The American College of Obstetricians and Gynecologists (ACOG) is the organization that US doctors turn to for practice recommendations. This post will review their guidelines on the management of late-term and postterm pregnancies. If you go past your due date, this is the information your doctor will be using to guide your care. Should babies just “come when they’re ready”? What are the risks?
Feeling forgotten when it comes to a birth plan because you have a high risk pregnancy? Most birth plans are geared toward low risk pregnancies and may not apply to your high risk birth. That doesn’t mean that you don’t get any say in your delivery! Having a high risk pregnancy can make labor and birth more complicated and will require certain adjustments from a low risk birth plan, but there are absolutely things you can do to customize your labor and birth. Whether you want to keep things as natural as possible, or just want to be prepared and learn about what you might expect in the hospital, having a birth plan in a high risk pregnancy is still a great idea! Read on to learn more about the different options!
Typically, the umbilical cord is cut immediately after birth in the hospital setting. Many organizations are beginning to recommend a change in practice to include delayed cord clamping. However, doctors are frequently hesitant to wait to clamp the cord. What does the evidence say?
Evening Primrose Oil (EPO) is a supplement that is commonly recommended as a “natural” induction method, but is it safe? Does it work? What does the evidence say?
Continue reading “Ways to Induce Labor Part 5: Evening Primrose Oil”
I’m going to take a break from the labor induction series and focus today on a question that was asked by a student midwife. While this blog is mostly focused on research recommendations and ways that they affect patient care, I also hope that students and providers can use it as a reference point as well. The midwifery student was asking for suggestions and tips for mastering the vaginal exam. Continue reading “The Elusive Cervix: Tips for Performing a Vaginal Exam”
Is nipple stimulation an effective way to induce labor? Or will it just give you sore breasts? What does the research say? Continue reading “Ways to Induce Labor Part 4: Nipple Stimulation”
Will using Castor Oil get you a baby? Or just an upset stomach? What does the research say on using castor oil for labor induction? Continue reading “Ways to Induce Labor Part 3: Castor Oil”
After writing the initial post about membrane stripping as a way to induce labor, there were comments that providers were telling patients that they could not strip their membranes because the patient was Group B Strep (GBS) positive, and this could cause infection. Is this based in research, or is this was just “common knowledge” that is being passed along? Continue reading “Ways to Induce Labor Part 2: GBS and Membrane Stripping”
Many women, whether by medical necessity or personal preference, will undergo induction of labor during their pregnancies. There are many methods available, both natural and medical. Some of these methods are research proven, others are old wive’s tales that have been shown to be ineffective, or even harmful. This series will look at research articles regarding different methods commonly used, and their effectiveness at inducing labor. Part 1 of this series will discuss research on Membrane Stripping. Continue reading “Ways to Induce Labor Part 1: Membrane Stripping”
Bleeding in early pregnancy can be a scary. Unfortunately, it is very common and can have many causes, most of which are no direct threat to the pregnancy. These can include a vaginal infection, a urinary tract infection, and postcoital (after sex) bleeding. While bleeding can be a sign of a miscarriage, it can also be due to a subchorionic hemorrhage. Subchorionic hemorrhage, also known as a subchorionic hematoma, is a frequent cause of vaginal bleeding in early pregnancy.
AGOC has new recommendations for managing labor to help decrease c-section rates. Parts 1 and 2 look at the article your doctor should be reading. Part 3 will discuss what you should expect them to recommend based on the research and what this means for you.
Part 1 reviewed the current state of cesarean sections in the US. It also reviewed ACOG recommendations for management of abnormal first and second stage of labor. Part 2 will discuss the second most common indication for primary c/s, an abnormal fetal heart rate tracing, as well as the effects of induction on c/s rate, and other common indications for primary c/s, such as twin and breech presentation. Part 3 will discuss what the patient can expect from their provider based on these recommendations.
One in three women in the US will give birth by cesarean section. ACOG recognizes that this is a problem, and that many of these cesareans are unnecessary and can be prevented by a change in labor management. I will be reviewing their 2014 Obstetric Care Consensus findings and recommendations in a 2 part series. I will follow that in Part 3 with what the patient can expect from their provider, based on these new recommendations.
