Avoiding Episiotomy During Childbirth
August 19, 2008
I coached as my wife was delivering our third child. She was at the final phase of delivery where the last few pushes would result in the birth of our second daughter. As the crown of our daughter’s head protruded slightly from the very end of the birth canal, my wife’s obstetrician yelled, “Stop! Don’t push…”
He quickly positioned a hypodermic needle and injected anesthetic into a section of my wife’s perineal tissue - the skin between the vagina and the anus. Next he grabbed a scalpel and carefully addressed the freshly anesthetized area. The attending nurse and I instinctively wheeled our heads to the side so that our eyes could not see what happened next. “I never watch this part,” she told me, as the doctor quickly performed a simple procedure known as an episiotomy. Our daughter was born minutes later. As mother and daughter were meeting face-to-face for the very first time, the doctor was busy stitching the incision created during the episiotomy.
The idea behind performing an episiotomy is twofold. The first reason is concern for the baby. Passing through the vaginal canal is the most stressful time for a baby experiencing a traditional vaginal birth. Cutting the perineal tissue creates a wider opening so that the baby can slip through more easily. The second reason is, in theory, to prevent out-of-control tearing of the mother’s perineal tissue. The idea is that, by making an incision, the area affected by cutting or tearing is controlled to a certain extent by the attending physician. The problem is that not all mothers experience tearing, so the laceration can be unnecessary.
According to an article by Salynn Boyles published on WebMD (http://my.webmd.com/content/article/110/109783.htm), The Journal of the American Medical Association (Vol. 293 No. 17, May 4, 2005) reports that researchers screened nearly 1,000 medical resources published in the past 60 years looking for data measuring the effectiveness of the procedure. Data from twenty-six articles contained relevant content and were aggregated to form conclusions.
The article reported that there was “fair to good” evidence that the results of routine episiotomy were not advantageous over the results of those with restrictive use of episiotomy. In cases where episiotomy was performed routinely, the severity of the laceration, the degree of pain suffered, and the amount of medication needed to treat was no better than for cases where episiotomy was not routinely performed.
Though most of the individuals were not followed late into life, relevant studies have shown no benefit from episiotomy for the prevention of urinary incontinence or pelvic floor muscle relaxation. Studies have also shown that “impaired sexual function - pain with intercourse - was more common among women” who had the procedure. A report published in the British Medical Journal in January of 2000 reported that women who received episiotomies during delivery had a significantly higher incidence of anal incontinence - the inability to control bowel movements and gas - than their counterparts who did not receive the procedure.
At best episiotomy is something no one wants to observe; at worst it can cause pain, lengthen the time it would normally take for a couple to resume sexual relations, and cause anal incontinence. The ideal situation would be to not only avoid episiotomy, but also to avoid tearing.
Informed mothers are learning more about this subject and taking the time to speak with their obstetricians about it, well in advance of their scheduled birthing date. They are adopting a strategy that includes special exercises using a device called EPI·NO. The EPI·NO is a soft balloon-like device that is inserted into the vaginal opening and gently filled with air to a specific pressure.
As the balloon is inflated the tissues are gently stretched. The pressure is then maintained for a period of time so that the tissues can adjust to the new opening. Daily the amount of air is increased slightly so that the vaginal opening is gently prepared to receive the baby’s head. The end result is that the tissues are not only better prepared for the birthing process, but - because the tissues are not suddenly and violently stretched - the tissues more readily return to their prior state.
The philosophy is not new. In fact, there exists an age-old African custom by which an expectant mother gently inserts a calabash or gourd into the vaginal opening, to manually stretch the pelvic floor muscles and the perineal tissues. This process is still in use today in many parts of Africa. Modern science provides us with knowledge and materials that perform a similar function, but in a safer and more sterile way.
Unlike the calabash or gourd, the EPI·NO can be used not only to prepare the pelvic floor muscles and perineal tissues for birth, it can also be used to regenerate the tissues through post-partum exercises. Approximately three to six weeks following childbirth (ask your OB/GYN when to begin), a mother can begin once again to use the EPI·NO.
