Below I have listed resources which you might find helpful. These are resources which I, colleagues, and/or other respected perinatal providers have recommended and/or which have been recommended by prior clients. You are encouraged to do your own discovery and confer with your medical provider where appropriate. Comments/details provided next to links reflect details available at the time that I added them to this page. Please confirm current details at the websites provided &/or elsewhere.
INTEGRATE: "babies who must accommodate a twisted space in womb are more likely to have difficulties after birth with feeding, digestion, sleep, & fussiness." ~Debra McLaughlin, CST, CPM, LM, author of MAP for Better Birth
Please read the entire article, or at least the closing section, "What's the Bottom Line?" Here are a few morsels to peak your interest in the article:
Calculation: "the estimated due date of 40 weeks is not accurate" In a study of 1,514 healthy women:
First Time Births: "50% of all women giving birth for the first time gave birth by 40 weeks and 5 days, while 75% gave birth by 41 weeks and 2 days" and
Subsequent Births: "50% of all women who had given birth at least once before gave birth by 40 weeks and 3 days, while 75% gave birth by 41 weeks.
Stillbirth: "Although most researchers have found an increase in stillbirth rates in the late term and post term period, the “absolute” increase in risk is small until about 42 weeks, after which it reaches about 1 out of 1,000."
ACOG Guidelines: "ACOG recommends that induction of labor should take place between 42 weeks 0 days and 42 weeks 6 days, and that induction at 41 weeks can also be considered. If a person planning a VBAC goes post-term, this does not mean they have to have a repeat Cesarean." [Here's an excerpt directly from the ACOG website: "labor induction may be considered when a woman is in week 41, and is recommended if she is in week 42."]
"In a large observational study that enrolled more than 17,000 pregnant people in Finland, researchers found that ultrasound at any time point between 8 and 16 weeks was more accurate than the LMP." In a more recent study, where researchers measured due date accuracy more precisely, it was "found that the most accurate time to perform an ultrasound to determine the gestational age was 11-14 weeks. About 68% of people gave birth ±11 days of their estimated due date as calculated by ultrasound at 11-14 weeks. This was a more accurate result than any of the other ultrasound scans, and more accurate than the LMP."
When is the baby ready to be born? A few research articles on this general topic:
"Parturition is timed to begin only after the developing embryo is sufficiently mature to survive outside the womb. It has been postulated that the signal for the initiation of parturition arises from the fetus... Herein, we provide evidence that this signal originates from the maturing fetal lung.... This hormonal signal, transmitted to the uterus by fetal AF macrophages reveals that the fetal lungs are sufficiently developed to withstand the critical transition from an aqueous to an aerobic environment." from article Surfactant protein secreted by the maturing mouse fetal lung acts as a hormone that signals the initiation of parturition
"The transition from a fetus to a newborn is the most complex adaptation that occurs in human experience. Lung adaptation requires the coordinated clearance of fetal lung fluid, surfactant secretion, and the onset of consistent breathing.... the cardiovascular response requires striking changes in blood flow, pressures and pulmonary vasodilation. The newborn must also quickly control its energy metabolism and thermoregulation... Abnormalities in adaptation are frequently found following preterm birth or delivery by cesarean section at term, and many of these infants will need delivery room resuscitation to assist in this transition." from PubMed article Physiology of Transition from intrauterine to Extrauterine Life
"The single most important thing we can do for a healthy baby across a life course is to ensure that microbial seeding occurs completely at birth through vaginal delivery, when possible; skin to skin contact occurs; and that the microbes are supported through breastfeeding of significant duration -- this should be on EVERY birth plan... that's what's going to influence the health across a lifespan versus one filled with diseases."