In the last post, I discussed the important points regarding Cholestasis of Pregnancy from the research article listed. In this post, I will discuss their findings as it relates to the patient.
Hello! I’m a nurse midwife practicing in Rockford, IL. I believe that education can help empower women in their healthcare decisions by allowing them to be active participants in their care. Education can also take some of the fear and self doubt out of decisions, as well as help women understand what choices are available. This blog will focus on women’s health, from pap smears and mammograms to pregnancy and birth. I will be reviewing current research and presenting it in an understandable way.
Healthcare is an ever changing field, and it can be difficult to balance art and tradition with science and technology. Sometimes, the latest technology is immediately adopted as the standard of care without having the evidence to back up its routine use, or leads to the belief that, “if a little is good, more is better” (continuous fetal monitoring in labor for low risk women, for instance). Everyone wants to end a birth with a healthy mom and healthy baby. Sometimes fear of a bad outcome can lead to overzealous testing, or the use of unnecessary interventions (by both mothers, and providers). The unfortunate reality is that no one can guarantee a healthy mom, or a healthy baby, no matter how much we try to intervene. Sometimes, though, people fear technology and interventions and end up throwing the baby out with the bath water. Just like the overuse of technology can lead to unnecessary interventions, so can the dismissal of these interventions as being “bad” lead to poor outcomes that may have been prevented.
Do epidurals sometimes slow down labor or make pushing more difficult, leading to a c-section? Sure. Do they sometimes help a mom relax and help her progress in labor? You bet. Does pitocin sometimes cause contractions that are too strong and lead to a stressed baby and a c-section? Yes, it does. Can a pitocin induction also help a mom with preeclampsia (severely elevated blood pressure and other organ damage in pregnancy) deliver before she or her baby are seriously injured? Absolutely. It is never black and white. The important thing is that whatever decision is made, be it to induce or continue the pregnancy, or to get an epidural or labor naturally, or to breastfeed or bottle feed, that it ultimately comes from the mother, with the guidance of her healthcare provider and her own due diligence.
It is an unfortunate reality that the current birth climate can leave mothers feeling ignored, disrespected, or even traumatized. Women go to their healthcare provider for their education, training, and experience, but also need to build a partnership based on trust. It can be difficult for a patient to navigate a recommendation that might not be her first preference in this climate. For example, a woman being recommended induction when she hoped to go in to labor spontaneously. Is the induction medically necessary? Is it because the doctor has a vacation coming up?
Given the recommendation, the woman should discuss with her provider why induction is recommended (maybe the women has chronic hypertension and diabetes) and the doctor feels that the risks outweigh the benefits. She should find out what other options are available (maybe her diabetes and blood pressure are well controlled and she can do extra outpatient monitoring to make sure the baby is doing well?). She should hear what her provider says, and look on her own. If she finds conflicting information, she should take it back to her provider and ask their thoughts. Maybe the doctor still feels a risk is too great, or maybe she was unaware of the latest research. Doctors and midwives are human, too, and have their own preferences, fears, and comfort levels. From there, the mother can decide if yes, she agrees that induction is the best route for her, or that she’d like to do an alternative, or possibly she feels like the risk is not great enough and she will do nothing. The important thing is that the mother was the one making the informed decision, and that she felt respected and heard through the process.
It is important to remember that ultimately, whatever decisions you make as the patient are your own. No matter how much pressure is applied toward a certain choice by your provider, the ultimate decision is ALWAYS yours. Educate yourself on the risks, benefits, side effects, and other options available. This is a conversation to be had with your provider. However, if you are ever uncomfortable with the chosen plan of care (whether it’s being induced, having a c-section, getting extra ultrasounds to monitor baby’s growth, getting a breast biopsy, etc), it is your RESPONSIBILITY to question and decide if it is right for you. I hope that by reviewing the research that providers use to guide their recommendations, I can help you, as the patient, understand why they might make a recommendation, or to find alternatives that may also be appropriate based on the research. Please keep in mind that this is not individual medical advice and that all decisions should be discussed with your provider.
Students and practicing providers, I hope you are also able to benefit from this, either by learning something new, keeping up to date on research, or passing on your wisdom!
Please feel free to ask questions, make topic suggestions, or just say hello!