medical rate
• Midwife (optional)

Once you find out that you are pregnant, draw up a list of all the birth expenses involved and try to put some money away for this big occasion. If you didn’t plan your pregnancy, don’t fret. Besides stress being bad for you and your little one, it won’t accomplish anything. Situations somehow just have a way of working themselves out.

Happy planning!

First things first, let’s look at false labour symptoms:

• Irregular contractions that are not increasing in frequency and severity.
• Contractions ease up when you walk around or change your position.
• Show/discharge, if any, is a brownish colour. This kind of discharge is usually due to intercourse or an internal exam within the past 48 hours.
• Foetal movements intensify momentarily with your contractions (let your gynae know immediately if the movements are getting frantic though).

Symptoms of real (early) labour:

• Contractions intensify and become more frequent and painful
• Indigestion
• Backache
• Diarrhoea
• A feeling of warmth in the abdomen
• Bloody show/discharge
• Pain that feels like menstrual cramps
• Waters break

When to go to hospital or call your midwife:

• If your contractions are five minutes apart or closer
• If you feel overwhelmed and need assistance getting through the pain of the contractions
• If you are bleeding or your waters break

If you are pregnant you are probably spending a lot of time reading up on anything pregnancy related. Keep in mind that every pregnancy is unique and that every book is simply a guide. Do what feels right. If waiting until your contractions are five minutes apart is cutting it a bit fine for your liking, go to the hospital when you feel you should. Your peace of mind and your baby’s safety are the most important aspects to consider.

Medication
While some women want to have a completely natural birth, many opt for medication as pain relief during labour and birth. There are three main types of medication available at most hospitals – namely an epidural, gas and air and pethidine. An epidural is probably the most popular option and said to be the one that currently gives most pain relief during labour and birth. Another medication available is entonox, also known as gas and air, consisting of 50% nitrous oxide and 50% oxygen. You can breathe this gas in through a facemask when each contraction starts, and keep breathing it in until the contraction is over. Pethidine, on the other hand, is a morphine-like drug that can be injected into your bum or thigh. Pethidine helps you relax and even sleep during the first stage of labour. When you are near delivery, however, you can’t use pethidine as it might affect the baby. Although these types of medication might give pain relief in labour, they have side-effects such as drowsiness, slowed labour, nausea and light-headedness.

Prepare your body
It’s so important to prepare your body, both physically and mentally, for the major task that lies ahead. You should watch your diet, get some exercise every day and aim to be fit and ready in order to help your baby come into this world. Practice breathing and relaxation exercises and read up about labour and birth so that you have an idea of what to expect on the big day. Although preparing your body for labour and birth will not ease the pain you’ll feel during contractions, it will at least give you some peace of mind as to what to expect and how you can deal with it.

TENS
TENS stands for Transcutaneous Electronic Nerve Stimulation and is a battery-powered stimulation connected by wires to electrodes placed on either side of your spine. With a TENS machine you are able to control the stimulation your lower back receives to block the transmission of pain impulses to the brain. TENS also stimulates your body to produce more natural painkillers – such as endorphins. A TENS machine can be hired for a home birth, but can also be available to you in hospitals.

Water
Giving birth in water is another option available for mothers-to-be. You can have a water birth at home with a private midwife or at certain hospitals that have birthing pools. With a water birth you will spend all stages of labour in a warm bath and can also deliver your baby here. Water has a calming influence on everyone involved and can benefit the mother-to-be in many ways. As water counteracts the effects of gravity, moving around is a lot easier and the mother-to-be feels more in control and can conserve energy. The welcome for your new baby is gentler, and a water birth can also reduce perineal trauma and eliminate episiotomies.

Non-traditional options
Non-traditional options include among others hypnosis, reflexology and acupuncture. Although these methods might not work for everyone or give complete pain relief in labour, they can have the power to help you relax and handle the situation better – if you just let yourself go with the flow. With acupuncture needles are inserted in your limbs or ears to block the pain impulses, while a woman who has been trained in self-hypnosis can use this technique to relax herself.

Relaxation and breathing
Most prenatal classes train you in relaxation methods and breathing. Women that are strong-minded can use this to help them get through labour – shifting their attention away from the pain. Power of the mind is an incredible tool; being in control mentally is a great way of dealing with the pain throughout the whole experience of giving birth.

