Reduce the Ring of Fire with St John’s Wort Oil

March 30, 2009 at 11:06 pm (Comfort Measures, Doula) ()

One of my favorite tips I received from an experienced midwife is a simple and effective way to ease the “ring of fire” some moms experience as their baby is crowning (as the widest part of the baby’s head is passing through the yoni).  She told me that she takes St. John’s Wort oil, a preparation of St. John’s Wort flowers in olive oil, and gently but thoroughly applies it to the perineum.  She told me that since she’d been using it, none of her clients had complained about the incredible burning, tearing, stinging pain of crowning.  Intrigued, I bought a jar of the oil for my second birth, and lo and behold, it worked!  I never felt his crowning in my perineum (although I was feeling the labor in every other part of my body…..unfortunately, I haven’t yet found a remedy for that), and he was the biggest of my babies, with a 14 3/4″ head. 

St John’s Wort is a well-used first aid remedy, because of its ability to ease nerve pain.  A description of its use, as well as many other helpful birth herbs, can be found here.  St John’s Wort can also be helpful when used in a massage oil if a mama is having painful back labor (since the nerves of the sacrum are frequently implicated in the pain of a posterior, or back, labor).  I usually carry a base massage oil, such as safflower, and then depending on the circumstances, I add  arnica oil (for tired, sore, bruised muscles) and/or St. John’s Wort Oil, and top it off with a few drops of lavender or rose oil.   If a mama is having nerve pain but would prefer not to use herbs, she can also try homeopathic Hypericum, which is the energetic form of the St. John’s Wort herb. 

As a doula who works in the hospital, I usually bring my oils with me, but I let my clients know that if they want them used during pushing, they will have to ask for them.  Doctors and midwives tend to be more likely to consider an herbal request from a mama than from a doula.  At a birth at a local community hospital, I was accompanying a mama who had expressed a strong desire to use St. John’s Wort during our pre-birth meetings.  When she started pushing, she said to her midwife, “I want that oil that Mayari has!  I want you to use it!”  Her midwife asked me what it was, and then shrugged and said “Why not?  Let’s see how it works!”  My lovely client, a first time mama, proceeded to push out her baby with no perineal pain at all, even though she (unfortunately) sustained a third-degree tear.  I was so pleased that the practitioners at this hospital were open to this gentle herbal assistance, and I have since found that many doctors, nurses and midwives are willing to try it if it’s what their patients want.

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Adrenaline in Birth News

March 23, 2009 at 4:01 am (Hospital Procedures)

This story came from my local NC newspaper:

http://www.citizen-times.com/apps/pbcs.dll/article?AID=2009903210323

This kind of training is obviously important for doctors who may run into emergency scenarios when caring for birthing women.  But doesn’t it also set in the idea that birth can always go wrong, that birth is always a potential emergency?  What about training scenarios where the mom and the baby are healthy….and the mom chooses to deny fetal monitoring…..or she won’t take RhoGam because of religious reasons….how about training for sensitivity when the need arises to examine a mom?  Do doctors train for these interesting communication situations, where they must employ all their skill and knowledge as a doctor and yet take into account the wishes and beliefs of their clients? Do they train for collaborative care?  It’s interesting to me that the special training scenario involves a situation where a doctor must take complete charge and use heroic measures to save a woman and a baby’s life.  This highly emotionally charged situation will be remembered much more quickly and clearly than the routine, mundane case of a woman for whom everything goes naturally and well.

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Breaking Waters: Amniotomy or Spontaneous Rupture?

March 19, 2009 at 2:01 am (Hospital Procedures, Informed Consent) (, , , )

One of the myths of childbirth is the idea of a dramatic beginning to labor:  a very pregnant woman is innocently going about her business when all of a sudden: gush-SPLAT!  Her waters break, she is immediately in hard labor, and she is rushed to the hospital.  Sometimes, it is true, labor starts with a tidal wave of breaking waters and intense contractions, but this is the exception, especially for a first-time mother.  The majority (although there are an amazing diversity of variations) of labors are comprised of a gradual buildup of contractions, increasing in intensity and strength.  The most common time for the membranes to break naturally is during the pushing phase, when the waters can act to “slick the slide” (to quote a favorite midwife of mine) and help the baby on down the birth canal.