By clenching the pelvic floor muscles - a process known as a “kegel exercise” - the new mother will see the pressure on the EPI·NO gauge rise. This is called “bio feedback” and helps to inform you that your pelvic muscle exercises are being done correctly and to track your progress as muscle strength returns. Expectant mothers can experience mild to severe anxiety as childbirth approaches. Using EPI·NO a few weeks in advance of childbirth can help to reduce this anxiety.
Clinical studies have shown that using EPI·NO will:
- Reduce the incidence of elective episiotomy
- Reduce the incidence of perineal tissue tearing
- Increase APGAR scores (measuring the overall health condition of the newborn baby)
- Decrease the need for certain drugs during childbirth
- Reduce anxiety for the mother
Women who have used EPI·NO in preparation for childbirth report some very satisfying results:
“My daughter was born after 12 hours of labor without problems and spontaneously without cut or tear, thanks to the training with the EPI·NO and to perineum massage. But the interesting thing about it was that, during the phase of the passage of the baby’s head, the thought came to me: you know this feeling, you have managed it before! Instinctively I knew what was happening and, above all, in which direction I should press. (Of course, during the training I did not press, but was conscious of the direction…) In addition, I cannot forget that I was able to practice the "letting go" in the pelvic floor beforehand and thus, was far less frightened before the birth ? ”
“I just made it to the delivery table, and the serious business began, 3 pressing pains and my son was there! No perineum cut, no tear, just a small scratch on the left labium and my baby is perfectly healthy. He was born just 1 ½ hours after entering the clinic! And he was my first child! I began with EPI·NO, as you recommended, [three weeks prior to the due date] and finally achieved a distension of 9.5 cm in diameter. On the basis of this experience, I can only recommend your EPI·NO to other women, and am actually doing just this … ”
“The birth was very quick (2½ hours). I had a very short expulsion phase (approximately 15 minutes) and gave birth with an uninjured perineum. I consider these factors to be due to the EPI·NO. … I think that without EPI·NO there would definitely have been a perineum injury, because when practicing the exercises one senses the progress and how the tissue becomes gradually more extensible. The handling of the instrument is easy. All in all I can most warmly recommend the EPI·NO … ”
More information about EPI·NO can be found by visiting the “Avoid Episiotomy” website (http://www.avoidepisiotomy.com).
Michael Callen is the author of the Weekly Weightloss Tips Newsletter (http://www.weeklyweightlosstips.com) and the Chief Technology Officer for WellnessPartners.com (http://www.WellnessPartners.com), an online retailer of dozens of health and wellness products such as conjugated linoleic acid (CLA), r+ alpha lipoic acid (R+ ALA), and green tea extract.
How Do I Date My Pregnancy?
August 9, 2008
Accurate dating of pregnancy is one of the most important steps in your prenatal care. Every decision you make and many tests that are run are directly related to or interpreted from where you are in your pregnancy. Using the first day of your last menstrual period as the starting point is the standard convention for dating pregnancies ¯ that’s because it’s a date most women can recall, whereas the actual date of conception is a little harder to pinpoint.
It can be confusing, though. For example, an embryo that is twenty-six days from conception would be about forty days from the first day of the last menstrual period for a woman with twenty-eight-day cycles. Therefore, she could be called "almost six weeks," even though she is only almost four. A "due date" is typically calculated based on 280 days from the first day of your last menstrual period. Actually, the normal gestation of a human fetus is 266 days from conception.
Confused yet? The relevance of menstrual dates is that most books use them to discuss the progress of your pregnancy and further divide it into three trimesters. If you get a book on fetal development, however, it will be using actual dates that start with conception.
Grab the full collection of The Pregnancy Secrets and hundreds of tips at The Pregnancy Secrets.