"If a mother must have a C-Section, then there are things that she can still do that can be really helpful for baby:
very important to have immediate skin to skin contact, when that's possible;
Breastfeeding of a significant duration -- 6 months or more is really important, again, to nurture the microbes in the baby's gut; in addition
vaginal swabs... may be important in attempting to seed what the baby would have gotten had the baby had vaginal delivery"
In newborns, GBS is a major cause of meningitis (infection of the lining of the brain and spinal cord), pneumonia (infection of the lungs), and sepsis (infection of the blood) (CDC 1996; CDC 2005; CDC 2009). Group B strep lives in the intestines and migrates down to the rectum, vagina, and urinary tract. All around the world, anywhere from 10-30% of pregnant people are “colonized” with or carry GBS in their bodies (Johri et al. 2006). Using a swab of the rectum and vagina, people can test positive for GBS temporarily, on-and-off, or persistently (CDC 2010). Being colonized with GBS does not mean that someone will develop a GBS infection. Most people with GBS do not have any GBS infections or symptoms. However, GBS can cause urinary tract infections and GBS infections in the newborn (CDC 2010), and people who have preterm births are 1.7 times more likely to be colonized with GBS during labor than people who do not have preterm births
Early infection is caused by direct transfer of GBS from the mother to the baby, usually after the water breaks. The bacteria travel up from the vagina into the amniotic fluid, and the fetus may swallow some of the bacteria into the lungs—leading to an early GBS infection. Babies can also get GBS on their body (skin and mucous membranes) as they travel down the birth canal. However, most of these “colonized” infants stay healthy
Researchers have estimated that the death rate from early GBS infection is 2 to 3% for full-term infants. This means of 100 babies who have an actual early GBS infection, 2-3 will die. Death rates from GBS are much higher (20-30%) in infants who are born at less than 33 weeks gestation (CDC 2010). Although the death rate of GBS is relatively low, infants with early GBS infections can have long, expensive stays in the intensive care unit. Researchers have also found that up to 44% of infants who survive GBS with meningitis end up with long-term health problems, including developmental disabilities, paralysis, seizure disorder, hearing loss, vision loss, and small brains. Very little is known about the long-term health risks of infants who have GBS without meningitis, but some may have long-term developmental problems
The CDC recommends measuring GBS with a culture test at 35-37 weeks of pregnancy. This is done by swabbing the rectum and vagina with a Q-tip, and then waiting to see if GBS grows. It takes about 48 hours to get the results back. The goal is to get the results back before labor begins (CDC, 2010). A culture test during labor is considered the “gold standard,” but this method is not used in practice because it takes too long to get results back....researchers found that the 35-36 week culture test only identified 69% of the pregnant people who actually had GBS during labor. Meanwhile, the in-labor rapid test was much more sensitive—it identified 91% of those with GBS during labor (Young et al, 2011).Since the Young study, at least two other studies have found that the rapid test identified 100% of people with GBS during labor. (Helmig et al., 2017; Wolheim et al., 2017).One drawback of rapid-testing is that it can still take up to an hour or more to get the results back, and people would have to wait to get antibiotics until the results came in (Honest et al. 2006; Young et al. 2011). In one study, researchers found that the average time it took to receive a result was 75 minutes when the test was conducted by laboratory staff, and 165 minutes when the test was conducted by midwives and obstetricians (Mueller et al. 2014).
"The CDC recommends that antibiotics be given every 4 hours, starting more than 4 hours before birth. Recent evidence supports these recommendation.. When penicillin or ampicillin was given more than 4 hours before birth, it was effective 89% of the time. In contrast, giving antibiotics 2-4 hours before birth was effective 38% of the time. Antibiotics given less than 2 hours before birth were effective 47% of the time. When Clindamycin (another antibiotic) was used in place of penicillin, it worked very poorly (only 22% effective). There was no statistical difference between the 2-4 hour window and the 2-0 hour window, so even though the percentages look different, they are not statistically significant.
"Most research has found that antibiotic resistance has not been a problem with penicillin, the drug most commonly used to prevent early GBS infection... Many people who have an allergy to penicillin can take Cefazolin instead... Which antibiotic a birthing person can take depends on the results of their GBS lab tests....
If you use the antibiotics, you will have an IV placed, but it only takes 15-30 minutes for the antibiotics to run in. The antibiotics are only given every 4 hours until birth, which for many people is only once or twice. When the IV is running, it should not limit positioning, walking, or even laboring in water.
For the hours in between, parents can ask for the IV can be “hep-locked” or “saline-locked” and detached, so that you are free from the IV pole....
There is a push for a GBS vaccine for several reasons: 1) in-labor antibiotics do not prevent GBS infection 100% of the time (Velaphi et al., 2003), 2) in-labor antibiotics can have side effects, 3) in-labor antibiotics do not prevent other GBS problems, such as preterm labor or late-onset GBS disease in newborns, and 4) developing countries have not been able to implement widespread use of antibiotics for GBS during labor.... Taking probiotics (lactobacilli) may lessen your chances of being colonized with GBS
"GBS positive, and I don’t get the IV antibiotics for some reason, what kind of tests will my baby need to have?" As long as your baby appears to be doing well and you did not have any additional risk factors (<37 weeks, infection of the uterus, water broken >18 hours), then there is no need for your baby to have any special testing. There are some situations where the CDC recommends that a well-appearing infant have some blood tests. The CDC also recommends 48 hours of “observation” for infants who are born to GBS positive mothers, but there is no need to separate mom and baby for this observation period.
HIGHLIGHT:Based on "Eighty-seven observational studies and 25 randomised controlled trials involving 55 859 and 2445 women, respectively, were included... Low blood vitamin D level could increase the risk of GDM, and vitamin D supplementation during pregnancy could ameliorate the condition of GDM"
The Deliberate Lies They Tell About Diabetes from Dr. Mercola - There is a staggering amount of misinformation on diabetes, a growing epidemic that afflicts more than 29 million people in the United States today. The sad truth is this: it could be your very OWN physician perpetuating this misinformation. [Ed: Although this isn't specifically about gestational diabetes, the information about how our bodies handle carbs is applicable to GD.]
One of our local midwives reported that one of her clients had blood sugar issues until she received a chiropractic adjustment. Apparently the nerves regulating insulin production or related function were under pressure from a skeletal issue that wasn't causing her any noticeable discomfort.
