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LOW INTERVENTION CHILDBIRTH

by Healthy Arrivals presented in conjunction with the Certified Nurse Midwives of HCA Midwest Health Whether you have made the decision for a low intervention birth experience or are simply considering it, our goal is to provide you with useful and valuable information, advice and resources around the many nonmedicine support options available to you during childbirth. The class covers all aspects of the low intervention experience, from making the mind-body connection to labor

support techniques—all aimed at equipping you for the most positive experience possible during birth.

About our Midwife services: At HCA Midwest Health, we believe in compassionate care for women by women. Our Certified Nurse Midwives (CNM) are committed to honoring women’s care choices and working to assure our patients

have access to those choices—from place of birth, prenatal care, type of birth or lifelong gynecology care. Our nurse midwives work in close and collaborative partnership with their colleagues and their patients. They are committed to understanding the needs and preferences of each woman under their care and delivering up a special brand of caring that meets them.

MIND-BODY CONNECTION Make a firm decision that you want an unmedicated birth.

Control:

Support:

• Letting go and surrender to your body • Breathing exercises/learning to achieve inner silence • Yoga • Meditation • Visualization/Relaxation Techniques • Hypnobirthing

• Birth Partner/Team • Supportive companion or Doula professionally trained to provide labor support (outside of friends or loved ones) • Birth Plan • 3rd Trimester: Reading List/Resources (*see list on page 6)

Believing in yourself. You can do this!

LABOR SUPPORT TECHNIQUES/SUGGESTIONS Mobility & Positions: Movement is typically desired and important in the course of unmedicated birth. Pelvic dimensions may vary as maternal position changes and can facilitate the descent and/or positioning of the baby and reduce pain.

• Birth Ball • Bed • Chair • Others

What if I have back labor?

Occiput Posterior Position: This is when your baby is face up with his or her back resting against your spine. This can make it more difficult to push your baby out and may cause severe lower back pain during contactions (usually babies are delivered facing down).

Positions/ Techniques that may help cope with pain and possibly get baby to rotate: • Side Lying/Pretzel position: (helps to lie on side baby’s back is facing - LOP/ROP) pillow under upper knee which is bent, bottom leg straight and tilt hips so bed supports your belly • Princess position: Sit cross-legged with back straight leaning slightly forward during contractions • Hands and Knees • Knees and Elbow (shoulders above level of pelvis for best results) • COUNTERPRESSURE by someone with strong hands or use tennis ball: Pressing in lower back during contraction

Believe In

yourself

Water Tub/Shower:

Safety:

Benefits: • Use of epidural, spinal, and paracervical analgesia/anesthesia was slightly lower for patients who use the tub • Duration of the first stage of labor may be shortened • Some studies suggest bathing did not increase the risk of maternal or neonatal infection, even in women with ruptured membranes

• No significant differences in narcotic use or overall analgesia outcome, total labor duration, operative delivery rates, perineal trauma, or neonatal outcomes • The water should be at or slightly above body temperature so as to not increase the woman’s core temperature, and her temperature should be monitored • Waterproof fetal monitors for evaluation of fetus during time in water • Consent form • Currently HCA Facilities DO NOT allow for water birth although this may change in the future

Timing: • Prolonged immersion (more than two hours) has been reported to prolong labor and slow uterine contractions by suppressing oxytocin production • Early immersion (before active labor) may space out contractions • CNM and/or Doula will help advise when/if to utilize tub and/or shower

Massage: • Not all women appreciate being touched during labor. This also can change from one stage of the labor to the next (partner patience, trial and error will help) • Firm versus gentle (Effleurage=“feather touch”) -- Lower back tends to be most popular area for firm massage (sacral area) -- Gentle massage on upper and/or lower back, lower abdomen • Tools to bring: Tennis ball, massage oil, handheld massagers • Heating Pads (hospital sometimes has heating pads) -- Microwave rice bag

Essential Oils (aromatherapy): “The science of using highly concentrated essential oils or essences distilled from plants in order to utilize their therapeutic properties” Tiran D. Mack* • Geranium - Helps to calm and de-stress the laboring mother, helping to create a serene environment. It can be used in the second and third trimester to treat exhaustion, edema, hemorrhoids and varicose veins. It is an anti-bacterial, anti-inflammatory, antiseptic and even an anti-depressant. This essential oil is also great to use for perineal massage • Jasmine oil - During labor Jasmine essential oils help to strengthen the contractions in a natural way while also providing comfort to the birthing mother. It should not be used during pregnancy because it can also induce labor by stimulating uterine contractions and also relieve pain.

• Lavender - Is helpful in dulling pain in the uterus as well as the back, legs and even *

headaches. It is also helpful to dull any pains after labor. Lavender is great for keeping mom calm during labor. This oil can also be used with coconut oil to apply to the skin and prevent stretch marks • Peppermint oil - Is said to be effective in helping move babies who are breech or posterior. By rubbing this oil on the top of the abdomen or the lower back, it can encourage the baby to turn to an optimal birthing position • Rose - Is great to rejuvenate skin and tissue, and also for softening ligaments. It helps the pelvis to expand and open up to allow the baby to pass through and also has cleansing effects on the uterus. This oil is a must-have for smaller mamas who are expecting a bigger baby • Ylang Ylang - Increases calmness and relaxation, helps to lower blood pressure and slow rapid breathing. This essential oil helps to balance the equilibrium

Complementary Therapies for Pregnancy and Childbirth (2nd ed.). Tiran D. Mack S (Eds), Balliere Tindall, New York, NY 2000

s e i b a b e v we lo

s e c r u o s re for moms!

Music/Audioanalgesia: (The use of auditory stimulation, such as music, white noise or environmental sounds to decrease pain perception) • May increase pain tolerance, reinforce or elevate moods, or cue the woman to move or breath rhythmically, especially if she has conditioned herself to do so before the onset of labor) -- Preplanned playlist (listen beforehand and visualize) -- Facilities have different amenities -- Plan on bringing your own speakers or headphones etc.

FURTHER READING OR RESOURCES Pregnancy, Childbirth and Postpartum Books: • Ina May’s Guide to Childbirth – Ina May Gaskin • The Complete Book of Pregnancy and Childbirth – Sheila Kitzinger • The Natural Pregnancy Book: Herbs, Nutrition, and Other Holistic Choices – Aviva Jill Romm • Our Bodies, Ourselves—The Boston Women’s Health Book Collective and Judy Norsigian • The Doula Book: How a Trained Labor Companion Can Help You Have a Shorter, Easier, and Healthier Birth – Marshall Klaus, John Kennel, and Phyllis Klaus • The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas and All Other Labor Companions – Penny Simkin

NOTES

NOTES

Research Medical Center 2316 E Meyer Blvd, Kansas City, MO 64132 Overland Park Regional Medical Center 10500 Quivira Rd, Overland Park, KS 66215