Labor

Mamas on Bedrest: Who should be at your side when you deliver?

June 11th, 2014

Greetings Mamas!

Mamas, “Who should be at your side when you deliver?”

Current wisdom is that it should be the baby’s father. But what if the baby’s father is unavailable? The birth of your baby is one of the most monumental moments of your life! You need to be completely comfortable, able to freely express yourself and receive nothing but support. You must choose a birth partner who is not only completely supportive of how you are birthing, but they must be able to advocate on your behalf if you are unable to advocate for yourself. With those parameters in mind, who will be at their birth of your baby as YOUR support? Share who you chose to be in the delivery room with you and why in the comments section below.

Mamas on Bedrest: What You Need to Know if Your Baby is Born Between 34-36 Weeks 6/7 Days

February 10th, 2014

VamessawavesMy daughter was a “late phase” preemie.

It’s kind of funny to me to recount those early days with her. She’s 11 now, pubertal and as sassy as they come! But in the beginning, everything was a juggling act to make sure that she had all that she needed to start her life off well.

My daughter was born at 36 weeks and 6 days and was literally 3 hours and 57 minutes shy of being a “term” infant. When she was first born the hospital staff kept referring to her as a “preemie” and I kept railing against this term knowing its implications. But as the days went by, she exhibited more and more of the signs of a preterm infant and I had to admit that she was in fact a preemie-no matter how close in hours and minutes she had been born to term.

When my daughter was born, she didn’t immediately cry. After the neonatal staff worked on her for a few moments, she did let out a wail that sent the biggest wave of relief through my body. But we weren’t out of the woods. On examination she had some fluid in her lungs and was in a bit of respiratory distress. So they wrapped her up, whisked her by my face and hurried her off to the nursery for a closer look.

In the days that followed, my daughter continued to have difficulty breathing. When I would nurse her, her oxygen saturation would drop into the low 80’s. She would also get quite tired while nursing and we had to supplement her feedings with bottle feedings. Although she never required supplemental oxygen nor slept in an incubator, she did initially have some problems with temperature regulation and slept on a little warming bed. The first time I saw her on this thing, with little eye covers over her face, it reminded me of a tanning bed and I asked “Why was my little brown baby was being tanned?” I was informed that the warming bed would help her regulate her temperature and help with bilirubin  metabolism (although she never did have an increased bilirubin level which is common in late phase preemies.) Overall, my daughter did really well and continued to progress during her 10 days in the NICU. By the time she was discharged, her father and I were providing the bulk of her care; holding her skin to skin, feeding her and changing her. I was increasingly frustrated that they would not allow her to go home and actually “had it out” with the neonatologist one day when he proposed yet another day of “watching”. But if I were to have my daughter today, knowing what I know, I would be (and I am now) ever thankful for the care of the NICU staff provided for my daughter.

In 2009, 71% of all preterm infants were late preterm infants, born between 34 and 36 weeks 6/7 days. The most common reasons for these early deliveries were:

 

  • Spontaneous Labor
  • Premature Rupture of Membranes
  • Pregnancy Induced Hypertension
  • Placental Disorders
  • Fetal Disorders
  • Intrauterine Growth Restriction
  • Multiple Gestation (Twins or higher order multiples)
  • Maternal Medical Disorders

Because many late phase preterm infants look like term infants, signs and symptoms of complications can be missed. But these can be a crucial errors. Late preterm infants born to mothers with antepartum hemorrhage ae 12 times more likely to develop problems in the early post partum compared to term infants. Infants born to mothers who had pregnancy induced hypertension are 11 times more likely to have post partum complications. The earlier the infant (i.e. the closer to the 34 weeks) the more likely they are to experience complications. And when an infant is an “early late phase preemie” and born to a mother with medical problems such as pregnancy induced hypertension, the more likely the infant is to have complications. The most common complication seen in late phase preterm infants are:

  • Elevated Bilirubin levels (hyperbilirubinemia)
  • Respiratory Issuesn (rapid, labored breathing and/or Pneumonia)
  • Hypoglycemia
  • Poor feeding (fatigue and poor weight gain)
  • Temperature instability (inability to regulate temprature due to lower amounts of brown and white fat on their bodies)
  • Infections

Any one or a combination of these issues may land the infant in the Neonatal Intensive Care Unit (NICU). However, not all infants who exhibit these complications need the expert skill rendered in the NICU. Well trained hospital staff and well educated parents can manage many of these infants.  So what do parents and care providers need to know?

Mamas, if at all possible, avoid having a cesarean section-especially if it is your first child. First time Cesarean section delivery of the 32-36 week infant increases the infant’s risk of developing the aforementioned complications as well as their risk of not surviving. Almost all of these infants end up in the NICU. While a cesarean section may be indicated if mama, baby or both are in distress, elective cesarean sections should be avoided.

Watch your child’s feeding patterns. Because these infants often tire easily with nursing, infants who fall asleep while nursing my be mistaken for being full when they are actually fatigued. These infants may have long periods between feedings and fail to gain weight. Parents of such infants must adopt an every 2-3 hour feeding schedule and keep a close watch on weight gain to ensure adequate nourishment and development.