Hydration is very important to keeping your blood sugars in a healthy range, and it can be the easiest way! When you are dehydrated, your blood becomes more concentrated, so the relative glucose level goes up, even without eating anything. If you're having trouble drinking lots of water, there are some excellent natural low-carb sweeteners that might help; I really like the Sweet Leaf flavored stevia drops. Or just heating the water can increase a perception of sweetness, so try drinking plain hot water or adding some of the unsweetened flavoring drops available.
The food products that are believed to be safe during pregnancy and have some reputation for lowering blood sugar are cinnamon and apple cider vinegar. The Mosby's Handbook of Herbs & Natural Supplements says that cinnamon is fine during pregnancy when used as a spice or for flavoring. If it's easier to take that same amount of cinnamon as a capsule, that's fine, too. The same is true of apple cider vinegar, which Mosby's doesn't mention at all, presumably because it's a basic food product.
You want to avoid large amounts of supplemental vitamin C in the first trimester, just because there is a vague association between mega doses of vitamin C and miscarriage. Mega doses of vitamin C can cause loose stools or diarrhea, and it's remotely possible that the sympathetic uterine contractions COULD cause a miscarriage. It's more likely that these contractions simply cause the uterus to start expelling a pregnancy that had already ended for other reasons, but no woman ever wants to think that she accidentally caused a miscarriage. So avoid large doses of vitamin C in the first trimester.
Once you're into the second trimester (12 weeks), then higher doses of vitamin C are good for you and baby. Your body needs the vitamin C with bioflavonoids to make collagen, which is the building block of strong tissues for your baby, and for the new tissues that your own body is making. (This includes the new perineal tissue that your body is making, and I've seen a good association in my clients between high doses of vitamin C and perineal tissues that are more elastic and less likely to tear. This also applies to the amniotic membranes, and I've also seen an association in my clients between high doses of vitamin C and amniotic membranes that remain intact until the pushing stage, or sometimes even through the birth itself, i.e. the baby is born "in the caul".)
Vitamin C is also a liver tonic, and higher doses of vitamin C are the safest way to lower blood sugars, although the effect may be mild. You will need to pay close attention to how changes in your vitamin C intake affect your glucose numbers. My clients seem to benefit so much from vitamin C with bioflavonoids in so many ways that it's my first recommendation for supplements in addition to a prenatal vitamin with bioactive forms of folate (B9), B6 and B12.
How much Vitamin C to take? Your body simply excretes excess vitamin C, which helps to loosen the stool and can cause diarrhea. So it's not possible to overdose on vitamin C, but you don't want to waste your money, and who needs diarrhea? There's a recommendation to take vitamin C "to bowel tolerance", meaning that you gradually increase the amount you're taking until you notice that your bowels are a little too active; then back off to the previous happy dosage. I'd suggest starting with 500 mg of vitamin C with bioflavonoids daily (taken with any iron supplements to help absorb the iron), and then add another 500 mg with other meals or before bedtime until you reach your ideal level. (And you've probably noticed that vitamin C is also an excellent remedy for pregnancy or postpartum constipation! The bioflavonoids will also help prevent or heal hemorrhoids. Vitamin C with bioflavonoids is truly the pregnant woman's friend!) (My favorite product is Thorne's Vitamin C with Bioflavonoids. It's hard to go wrong with vitamin C, but many forms will not have the bioflavonoids that are so important. If you really need to watch your expenditure, you could take one of the Thorne per day and then take a less expensive form through the rest of the day.)
One of my clients was taking some silymarin to prevent a recurrence of intense itching from a previous pregnancy, and she noticed that it reliably reduced her blood sugars to a level that she couldn't achieve otherwise. It makes sense that additional liver support might benefit blood sugars levels, Silymarin is generally regarded as safe during pregnancy, but there is no formal research data to confirm this. It is frequently used to increase milk production postpartum. This wouldn't be my first recommendation to help keep blood sugars in a good range (I like to keep it simple), but if diet and exercise and cinnamon and vitamin C with bioflavonoids isn't enough for you, then this might be something to discuss with your healthcare provider. Even with the limited research, the Mayo Clinic says that milk thistle is generally safe, although it naturally recommends caution during pregnancy; since silymarin is the extract of milk thistle that is most helpful to the liver, taking silymarin instead of whole milk thistle avoids exposure to the other chemicals in milk thistle. My personal naturopath has told me that they consider silymarin to be safe for pregnancy women. (My favorite product is Metagenic's Silymarin 80. )
To Burn More Fat, Drink Apple Cider Vinegar - One study found that taking two tablespoons of apple cider vinegar before bed lowered blood sugar levels in people with type 2 diabetes by up to 6 percent the following morning. And the studies are only mounting…
Controlling Diabetes... The Natural Way By Angela Pirisi - CLA has the therapeutic potential to alter fat body mass and help manage insulin resistance. Studies have shown, for instance, the ability to decrease diabetes risk through dietary and supplemental means, such as fiber-rich cereal foods, magnesium, chromium picolinate, biotin, coenzyme Q10 and conjugated linoleic acid (CLA).