Worldcopyright Marc Hofkens and Cosblad Publications NV. You can use and publish this article on the condition that you don’t change anything and you add this resource box at any time.
http://www.the-pregnancy-secrets.com
Common Sense Approach To Weight Loss After A Pregnancy
July 30, 2008
Every woman gains weight while she is pregnant. This is the way how it is and always has been. And it is as it is: It is also perfectly normal for a woman wanting to lose weight after a pregnancy. There is absolutely nothing wrong with aspiring to get yourself back into shape right after having giving birth to a baby. In fact - weight loss to a certain degree is certainly encouraged. Overweight just causes different health issues in the mid to long term.
However - it is very important that the woman takes a common sense approach when she is attempting to lose weight after a pregnancy. Keep in mind, the weight will not come off overnight, but it will come off if you “attack” it in the right way.
One of the biggest mistakes made by women is to try on clothes from before pregnancy. It is very important that you don’t try to fit back into your pre-pregnancy clothes right after birth. Accept the fact that you will still be carrying around most of the fat you gained to help keep your baby safe and sound during pregnancy.
Usually it is recommended and acceptable that most women can safely lose between one and two pounds per week after giving birth. This “burn rate” will help ensure a safe, healthy and steady weight loss without compromising mom’s health or the health of the new baby.
Do avoid becoming obsessed of how fast the weight has to come off your body. Having a goal is great and keeps you motivated. However - over-doing it will not bring the results expected. In fact, it might may things even worse. Pregnancy depressions are already common enough. There is no need to become depressed because the weight loss is not happening fast enough.
About the Author
Christoph Puetz is a successful entrepreneur and international book author. Examples of the work he is involved in can be found at Health Portal, Highlands Ranch and at Parenting Information.
The article can be published by anyone as long as the resource box (About the Author) is posted on the website including the links. These links must be clickable.
What Would I Do Without My Doula?
July 20, 2008
By the time my husband and I finally got pregnant the first time, I had done a lot of reading about birth options and we had already decided to have a midwife instead of a doctor. We believe that pregnancy is a healthy state of being, and unless something came up, a midwife was the best way to go for us. Besides, where we live, a midwife can deliver babies at hospitals, so I felt that was the safest way to go. (Although, now, I feel I could have had my babies at home… but that is a whole other article!).
When I was a few weeks pregnant I came across an article on doulas, but I had never heard of a doula so I wasn’t quite sure what to make of it. A doula is a woman who supports women through childbirth. “Doula” is an ancient Greek word meaning “servant to women”. A doula provides a woman with continuous emotional support, aides in her physical comfort, and encourages the laboring woman. She also provides praise, reassurance, and explains what is going on during the labor. While some husbands and partners may feel that it’s their job to offer support to the laboring woman, and therefore initially feel that they would not want a doula, after the birth they are very pleased and relieved that they had one. A doula can help husbands and partners by suggesting ways they can help the laboring woman, and doulas actually assist the husband to feel like he is contributing.
Studies have shown that women supported by a doula during labor have:
- 50% reduction of cesarean rate
- 25% shorter labor
- 60% reduction in epidural requests
- 30% reduction in analgesia use
- 40% reduction in forceps delivery
From Mothering the Mother: How a Doula Can Help You Have a Shorter, Easier and Healthier Birth by Marshall H. Klaus (Perseus Press, 1993)
When I was about halfway through my pregnancy, we decided to interview some doulas and see if it would be right for us. We met with three doulas. The first one was Jan, who we ultimately picked. We liked her right away and I wanted to hire her on the spot, but my husband insisted that we meet the other doulas too because we might find someone we like even more. (How could that be possible?, I wondered.) Well, it turned out that the other two doulas were wonderful too, but our instincts told us to go with Jan. So we hired her.
We had to give her a deposit of $100 to confirm our commitment, and sign an agreement as well. How do I describe this fabulous woman? She is very tall and has a great presence. She is quiet, knowledgeable and thoughtful; she doesn’t speak a lot, but when she does it is carefully thought out. In other words, she is not “chatty” but not shy either. She has an engaging smile, she is discrete, and she is strong. I felt like she could sweep me up in her arms and take care of me!
