(Also known as low dose epidural or ambulatory epidural.) When a woman in birthing time seeks for a conventional epidural procedure, the entire lower portion of her body becomes numb. This means she won’t be able to get out of bed during birthing time, but she’ll be fully awake and aware during the baby’s birth. A walking epidural – also called a combined spinal epidural (CSE) – involves a combination of a lower dose of anesthetic with a opiate-based narcotic, often either fentanyl or sufentanil. Walking epidurals work fast and focus on numbing only the abdominal nerves, so women who have walking epidurals are more mobile during birthing time. However, the term “walking” epidural is considered by many to be more optimistic than realistic. A woman who’s had a walking epidural will be able to move around in bed and probably be able to get up to go to the bathroom, but it’s unlikely that she’ll be comfortably strolling down the halls of the hospital in between waves. Keep in mind, though, that in hospitals where walking epidurals are offered, it’s possible that an expectant mother won’t be allowed to actually walk around much, to avoid potential legal issues in case of a fall.
Walking Epidural – Pros and Cons
Due to the narcotic-anesthetic combination, walking epidurals provide very quick relief from labor uncomfort – women feel the effects in about 2-5 minutes – as opposed to conventional epidurals, which can take about 20 minutes to work. In either kind of epidural, the catheter used to inject the drugs is left in place, so more can be delivered if needed; the first dose usually lasts about three hours. With a walking epidural, an expectant mother should be able to move around more comfortably even while still in bed or sitting in a chair. This can be particularly helpful during the second stage of birthing time, when a sitting or squatting posture might assist in birth. Walking can even shorten the first stage of labor, moving the process along a bit more quickly. Also, walking during birthing time gives gravity the chance to do some of the work. When it’s time to push, a woman who’s had a walking epidural should be able to push more easily than one who’s had a conventional procedure, which offers less control over the lower body. Generally, potential side effects of walking epidurals are the same as with conventional epidurals, although lessened because of the lower dose. These include itching (also referred to as pruritis), shivering, a drop in blood pressure, soreness at the injection site and headache. Also, since narcotics are used in walking epidurals, some of this will get to the baby, even if only temporarily. Both mother and baby might be groggy for a brief while as a result of a walking epidural. And while conventional epidurals are readily available at hospitals and generally covered by insurance policies (but check this out in advance to make sure!), walking epidurals are not necessarily in as widespread use. Women should talk with their doctors before their due date if interested in a walking epidural to find out if it’s an option.
Source (modified for hypnobabies vocabulary purpose)
Spinning Babies is an approach to optimize the physical relationship between the bodies of the mother and baby for the easing of childbirth. Spinning Babies is a new paradigm that takes clues from baby’s position and station for natural, physiological solutions. Try it in any birth setting, childbirth program, or pain management plan.
Align the uterus so baby can curl and enter the pelvis as a small, compact – and more active participant.
Release tight ligaments or muscles which may pull or twist may relieve pelvic pain now or discomfort during birth.
Support what’s loose in womb or pelvis with a pregnancy belt.
Open the pelvis to let baby move down during the birth process.
Share birth wisdom with parents and providers in ever deepening layers of understanding birth
Begin with activities to support the range of motion and alignment, to reach a healthy mix of mobility and stability for the pelvis. Comfort and function return to the body.
This is the interesting and relatively “new” trend I want to speak about.
In most cases, when a baby is born, the cord is cut just after he or she is born, then the placenta detach and is being delivered few minutes later (sometimes can takes an hour).
More and more parents and hospitals are seeing the benefits of delayed cord clamping, which i’m talking about here : delayed cord clamping.
This lotus birth is a step further. It involves leaving the baby attached to the placenta until the cord detach by itself, it can take approximately up to 10 days. Obviously, there is no medical benefit of it. Following a baby’s birth (first breath), less than 5-10 minutes later, the cord stop pulsating : there’s no more exchanges between the placenta and the baby. Lotus birth can be “half” (few hours) or “full” (until the cord detach from the baby).
Back to few years ago, when I learned about it, I was a little bit puzzled. Why on earth people would choose that ? Especially since there is no medical benefits. I didn’t understand. I wanted a wireless baby. A wifi baby !