GDM: Vitamin D, Calcium Combo Improves Metabolic Profile [6/25/14] - Women with gestational diabetes mellitus (GDM) who took supplemental calcium plus vitamin D at 24 to 28 weeks' gestation experienced a number of benefits, including reduced fasting plasma glucose, serum insulin levels, and serum low-density lipoprotein (LDL) cholesterol levels and increased high-density lipoprotein (HDL) cholesterol levels . . .
For women who are really having trouble getting their numbers down, even with strict avoidance of all carbs, I will sometimes recommend some (or all!) of the following: CLA - Conjugated Linoleic Acid - 1-2 grams w/each meal Apple Cider Vinegar Cinnamon, either as part of foods or in moderate amounts from capsules Calcium - make sure she's getting the top end of the RDA for pregnant women Magnesium - make sure she's balancing her calcium supplement at a 1:1 ratio, plus extra if she eats a lot of dairy or non-dairy calcium sources Chromium - RDA Probiotics (not sure which is best) Biotin (Vitamin B7) Vitamin C - some sources say to take this on the higher end of bowel tolerance, and others say to avoid it at night if you're specifically trying to lower your fasting glucose numbers. Coenzyme Q10, CoQ10 pH balancing may be important
EXCERPT: "during pregnancy, less oxytocin is released in response to nipple stimulation than when a woman is not pregnant.5 ... Contrary to popular belief, the uterus is not at the beck and call of oxytocin during the 38 weeks of the “preterm” period. Even a high dose of synthetic oxytocin (Pitocin) is unlikely to trigger labor until a woman is at term.6.. While the baby is growing, the uterus is geared to have a muffled response to oxytocin; at term, the body’s preparations for labor transform the uterus in ways that make it respond intensely to oxytocin... “oxytocin receptor sites,” the uterine cells that detect the presence of oxytocin and cause a contraction... are sparse up until 38 weeks, increasing gradually after that time, and increasing 300-fold after labor has begun.6,7 The relative scarcity of oxytocin receptor sites is one of the main lines of defense for keeping the uterus quiescent throughout the entire preterm period—but it is not the only one... In order for oxytocin receptor sites to respond strongly to oxytocin they need the help of special agents called “gap junction proteins”. The absence of these proteins renders the uterus “down-regulated,” relatively insensitive to oxytocin even when the oxytocin receptor site density is high. And natural oxytocin-blockers, most notably progesterone, stand between oxytocin and its receptor site throughout pregnancy. 8,9,10With the oxytocin receptor sites (1) sparse, (2) down-regulated, and (3) blocked by progesterone and other anti-oxytocin agents, oxytocin alone cannot trigger labor. The uterus is in baby-holding mode, well protected from untimely labor.4"
Rachel Yellin's "Pregnancy, Birth & Beyond"Audio Relaxation Program(s): see here(TIP: Save 20% off of any or all 3 using code "delighted" at check-out.) (Rachel is a local Childbirth Educator, Depth Hypnosis Practitioner, and retired Doula.)
GentleBirthprogram/app: "GentleBirth combines mindfulness, hypnosis, CBT and sport psychology"
Releasing Psoas During Pregnancy (TRE position ("Constructive Rest Position"); see also Pigeon Pose, Modified Camel Pose, Modified Warrior 1 with a brick at the wall, and the Kneeling Lunge Pose) [article shared by Caitlin Clarke, D.C.]
Self-Care Spinning Babies (Seeking Balance, then working with Gravity & Movement to optimize space for baby's descent)
Daily Essentials: walk, Forward Leaning Inversion, healthy posture/positioning (awake & sleeping), stretches, psoas release, hip release, pelvic tilts (cat-table), rebozo manteada (circular sifting), etc.
Contracting Power of the Uterus, attributedto birth expert Carla Hartley "The purpose of labor contractions and retractions is to BUILD the fundus [top of the uterus, which will, when it is ready, EJECT the baby, like a piston. Without a nice thick fundus, there is no power to get baby out....Assigning a number to cervical dilation is of little consequence and we make a huge mistake by interpreting progress or predicting time of birth to that number."
Anatomy of pelvis, rotation of baby & benefits of birthing upright (using "dutch pelvis" visual)
Evidence Based Birth's Overview on Pain Management -- Improved Outcomes with
Gate Control approaches (massage, pressure, & other touch; movement & positions; tub/shower/heat; TENS Unit) &
Central Nervous System Control approaches (education/childbirth prep; deep breathing; visualization, hypnobirthing; continuous support from Doula; music, aromatherapy, relaxation)
Patience, Healthy Diet, Hydration, Peace
At Home Ideas:
Physical: nutritious food/drink, movement/exercise, orgasm/sex -- See also:
Sex: “Researchers think there’s three ways that sex could possibly affect natural labor induction. The prostaglandins in the semen, orgasm that stimulates uterus activity, and the increase in natural oxytocin from sexual activity. In summary, it’s safe to attempt unprotected, vaginal sex as a means to induce labor, as long as the membranes are intact, the sexual partner has been tested for sexually transmitted infections, and there are no other health concerns.” From EBB article
Orgasm (with or without intercourse)
Intercourse without condom (semen as nature's prostoglandin)
PubMed article 1: Those "who consumed six date fruits per day for 4 weeks prior to their estimated date of delivery... who consumed date fruit had significantly higher mean cervical dilatation upon admission compared with the non-date fruit consumers..and a significantly higher proportion of intact membranes... It is concluded that the consumption of date fruit in the last 4 weeks before labour significantly reduced the need for induction and augmentation of labour."
