http://www.latimes.com/health/boostershots/la-heb-childbirth-20110614,0,2941171.story
Pregnant women show an amazing lack of knowledge about childbirth options, study shows
By Shari Roan, Los Angeles Times / For the Booster Shots blog
June 14, 2011
Fewer pregnant women and their partners are attending prenatal education classes these days and appear to be quietly following whatever advice the doctor or midwife recommends, researchers said Monday.
Doctors, led by Dr. Michael Klein of the Child & Family Research Institute and University of British Columbia, surveyed 1,318 healthy pregnant women. They found many seemingly unprepared to make their own decisions regarding childbirth options, such as whether to have natural childbirth or a Cesarean section.
Caesarean sections are a major factor in pregnancy-related deaths, report finds
Fewer than 30% of the women, all first-time mothers, said they had attended prenatal childbirth classes. Many said they used the Internet or books to become informed about childbirth. Still, a shockingly high number could not answer basic questions regarding the pros, cons or safety issues associated with epidurals, episiotomies, Cesareans and other childbirth options. The women who were receiving obstetrical care from midwives tended to be more informed about their options compared with women receiving care from a medical doctor.
"[E]ven late in pregnancy, many women reported uncertainty about benefits and risks of common procedures used in childbirth," Klein said in a news release. "This is worrisome because a lack of knowledge affects their ability to engage in informed discussions with their caregivers."
The study was published in the June issue of Journal of Obstetrics and Gynaecology Canada.
The type of provider mattered greatly in terms of what kind of care women received. The researchers published a related study in May in the journal Birth that showed younger obstetricians were much more likely to favor the routine use of epidurals and expressed more concerns about the safety of vaginal birth compared with older obstetricians. The younger obstetricians seemed to view C-sections as the preferred option for childbirth, the authors noted. In the United States, efforts have begun to reduce C-section rates. About one-third of all U.S. women have a surgical birth.
1. How long is the baby under water after birth?
The amount of time the baby is under water will not harm or help the baby. Many practitioners usually bring the baby up within 10 seconds or mom or dad can lift baby out of the water themselves. There is no physiological reason to leave the baby under the water for any length of time. There are several water birth videos that depict leaving the baby under the water for several moments after birth and the babies are just fine, because babies can breathe under water as long as they haven't taken their first breath of oxygen.
Physiologically, the placenta is supporting the baby with oxygen during this time though it can never be predicted when the placenta will begin to separate causing the flow of oxygen to baby to stop. The umbilical cord pulsating is not a guarantee that the baby is receiving enough oxygen. The safe approach is to remove the baby, without hurrying, and gently place him into his mother's arms.
2. What is the cost of a water birth?
The cost of a water birth is significantly less than that of a hospital birth and some provinces and states are now insuring them as standard coverage. The rental of the pool can be anywhere from $0 if you use your own home tub or a pool (or your midwives have them to borrow), if you rent or purchase it can be a few hundred dollars.
3. What should the water temperature be in the pool?
Water should be monitored at a temperature that is comfortable for the mother, usually between 95-100 degrees Fahrenheit. Water temperature should not exceed 101 degrees Fahrenheit as it could lead to an increase in the mother's body temperature which could cause the baby's heart rate to increase. It is a good idea to have plenty of water to drink and cold cloths for the mother's face and neck. A cool facial mist from a spray bottle is a welcome relief for some mothers as well.
4. When should I get into the water?
You should get into the water whenever you feel you are ready. When you begin to feel strong contractions, you brain will desire comfort, this is usually a good indicator. However, test the water prior to immersing. When you enter the water, your brain sends relaxation hormones to your body within 20 minutes of entering the pool and peak around 90 minutes. It is recommended to get out and walk around as a change of scenery and reimmerse to re-engage the relaxation chemicals in your body.
5. Who should I have with me?
It is recommended to have a midwife or doula at all times to monitor the baby and you. You may have any other support people around to encourage and relax you as this is the most important goal. You can even have a spouse or partner in the tub with you for periods of time.
6. What should I wear in the pool?
You can wear anything that feels comfortable that will not impede the delivery of the baby or many women wear nothing at all.
7. How long does a typical water birth take?
A water birth takes as long as any natural birth. The water is a means of relaxing. There is no evidence that it speeds up or slows delivery.
8. What if something goes wrong?
Have a backup plan and be flexible. A birth does not go always as planned and may move faster or slower than expected. There are many things that can be remedied by itself through birth and listening to your support staff and doula or midwife for their guidance. If a medical intervention is required, ensure you have items packed prior to the birth and any other support measures needed on call.
9. What can prevent the baby from breathing under water?
There are four main factors that prevent the baby from inhaling water at the time of birth:
- Prostaglandin E2 levels from the placenta which cause a slowing down or stopping of the fetal breathing movements. When the baby is born and the Prostaglandin level is still high, the baby's muscles for breathing simply don't work, thus engaging the first inhibitory response.
- Babies are born experiencing mild hypoxia or lack of oxygen. Hypoxia causes apnea and swallowing, not breathing or gasping.
- Water is a hypotonic solution and lung fluids present in the fetus are hypertonic. So, even if water were to travel in past the larynx, they could not pass into the lungs based on the fact that hypertonic solutions are denser and prevent hypotonic solutions from merging or coming into their presence.
- The last important inhibitory factor is the Dive Reflex and revolves around the larynx. The larynx is covered all over with chemoreceptors or taste buds. The larynx has five times as many as taste buds as the whole surface of the tongue. So, when a solution hits the back of the throat, passing the larynx, the taste buds interprets what substance it is and the glottis automatically closes and the solution is then swallowed, not inhaled.
10. What types of pools can I use?
There are many types of pools women choose to use or rent. There are designated water birthing tubs you can rent for about $300-$500. Many women suggest using a deep kiddie pool, a trough or your own tub if it is large enough as these are often the same benefit and a smaller price.
Further Reads and Resources Sources
1 http://www.waterbirth.org