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What is an episiotomy?

by Maxine
Posted April 25 2011 02:49pm
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An episiotomy is an incision of about 2.5 – 5 centimetres (1-2 inches) long, made to the bottom of your vagina to make the opening larger so your baby can be born. Your care provider would numb the area with a local freezing and then make the incision. Following delivery the incision will be stitched.

Currently there is no sound research to support the use of episiotomies being done routinely. The Society of Obstetricians and Gynaecologists of Canada recommends that "Episiotomies be done only if necessary, depending on the situation at the time of birth."

The disadvantages of this practice for mom include:

  • Pain and swelling due to the cut
  • Possible infection
  • Possible Increased blood loss
  • Possible painful sexual intercourse over a longer period of time

 


Video Alert!
When you're in the process of delivering your baby, it is important to Avoid Unnecessary Interventions.
Watch this video to learn more


 

Talk to your health care provider before you go into labour to discuss when your health care provider would use this practice.

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Medical practices (procedures) that may be used during labour

by Maxine
Posted August 25 2010 03:44pm
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The following medical practices may or may not be done depending on your labor, your caregiver's usual practice and the hospital's policies.

Common medical practices during labor include: monitoring your vital signs; timing the frequency and strength of your contractions and how you are coping; assessing the thinning and opening of the cervix and monitoring baby’s heart rate. 

The following medical practices may or may not be done depending on your labor, your caregiver's usual practice and the hospital's policies. Medical practices include, augmenting labor, inducing labor, continuous electronic fetal monitoring, giving intravenous fluids, giving oxygen to mom or baby, doing an episiotomy, using forceps or a vacuum extractor to help deliver your baby and or doing a caesarean section to deliver your baby. 

Talk with your healthcare provider about the practices that she uses before you go into labor.  Your healthcare provider can tell you about the policies or rules in the birth setting where you will deliver, or take a tour of your birth setting.  Taking a tour of your birth setting before going into labor allows you to see what the rooms and staff are like and to ask about their policies. This may help you and your partner or labour support person to feel more prepared for labour and birth.

What are vital signs?

Vital signs include blood pressure, heart rate, breathing rate and temperature.  These will be taken regularly during your labour by a nurse.  If complications arise with mom or baby these may be taken more frequently.  During labour your baby’s heart rate is assessed by using a doppler or using the electronic fetal monitor.

How does the labour staff assess my progress in labour?

Your health care providers will monitor your progress in several ways.  They assess the bloody show (the blood tinged mucus discharge) that occurs during labour.  They will time the frequency, length and strength of your contractions. They will do an internal examination by inserting two gloved fingers into your vagina to feel for the cervix at the end of your uterus.  The cervix must thin and open to 10 cm before your baby can be pushed down the birth canal.  Internal exams may only be done once or twice during your labour to prevent any bacteria from reaching your baby.

What is electronic fetal monitoring?

Electronic fetal monitor shows the baby’s heart rate and the frequency, length and strength of your contractions.  It may be used when you are admitted to the labour area to obtain a 20 minute reading or to obtain periodic readings during your labour to monitor your baby or it may be done continuously if there are concerns about how your baby is coping with labour.

Like any medical procedure there may be disadvantages to using it.  The disadvantages of this practice include:

  • Decrease in mom’s freedom of movement.
  • Limits mom’s ability to use the shower or bath for comfort or relaxation.
  • Sounds from the monitor can be distracting for some women and partners.
  • The Interpretation of fetal heart rate tracings is dependent on the expertise of the staff and there could be different interpretations made.
  • Continuous fetal heart monitoring has been associated with higher rates of Caesarean Section.

What is intravenous (I.V.) fluid?
These are solutions that may be given during labour to provide fluids for energy or as a way to deliver medication.  Solutions may be saline (salt – for fluids and blood balance) or dextrose (sugar – for energy). 

