Families First of Loudoun

Beyond the Bishop Score

Since the 1960′s, the Bishop Score has been a frequently used predictor in assessing feasibility of induction of labor. This scoring system attempts to predict the success of induction by assessing five factors: position of the cervix in relation to the vagina, cervical consistency, dilation, effacement and station of the presenting part. The higher the score, the higher rate of success of the induction. A score less than five indicates an unfavorable cervix for induction. Some texts also reference the Burnett Scale* which assesses approximately the same factors.

In an effort to find a more accurate predictor of successful induction, two relatively new methods are now being used: transvaginal sonography of the cervix and comparative levels of fetal fibronectin.

The length of the cervix can be measured by transvaginal sonography. In expectant mothers with an unfavorable Bishop score (typically less than 7), a cervical length of less than 26 mm is associated with a lower risk of cesarean section and a shorter duration of labor. In several independent studies, when the Bishop score has been as low as 3 and the cervical length was 28 mm, successful induction has been achieved.

To measure the cervical length, an expectant mother goes to an office or radiology department of the hospital. It is an outpatient procedure, where the mother’s bladder is empty and she wears a hospital gown. A transducer (roughly the size of a tampon) is used to transmit ultrasound/ sound waves, which bounce back to produce an image that can be recorded. The transducer is inserted into the vagina and the image is noted on the monitor or it can be printed. This information is reported back to the physician for evaluation.

Fetal fibronectin is a protein that can be found in fetal membranes and amniotic fluid. When present in cervical and vaginal secretions, fetal fibronectin can be useful in determining a woman’s risk for preterm labor and may be predictive in estimating when the mother is ready for labor.

The test for fetal fibronectin is simple and painless, involving only the swabbing of the vaginal and cervical area for a sample of secretions.

It is important to note that expectant mothers showing signs of preterm labor should be tested at 24 to 25 weeks’ gestation, while high-risk women without symptoms can be tested as early as 22 weeks’ gestation and continually tested as appropriate.

Is there, then, a relationship between cervical length, fetal fibronectin and the increase of oxytocin receptor sites on the uterus? We will be anxiously awaiting research on this!

From Birthsource.com

Cord Blood – To bank or not to bank

I found this article on Midwife Thinking blog and after reading several times, I am still on the fence about how I feel.  On one hand I have heard wonderful stories about cord blood making a better quality of life your very ill children and on the other hand shouldn’t all babies receive all of the their own cord blood in hopes of them not getting sick?  I have been thinking about this a lot in the last few days and still don’t know how I feel.  I can see both sides of wanting to do it and not wanting to do it.   I did not bank cord blood with my 2 children but at the time decided not to do it.  If I were to have another child what would I do?  I DON”T KNOW.  What are your thoughts or experiences?

Cord Blood Collection: confessions of a vampire-midwife Posted on February 10, 2011 by midwifethinking

When I was a bright-eyed and bushy-tailed student midwife I was awarded with a certificate and a box of chocolates. My achievement was collecting the most cord blood in the hospital. At that time the Local Health District was trialling a cord blood bank. The collected stem cells were to be used for treating leukemia and for research. Every woman birthing in the hospital was asked to donate cord blood for the good cause, and many generously agreed. I was exceptionally good at collecting the blood. This post is a small attempt to repent for my sins.

In recent years cord blood collection and storage has become popular, particularly in the private sector. Cord blood contains magical stem cells, and the idea is that if your baby becomes ill in the future you may be able to use these cells as treatment. My concern with cord blood banking is the inadequate and misleading information given to parents. This misinformation raises both ethical and legal issues. The procedure involved in collecting cord blood is sold as ‘simple, safe and effective’. When it comes to decision making about cord blood only three options are presented: keep it (pay for storage), donate it (to a public initiative) or throw it away. What about letting it finish its journey up the umbilical cord and into the baby?

Even the term ‘cord blood’ is misleading – blood is merely collected via the cord. In addition the promotional materials talk about collecting ‘blood from the placenta’ without acknowledging that the baby/placenta are one blood circulation unit. After birth the blood from the placenta transfers to the baby, assisting transition to breathing. Knowledge about the short term and long term health benefits of allowing placental circulation to complete the job is becoming widespread. See this post for an overview of the physiology of newborn transition to breathing, and for links about the health benefits of full blood volume for babies. With further research one of the long term benefits may actually turn out to be protection against some of the illnesses stem cells are being collected to treat.

Parents need to be informed that cord blood collection requires premature cord clamping, and that the blood being collected belongs to their baby.

In the procedure guide for collection there is no mention of when to clamp the cord. This may lead parents to believe they can delay cord clamping and still collect cord blood. This is not an option. After the placenta has finished transferring blood to the baby it is difficult to collect even the few mls needed for blood group testing (Rh neg). The large umbilical vessels are empty and by the time the placenta has been birthed the blood in the small vessels has begun to clot. You have to faff about trying to scavenge enough un-clotted blood from the small vessels covering the placenta. The minimum required for cord blood collection is 45mls. Take a look at the photograph of a placenta that finished its circulation before being clamped. If you reckon you could get 45mls out of that, you deserve a certificate and some chocolates.

Paediatric guidelines state that ‘blood draws in infants and children should not exceed 5% of the total blood volume in any 24 hour period’. A 3.6kg newborn has a blood volume of around 280mls – so the maximum blood draw would be 14mls. How come these rules don’t apply immediately following birth? The collection bag for cord blood holds 250mls (35mls already taken up with anticoagulant fluid). The minimum amount of blood acceptable for collection is 45mls, and the maximum possible is 215mls. During my vampire-midwife days I reckon I generally filled at least half of the bag – so around 90mls. In the photograph at the top of this post the bag looks more than half full. This amount of blood represents a significant proportion of the newborns blood volume.