PubMed article 2: "The women in the dates-consumer group had significantly less need for augmentation of labour... In this study, date consumption reduced the need for labour augmentation with [synthetic] oxytocin but did not expedite the onset of labour. Therefore, dates consumption in late pregnancy is a safe supplement to be considered as it reduced the need for labour intervention without any adverse effect on the mother and child." [This article didn't specify how many dates were eaten per day nor when in the pregnancy this was begun.]
JMRH article: "Since the 37th week of gestation, the experimental group consumed date fruit (70 to 75 gr per day) until the onset of labor... Mean cervical dilatation was higher in women consuming date fruit, compared to the non-consuming group. Since date fruit is full of energy and nutrients, it is recommended for pregnant women to help with cervical ripening, particularly in the last weeks of gestation."
EBB article: "randomized trials have found that eating date fruit in late pregnancy, around 60-80 grams a day of fruit, may increase cervical ripening, reduce the need for a medical labor induction or augmentation, and one small study found a positive effect on postpartum blood loss. However, nobody’s looked at this in women with gestational diabetes, so if you have gestational diabetes, these results probably don’t apply to you."
Castor Oil - “it’s difficult for us to draw conclusions about the effectiveness and safety of taking castor oil at term to induce labor because very few studies have been done. There is strong evidence, though, that it causes nausea in whoever takes it… it smells kind of like a mixture of rubber and paint” from EBB article
LAST RESORT?: some suggest saving castor oil as a last resort home approach (like, on day prior to hospital's induction)
Mental/Emotional/Energetic: affirmations, visualizations, meditation, rest, butterfly hug, EFT, and things that make you feel good (massage, snuggling, laughing, etc.) -- for you and your baby (include talking, singing, guiding your baby)
Other Professionals Ideas:
Acupuncture: “we do, though, need more research in this area, because there is a lot of variation in how acupuncture is delivered in all of the different studies. So far, we don’t have any evidence of harm in using acupuncture to induce labor or ripen the cervix in healthy, low risk pregnant people, other than the potential of minor side effects that are not related to pregnancy. There’s also little evidence of benefit, but some evidence suggests that acupuncture at the end of pregnancy might help with your cervix becoming more ripe and ready to go into labor.” EBB article
Spinning Babies FB thread re: transverse breech at 35 weeks:
per Gail "Some moms I've helped had wonderful, dramatic results with Pulsittila... and also had a healing crisis.... I love Kali Carb for relieving back pain including back labor. I haven't seen a healing crisis for that one. Or for a few doses of Arnica
per Rena Sassi (on SB FB thread): "I'm a homeopath, you can give herpulsatilla 30c once a week till week 38 and then give it at 200c. If baby still hasn't turned by the time labor starts you can increase it to 1M. You can give Kali-c ifpulsatilla hasn't worked after trying it at 200c.
Blue &/or Black Cohosh -- "the research that we have suggests that there are major safety concerns with both of these herbs" from EBB article
Evening Primrose Oil --
"there is almost no research on this topic. The one randomized trial that found the EPO did improve cervical ripening, but it made no difference in how quickly women into labor. The birth center study found more labor complications or a trend towards more labor complications in the group that took EPO. The case report of the baby with skin problems after their mother took EPO is troubling, but we can’t know for sure if the EPO is related to that or not. So at this time the use of EPO during pregnancy or to induce labor is experimental mostly based on anecdotes and we don’t have any scientific evidence that it is effective or safe." from EBB article
"Research on the use of EPO for other aliments among non-pregnant people has suggested there could be a possible association between the use of EPO and bleeding problems during surgery.... As a result, Medline recommends that people don’t use it at least 2 weeks before a scheduled surgery... Since we cannot predict who will have a vaginal birth and who will have a cesarean, it is important to consider that EPO could contribute to hemorrhage during a cesarean and possibly even during a normal vaginal delivery. We just don’t know because there is a lack of data." from VBAC Facts
Nipple Stimulation -- "the available evidence does support breast stimulation as a non-medicine or a non-pharmacological way to improve the ripening of your cervix, start labor and reduce rates of postpartum hemorrhage, and in the large randomized trials, we did not see any adverse effects. However, there are some case reports that did warn of uterine hyperstimulation after breast stimulation and women should be counseled of this risk by their healthcare providers if their providers are recommending breast stimulation... A variety of techniques are described in the research evidence but researchers consistently recommend that women focus only on one breast at a time and include rest intervals. Researchers seem to agree that people who have high risk pregnancies should not use breast stimulation to induce labor until there’s more evidence that it’s safe in this population." from EBB article
To Be Deteremined:
Red Raspberry Leaf -- "there’s very little research on the human consumption of raspberry leaf during pregnancy. There were no adverse outcomes found in the two studies where they gave raspberry leaf to humans. One animal study did find early puberty in the female offspring of the rats that were treated with raspberry leaf in very high doses and more health problems in the third generation. The results from the remaining animal studies are contradictory as to whether raspberry leaf can induce contractions or cause relaxation of the uterus. Neither the randomized trial with humans nor the observational study found any significant results with regards to the outcomes that they looked at. It might just be that we need larger numbers of people in these studies in order to see the effects of red raspberry leaf." from EBB article
"In another large study, researchers assigned some women to wait for up to 72 hours for labor to begin after their water broke. Out of these women, 83% went into labor on their own and had a normal vaginal birth (Shalev et al., 1995)."
