The six Lamaze Healthy Birth Practices below are supported by
research studies that examine the benefits and risks of maternity care
practices. Therefore, they represent "evidence-based care," which is the gold
standard for maternity care worldwide. Evidence-based care means "using the best
research about the effects of specific procedures, drugs, tests, and treatments,
to help guide decision-making." Please note: The English versions
were revised in 2009.
Let Labor Begin on Its Own
Walk, Move Around, and Change Positions Throughout Labor
Bring a Loved One, Friend, or Doula for Continuous Support
Avoid Interventions That Are Not Medically Necessary
Avoid Giving Birth on the Back and Follow the Body’s Urges to Push
Keep Mother and Baby Together – It’s Best for Mother, Baby, and
Breastfeeding
Ten Steps of the Mother-Friendly Childbirth InitiativeFor
Mother-Friendly Hospitals, Birth Centers,* and Home Birth Services
To receive
CIMS designation as “mother-friendly,” a hospital, birth center, or home birth
service must carry out the above philosophical principles by fulfilling the Ten
Steps of Mother-Friendly Care.
A mother-friendly hospital, birth center, or home birth service:
Offers all birthing mothers:
Unrestricted access to the birth companions of her choice, including
fathers, partners, children, family members, and friends;
Unrestricted access to continuous emotional and physical support from a
skilled woman—for example, a doula,* or labor-support professional;
Access to professional midwifery care.
Provides accurate descriptive and statistical information to the public
about its practices and procedures for birth care, including measures of
interventions and outcomes.
Provides culturally competent care—that is, care that is sensitive and
responsive to the specific beliefs, values, and customs of the mother’s
ethnicity and religion.
Provides the birthing woman with the freedom to walk, move about, and
assume the positions of her choice during labor and birth (unless restriction is
specifically required to correct a complication), and discourages the use of the
lithotomy (flat on back with legs elevated) position.
Has clearly defined policies and procedures for:
collaborating and consulting throughout the perinatal period with other
maternity services, including
communicating with the original caregiver when transfer from one birth site
to another is necessary;
linking the mother and baby to appropriate community resources, including
prenatal and post-discharge follow-up and breastfeeding support.
Does not routinely employ practices and procedures that are unsupported by
scientific evidence, including but not limited to the following:
shaving;
enemas;
IVs (intravenous drip);
withholding nourishment or water;
early rupture of membranes*;
electronic fetal monitoring; other
interventions are limited as follows:
Has an induction* rate of 10% or less;†
Has an episiotomy* rate of 20% or less, with a goal of 5% or less;
Has a total cesarean rate of 10% or less in community hospitals, and 15% or
less in tertiary care (high-risk) hospitals;
Has a VBAC (vaginal birth after cesarean) rate of 60% or more with a goal
of 75% or more.
Educates staff in non-drug methods of pain relief, and does not promote the
use of analgesic or anesthetic drugs not specifically required to correct a
complication.
Encourages all mothers and families, including those with sick or premature
newborns or infants with congenital problems, to touch, hold, breastfeed, and
care for their babies to the extent compatible with their conditions.
Discourages non-religious circumcision of the newborn.
Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital
Initiative” to promote successful breastfeeding:Have a written breastfeeding policy that is routinely communicated to
all
health care staff;
Train all health care staff in skills necessary to
implement this policy;
Inform all pregnant women about the benefits and
management of
breastfeeding;
Help mothers initiate breastfeeding
within a half-hour of birth;
Show mothers how to breastfeed and how to
maintain lactation even if they
should be separated from their infants;
Give newborn infants no food or drink other than breast milk unless
medically indicated;
Practice rooming in: allow mothers and infants
to remain together 24 hours
a day;
Encourage breastfeeding on
demand;
Give no artificial teat or pacifiers (also called dummies or
soothers) to
breastfeeding infants;
Foster the establishment of
breastfeeding support groups and refer mothers
to them on discharge from
hospitals or clinics
† This criterion is presently under review.
"Its always a risk/benefit analysis. There are risks and benefits to either scenerio and its a matter of choosing which risks are acceptable and which benefits are most important to you.
The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes.
The Midwives Model of Care includes:
The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.
Copyright (c) 1996-2008, Midwifery Task Force, Inc., All Rights Reserved
The Breastfeeding Promotion Act (H.R. 2819, S. 1244) includes five provisions:
"The perception that their infant was not satisfied by breast milk alone was cited consistently as 1 of the top 3 reasons in the mothers' decision to stop breastfeeding regardless of weaning age (43.5%–55.6%)"(most have a fine supply btw)
Now the best wy to asess milk supply is by observing weight gain and counting wet and poopy dipes.
the world health organization has new weight gain charts based on breastfeeding you can refer to. heres the one for girls http://www.who.int/nutrition/media_page/cht_wfa_girls_z_0_5.pdf and heres the one for boys http://www.who.int/nutrition/media_page/cht_wfa_boys_z_0_5.pdf
and heres a quick diaper counting link from kellymom http://www.kellymom.com/bf/supply/enough-milk.html (basically you want to see 6 or more wet dipes a day and at least 1 poopy dipe, though younger infants, less than a month old often have several little poops each day rather than 1 big one)
if your baby isn't gaining and isn't wetting and pooping it could be a supply issue. ( it could also be transfer issue - you could be making milk and s/he isn't taking it in ) in either case please see a healthcare provider to be sure baby is ok and see a lactation counselor or a lactation consultant to check for breastfeeding issues such as a bad latch.
if you determine a low supply is the culprit there are lots of ways to increase your supply but the simplest is just to nurse.
if increasing the time you spend nursing your little one doesn't increase supply you can add a pumping session or several into your routine.
and there are foods, herbs and medications that can increase supply if necessary. heres another link from kellymom http://www.kellymom.com/herbal/milksupply/herbal_galactagogue.html that gives a good list of various galactagogues and the dosages and side effects
and that leads me to the warning portion of this post: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm149533.htm
Reglan or metoclopramide is a drug used to treat reflux and other gastric conditions but it also increases milk supply. it is not fda approved for use as a galactagogue but is often used as one.
from the fda release linked above:
"Current product labeling warns of the risk of tardive dyskinesia
with chronic metoclopramide treatment. The development of this condition is
directly related to the length of time a patient is taking metoclopramide and
the number of doses taken. Those at greatest risk include the elderly,
especially older women, and people who have been on the drug for a long
time.