In some hospitals having an I.V. was routine for all mothers in labour; it is now considered an option to be used for medical reasons only, (such as having an Epidural, Labour Augmentation, Infection, Low blood pressure, Dehydration, Induction etc.). The main disadvantages to I.V.s are the possibility of infection at the site where the I.V. needle is inserted.

What is oxygen?

Oxygen is a gas that may be given to mom or baby if a medical concern arises.  It is given by mask or nasal prongs. Oxygen is used (by some hospitals) if baby’s heart rate takes a sharp decrease (called deceleration).  Oxygen is used during a caesarean section until the baby is delivered to insure that baby is getting sufficient oxygen.

What is augmentation of Labour?

Augmentation is the use of mechanical or chemical methods to strengthen contractions or encourage a labour that is going slowly.  Generally, care-providers start with the least invasive method and work up to the more invasive methods. Methods used include artificial rupture of membranes or use of oxytocin. 

Mechanical Methods:
Artificially rupturing the membranes that surround your baby is called an Amniotomy- it is also commonly called “breaking the water.” Your doctor or midwife inserts a sterile device which looks like a crochet hook into your birth canal, through the opening in your cervix and places a small tear in the membrane. The procedure feels similar to an internal examination of the vagina, and is almost painless. If the Amniotomy does not work another option will be decided on.

The disadvantages for this practice include:    

For Mom:

  • Some discomfort.

For Baby:

  • May result in changes in your baby’s heart rate.

For both Mom and Baby:

  • Once membranes are artificially ruptured, there is a greater risk of infection for Mom and baby.
  • If these procedures do not work, other ways to start labour are used.    

Chemical methods:
Giving Mom a drug called Pitocin, which is a synthetic form of oxytocin which is naturally released in your body during labour.  Your contractions will be monitored to help determine the appropriate dose.  Once strong contractions have started the Pitocin would be stopped. There are several disadvantages to this method:

For Mom:

  • Stronger contractions which may require pain control measures such as narcotic drugs or epidural.
  • May create cascade of subsequent interventions, such as the need for pain relief, continuous fetal monitoring and increased chance of forceps or vacuum extractors or Caesarean birth.
  • If the induction fails then an emergency Caesarean section would be needed.

For Baby:

  • Possible difficulty coping with the stronger labour contractions.
  • Possible Caesarean birth and the risks that go along with Caesarean.
  • May contribute to jaundice in baby.

What is an episiotomy?
An episiotomy is an incision of about 2.5 – 5 centimetres (1-2 inches) long, made to the bottom of your vagina to make the opening larger so your baby can be born. Your care provider would numb the area with a local freezing and then make the incision. Following delivery the incision will be stitched.  

Currently there is no sound research to support the use of episiotomies being done routinely.

The Society of Obstetricians and Gynaecologists of Canada recommends that “Episiotomies be done only if necessary, depending on the situation at the time of birth.”
The disadvantages of this practice for mom include:

  • Pain and swelling due to the cut
  • Possible infection
  • Possible Increased blood loss
  • Possible painful sexual intercourse over a longer period of time

 


Video Alert!
When you're in the process of delivering your baby, it is important to Avoid Unnecessary Interventions.
Watch this video to learn more


 

Talk to your health care provider before you go into labour to discuss when your health care provider would use this practice.

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Finding A Doula

by Maxine
Posted July 27 2011 01:37pm
Filed under:

Research says that having a doula (a trained labour support professional) as part of your labour support team can keep birth safe and healthy and help you avoid unwanted interventions. But how do you find someone who is a good fit for you? This handout features some tips you can use when trying to find a doula.

 

Download the Finding a Doula handout (PDF)

 

Still unclear about the role of a Doula? Learn more »

 

This information was provided with permission by:

Injoy-MothersAdvocate-Lamaze
Injoy
Mother's Advocate
Lamaze

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What Should I Know About Premature or Preterm Labour?

by Maxine
Posted August 5 2010 10:52am
Filed under:

The questions and concerns that expectant parents have about premature or preterm labour are many. What are the signs? Can something be done to prevent it? Will premature labour affect the baby? Who is more at risk? What can dad do if mom goes into premature labour? Here are some answers to these common concerns. Of course, you should also talk to your pregnancy care provider about any of your concerns.