Now that I’m constantly looking for new trends, new researches, or just spend a lot of time being with new parents, new moms and newborns, I realized there is benefits of a lotus birth :
For some parents, having their baby being held by someone else the first days of life is extremely hard. Sometimes, families or friends forgot good manners with the excitation and joy and we can witness a newborn baby passing from arms to arms the whole afternoon under the perplexed look of the new parents. Well, let’s say that having a baby attached to a placenta will make it way harder and awkward for friends and families to hold the baby.
In the womb, a baby is in a warm atmosphere, always fed and comfortable, hearing her mother’s heartbeat. MRI and ultrasounds shows that babies are already playing in the womb with their ombilical cord who act as a “lovey”. I recently read an article about octopus being given to preemie for comfort. Some people think that lotus birth are a way for a baby to adapt softly to this whole new world.
One other benefit I see is for the new mother. In the 21st century, it can be hard to rest after the birth. Yet, it’s really important during the post partum period to do close to nothing the first week, and take it extremely slow after that. The mother will recover much faster. Having to carry not only the baby but also the placenta around might be more challenging. I remember I was especially bad about resting when my daughter was born : I couldn’t stay in bed. Don’t get me wrong – I’m not an hyperactive kind of girl, but I need to get things done. My midwives were urging me to stay 1 week in bed, getting up only for the bathroom, showering etc. I was forbidden to climb our stairs during week 1. It was SO hard for me. I believe that having my daughter in lotus would have clearly made things much harder for me !
Now the risks …. since the placenta/cord are dead tissues; with no refrigeration, it will rot. Bacterias can spread and an infection can occur, which can become life threatening for the newborn. It is very important to take care of the placenta, DIY kits exists for that, most of them are sold by doulas. The placenta’s care generally involve to rince it, dry it, and then kind of “season it” with salt, herbs, essential oil, flowers, all wrapped in a fabric bag. If you choose to try the Lotus Birth, it’s important to keep an eye on the placenta, any bad smell should alert you. What we see in stories is that the placenta in lotus birth should have a “musky smell” after being cared of, but nothing terrible.
Lotus birth might also be impossible in case the cord needs to be cut at birth, if the baby or mother needs urgent care.
Home birth is defined as giving birth to a baby in your place of residence. Home birth can be planned (87% of U.S. home births) or unplanned (13%). It can be attended by a midwife (62% of U.S. home births), a physician (5%), or others, such as family members or emergency medical technicians (33%) (MacDorman et al., 2012). In this article I will be focusing on planned home birth with a midwife.
Who is a good candidate for a home birth?
There is a lot of controversy over who should be eligible to give birth at home. Many countries have standardized “lists” of what makes a woman a good candidate for a home birth, but the U.S. does not. The list below is taken from the criteria used in Janssen’s (2002; 2009) studies on home birth in Canada.
Women who are considered “low risk” and may be good candidates for home birth include the following (this should not be considered an exhaustive list):
A woman who is pregnant with a single baby and has made an informed choice to birth at home
Baby is head down at term
Between 37 and 41-42 weeks pregnant (researchers differ on the 41-42 weeks)
No serious medical conditions (heart disease, kidney disease, blood clotting disorders, type I diabetes, gestational diabetes managed with insulin, preeclampsia, or bleeding)
There are 2 main types of midwives who attend home births in the U.S. A certified nurse midwife (CNM) has a nursing degree plus at least a master’s in midwifery, and is certified by the American College of Nurse Midwives. These midwives are legal in all 50 states and can deliver babies in hospitals, birthing centers, and homes. However, the majority of births attended by CNMs take place in hospitals.
The majority of home births in the U.S. are attended by direct-entry midwives—these are midwives who are directly trained in midwifery and did not go through a nursing training program. A common type of direct-entry midwife in the U.S. is a certified professional midwife (CPM). CPMs are educated through class and clinical experience. The clinical component consists of an apprenticeship under the supervision of one or more preceptors. The average apprenticeship lasts 3-5 years. The CPM certification is offered by the North American Registry of Midwives. CPMs have legal status in 26 states and attend births in hospitals, birthing centers, and homes.