Tardive dyskinesia is characterized by involuntary, repetitive
movements of the extremities, or lip smacking, grimacing, tongue protrusion,
rapid eye movements or blinking, puckering and pursing of the lips, or impaired
movement of the fingers. These symptoms are rarely reversible and there is no
known treatment. However, in some patients, symptoms may lessen or resolve after
metoclopramide treatment is stopped."
"A Cochrane systematic review6 identified five randomized controlled
trials (RCTs) comparing active and expectant management that included more than
6,400 women. Compared with expectant management, active management was
associated with: a shorter third stage (mean difference, -9.77 minutes); a
reduced risk of postpartum hemorrhage (number needed to treat [NNT] = 12) and
severe postpartum hemorrhage (NNT = 57); a reduced risk of anemia (NNT = 27); a
decreased need for blood transfusion (NNT = 65); and a decreased need for
additional uterotonic medications (NNT = 7).6 Active management also was
associated with an increased risk of maternal nausea (number needed to harm
[NNH] = 15), vomiting (NNH = 19), and elevated blood pressure (NNH = 99), likely
caused by the use of an intramuscular ergot alkaloid as the uterotonic
medication in four of the five studies in the systematic review. There were no
advantages or disadvantages for the baby with either approach."BTW: let me explain nnt and nnh. actually heres a wiki on it http://en.wikipedia.org/wiki/Number_needed_to_treat
dr. sara j. buckley weighs in in favor of a physiologic third stage here http://www.birthresourcenetwork.org/the-news/68-leave-well-alone-a-natural-approach-to-the-third-stage-of-labor dr. buckley takes the reduction in blood transfer from the cord to the baby into account in her article.
"While the aim of active management is to reduce the risk of haemorrhage for the
mother, 'its widespread acceptance was not preceded by studies evaluating the
effects of depriving neonates [newborn babies] of a significant volume of
blood.'10
It is estimated that early clamping deprives the baby of 54 to 160
ml of blood,11 which represents up to half of a baby's total blood volume at
birth. "and here is a very detailed look at the third stage from childbirth connection
http://www.childbirthconnection.org/pdf.asp?PDFDownload=gecpc3ch33
this is actually taken from the book A Guide to Effective Care in Pregnancy and Childbirth (Oxford University Press, 2000)
In all that i just read it seems to boil down to what the mother wants. the risk of post partum hemmorhage is about 4%. some women would want to do everything to eliminate even that risk whereas others would prefer to have that time of undisturbed bonding as a new family.
in my own case i would have strongly prefered a physiologic third stage. but i can see that active management is an evidence based option as well. it does reduce risk....i just don't feel that the risk is high enought to warrant all the fiddling.
of course there is a third option...... http://en.wikipedia.org/wiki/Lotus_birth
and from london based delia lloyd http://www.politicsdaily.com/2009/07/16/no-pain-no-gain-the-value-of-epidurals-during-childbirth/
I posted rixa's reply seperately in the previous post. and she did an awesome job of collecting all the chatter. all i really have to say is trhat all the hoopla about him being a MAN is getting in the way of what he has to say. its sexist at the very least....i mean do we also question so strongly the pronouncements of other males dealing in birth such as the mostly male writers of obstetrical texts?
a study about bottle-feeding
dick morris makes claims that govn't is telling women to quit having cesareans
http://mediamatters.org/research/200906250042
actually according to healthy people 2010 we do have a goal to reduce primary section rates from %18 in 1998 to %15 in 2010 and the repeat section rate from %72 to %63
however the site states
"(The targets presented here apply to the population as a whole and are not intended to be used as practice outcome objectives for individual physicians or institutions, as the medical needs of the patients in each practice will vary.) In addition to monitoring rates of cesarean births, the outcomes of these deliveries (for both the mother and the infant) should be watched closely to assure that changes in the mode of delivery do not put women or their infants at risk."
so section rate reduction is not being pushed in terms of a money saving strategy....thats really all i can find about obamas take on section rates....and of course these goals were crafted before obama took office anyway
anybody with more info? please comment....
and heres gloria lemays take on a letter posted on the american college of nurse midwives site http://www.glorialemay.com/blog/?p=147
i still don't know what i think about the situation. i'm an aspiring midwife. i'm currently thinking of going the cnm route rather than cpm because taht would allow me to bring the midwifery model of care to more women. if things were to change legally in this state to allow for legal recognition of cpms then i might go that route....
i do think the letter was unecessarily divisive, and i have not seen any research to support the conclusion that cpms are not qualified providers, BUT i do like the idea of a standardized education for cpms.
i don't see why apprenticeship couldn't be incorporated into that.
okay well this was kind of a lazy post but ithink its all i got for now....
BellyWise Birth Support offers information and support to guide you through pregnancy, birth and early motherhood. As an independant childbirth educator I will guide you through the wealth of information available in order toensure that you understand all the options available to you. I am a Certified Lactation Counselor (CLC) and I provide breastfeeding support both online and locally.
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