Other
There are also a few other pain relief options during labour. Using soothing music, dim lights, firm massage or heat/cold application to the lower back and the support and touch of a birthing partner can help ease the pain. Taking hot showers and making sure you keep hydrated can also help, and don’t forget to keep moving or walking around. Lying on your back is actually the most painful position during labour, so take the pressure off your back and use gravity to help your baby move down into the birthing canal.

By looking at the options available to you, you can at least prepare yourself for what’s to come and have some sort of idea of how you would like to experience labour and birth. Remember, however, that childbirth isn’t a test of endurance. You have not failed if you ask for medication.

References:
www.mayoclinic.com
www.webmd.com
www.waterbirth.org

What is an epidural?
An epidural is a local anaesthetic that numbs the nerves in the part of your body that feels pain during labour. With an epidural you remain alert because the medication doesn’t travel through your blood, which in turn means it won’t affect your baby. The aim of an epidural anaesthetic should be pain relief rather than complete numbness and lack of feeling; a low dose epidural can leave you with enough feeling to push with your contractions and even allow you to walk around during labour.

How is an epidural administered?
When you have an epidural you will be asked you to curl forwards and sit completely still while a small area on your lower back will be numbed by injecting a local anaesthetic. It’s vital that you remain motionless in order to prevent problems and for the needle to be successfully inserted in the correct way – increasing the effect of the epidural. The needle is inserted into the area surrounding the spinal cord in your lower back, and a small tube is threaded through the needle into the epidural space. The needle is then removed, which allows medication to be given through the tube whenever necessary. The tube will be taped to your back to prevent it from slipping, and the frequency and amount of medication can now be easily adjusted.

What are the different types of epidural?
There are a few different varieties of an epidural – mainly based on the dosages as well as the combinations of medication used. A traditional or regular epidural sees a combination of narcotic and anesthesia given through the tube and into the epidural place whenever necessary throughout labour and birth. A variation of the traditional epidural is a patient controlled epidural, where you are able to control the doses you receive by the push of a button and don’t need a doctor or midwife’s assistance. A walking epidural is a light epidural which allows you to move more freely as it only numbs the nerves of your abdomen, while a spinal epidural is an initial dose of narcotic, anesthetic or a combination of the two – injected beneath the outermost membrane covering the spinal cord, and inward of the epidural space. The spinal epidural unfortunately wears off quicker than a regular epidural and there is no tube in place that allows for more medication to be injected.

Is it ever too late to have an epidural?
Most doctors or midwives prefer their patients’ contractions to have an established pattern and the cervix to be dilated to around 4-6 centimetres before they administer an epidural. Theoretically, after this stage, it’s never too late. However it might be more difficult to stay still during the administration of the epidural in late labour – when your contractions are coming closer together. And if the epidural is requested when you have started pushing, you might have to lie on your side rather than sitting up as the baby will have moved down towards the birth canal already. Always keep in mind that as soon as you have started pushing, it shouldn’t be too long before your baby is born. So if you choose to have an epidural at this stage it might not even come into effect before your baby is born. On the same note, if your labour progresses quickly and your cervix is already 8cm when you arrive at the hospital, there might simply not be enough time to administer the epidural – it takes about 15-20 minute to administer, and another 15-20 minutes for the medication to come into effect. Also, if you haven’t decided on having one in advance, but change your mind at the last minute, there might not be an anesthetist available straight away. The best advice we can give you is simply to be prepared to put your trust in and listen to your doctor or midwife, as they are experts and will know what’s best for you in any specific situation.

What are the advantages of having an epidural?
Let’s take a look at a few advantages of having an epidural anaesthetic:

• Because the pain medication doesn’t go directly into your bloodstream, your baby is unlikely to be affected.
• If you are going through a long labour, the epidural allows you to rest more and to prepare yourself for the birth.
• An epidural will manage your labour pain effectively and allow for less discomfort.
• Pain relief means you can breathe more easily and there is less stress on your heart.
• Because an epidural is a local anaesthetic you can still be alert and awake to experience the birth of your baby.
• If you have high blood pressure, the epidural benefits you by lowering it.

