Cord Presentation and Cord Prolapse

What is the difference ?

1. With a cord presentation, the umbilical cord lies in front of the presenting part with the membranes still intact.
2. With a cord prolapse, the cord lies in front of the presenting part and the membranes have ruptured. The loose cord may lie between the presenting part of the fetus and the cervix, in the vagina or outside the vagina.

Why is prolapse of the umbilical cord a serious complication ? 

Because the flow of blood between the fetus and placenta is severely reduced and may stop completely, causing fetal distress and possibly fetal death.

Information found on this website:
Ebwhealthcare.com

The Case Against Newborn Suctioning

In research of when and how to suction, I came across this document. It basically states that newborns do not need to be suctioned and states why.

Here is the link

The Case Against Newborn Suctioning

Resuscitation - Newborn Life Support

I found this Awesome information in regards to the resuscitation of a newborn and newborn life support. The thought of having to do this to my own baby completely freaks me out, but knowing the information helps me feel more confident. I have done CPR on adults in the hospital before but to a newborn it is much different. It made me fell a little more comfortable when it was stating that most babies at term will not need this. It also reassured me by basically saying that in most cases a few puffs of air to open the lungs is all that you need.

Here is the link.
(I had to save it to Google Docs, so that I could post it, since it is in Pdf. format)

Resuscitation, Newborn Life Support Document

Resuscitation and Premature Cord Cutting

Here was a great blog entry that I found on a midwifes website. She reinforces the need to delay cord clamping and gives some helpful suggestions as what to do if the baby first has trouble breathing.

One good thing that I learned is that some babies make a slower transition to breath. She states,
"Their colour change may be the only obvious indication that they are making the transition. The cord pulses at the same rate as the baby’s heart, so feeling (or watching) it will reassure you that all is well."

I think I am going to be more prone to freaking out, so this was helpful for me to read.

If there is a problem she suggest milking the cord firmly toward the baby... to initiate breathing. I definitely would not have thought to do that on my own.

Her other suggestions include :

Suggestions

• Try and ensure that the baby does not arrive compromised by minimising unnecessary interventions.
• Do not clamp or cut the cord.
• Give the baby time to transition – if the cord is pulsing the placenta is providing oxygen… relax and reassure the mother if she needs reassurance.
• Do not clamp or cut the cord.
• If the baby requires assistance, start small – gentle stimulation, talking, blowing in his face (all can be done by a parent).
• Do not clamp or cut the cord.
• Milk the cord firmly towards the baby. This shunt of blood into baby is often enough to initiate breathing.
• Do not clamp or cut the cord.
• If further measures are needed, take the resuscitation equipment to the baby and resuscitate him in his mother’s arms.
• Did I mention – Do not clamp or cut the cord.

Note: Routine suctioning of the baby is totally unnecessary, invasive and could potentially create problems by stimulating a vagal response (a drop in the heart rate). "

The Website: Midwife Thinking Blog

Intermittent Fetal Monitoring or Continous Fetal Monitoring ?

I had never previously considered whether to have the "baby monitor" on all the time or just have it checked every now and then. I guess I figured the more monitoring the baby gets the better. With my previous births, in the hospital, this is just how it was. I was discouraged to take the monitor off, even though there was no complications. I do regret this decision now, looking back. Here is why.

*The continuous monitor limited my mobility.
* Limited mobility causes more pain during labor.
* Decreased mobility decreases circulation which decreases oxygen to the baby.  The decreased oxygen changes the heart rate of the baby, and the monitor detects the problem.

(It is ironic how the continuous monitor is the initial problem, and ends up detecting what problem it causes.)

Now I do have to say that if you have an epidural then I can understand being on a monitor because of all the risk and complications that an epidural can cause... your mobility Is going to definitely be limited, and you are adding More Risk to you and your baby and need to be monitored more closely.

* Another reason why I regret having previously been on a continuous monitor... (Not sure why) but I hated calling the nurse over and over to come "hook me back up."
I now see that if I was up and moving more then my labor would have gone a lot faster (with my first and third birth). My second was so fast, but I think it was because I was walking and sitting up until we got to the hospital and he was born.

Still more reasons...

* The doctors and nurses focus more on the monitor than the patient.
( I was a witness to this when I was in nursing school and did my labor and delivery rotation. )

Something new that I have learned...

According to new research (many websites are now saying)

Continuous monitoring Increases your chance of having and unnecessary C-Section. What ? Really ?
 

I was reading this one website that just casually mentions this in their article. It states.
(EFM stands for Electronic fetal monitoring)

"Besides the risk of an unnecessary cesarean section , other risks posed to the mother by EFM include her immobilization in bed. Immobilization simultaneously limits changing positions for comfort and causes changes in blood circulation, which decreases the oxygen supply to the fetus and can lead to abnormal changes in the FHR on the EFM that was applied to detect these changes. Another problem with the use of the EFM is that practitioners have a tendency to focus on it instead of the laboring woman. For these and other reasons, the United States Preventive Services Task Force states that there is some evidence that using EFM on low-risk women in labor might not be indicated. EFM, however, has become an accepted standard of care in many settings in the United States for management of labor. Interestingly, there has not been a reported reduction in perinatal morbidity in the United States with the use of EFM. There is a benefit to using EFM in women with complicated labors, such as those induced or augmented with oxytocin, prolonged labors, vaginal birth after having a cesarean section, abnormal presentation, and twin pregnancy. Link to website


I noticed that it basically said that even though the EFM seems to doing more harm than good, the practice in the U.S. is to still use it. ("has become accepted standard of care") 


So again I am just sharing this journey of research with you, as I learn what is best for me and my baby during pregnancy, labor, and delivery.  

How To Monitor FHR During Labor

A midwife recommended this website to me and his has been helpful in knowing how to monitor the FHR- fetal heart rate, during labor. I have a medical grade fetal Doppler that I use now to listen to the baby, but I was unsure when exactly that you use it with labor or birth. I wondered if you were to use it during a contraction or after a contraction. I knew that the babies heart rate was suppose to change with contractions but I didn't know the heart rate ranges. This website gives an in depth explanation, it gets sort of complicated, but if full of great information.


Intermittent Auscultation CCC

When and how to use oxygen during labor.

This is a question that I was asking myself. Basically I came to the conclusion that if there seems to be fetal distress, as detected by fetal heart rate monitoring, then the mother can receive oxygen along with interventions, such as changing positions. 

"Intra-uterine resuscitation is designed to immediately reduce the stress on the unborn baby by instructing the mother NOT to push, use of anti-gravity positions, lying left side, bolus of IV fluids, etc. 

Administration of maternal 02 due to fetal bradycardia should also be noted on the FHT graph. 

Maternal O2 at 8 liter via tight fitting mask is recommended for evidence of fetal hypoxia. 

Midwives need to anticipate that intrauterine resuscitation will be followed by the need to perform neonatal resuscitation. Oxygen supplies should be adequate to meet the needs of both procedures. In that regard, it is useful for the second call midwife to also make available her own cylinder of oxygen as a backup. "

College of Midwives Website