There are several other types of midwives, including certified midwives (CM), direct-entry midwives, and lay midwives. You can read definitions of these types of midwives here.
Advantages of home birth…
Statistics show that home birth is as safe or safer than hospital birth for low-risk women with adequate prenatal care and a qualified attendant.
At home a woman can birth in the privacy and comfort of the familiar surroundings of her own home, surrounded by loved-ones. in whatever positions and attire she finds most comfortable.
The birthing woman maintains control over everything impacting her baby’s birth. Meeting her needs is the only focus of all those present. Nothing is done to her without her consent.
Birthing time is allowed to progress normally, without interference and unnecessary interventions.
Studies show that the risk of infection is reduced for both the mother and the baby.
During birthing time the woman is encouraged to eat, drink, walk, change positions, make noise, shower, bathe, etc.
Care-givers are invited guests in the birthing woman’s home. She can have anyone she desires present: family, friends, children, etc. Her medical team (midwife and birth assisiant) do not go home because their shift has ended or because it was supposed to be their day off or because it is a holiday or because they planned something else.
She doesn’t have to worry about when to go to the hospital since her care-providers come to her.
Continuous one-on-one care is given by the midwife, providing ongoing assessment of the baby’s and mother’s condition throughout the birth process and postpartum period. Her care provider knows her well and she knows her care provider. They have established a trust relationship.
Women are supported through the hard work of birth, and encouraged to realize the insights, and experience the personal growth as a human being to be derived from such a powerful, life-changing event.
Bonding is enhanced and includes everyone who has contact with the baby including neighbors and relatives. Breast feeding is facilitated by the baby remaining with the mother.
Cesarean Section and forceps deliveries are unavailable – transportation to the hospital is necessary if these interventions are required. However, rates of both, as well as episiotomy, are very low.
The cost of a home birth may be less than a hospital birth, and is often covered by insurance if a CNM is utilized.
Pregnancy and birth are viewed as normal, natural body functions and not as an illness or disease.
Disadvantages of home birth…
Client’s must assume a greater level of responsibility for their own health: physical, mental and spiritual. This requires active ongoing participation in decision making in all aspects of their care, and a willingness to accept the consequences of those choices and decisions.
Since the hospital is the currently socially acceptable location for birth, choosing otherwise may result in negative judgments and lack of support.
Cesarean Sections, forceps deliveries and neonatologists are not available at home, transport is necessary for these and other medical interventions.
Personal arrangements must be made for postpartum care, such as meals, housekeeping, child care etc.
The cost of a home birth may not be covered by the client’s insurance.
Analgesics are not readily available with a home birth.
How much does it cost ?
$5000 and up in Los Angeles. That includes all the prenatal care (without blood tests, ultrasounds etc), the birth, and generally 1-3 postpartum visits. Most of the midwives accept payment plans and check with your insurance for reimbursement. Some insurances accept home birth but do not have any midwives “in network” so you have to write a letter to them for an “exception gap”. If they do not accept home birth (you can still do it, but you can’t claim any of the bills), you can also write a letter to tell them how cheap and safe home birth is in your case. They sometimes will accept to make and exception and cover it.
Free standing birth center
Birth centers are pretty much the same than home birth, except that it’s like going to someone else’s house. Like home birth, only low-risks pregnancies are accepted.
Advantages of a birth center birth…
The facility is usually only provided for pregnancy and birth events.
In a birth center, pregnancy and birth is considered a natural and healthy process.
During pregnancy and birth, women are encouraged to take charge of their own health care.
It provides an alternative to parents not comfortable with home birth, yet do not want to give birth in a hospital.
It has many of the same advantages as home birth, such as greater parental control, non-interventive obstetrical care, freedom to eat and move during birthing time, and to give birth in any position, and to have any number of family and friends attend the birth.
The parents are usually encouraged to bring family members to their prenatal visits.
It offers personalized care at much lower costs than traditional hospitals.
In most centers, parents can meet the entire staff prior to the birth.