Jan came over several weeks before my due date to do some one-on-one prenatal training with both James and I. She is a lactation consultant as well so she helped by answering my questions about breastfeeding in addition to my questions about what to expect during labor.
I went into labor three days before my due date, on August 13, 2001. It was about midnight and I was just getting into bed when I felt (or heard?) a loud POP! And then another one. And warm liquid dribbling down my legs. My water had broken. Yay! This was finally happening.
The contractions started immediately and James rubbed my thigh while I rested on the bed. The contractions got closer and closer together and James called Jan at about 5:00am when they were about 5 minutes apart. They got really intense after that and by the time Jan arrived, I was vomiting in a bucket on my bed.
Jan threw down the birth ball she was carrying, flew across the bed, grabbed my hand, looked me straight in the eye with her face close to mine and said, “I want you to breathe like this.” In an instant, she had me calmed down and breathing effectively. She was amazing. I went from being in a total panic to feeling like everything was going to be ok.
When my midwife arrived at 7:00am, she told me I was about 3 centimetres dilated. I was so disappointed! But Jan was my cheerleader, telling me that I was working so hard, and managing so well, and that my body was only going to give me what I could handle. She helped James help me by suggesting things he could do for me, and he felt taken care of by Jan as well.
It was only about an hour later that Jan noticed my breathing had changed and she called out to our midwife who was in another room doing paperwork. Our midwife didn’t think that I could have progressed that quickly but Jan stood her ground and said, “It really sounds like she is trying to push.” So the midwife checked me again (doulas do not perform medical tasks) and I was about 7 cm dilated! This was going fast. Suddenly everybody sprung into action and started gathering up all the bags and things we needed for the hospital. If it wasn’t for Jan, I really don’t think we would have made it on time.
While James drove, Jan sat with me in the backseat holding my hand, talking to me, encouraging me and calming me. She was so amazing! After we got to the hospital, she never left my side. James had to go fill out the paperwork and park the car, but Jan was there beside me constantly.
I felt such complete trust in Jan that I had to hold her right hand a particular way through each contraction. It was quite funny! A contraction would start and I’d yell, “Hand! Hand!” and Jan would come running and grab my hand. I don’t know why, but it was only Jan’s hand that comforted me. It had to be Jan’s hand.
She also helped by taking me to the bathroom and getting me water to drink, a cold cloth for my forehead (without being asked), and waving tissues with aromatherapy oil on them around the room. I found that I couldn’t communicate what I wanted or needed, but Jan always seemed to know, thank goodness. She suggested different laboring positions and she helped during the delivery by suggesting positions for pushing, too. I only pushed one hour and then our beautiful Hana was born. (Hana means “flower” in Japanese). Jan stayed with me while I delivered the placenta (James was on the other side of the room with Hana) and helped me attempt to breastfeed right away. She stayed for about 4 hours after Hana was born and helped me take a shower and gave me lots of help with breastfeeding.
What more can I say about having a doula? She made my birth experience fantastic. I am one of those people who can honestly say that I enjoyed labor (twice!) and I want to do it again! When we found out we were pregnant for the second time, I could not imagine doing it without Jan. It was a much easier labor and birth, but I am still so grateful that Jan was there ? she made it a great experience again. It is true that continuous support during labor has many, many benefits, and I am one of the “lucky” (or is it “well prepared” because I hired a doula?) women who was able to fully experience birth without drugs, or intervention. I had a healthy birth and a healthy baby. And a doula to help us through it all.
For more information, or to find a doula in your city, visit http://www.dona.org, the Doulas of North America website.
I wish you all the best during your labor and birth!
Suzanne Doyle-Ingram is the mother of two daughters, Hana and Alexa, and married to her best friend James, who is a stay-at-home dad and educational game developer (and he makes a mean grilled chicken!). Suzanne is also the creator of http://www.pregnancy-leads-to-new-babies.com, an informative site for pregnant women and new moms, which provides information on pregnancy, labor, and how to take care of your new baby. As a family, Suzanne, James, and the girls enjoy kite flying, swimming at the beach, and visiting new restaurants. Visit her website at http://www.pregnancy-leads-to-new-babies.com for more of Suzanne’s articles.