"Some researchers have found that it may take longer for people giving birth for the first time to go into labor after their water breaks.One study found that 20% of people giving birth for the first time waited longer than 48 hours for contractions to begin after PROM, while only 7% of those who had given birth before took longer than 48 hours after PROM (Morales & Lazar, 1986)."
RE: "24 Hour Clock":
"the “24-hour clock” rule is no longer valid today"
"The concept of the 24-hour clock actually started in the 1950s and 1960s....However, it is important to understand the differences between how women were cared for in the 1950s and 1960s and how they are cared for today—many decades later."
"Today, we have access to better quality research about what happens when women wait for labor to start on its own or induce labor after term PROM. This research shows that with proper care, waiting for up to 48-72 hours after the water breaks does not increase the risk of infection or death to babies who are born to mothers who meet certain criteria.* However, waiting means that birthing person may have a higher chance of experiencing infection themselves (Hannah et al., 1996; Pintucci et al., 2014)."
What Might Help Prevent PROM:
healthy vaginal bacteria
saying no to routine vaginal exams in prenatal check-ups
saying no to membranes sweeping/stripping, especially if more than 1cm dilated
low-dose of Vitamin C "One study has found that low-dose Vitamin C may prevent PROM, while two studies have found that high-dose Vitamin C may actually increase the risk of PROM." (See EBB article for details.)
healthy intake of Omega-3 fatty acids (in particular, DHA)
Concern About Chorioamnionitis (Infection of the Membranes) aka Chorio (after any ROM):
"Researchers today frequently criticize the Term PROM definition of chorio for being “too loose.” This means that the Term PROM researchers probably over-diagnosed chorio.
According to the American College of Obstetricians and Gynecologists, chorio can be diagnosed if a mother has a temperature > 38 degrees Celsius (100.4 F) AND usually at least one other indicator: fast fetal heart rate, fast maternal heart rate, abdominal pain, high white blood cell count, or foul smelling fluid.
The American Academy of Pediatrics has even stricter standards for diagnosing chorio: a mother’s temperature of >38 degrees Celsius (100.4 F) AND at least TWO other indicators: fast fetal heart rate, fast maternal heart rate, abdominal pain, high white blood cell count, or foul smelling fluid."
"In 2014, researchers published a large study that people with term PROM, and they found that with screening and treatment for GBS, the overall rate of chorio was 1.2% in a sample that included many women who waited for labor to begin on its own (Pintucci et al., 2014)."
"The number of vaginal exams that someone with PROM has after their water breaks is a very important (possibly the most important) predictor of whether someone with term PROM will develop chorio....a person’s risk of chorio increased as the number of vaginal exams that they received increased (Seaward et al., 1997)....The strong link between the number of vaginal exams and the risk of chorio has been confirmed in many other studies....In fact, vaginal exams have been shown to nearly double the number of types of bacteria at the cervix (Imseis et al., 1999)."
(No) Concern re: Cord Prolapse & PROM:
"There was no evidence that term PROM increases the risk of cord prolapse... To read more about cord prolapse and whether or not bed rest is required with term PROM, read this article."
(No) Concern re: Newborn Infection with PROM:
"There were no differences in newborn infection rates between any of the groups."
[FYI] "Several other studies have looked at risk factors for newborn infection. These risk factors included:
"no statistical differences in stillbirths or newborn deaths between the groups. Despite the fact that the study included more than 5,000 mothers, it was still not a large enough study to tell a statistical difference in deaths. Because stillbirths and newborn deaths are such a rare event, you would need more than 28,000 people in a randomized trial to tell a difference in mortality rates between groups"
(No Concern) re: Other newborn outcomes with PROM
In the Term PROM study, there were no differences between groups in the following newborn health issues:
Need for resuscitation
Seizures due to low oxygen levels
Decreased level of consciousness
Abnormal feeding at 48 hours
Professional Guidelines (from ACOG, etc.): see EDD article
Birth Prep: Technology/Interventions for Sensation/Pain Management Sterile Water Injections:
[LOW profit for hospital, so may not be typically offered or even known] using “sterile water, a disposable syringe, and a short needle…These injections are given into the person’s lower back. The onset of pain relief is fast, so it works pretty quickly within about two minutes, and the pain management effects can last as long as two hours. Sterile water injections can be given any time during labor” [NOTE: Using nitrous (see below) during administration of injections, receiving injections during a surge, or with 2 providers administering simultaneously may reduce discomfort while shots are being given.] https://evidencebasedbirth.com/sterile-water-injections-for-pain-relief-during-labor/
TENS Unit - best begun during early labor, if planning to use it?