Since people hold the idea that labors typically start with broken waters, it is understandable that one of the most common and accepted interventions during labor is amniotomy, which is artificial rupture of the membranes (amniotic sac) by a doctor or midwife using an amnihook.  If the membranes haven’t broken on their own, won’t it help  speed things along if a practitioner does it?  This thinking has led to the acceptance of a practice which, when used routinely, may or may not be beneficial, and which does have documented risks to the mother and the fetus.

According to Henci Goer (The Thinking Woman’s Guide to a Better Birth, Perigree, 1999) there are two different types of amniotomy: those done routinely, early in labor, and those done later on for a specific reason.  Let’s look at each type.

The use of amniotomy in early labor is based on the presumption that, when the waters break, it fits the baby’s head tightly into the cervix, allowing contractions to work more effectively to speed dilation and resulting in a shorter labor.  Some studies have shown a shortening of labor by 1-2 hours when this kind of amniotomy was employed (Goer 99).  But before these results influence a mother’s decision about amniotomy, she should ask herself why these labors were shorter, and whether there are any risks resulting from amniotomy that might outweigh the benefit of a possibly shorter labor.

The length of labor described in these studies may be deceptive.  In nine studies of amniotomy vs. “conserving membranes”, Cesarean rates were consistently higher for women whose waters were broken by their practitioner (99).  A Cesarean delivery is usually done before the last minutes of labor, so the length of these labors would have been artificially shortened by the surgery. If amniotomies are more likely to result in a Cesarean section, perhaps it would be prudent to reserve their use until later in labor, when or if an indication arises for which they might be truly beneficial.

Another downside of amniotomy use in early labor is the perception of pain.  Many labor stories (mine included) mention that after the waters break, the pain becomes more intense,  This makes sense, since the amniotic fluid provides a cushion between the mother’s pelvis and the baby’s body.  Once that cushion is removed, the baby exerts more pressure on the mother’s tissues and bones which in some cases can result in more pain. If this happens toward the end of labor, it provides impetus for the mom to push harder and get the baby out.  If it occurs in the beginning of labor, then the process can become more painful at a time when there’s less that the mother can do actively to relieve that pain.  This is not to say that if waters do break naturally or artificially in early labor, it means that the labor will become unmanageably painful.  There are many comfort measures that are quite helpful.  However, if it’s not necessary, why should the mother be subjected to a potentially more painful labor early on unless it’s a natural part of her body’s plan for the birth?

So we see that the supposed benefit of early artificial rupture of membranes might not hold up under scrutiny, and we see that for some mothers there is an elevated experience of pain resulting from amniotomy.  Bur are there any objective, medical risks resulting from amniotomy?  According to Goer, the answer is yes.

As I’ve already mentioned, the amniotic sac provides a cushion around the baby.  When these waters flow out of the womb, the baby is subjected to more of the pressure resulting from contractions.  In extreme cases, the cord can become displaced and pinched, cutting off the baby’s supply of oxygen (cord prolapse).  Even when this doesn’t happen, some babies don’t respond well to the added stress of contractions without the cushioning water.  Their heartrate can become irregular or too slow, and they can descend into fetal distress.  Since these abnormal heart rates are one of the primary causes for Cesarean sections, it makes sense that women who have amniotomies are more likely to have Cesareans than women whose membranes rupture naturally.

Goer also cites several studies that link amniotomy to higher maternal infection rates (101).  Once the waters are broken, the bacteria that are always present in the birth canal can travel up into the womb, precipitating an infection in the mother, the baby, or both.  Vaginal exams, which are frequently performed in the hospital, can hasten this transfer of bacteria.

These risks to mother and/or baby, combined with the questionable nature of the benefits, might lead one to question the necessity of routine early amniotomies.  But what about breaking the waters for a specific reason later in labor?

Sometimes when a mother reaches 7 or more centimeters dilation and then doesn’t progress for a while, a practitioner may recommend amniotomy to remove “bulging forewaters” (a bubble of amniotic sac and fluid that is coming through the cervix before the head).  Again the thinking behind this recommendation is that breaking the waters will help to bring the baby’s head fully onto the cervix, allowing the cervix to dilate more effectively.  In my experience as a doula, I have seen amniotomy in this case to be effective for some mothers.  When labor is already well established, and positions and movement have been tried but haven’t been effective, amniotomy may be helpful to complete dilation and aid the baby’s descent into the birth canal.  However, I think a mother should always check in with her own body and intuition- if she feels like it’s not a good idea, then in the abscence of medical necessity, it’s her right to refuse an amniotomy.  If the mother’s first response is “Yes!  Anything to help move this along!” then it might be a good idea to go ahead with breaking the waters.  Each case of amniotomy at a late stage in labor is individual, and should be evaluated according to the mother’s and practitioner’s judgement.