The rate of Cesarcan and forceps deliveries is considerably than a hospital.
The discharge time after birth is normally measured in hours, not days.
Disadvantages of a birth center birth…
Rigid screening criteria often eliminates healthy mothers, i.e.; VBAC, mother over 35 (depending of facilities).
The mother is moved to birth center during birthing time
Many centers have rigid rules concerning transporting of the mother to the hospital i.e.; prolonged labor, ruptured membranes. Mother may have to be moved during birthing time.
There are usually no pediatricians on staff if the baby has special needs after the birth.
The mother cannot remain at the birth center for a two or three day rest; discharge is usually within 4 to 24 hours.
How much does it cost ?
In Los Angeles the cost of a free standing birth center is $6000 and up. That include the same as the home birth. It often include some classes (breastfeeding, newborn care, nutrition, baby wearing…). Birth center have a better coverage than home birth but there is insurance that refuses them too. You can also write a letter to try an exception gap. My insurance didn’t cover my birth center, they had another one in-network. However, that one was 1:30hrs away from my home. So I asked for an exception gap and we were covered 85%. The downside is that you start your coverage only after it has been accepted. I didn’t know that so I asked for the exception gap a little late in my pregnancy.
Some birth centers accept Medical. Contact me for more info.
Giving birth in a hospital is the most common choice in the US. Hospitals accept both low risks and high risks pregnancies. They are well covered by insurance and some of them accept medical.
Advantages of a hospital birth…
Many mothers feel safest birthing in a hospital.
It is the safest environment for the mother at risk for medical complications during labor.
Emergency personnel and equipment is available if the mother develops complications or needs medical attention.
It avoids the rush of a last-minute transfer to the hospital (from home or a birth center) if medical problems arise.
Anesthetists are available
It is the only option available in the event a cesarean section is necessary.
Immediate pediatric attention is available should the newborn need medical care. Baby does not need to be taken off site to be routinely examined by a pediatrician.
It has round-the-clock help for the mother and baby (food, diaper changes, medical assistance and information.)
Disadvantages of a hospital birth…
The parents are not on “home ground” and do not have the same control they would at home.
Hospitals are primarily associated with illness.
Hospitals can seem impersonal and intimidating.
As a large institution, the hospital has rules, policies and red tape; they are rarely altered to accommodate an individual.
Less privacy is available.
The partner is often less actively involved in a hospital setting, and may fell like an “outsider”.
The mother’s birth is usually managed by experts trained in pathology, not normal births.
The risk of iatrogenic complications and infection to the mother and baby is greater among mothers who deliver in hospitals, than among those who give birth at home or in a birthing center.
The mother is at a significantly higher risk of having an unnecessary cesarean section.
Some routine separation of the mother and baby is almost unavoidable.
Most hospitals do not allow the mother much rest.
How much does it cost ?
The cost vary greatly between vaginal birth, length of stay, medical care etc. In the US, an average birth in a hospital cost $30.000. That does not include any prenatal care, and generally 24 hours of post partum care while in the hospital. Fortunately, insurances cover the cost of it and you generally have to pay your maximum annual out-of-pocket. It can be entirely free if you have mediCal.
“In Hypnobabies we refer to EDD (Estimated Due Dates) as Guess Dates. There is really a 5 week window in which a baby can come and be considered full term. From 37-42 weeks is normal. So I actually like to say a Guess MONTH!My first baby was a preemie, born at 34 weeks. So when I was pregnant with Carson, I really wanted to go full term, but I never imagined I would have him at 42 weeks. His “due date” was August 18th. I always said, “He will be born sometime in August.” He was, he squeaked in on August 31st.When I was pregnant with Bryson I figured I would probably go to 42 weeks again. He was due the beginning of October. I had 2 friends who were “due” the same time I was. They both had their babies the beginning of October. I remember vividly being at a soccer game, seeing my friend with her 2 week old baby and me still being HUGELY pregnant. I was OK with it, because mentally I told myself, he will be here by Halloween. It seemed like all my friends were freaking out that I was still pregnant, but because of my mind-shift of a “guess month” I was pretty zen about it.I really recommend that moms be vague about their “due date” or if pressed add 2 weeks to it. I would try to tell people I am due in October and they would say, “But WHEN?” So I would say, “He will be here by Halloween.”Remember it isn’t an Expiration Date, it is a Guess Date!”