"This can sometimes cause the baby to be somewhat posterior, although this tends to correct itself as the baby moves lower into the pelvis and the back moves down, beyond the placental location. Sometimes, in an effort to correct this apparent posterior position, moms will spend a lot of time on hands and knees. This can be a problem with an anterior placenta in that then the baby's weight is right on top of the placenta, which can cause some cord compression, especially with big babies or low fluid levels. This can result in minor fetal distress or meconium. So moms with anterior placentas who are doing hands and knees might want to limit the time to 2 or 3 minutes at a stretch."
"Having an anterior placenta can interfere with an external version to turn a breech baby at term, so if you have an anterior placenta, you might want to doublecheck with your provider to make sure the baby is head down by 34 weeks and request an external version then, while the baby is small, rather than waiting until 38 weeks, the typical time."
Spinning Babies' Discussion
Personal Practices -- Physical:
Spinning Babies suggestions, like inversions, etc. (see also specific suggestions based on week of gestation)
continually rest hands below mom's navel
Cold (peas, etc.) applied to mom's belly where baby's head currently is, and warmth (heating pad) where you want baby's head to go
Shine flashlight to bottom of belly
Have partner put head at bottom of belly & vagina & call to baby "come here" &/or otherwise talk to baby
Play music (rhythmic, classical, &/or whatever you think baby will respond to) at bottom of belly & vagina
Swing & pump legs
10 head stands in a row in swimming pool, then get out & do child's pose
REST (could baby be too tired to turn (if mom has not been getting enough rest)?) &
CALM the mind (meditation, following the breath, etc.)
SOFTEN the body (restorative yoga, etc.)
Personal Practices -- Energetic/Emotional:
ASK baby to turn... (out loud or "inner voice")
visualize baby turning
Explore/clear emotional issues (such as resistance to and/or fears about birthing / motherhood; tension with any family members (partner, own mom, in-laws, etc.); worries about how other children will adapt; etc. Mom might journal and/or "chat with her baby" via pen & paper to gain insight on issue &/or what baby needs to turn)
"Basically emotional issues are one of the top causes for baby being breech." ~Juli Tilsner, Midwife, Childbirth Educator, & co-founder of Cornerstone Doula Trainings
Affirm to baby that mom is ok and that baby doesn't need to take care of mom (from the point of view that maybe baby could be trying to stay close to mom's heart, if trying to take care of mom emotionally, etc.)
American College of Obstetricians and Gynecologists ("ACOG")
"Cesarean delivery will be the preferred mode for most physicians because of the diminishing expertise in vaginal breech delivery. Planned vaginal delivery of a term singleton breech fetus may be reasonable under hospital-specific protocol guidelines for both eligibility and labor management... The number of practitioners with the skills and experience to perform vaginal breech delivery has decreased. Even in academic medical centers where faculty support for teaching vaginal breech delivery to residents remains high, there may be insufficient volume of vaginal breech deliveries to adequately teach this procedure" from Committee Opinion
Society of Obstetricians and Gynecologists of Canada:
"It may be possible to deliver a breech baby vaginally if your health-care professional is trained in vaginal breech childbirth and other birth factors are normal..." See here
"Careful case selection and labour management in a modern obstetrical setting may achieve a level of safety similar to elective Caesarean section... Many recent retrospective and prospective reports of vaginal breech delivery that follow specific protocols have noted excellent neonatal outcomes." See here
Discussion on research of scheduled cesarean vs. vaginal delivery for breech presentation:
"Proponents of vaginal breech birth point out problems with the way the study was conducted. First, the vaginal birth mothers were often attended by clinicians who were inexperienced and/or poorly trained in breech birth. Second, these babies were delivered in a breech-unfriendly manner. The mothers were not active during labor, were often induced, and/or used augmentation (pitocin) and epidurals. Critics says these common elements of hospital birth spell danger for breech birth. Third, of the babies who died or had problems, most seem unfairly categorized (see below). Knowledgeable caregivers experienced in vaginal breech birth claim that active, natural, drug-free birth with a trained and experienced caregiver is as safe or safer than a cesarean." from http://www.betterbirthblog.org/breech/term-breech-trial/
"the approach to delivery has been controversial. Previous cohort studies have shown, in general, that planned caesarean section (CS) is better than planned vaginal birth (VB) for the term breech fetus. These studies are potentially biased, as the women have not been allocated randomly to the different modes of delivery. Furthermore, they may have included pregnancies which would not usually be considered for a trial of labour, e.g. footling breeches (where a foot or feet enter the birth canal ahead of any other part of the body), or the clinicians (both obstetricians and midwives) undertaking vaginal breech delivery may not have been experienced in the technique." from http://www.caesarean.org.uk/articles/termBreechTrialCC.html
Sutter Davis ("Dr. Annette Fineberg at Sutter Davis.. is one of very few OBs within driving distance of the Bay Area skilled in breech birth. She’s also the only 'local' OB breech expert who actively supports/encourages people with breechbabies to birth in non-lithotomy positions and labor in the tub prior to stage two -- and she is the only one who doesn’t pressure them to get epidurals." ~Jen Kamel (Founder, VBAC Facts))
Swollen Cervix (all from from Spinning Babies 5/1/2018 Swollen Cervix Newsletter)
"A swollen cervix is not a reason for surgery! It doesn’t always mean the baby is too big and won’t fit. In fact, I haven’t seen a swollen cervix that wasn’t resolved with Forward-leaning Inversion or other bottoms-up techniques. Patience often works with position changes."