Infertility and Pregnancy
July 9, 2008
When a couple is unable to conceive a child, it is the couple’s problem, and not the "fault" of one partner or the other. Female issues are the most common reasons cited, but some studies suggest that up to 40% of infertility is caused by one or more reasons originating with the male partner.
For men, the problem can only be from one source- the sperm. However, that can involve a variety of difficulties from low sperm count, to poor motility, or abnormal shape/structure of the sperm. In many instances the cause of the sperm difficulties are idiopathic, with no known reason. Some issues may be a result of a past illness, current drug therapy, personal habits such as drinking and smoking, or varicocele veins. Recommendations for improving things like sperm count, include looser clothing around the genitals, eliminating hot baths or hot tubs, giving up alcohol and smoking, and stress reduction.
For women, the difficulties are more varied, and cover a range of functions and issues within her reproductive system. She may have ovulation problems that are due to problems with the thyroid gland, hormone imbalance, and physical or emotional stress. The cervix can also be a cause for concern, either through narrowing, acidic mucous, or a literal "sperm allergy". Her uterus may be harboring cysts, fibroids, and polyps, or she may have endometriosis, a condition where tissue from inside the womb, has attached itself somewhere in the abdomen, possibly blocking or restricting normal function of the fallopian tubes and ovaries.
Even when a couple has taken all the recommended tests, some 10% remain infertile, for no known reasons. For them, hormonal fertility treatment or in vitro fertilization, may be viable options for having a family.
Visit http://www.MalcolmsWeb.com and sign up for free weekly tips that will take the mystery and fear out of pregnancy.
How To Avoid Post Partum Depression
June 29, 2008
New mothers sometimes experience "postpartum blues." This is understandable. Pregnancy and birth are very dramatic events for your body ? both physically and emotionally. So, it’s common to feel a little weepy, irritable or moody in the first few days after birth.
If you eat well, supplement your diet with high quality whole food supplements (especially omega-3 oils and B vitamins) and get enough rest, mild cases should pass quickly.
But, if "the blues" continue for more than just a few days, or if you’re feeling really depressed and down, please don’t try to tough it out. Get professional help. Ask your midwife or doctor to connect you with someone who can give you appropriate counseling.
Here are some tips that can help prevent or ease the symptoms of postpartum depression:
1. Ask for help after the birth. Here are some things friends and family could do for you during the first few weeks that might work better than giving the traditional baby shower gifts. They can:
Bring you a complete dinner (hot and ready to serve);
Volunteer to do your laundry;
Take care of your house cleaning;
And/or entertain older children with a day of play.
2. Get yourself out of the house ? if only onto the deck or front steps ? for at least a few minutes each day. Set up a lawn chair, wrap up yourself and your baby in a blanket and take a break. Set aside this time for you and baby.
3. Take it easy. Play with your baby. Visit with friends and family. Listen to relaxing music. Watch some old "feel good" DVD’s. Get someone to take you and baby for a long ride in the car. Baby will probably fall right off to sleep and you’ll get a chance to shut your eyes and relax for a few moments too.
4. And most importantly, eat really well and get yourself on a complete whole food nutritional program including pure omega-3 oils with EPA and DHA. I’ve seen high quality whole food supplements, combined with wholesome eating, consistently succeed in overcoming postpartum depression.
This is a special time for both you and your baby. It’s important to relax and enjoy it. And remember, if your depression continues for more than a few days, please don’t be afraid or ashamed to ask for help. Support is only a phone call away at the National Post Partum Depression Hotline 1-800-PPD-MOMS (773-6667).
Moss Greene makes it easy for you to create buoyant, vibrant health. Learn the simple things that make a big difference in how you look and feel. To receive your free newsletter visit her Health and Fitness Newsletter page.