The risks of late amniotomy are less than those of early amniotomy, because there is less time for the risks to develop.  This is especially true for infection, since the amount of time that passes after the breaking of the waters is a big factor in whether or not an infection will set in.  In regards to fetal distress, it can still occur at a late point in labor, but if the amniotomy is done closer to birth, the baby has less time to become exhausted and depleted.  And if the baby’s head is well engaged, there is less chance of a cord prolapse, although it is still a possibility.

As a doula, my personal birthing philosophy is that bodies are wise, and birth will generally proceed best if left undisturbed by interventions.  However, there are some isolated cases where I’ve seen a late-in-labor amniotomy help a mom to birth her baby more quickly and easily.

Whatever your feelings are about the breaking of your waters, it is a good idea to ask your doctor or midwife about their protocols concerning amniotomy.  As Goer says, “Many caregivers consider amniotomy so trivial that they may not think to advise you that they are about to do one” (102).  If your practitioner does suggest rupturing your membranes during labor, it is entirely reasonable to ask for five minutes to think about the procedure before making up your mind.  This will give you some unpressured time to check in with your body, or read a page in a book, and from there make the decision that is best for you and your baby.

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Communitas in the childbearing continuum

March 1, 2009 at 5:11 am (Doula)

Communitas refers to “an intense community spirit, the feeling of great social equality, solidarity, and togetherness. Communitas is characteristic of people experiencing liminality together.” www.wikipedia.org/communitas   Doulaing incoporates much in the way of skills, information, techniques, and emotional integrity, but it is all held together by the spirit of communitas.  In the most liminal experience of a woman’s life, the bringing of a child from the shelter of the womb, through the threshold of birth and into the community of life, the support and solidarity of the people she draws around her can make the difference between experiencing birth as trauma and pain or experiencing it as a doorway into power as a woman and an actualized human being.  How can this sense of communitas be fostered throughout the childbearing continuum?

Prenatally, I meet with mothers at least twice and often more frequently.  Most of this meeting time is spent listening- listening to her needs, her wishes, her hopes, her fears, her plans for family and motherhood.  Listening to her partner, what he or she brings to the pregnancy and birth, where he or she would like support.  Listening on a more subtle level to the mother’s body, seeing how it responds to what she says and what others say around her.  How she interacts with her body and her baby.  Listening in complete stillness to see if the baby wants to communicate anything.  Only by listening can I learn how as a doula I can best support this family at this sensitive time.  After listening, I speak of what I hear from the family and what my own experience has been.  In this way, we share our stories, and in sharing stories, we create a common space where our brief community can flourish.

During the labor, communitas is fostered by trust, support and expectation.  I trust implicitly that every mama-baby unit will birth in the way that is best for them.  I trust that partners, family, friends or nurses will join the labor dance skillfully and will teach me to support this beautiful woman as I also teach them.  I support the birthing by respecting the mama’s own style of laboring, whether that be singing, moving, yelling, or silent concentration.  I support the birth space by limiting interruptions as much as possible and maintaining the energy of love and compassion throughout the birth time.  I expect that we as a birthing team will be incoporated into the caregivers’ routine with respect and courtesy, and that we will be able to negotiate the mama’s care smoothly and with equanimity.  I expect that the mother’s body and spirit will be honored.  When trust, support and expectation coincide in this way, our community can enhance and make sacred the birth, wherever and however it takes place.

After the birth, communitas continues.  We tell stories of the birth and recount the mother’s grace, strength, humor and bravery.  The new baby is welcomed into the world, and the love and camaraderie we have created amongst ourselves cradles her, as well.  I continue to visit the new family several times, watching with respect and amazement as they create their own beautful vision of what they will be.  And even when the visits are over, each family remains in my heart forever, each birth a strand in a web that connects me to the whole. 

Communitas- the spirit of community, the equal and complete participation of all members of a group, is the perfect description of how people come together to support a birthing mama-baby.  As a doula, my aspiration is to facilitate this support and watch a mother come into her highest power as she brings the miracle of a new child into our world.

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