So what position should I be in anyways?.....

This post comes from a question about positions during the pushing stage of labor. In one of my previous posts http://thebeginningofmotherhood.blogspot.com/2009/02/emergency-pain-control.html, I mentioned how you should not give birth laying on your back. So, if that's the case, what position can you push in? Answer: just about any position but that one:)

Here's the extended answer:)

It has been shown that being in an upright position helps to decrease the amount of pushing time, decrease the amount of tears, and decrease the amount of instrument deliveries. These positions include squatting, sitting, and on your hands and knees. There are good things and bad things about all of these. Obviously squatting would get tiresome, but if you have good help, they can help support you from behind. Hands and knees can also get tiresome, but it is one of the best positions to turning baby into the right position. You can also use a birthing stool to sit on, or if you are at the hospital, get the bed positioned to help support you sitting up. This is one of my favorite positions.

For those who have epidurals, or are just plain exhausted, the side-lying position has been shown to help. Essentially you have one leg raised while you are pushing on your side. With an epidural, you can also have the head of the bed raised to allow you to be more upright. Just make sure you are fully up and not just half way as this will decrease the space in your pelvis.

A good book to look at for positioning is Penny Simkins book, Labor Progress. She does a wonderful job of explaining different positions throughout the labor and why you would use them.

If you feel a need to be in any kind of position, I would stick with that. Many times, a woman's body can tell how they need to be to help move that baby down. Your biggest hindrance will be with medical staff that aren't used to these positions. I would make it clear from the get go that you want to push differently. Talk to your doctor about this also. Some are fine with doing whatever, and others are pretty stuck in the lying on the back mode.

I also had a question about doula's. First off, I'll say that I never had a doula, but probably could have used one. I have a wonderful supportive husband, but I feel like a doula who has been trained and been to many births, has experiences that neither I nor my husband had had at the time. Plus a doula allows the husband to take breaks when needed. A good doula will help the husband in his supportive role. I also think that there is something different about how men and women think, and having a women's support along with your husbands would make a difference.

Studies on doula's have shown that women who use doula's have shorter pushing times, less instrument deliveries, and breastfeed longer(Journal Of Obstetric, Gynecologic, And Neonatal Nursing: JOGNN / NAACOG [J Obstet Gynecol Neonatal Nurs] 2009 Mar-Apr; Vol. 38 (2), pp. 157-73.).

I would interview them first to see if they would fit well with what you want to do and how you feel about things. If you plan on having a hospital birth, I would also try and find a doula that has worked well with the medical staff in the past. If money is an issue, try and request a nurse that has had natural birth experience. Sometimes, you can get a nurse to help with the labor support if needed.

References:

The Journal Of The American Osteopathic Association [J Am Osteopath Assoc] 2006 Apr; Vol. 106 (4), pp. 199-202.

The Journal Of Perinatal Education: An ASPO/Lamaze Publication [J Perinat Educ] 2006 Fall; Vol. 15 (4), pp. 6-9.

Journal Of Obstetric, Gynecologic, And Neonatal Nursing: JOGNN / NAACOG [J Obstet Gynecol Neonatal Nurs] 1997 Nov-Dec; Vol. 26 (6), pp. 727-34.

H1N1

I got a few questions sent to me, so I thought I'd post them here as I'm sure a lot of people are wondering about these things.

"What are the hospitals doing to protect mothers and babies from H1N1?"

To the dismay of many, hospitals all over are limiting visitors and not letting children into LD units. While this may seem harsh, one of the biggest problems at hospitals is infections. If you are choosing to have your baby at a hospital, I think that this is a good way to limit the amount of germs that are spread around. At the hospital I work at, they are making anyone who comes in with flu symptoms put on a mask. They are also trying to keep the sick moms in a completely different area than those who are not sick. I work for a corporation that owns three hospitals in my area. If there was to be a huge outbreak, one of those hospitals is designated as the sick hospital. I would assume that those who are caring for sick patients will only be with sick patients. That means that if someone is healthy, they won't get a nurse that is also taking care of someone who is sick. If someone is sick, the nurse is required to put on a gown, gloves, and mask. While I didn't really want to be vaccinated:), all the nurse were required to be. As you can spread the virus before symptoms show up, I was ok with that.

Do you think there is an increased risk to newborns in the hospital because of this outbreak?

Anytime there is virus' and germs around, newborns are at risk. As there are many people coming and going at the hospital, there are more germs there. That has always been the case though. Chances are, with the way this virus is spreading, the newborn would be exposed to it pretty much anywhere. The problem with hospital bugs, though, is the mom hasn't had a chance to develop an immunity to it and thus pass it on to baby. At home, the mom is exposed to all the germs there and has passed on the antibodies to her infant already. Therefore, I couldn't say for sure if there is an increased risk. I think it would depend on what is already in your community. As far as I know, though, no newborns have died from this virus thus far.

What would you suggest (to help prevent infection)?

Breastfeed!:) Whatever mom's body produces to fight off the virus will be passed on the infant. Try and get a good first feeding in. Colostrum is amazing stuff. I would also make sure that whoever walks in that room with mom and baby are washing their hands or using hand sanitizer. Make sure your nurses and doctors do this too. I personally would also keep baby with you as much as possible instead of taking it out to be exposed to others germs. I would ask for the nurses to do all the stuff they need to do in the moms room. I'm not sure if this would be accepted, but it wouldn't hurt to ask. I just think that limiting the exposure of baby to other people would be the best thing in the hospital. Moms should also make sure they are getting enough to eat and are limiting their stress. These things make a huge difference in our ability to fight off disease. I know these aren't used that much, but I think a post partum doula would be so helpful with this.

Now here's the tricky part for mom in labor...fear and stress can lead to a more difficult labor, therefore, I feel like it is essential that we don't let these emotions take us over. Just know that there are always things we can do and have control over, and there are somethings we can't control. The trick is learning to do what you can and letting the rest go.