I wonder how many parents would consent to someone coming onto the postnatal ward and sticking a needle into their baby to collect around a third of their blood volume? It’s the same thing… only the needle is in the baby not the umbilical cord.

I am not saying cord blood banking shouldn’t be an available option. All I am suggesting is that parents need adequate information before they make a decision to withdraw a significant amount of their baby’s blood volume. They need to be able to weigh up the definite benefits of full blood volume at birth vs a possible treatment for an unlikely future illness. Cord blood is baby’s blood.

PS: I no longer participate in stealing babies blood. We live and learn.

Saying “No” to Induction

When Halloween arrives, I not only think about ghosts and goblins, but I think about when I was pregnant with my second child almost 10 years ago (wow!…has it really been that long?!). His due date was October 31^st, and on Halloween night when my neighbors came by my house to bring their children trick or treating, instead of “trick or treat” I heard, “You haven’t had that baby YET?!” Here I was, very pregnant (you’ll find out why soon) but waiting patiently for my baby to determine when he wanted to be born. I was in no hurry. I knew my body and my baby were doing amazing things in preparation for birth. This leads me into this article that I feel states very important facts about why women may want to become well informed before they decide to have their labor induced. My son was born, when he was ready to be born, exactly a week after Halloween, November 7^th weighing a little over 9 ½ pounds. It was a wonderful birth and one worth waiting for!

Saying “No” to Induction
Judith A. Lothian, PhD, RN, LCCE, FACCE

JUDITH A. LOTHIAN is a childbirth educator in Brooklyn, New York, and a member of the Lamaze International Board of Directors. She is also an associate professor in the College of Nursing at Seton Hall University in South Orange, New Jersey.

Abstract
Induction rates have increased dramatically. A childbirth educator wonders how she can help pregnant women say “no” to induction. This column describes the last days and weeks of pregnancy as vitally important for both the mother and her baby, insuring the baby’s maturity and the mother’s readiness for labor. Women are encouraged to appreciate the last days and weeks of pregnancy and to have confidence that when a woman’s body and her baby are ready, labor will begin spontaneously. This information, as well as knowledge of how induction alters the process of normal labor and birth and increases the possibility of having a near-term infant, is the foundation for informed refusal.

Read the rest of this entry »

The Need for Chiropractic Care During Pregnancy

The Need for Chiropractic Care during Pregnancy

Happy Birthday!  Depending on your age, a birthday may be a time of introspection, celebration, or both.  The “holiday” that marks a newborn’s first breath leads to many challenges and opportunities for mom and the family.  How can you help mother and child embark on this adventure?  Here are some facts and tips.

As a pregnancy proceeds, mom’s body undergoes numerous changes.  The most obvious changes involve body shape and posture, but a hormone called relaxin subtly makes ligaments a little looser.  A good analogy is that the “rubber bands” (ligaments) that hold bones together become more easily stretched.  Though this extra “play” between the bones will be useful upon delivery, it can also predispose mom to injury (knees, fallen arches, back pain).  Since the feet are part of the shock-absorbing system that protects the knees, hips, and spine, and since chiropractic doctors are uniquely trained to help the human frame function at its best, it’s not surprising that some chiropractors will prescribe orthotics to support the feet to help limit pain during pregnancy and avoid permanent post-pregnancy fallen arches. Read the rest of this entry »

Hypnosis for Fertility

Have you ever heard of the couple who wanted a child so badly but they could not conceive so they adopted and then the new mother became pregnant?  How did this happen?  The pressure is off?  It certainly is not uncommon advice to hear from friends and relatives when you are attempting to conceive “to just relax.”  It’s sound advice but unfortunately it doesn’t quite work like that.  If people could “just relax” on command I am fairly certain that as a psychologist I would be out of a job.

Read the rest of this entry »

Preventing Preeclampsia

HypnoBirthing

There are many myths about childbirth that are perpetuated by the screaming, maniacal woman in the movies to the myriad of horror stories you hear from strangers in the grocery store once you are obviously pregnant.  I recall my aunt recounting how Carol Burnett described childbirth as pulling your lower lip over your head.  Sounds pleasant, right?

However, for me, and many other women, this is not the experience they have chosen for childbirth.  Chosen is the key word.  You actually have many choices for how you would like your childbirth to be.  For instance, at home or at the hospital?  Epidural or natural?  When nature comes calling or inducement? Standing or squatting?  In the bed or in the bath?  Many women do not realize that they have choices when it comes to how they want to birth their babies.   That is the purpose of HypnoBirthing – to help the mother have the safe, natural childbirth that she desires.

Read the rest of this entry »

The Purpose and Value of Labor Support

The purpose of professional labor support in the United States has changed over the years.  Doulas are there to provide physical and emotional support for the mother and her partner.  Doulas are becoming more mainstream in the labor and birth settings.

Years ago the birthing mother’s mother, sisters, aunts and other family members were a big support for the families but as people are moving across the country and away from family that leaves them with little support.  Sometimes the mother or couple chooses not to have family there. Sometimes it is even a single mother needing extra support.  This is where doulas come in and provide the support that would otherwise be lacking.

A doula is a calm, nurturing person with an understanding and respect for the birthing processes. Read the rest of this entry »

Doulas: Don’t Give Birth Without One!

You ask, “what is a doula and why should I hire one? For centuries, women have surrounded women during childbirth. Doula is a Greek word that means “woman servant.” Doulas are trained in non-medical ways to best serve women during their births so that they can have better birth experiences. Because of this, a doula becomes an important part of the birth team along with the care provider. Doulas attend births at hospitals, birth centers, and homes.

How does a doula serve the woman during labor so she can have the best birth possible? Read the rest of this entry »