Making Space for Baby: Forward Leaning Inversion & Sidelying Release (either order) ("Sidelying Release and FLI can be done in general in early labor and for any sign of a slow-down in labor or once you know about the swelling."
Relieving Pressure: Bottoms Up positions (knee-chest, FLI), hands & knees
Reducing Swelling: Arnica "You may like to consult a qualified homeopath for best suggestions.What some women in labor have chosen to do is insert 3-5 pellets of a 6x dose vaginally - They are not touched but poured into a dish and then held between the gloved fingers of the midwife."
"women who attempt trial of labor after cesarean delivery (TOLAC) have a 60 to 80 percent success rate of achieving a vaginal birth. The latest Practice Bulletin states that VBAC allows women to avoid major abdominal surgery and lowers their risk of hemorrhage, blood clots and infection. It also shortens the recovery period and reduces women’s risk of experiencing maternal morbidity or mortality during delivery in a future pregnancy due to repeated C-sections."
“There are certain conditions that can make VBAC less likely if TOLAC is attempted, including advanced maternal age, a high body mass index, a high birth weight and a previous C-section that resulted because the cervix failed to dilate.”
"There can be a risk of uterine rupture and other complications, therefore home birth is contraindicated for all women undergoing TOLAC. ACOG recommends TOLAC and VBAC only be attempted at Level I facilities or higher. This ensures that emergency care is available if the life of the mother or fetus are in jeopardy and an emergency C-section needs to be performed."
TIP when OB/MD citing ACOG: "What is the date of the ACOG recommendations you are referencing?" ["Turns out [the OB] was not aware, and was shocked to learn, that ACOG released a new VBAC Practice Bulletin
"In 2016, Cochrane researchers pooled the results from 46 randomized trials that included 3,850 mothers and their healthy infants (Moore et al. 2016). Eight of the trials included people who had given birth by Cesarean and six of the trials included late preterm infants (greater than 35 weeks’ gestation). The researchers found significant evidence that skin-to-skin care influences breastfeeding. Mothers who had skin-to-skin care with their babies were 24% more likely to still be breastfeeding at one to four months after giving birth compared to the mothers who received routine hospital care. They also tended to breastfeed their infants longer, by 64 days on average. When the researchers looked at the rate of exclusive breastfeeding from six weeks to six months after the birth, they found that the mothers who had skin-to-skin care were 50% more likely to exclusively breastfeed. Babies held skin-to-skin with their mothers were 32% more likely to breastfeed successfully during their first feed and they had higher blood glucose levels by more than 10 mg/dL. That amount of difference in blood glucose levels is clinically significant because infants with low blood sugar may be given formula, a practice that can interfere with breastfeeding. Overall, the babies that had received skin-to-skin care had better combined scores for heart rate, breathing, and oxygen level during the first six hours after birth. The researchers did not find any differences when they looked at skin-to-skin care beginning within 10 minutes of the birth or after 10 minutes of the birth, or when they compared less than one hour of time spent skin-to-skin to more than one hour. Almost all of the included studies began skin-to-skin care within one hour after the birth. Larger studies are needed to better understand any differences between birth, very early, and early skin-to-skin time and differences between longer and shorter time spent skin-to-skin.
"To summarize, the benefits of early skin-to-skin care included:
Longer and more effective breastfeeding; more likely to exclusively breastfeed
Less breast engorgement/pain at three days
Less anxiety three days after birth
Higher satisfaction—mothers were six times more likely to want the same care in the future when they held their babies skin-to-skin rather than swaddled.
More effective suckling during the initial breastfeeding session
Less crying– babies who received skin-to-skin care were 12 times less likely to cry during the observation period
Heart rate, breathing, and oxygen levels were more likely to remain stable
A beneficial increase in blood sugar
In fact, the benefits of skin-to-skin care are so clear that the World Health Organization recommends that ALL newborns receive skin-to-skin care, no matter the baby’s weight, gestational age, birth setting, or clinical condition (WHO, 2003). Skin-to-skin should begin immediately after birth and continue uninterrupted for at least one hour or until the first breastfeeding session for mothers who are breastfeeding.
Oral Vitamin K Regimen for Newborns (from Evidence Based Birth) "the most promising oral regimen seems to be giving a weekly dose of oral vitamin K for the first six months of life...The main concern that doctors have with using oral vitamin K instead of the shot is that oral vitamin K probably won’t work for babies with undiagnosed gallbladder problems. Gallbladder problems in babies are rare.. the weekly dose seems to protect these babies with undiagnosed gallbladder disease."