What are the disadvantages of having an epidural?
Let’s take a look at possible risks associated with an epidural anaesthetic:

• Patients with some neurological or bleeding disorders, evidence of severe infection or those having had major back or spine surgery, can’t have an epidural.
• Your epidural can cause your labour to slow down and also make your contractions weaker, which in turn means pushing can be difficult and your baby might need assistance to come down the birth canal.
• The epidural reduces your ability to go to the toilet or walk around, and might take quite a while to wear off once it’s all over – depending on the dosages.
• Epidurals can cause your blood pressure to drop, which means that you and your baby’s heart rate need to be monitored.
• You might experience a severe headache caused my leakage of spinal fluid.
• In rare instances permanent nerve damage, or infection of the area where the epidural was inserted, can occur.

How can an epidural affect my baby?
This is a controversial issue and research is to some extent ambiguous. Whether the medication affects your newborn baby or not varies according to factors such as dosage, type of medication and how long labour takes. Although the medication is very unlikely to harm your baby, studies claim that possible side-effects could be that while in-utero, some babies might have trouble getting into position for delivery, and once born some babies might have problems related to breastfeeding – such as latching on.

Should I or shouldn’t I?
As discussed above, there are both advantages and disadvantages of having an epidural. But at the end of the day there is no right and wrong, and it’s entirely up to you to make a decision you feel is the best one for you. Take your time to think about it and discuss it with your partner as well as your doctor or midwife. Try to make up your mind well in advance of the birth – which means there is one less thing to worry about when you’re in the middle of it and perhaps not in a position to think straight. Even though you have made up your mind beforehand, you are still allowed to change your mind once you are in the middle of labour and really don’t know what you were thinking when you made your decision a few months ago. Just keep in mind, however, that if you haven’t planned to have an epidural but change your mind once you are in labour, it might not be available to you at that point.

References:
www.webmd.com
www.babycentre.co.uk
www.americanpregnancy.com

Stages of Labour

• The first stage is labour, and include three phases. Phase 1 is early thinning of cervix and dilation to three centimetres. The second phase is active and there’s dilation to seven centimetres. The third phase of labour is transitional and you will be fully dilated at 10 centimetres.
• The second stage is delivery of the baby.
• The third stage is delivery of the placenta.

The first stage of labour is the longest stage and sees your cervix open up in order to allow baby’s head into the birth canal. This stage can take up to 12 hours if it’s your first baby. Contractions will become more intense and longer as stage 1 comes to and end.

What you may feel physically

• Menstrual-like cramps
• Feeling of warmth in your abdomen
• Backache
• Bloody show
• Diarrhoea

What you may feel emotionally

• Excitement
• Relief
• Anticipation
• Uncertain
• Nervous

What you can do

• If you feel hungry, eat light snacks as digesting a heavy meal will compete with the birthing process for body resources
• Avoid anything acidic – such as orange juice

Stage one: Labour: Phase 2

What you may feel physically

• More intense pain as the contractions become stronger (you might be unable to talk through them)
• Increasing backache
• Leg discomfort
• Fatigue
• Your membranes may rapture

What you may feel emotionally

• You may find it difficult to relax and become more restless
• You may become more focused as you’re eager to get this wrapped up
• Confidence may take a knock and you may wonder whether you’re up for this
• It’s now time for action

What you can do

• When you feel overwhelmed by the pain of your contractions, start your breathing exercises
• Drink some water
• It’s asking a lot, but try to relax between contractions
• If you can’t walk around, try to at least change positions
• Go to the loo for a number one – even though you may not feel the urge to
• Don’t be a martyr… if you need pain relief, demand some

Stage one: Labour: Phase 3

What you may feel physically

• Strong pressure in your lower back and/or perineum
• Rectal pressure – with or without the urge to push
• Nausea and/or vomiting
• You may feel hot and sweaty or cold and shaky, or even alternate between the two
• You may experience leg cramps and your legs may tremble uncontrollably

What you may feel emotionally

• You may feel overwhelmed (who wouldn’t?)
• Impatient (at not being able to push yet)
• Confused and irritable
• The good news is that you may find yourself excited in the midst of all the stress

What you can do

• Instead of thinking about the work that’s ahead, think of how far you’ve come and that you’ll be able to hold your baby soon
• If you feel the urge to push, rather pant or blow or bite into a pillow, as pushing against a cervix that is not fully dilated can cause it to swell – which can delay delivery
• Try to relax between contractions, switch to locomotive-mode and start those breathing exercises

Stage Two: Delivering your baby

Your cervix is fully dilated – congrats! You’ve made your way into the second stage without killing anyone! Yet… Moving from stage 1 to stage 2 is called transition, and can last anything from a few minutes to more than an hour. You may experience confusion or a sense of being overwhelmed at this stage as you’re no doubt wondering whether you are up for the task ahead.