This is a guest post from natural mama Abby Deliz. Abby is a mother of three children (Luke, 8; Hannah, 5.5; and Landon, 7 months), and she is also a Master’s student at Claremont Graduate University. Abby has contributed several other wonderful articles on this site on the topic of c-section recovery.
What are the repercussions of an unplanned cesarean?
C-sections (when unplanned) come with plenty of negatives – a longer hospital stay, weeks of recovery time, and lifting and driving restrictions. Emergency cesareans often come with added emotional trauma and increased rates of postpartum depression and anxiety.
A cesarean mama might feel that her birth experience didn’t measure up to what it was “supposed” to be, to what her friends experienced, or to what she heard about in the media. She might have been completely unconscious when her baby was born with her arms strapped down and loved ones out of the room. Baby might have been 10 feet away, surrounded by doctors, or even taken to the NICU.
Mama might not meet her newborn, let alone breastfeed him or her, until hours later.
Does a cesarean have to be a traumatic experience?
No. The answer is simple. You can make your surgical birth experience almost everything you dreamed of when you planned a natural birth. It’s thankfully a new trend we’re seeing in some Los angeles hospitals and the practice is called Gentle Caesarean.
A gentle cesarean can be part of your birth plan if you know you’ll need a c-section, or it can be part of a back-up plan.
The best part about a gentle cesarean is that you can pick and choose which aspects will create your ideal birth atmosphere.
What is a “Gentle Cesarean”?
A gentle cesarean (sometimes called a family-centered birth) includes many features, but its overall purpose is to invoke a peaceful, calm atmosphere that closely mimics what happens during and immediately after a natural childbirth.
If you prefer a gentle cesarean to the traditional protocol, you’ll want to add the following to your birth plan :
Mama should request an epidural or spinal block; general anesthesia should be avoided at all costs, barring any emergencies
Mamas should request that anesthesiologists do not automatically give her extra drugs to relax, so that she can be fully present for the experience
If mama cannot be conscious, father should be allowed to hold baby skin-to-skin immediately after birth, barring any medical complications with baby
If mama has EKG or baby monitoring devices, they can be placed in areas that don’t infringe her ability to see, hold or breastfeed baby.
Mama can watch baby lifted from her belly through a clear drape; if this is makes you squeamish, the drape can be lowered and baby can be lifted above it
Mama’s gown can be lowered and baby can be placed on mama’s chest while mama is being sutured. To facilitate this, mama must ask that her arms are not strapped down
Baby can breastfeed immediately while in the operating room
Parents can request cord clamp/cut delay until it stops pulsing
Parents can request that the placenta be saved and/or frozen until discharge from the hospital
Music of the parent’s choice can play in the operating room
Doctors and nurses are asked to refrain from “shop talk” (I distinctly remember hearing doctors converse about my scar tissue and incisions during my second cesarean) or their weekend plans
Ask your doctor for a vaginal swab to give your baby the best microbiome possible (see below)
Baby can be held by mama while wheeled into recovery, and continue to bond with parents there
Any and all usual post-birth procedures such as cleaning the baby and weighing the baby are delayed until parents are ready
A doula, grandparent, or friend are permitted to photograph or videotape the birth so that parents can concentrate on bonding
What is a vaginal swab, and how does it help my baby?
When a baby goes through the birth canal during a vaginal birth, he or she is exposed to a plethora of microbes – in baby’s mouth and on the skin. These bacteria help build a healthy microbiome for your baby, which could reduce his or her risk of inflammatory illnesses like Crohn’s disease, heart disease, infections, and much more.
The absence of this bacteria transfer in cesarean babies might explain why some studies have found that cesarean babies have higher rates of asthma, allergies, obesity, and other health concerns.
Does a cesarean mean that your baby has to go without the benefits of these microbes?