What is premature labour?

Preterm labour is contractions or the rupturing of membranes that happens before 37 weeks of pregnancy.

How common is premature labour?

About 1 in 13 babies in Canada are born before 37 weeks.

Is premature labour a problem for the baby?

Premature labour can be a problem for your baby. The longer that your baby stays in the mother's uterus, the longer the baby has to grow and develop in this very special environment. A baby that is born too early may face many problems because some of the baby's body systems have not yet matured.

Some of these problems may affect a baby for life. A baby's lungs, digestive system, eyes, ears, skin and immune system can all be affected if the baby is born too early. Additionally, premature babies do not have many fat deposits and often have trouble staying warm.

What causes premature labour?

In many cases, it is still not clear what causes premature labour. About half of premature labours happen in totally healthy women with normal pregnancies. However, research has shown that there are some factors that may put women at risk for premature labour.

What factors can increase the risk of premature labour?

  • Not having regular prenatal care

  • Smoking

  • Not eating enough healthy food

  • Using street drugs

  • Having previous miscarriages

  • High blood pressure

  • Extra stress

  • Physical or emotional abuse

  • Being underweight, less than 45.5 kg

  • Constant illness such as high blood pressure or diabetes

  • Working more than 8 hours a day, working night shifts or changing shifts

  • Very tiring physical work

  • Having a previous preterm baby

  • Expecting more than one baby

  • Infections such as vaginal, bladder and kidney infections

  • Fibroids in the uterus or what is referred to by doctors as an "incompetent cervix" that opens early

It is important that you know the signs that indicate a potential problem with your pregnancy and that you discuss any questions or concerns with your doctor or midwife.

What are the signs of premature labour?

  • Contractions or stomach cramping

  • Fluid leaking from the vagina

  • Bleeding or clots from the vagina

  • Backache or pressure in the back

  • Pressure in the perineum as if the baby is pushing down

  • More discharge from the vagina

Are severe or constant headaches, change in vision or dizziness also signs of premature labour?

These are not signs of labour, but they may show that mom is developing pregnancy induced hypertension (PIH). These symptoms are signs that there may be a problem with the pregnancy.

Other signs that you should discuss with your doctor are sudden, severe or constant nausea and vomiting, sudden swelling of hands, feet or face, fever or changes in your baby's movement. It is very important that you know about and recognize these signs of pregnancy problems.

These are signs that your doctor needs to know about. Call your doctor or midwife if you develop any of these signs.

What should happen if mom does go into premature labour?

  • Call your doctor or midwife after you have arrived at the hospital.

  • If mom is having contractions or stomach cramping, rest a hand on her lower belly. When mom feels tightening or squeezing, time how long it lasts and how many minutes go by before the next tightening occurs. The staff at the hospital may ask how long the cramps last and how often they are coming.

  • Go to the hospital if you have any of the following signs of preterm labour: there is fluid or blood leaking from the vagina, if mom feels the baby is pressing down, if there are regular contractions or if there is a backache that comes and goes with a pattern of stomach cramping or there is more discharge from the vagina than normal.

What can you do to prevent premature labour?

  • Get regular prenatal care from a healthcare provider as soon as possible.

  • Get regular dental care from a dentist.

  • Brush and floss regularly.

  • Eat properly.

  • Quit smoking.

  • Stop using street drugs.

  • Reduce stress.

  • Avoid tiring work.

  • Ask for help if being abused physically or emotionally.

  • Ask for help to deal with smoking and drug use.

  • Take time to rest during the day.

  • Avoid overdoing it when exercising.

  • Learn the signs of premature labour; with prompt medical care, premature labour may be stopped.

  • Know what steps to take if you think you are in premature labour. Check with your doctor or midwife for advice.

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