If the hospital allows it, find a position that is comfortable to you or make yourself as comfy as possible on the bed. During the second stage your baby is pushed through your pelvis and birth canal. If the head becomes visible, you can ask for a mirror if you don’t want to miss this moment. The head will appear and disappear a few times between contractions, but don’t get discouraged. This process is all about two-steps-forward and one-step-back!

Episiotomies are no longer routine but they are not uncommon. It’s your choice whether you’d like to tear naturally or prefer medical intervention in the form of an episiotomy. If you choose to have one, a cut will be made at the entrance to the vagina as your baby is being born.

What you may feel physically

• An overwhelming urge to push
• You may feel a burst of renewed energy or you may feel tired
• Tremendous rectal pressure
• Very visible contractions
• A burning or stinging feeling at the vagina as the head eventually crowns and a slippery, wet feeling as the baby emerges

What you may feel emotionally

• Relieved as you can eventually start pushing
• Self-conscious, inhibited, scared
• Excited for what’s lying ahead
• In a prolonged second stage it’s perfectly normal to find yourself more concerned with getting this over with than with seeing your new baby

What you can do

• Give it all you’ve got
• Don’t let inhibitions or embarrassment break your pushing rhythm – there is absolutely nothing that they haven’t seen or experienced before
• Do what comes naturally
• Try to rest between contractions – the end is in sight

So when do you get to hold your baby? This depends on the condition of mom and baby. If it was an uncomplicated birth, chances are your baby will find its way to your chest moments after entering this world, at least for a little while. His nose and mouth will have to be cleared of fluid, the umbilical cord clamped and cut. Baby will be dried quickly while being checked to make sure he is breathing adequately

A few minutes after birth your baby will be surveyed and get assigned an Apgar score. This test include categories such as appearance, pulse rate, response to stimulation, activity and respirations.

Don’t be in a hurry to feed – your baby’s probably got a lot of fluid in his system. Wait until you’re more comfortable so that you can sit back and take in the moment. Your birth plan should note that they must bring your baby to you for breastfeeding as soon as possible, and that he should not have a bottle under any circumstances. If you are bottle-feeding, however, supply them with your choice of bottles beforehand.

Stage Three: Delivering the placenta

Your baby’s arrival marks the end of stage 2 and the beginning of the third stage – namely delivering the placenta. The placenta will be eased out gently, assisted by your gynaecologist’s hand on your abdomen. You may be asked you to push at the same time, but relax – because all the hard work is done! The third stage can last up to twenty minutes, depending on each person. If you breastfeed immediately it will speed up the process as the suction action causes the uterus to contract. Amazing, hey?

What you may feel physically

• Tired or energised
• Very thirsty and hungry after a long labour
• Cold
• A bloody discharge called lochia, which similar to a heavy period

What you may feel emotionally

• Sense of relief, talkativeness, happiness, excitement
• New sense of responsibility
• Impatience at having to push out the placenta or submit to the repair of an episiotomy/tear, when all you can think about is holding your new baby

Some new moms feel that they are struggling to bond with their new baby right away, some may even feel resentful (I can’t believe she made me suffer like this!), while other moms feel an immediate bond with their baby. It’s all normal – your motherly love will kick in soon enough, so be kind to yourself as you’ve been through a major experience.

What you can do

• Help expel the placenta by pushing when asked to
• Be patient while they are repairing your episiotomy or tear
• Nurse or hold the baby once the cord is cut. In most hospitals a newborn baby is kept in an incubator for a while or your partner will hold baby while they are busy sorting out your placenta
• Take time to pat yourself on the back – you’ve done an amazing job!
• Remember to thank your partner as he was probably more stressed than you and may feel a bit overwhelmed, underappreciated or left out

Take these tips and make them your own by adding some personal flavour – such as your own choice of pain relief, extra pillows, an alternative like water birth etc. You should feel more at peace now, knowing what’s to come! Do whatever you have to in order to ensure that you are as comfortable as possible, and leave the rest up to Mother Nature. Soon enough you will be staring down at your beautiful, fragile, newborn baby – and it will all be worth it!

Reference:

• G. Ezzo & R. Bucknam: On Becoming Baby Wise. 1998: Multnomah Books, USA.