Not necessarily. With a gentle caesarean, your doctor or midwife can collect a vaginal swab and wipe it on your baby’s skin and in his or her mouth to contribute toward a positive microbiome. Another option is to take a swab of your vagina and wipe it on your nipples before baby breastfeeds.
While this is a relatively new practice, (indeed, I missed out on it with my three kids – a shame since I suffer from Crohn’s and its related enemy, arthritis), research is currently underway to study the efficacy of the practice. “
My french doula note : Please understand that studies about vaginal swab/vaginal seeding during c-section are just starting. We do not know yet the real benefit or
consequences of this practice. Do you own researches and talk with your ob/gyn about it.
Midwives have lots of research support encouraging them to be patient with the second stage and wait for physiological expulsion of the baby. Recognizing ways in which we can support the mother to enter that deep trance brain wave state that leads to smooth birth is imperative. I find it very helpful to have new language and concepts for explaining the process to practitioners. Dr. Odent has taught me to wait for the “fetus ejection reflex.” This is a reflex like a sneeze. Once it is there you can’t stop it, but if you don’t have it, you can’t force it. While waiting for the “fetus ejection reflex,” I imagine the mother dilating to “eleven centimeters.” This concept reminds me there may be dilation out of the reach of gloved fingers that we don’t know about, but that some women have to do in order to begin the ejection of the baby. I also find it valuable to view birth as an “elimination process” like other elimination processes-coughing, pooping, peeing, crying and sweating. All are valuable (like giving birth is) for maintaining the health of the body. They all require removing the thinking mind and changing one’s “state.” My friend Leilah is fond of saying, “Birth is a no-brainer.” After all “elimination processes” are finished, we feel a lot better until the next time. Each individual is competent to handle her bodily elimination functions without a lot of input from others. Birth complications, especially in the first-time mother, are often the result of helpful tampering with something that simply needs time and privacy to unfold as intended.
Do not disturb
For anyone who has taken workshops with Dr. Michel Odent, you will have heard him repeat over and over, “Zee most important thing is do not disturb zee birthing woman.” We think we know what this means. The more births I attend, the more I realize how much I disturb the birthing woman. Disturbing often comes disguised in the form of “helping.” Asking the mother questions, constant verbal coaching, side conversations in the room, clicking cameras—there are so many ways to draw the mother from her ancient brain trance (necessary for a smooth expulsion of the baby) into the present-time world (using the neocortex which interferes with smooth birth). This must be avoided. A recent article on the homebirth of model Cindy Crawford describes how the three birth attendants and Cindy’s husband had a discussion about chewing gum while she was giving birth. Cindy describes her experience: “It was absolutely surreal. There I was, in active labor, and they’re debating about gum! I wanted to tell them to shut up, but at that point, I couldn’t even talk.” (Redbook, March 2000). This was in her own home, and she couldn’t control the disturbance that was happening in her first birth. Needless to say, she had a long, painful, exhausting second stage.
Human birth is mammal birth. A cat giving birth to her kittens is a good model to look to for what is the optimal human birth environment: a bowl of water, darkness, a pile of old sweaters, quiet, solitude, privacy and protection from predators. When given this environment, 99.7 percent of cats will give birth to kittens just fine. We spend so much money in North America on labor, delivery and recovery (LDR) rooms and now, adding postpartum, LDRP rooms. Yes, it is an advancement that women are not moved from room to room in the birth process, but there is so much more that can disturb the process: lighting, changing staff, monitoring, beeping alarms, exams, questions, bracelets, tidying, assessing, chattering, touching, checking, charting, changing positions and so on.
When midwives come back from the big maternity hospital in Jamaica, they bring an interesting observation about birth. The birthing women are ignored until they come to the door of the unit and say, “Nurse, I have to go poopy.” They are then brought into the unit and within twenty-five minutes give birth to the baby. Cervical lips are unheard of. Most times, the head is visible when the woman gets onto the birth table. Her entire eight-centimeter-to-head-visible time is done in the company of the other birthing mothers, and she is cautioned not to go near the midwives until the expulsive feeling in her bum is overwhelming. Cesarean section and instrument delivery rates are very low.
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