These infants should not be discharged early. Late preterm infants have a high rate of “bounce back admissions”. Many of the complications that arise do so within the first 48 hours to 2 weeks post partum. Careful monitoring in the hospital for 48 hours can allow medical staff to detect arising complications and treat them early to avoid major problems as well as readmission. While these infants should be assessed often, they don’t necessarily need to be in the NICU. They should be evaluated by a pediatrician 48-72 hours after discharge and at 2 weeks then 8 weeks. This may seem like a lot, but complications, if they are going to arise, will occur within the first 28 days of life.

Looking at my daughter today I can hardly believe she was the tiny little baby I held so close. Just 3 inches shorter than me (Okay, I’m only 5 ft, but she’s only 11!) and already developing the curves of a young woman, she has grown and developed really well. She has asthma that is well managed and does anything she wants to do. But those early days of keeping her bundled up (she was an October baby) and watching her feedings were hard-but well worth it. And the expert care of the NICU staff are much credited with her health success. I was a stressed out mama then, just wanting to take my baby home.  But I am forever grateful that the staff-the neonatologist in particular-stood firm, monitored her carefully and only sent her home when they were absolutely sure that she wouldn’t come back. And she never has!!!

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Resources:

Erica Saleski Forsythe, MSN, RN, Patricia Jackson Allen, MS, RN, PNP-BC, FAAN “Health risks associated with late-preterm infants: implications for newborn primary care.” Pediatric Nursing. 2013 Jul-Aug;39(4):197-201. 

MedScape OB/GYN Women’s Health

Mamas on Bedrest: Who will attend your baby’s birth?

February 3rd, 2014

002_02Good Morning Mamas!

Have you considered having a midwife attend the birth of your baby? As a Mama on Bedrest, you most likely have been told that you are high risk and that you must have a your baby delivered in a hospital with a obstetrician. For many of us, this may be the case. But for women who go to term and in whom preterm labor, premature rupture of membranes, cervical insufficiency or other complications that become somewhat moot at term, having a midwife attend your birth is a viable option.

Why consider a midwife? If you are looking to minimize the amount of intervention you receive during your birth, then having a midwife attend your birth is the way to go! Certified Professional Midwives (CPM) and Certified Nurse Midwives (CNM) are highly trained and highly skilled health care professionals who have studied women’s health and the childbearing process in depth and have proficiency in providing care to the childbearing woman and her newborn baby. However, a midwife differs from an obstetrician in that she provides minimal intervention and is much more of an attendant to the process. A midwife is not a surgeon and does not bring surgical skills to the birth. However, CPM’s and CNM’s are trained in emergency procedures and are capable of managing a wide variety of birth complicatA midwife will allow a woman to birth her way; A woman may birth in bed, standing, squatting, on her hands and knees or in water (if she is an appropriate candidate for such a birth!). For women who are appropriate candidates and who choose to do so, some midwives will attend their births in their homes, in a comfortable environment, in the company of family and friends.

So who is not an appropriate candidate for having a midwife attend the birth of their baby? Any woman who has an unstable medical condition such as pregnancy induced hypertension, pre-eclampsia, Uncontrolled Gestational Diabetes, placenta previa or instability of the infant. These are major medical conditions and need to be addressed by medical doctors. Any condition that necessitates a cesarean section (specifically placenta previa and potentially pre-eclampsia with uncontrolled high blood pressure) these women should be attended by obstetricians. And a caveat for Mamas on Bedrest is that because of our histories, I do not recommend attempting home births. Even if a  Mama on Bedrest is attended by a midwife, I highly suggest that she be attended in a birthing center closely associated with a hospital or in a hospital where emergent medical care can be administered quickly if needed.

Why do I bring this discussion up? Because I want Mamas on Bedrest to explore all their options for their perinatal care. Unfortunately, many Mamas on Bedrest are told how they will birth their babies, told how their birth is going to go and are simply expected to show up and let the process happen to them. Having a baby is a very active process and it is my hope that all of you are as active participants as possible! This often doesn’t happen in the traditional hospital setting. There is little room for personalization, to have family members present, to be able to stand or walk during labor, to be able to deliver in a squatting position. But in a mama, these are all viable options and options that can make her labor and delivery easier, more comfortable and more memorable. As Mamas on Bedrest we have already lost so much of our pregnancy experiences because of bed rest. And while most of you would gladly do bed rest again if it means the safety and well being of your baby, whenever possible, my hope is that Mamas on Bedrest will be able to make informed health care decisions that will not only make for healthy and safe labors and deliveries for mamas and babies, but also make for memorable moments in the life of Mamas and babies.

If you have been considering having a midwife attend your birth, see what is available in your area. You may be able to deliver in a freestanding birth center or in a birth center attached or adjacent to a hospital. You may be able to have a combination of an OB and a midwife. There are as many possibilities as we can think of, but the first step is to have the desire and then to ask and see what is possible.

Who attend your baby’s birth? Share your story in the comments section below.