Thursday, August 29, 2013

Labor and Birth Myths: Fact or Fiction?

This post will be all about myths surrounding labor and birth! Again, if there's anything that you'd like me to address that isn't covered in this post, let me know and I'll look into it!
  • Routinely pushing and/or laboring on your back is the best way to labor and give birth: FALSE
    • Oh, oh, oh, this could not be more false. Think about it: you want the baby to descend into the birth canal, put pressure on your cervix so that you will dilate and efface, and for your pelvis to open up and stretch so that baby has room to come out, right? So, how does it make sense to lie back (forcing baby and your body to work without the help of gravity), and have your legs together in bed while laboring (which doesn't exactly open your pelvis), and push while supine (which keeps your pelvis closed and again takes away the benefit of having of gravity working for you). The best, most physiological positions for labor and birth are standing, side-lying (with the legs open, usually with the help of your OB/midwife/nurse/doula/partner), sitting on a birthing ball, squatting, and on hands and knees. The pelvis can open wider this way, which facilitates descent of the baby and mother's dilation/effacement, and reduces the likelihood of things like tearing, poor fetal positioning, back labor, and baby getting "stuck." Movement in labor (such as walking, rocking, crawling, and swaying) are also good pain management techniques.
    • Here are some sources on the matter:  http://evidencebasedbirth.com/what-is-the-evidence-for-pushing-positions/ , http://www.birthingnaturally.net/birthplan/options/push.html , http://www.bestchance.gov.bc.ca/birth/preparing-for-labour/comfort-positions-during-labour.html
  • You should not have food or drink while in labor: FALSE
    • This is an old myth. It comes from the idea that a woman can aspirate (essentially vomit and it goes into her lungs, to put it simply and bluntly) if she has to be put under general anesthesia during labor. Good reason, right? Well, not really, actually. The likelihood of that occurring is less than the likelihood of being struck by lightning. And even if your stomach is empty, that is no guarantee that you will not throw up stomach acid (I certainly did in my first labor), which will get into your lungs and cause the real damage if you aspirate. Also, fasting during labor has been associated with longer and more painful labors, maternal exhaustion and low blood sugar issues, and dehydration. IV fluids can help, but they're not the same, and they carry some risks. And the likelihood of actually needing general anesthesia to perform a cesarean is miniscule, due to our modern advances in regional anesthesia (spinal block, epidural, etc), so this notion is quite outdated. 
    • So then, why are we adhering to a practice that has no basis in evidence, and is doing more harm than good? Luckily, policies are starting to change, thanks to recent studies. I personally was allowed to drink as much water as I wanted while in labor with my second (I did not want to eat due to vomiting, and my labor was fast anyway), and it made a world of difference.
    • Good articles and sources with recent studies: http://evidencebasedbirth.com/q-a-food-and-drink-during-labor-9/ , http://summaries.cochrane.org/CD003930/eating-and-drinking-in-labour , http://www.ncbi.nlm.nih.gov/pubmed/21073829 , http://www.sciencedaily.com/releases/2010/01/100119213043.htm
  • Modesty will matter to you when you're in labor and giving birth: FALSE
    • Don't worry, I was freaked out about this, too. I was worried about having my nether regions on display while being checked, pushing, and everything in between. I didn't want everyone in the room (I think there were four nurses, my husband, and my OB in the room with my first was born) staring at my ... you know. But when the time came, I honestly didn't care. I didn't think twice about having my L&D nurse down there helping to stretch me and using perineal counterpressure as I pushed. I didn't even think about it. Second time around, I cared even less. Once you're there, you really won't be thinking about modesty: you'll be focused on dealing with labor and the excitement of meeting your baby.
    • This doesn't need any sources. It's a mom thing :-) 
  • Labor always starts with your water breaking: FALSE
    • Just from my personal experience, I can tell you that this is false. My water has never broken on its own. With my first, the OB broke my water (routinely and unnecessarily) at 6cm, and told me that I had very thick membranes. With my second, my midwife broke my water right before I started pushing in earnest, because my bag of waters was bulging into the birth canal (I had excess amniotic fluid) and preventing my daughter's head from fully engaging. She also commented how think my membranes (amniotic sac) were, and said that they probably would not have broken on their own.
    • Only about 10% of labors begin with the water breaking. Your labor starting will more than likely not be the embarrassing moment in the grocery store that you see on TV, where a mother's water breaks and she's standing there in a puddle of amniotic fluid and screaming that she has to get to the hospital right now. Not only is SROM (spontaneous rupture of membranes) statistically unlikely to happen without noticeable contractions, but when your water breaks, it is unlikely to be a huge gush like that. If you are standing or sitting and baby's head (or any other body part) is blocking your cervix, the amniotic fluid won't be able to escape as well, and you may only notice slight trickling, and it may not even be a steady flow. It may become more noticeable if you lie down, but it still probably won't be the flood most first-time mothers imagine. 
    • Resources on this subject:  http://www.bellybelly.com.au/birth/waters-breaking#.Uh--ej_wa1s , http://www.mayoclinic.com/health/water-breaking/MY01442/NSECTIONGROUP=2 , http://www.parenting.com/article/labor-and-delivery
  • You need to go to the hospital the second you start having contractions: FALSE
    • "Come to the hospital once your contractions have been 3-5 minutes apart and longer than 30-45 seconds for at least an hour." Ever heard that? I did. And that's what I did. I arrived at the hospital for my first at only 3cm dilated. And I then got stuck in bed, unable to move, vomiting uncontrollably, and ended up with all kinds of interventions that I didn't want (iv fluids, continuous monitoring, blood pressure cuff, stadol in my iv, anti-nausea meds, and an epidural). Evidence suggests that if you want to avoid interventions and you are low-risk, you should stay home as long as possible before heading to the hospital (or birthing center, or before calling your midwife if you're having a home birth). The rule of thumb is that if you are having trouble walking and talking during contractions, or you are starting to sound "grunty" during intense contractions, you should get going. 
    • If you live a good distance from the hospital and you're worried about making it there in time, call your doctor/midwife, and they can help you decide if you should go in yet or not. But remember, early labor, especially in first time moms, can last for hours (even days for some), so heading to the hospital too early, just to be told you haven't progressed enough to be admitted (or aren't in active labor at all), can be a big disappointment. It's much more comfortable to labor in your own home, where you can eat, drink, bathe, shower, sleep, and do things your way while in early labor. Going in too early can mean taking the control out of your hands, and putting you on the hospital's timetable (which may not be evidence-based care). 
    • Also, if your labor stalls at any point (which is perfectly normal), you may be diagnosed as a "failure to progress," and your labor could be augmented, or you could be sent in for an unplanned cesarean, whereas if you labor where you're more comfortable and off of the "hospital clock," you might be able to wait it out and give your body the time it needs and not fall victim to a doctor's "failure to wait." If such interventions are things you want to avoid, it's best to stay home as long as possible before you head up to the hospital.
    • Some sources: http://www.babies.sutterhealth.org/laboranddelivery/labor/ld_when-hosp.html , http://pregnancy.familyeducation.com/labor-and-delivery/signs-and-stages-of-labor/35965.html , http://pregnancy.about.com/od/laborbirth/f/goingtohospital.htm
  • You are in active labor at 3-4cm dilation, even without effacement, regular contractions, etc.: FALSE
    • I wasn't. I walked around at 4cm dilated and 60-80% effaced, with prodromal labor, for weeks with my second before I went into real, active labor. Some women dilate as much as 6cm before active labor starts. If my midwife had gone simply off of my dilation and had augmented/induced my labor, my daughter would have been born too early. Some women take longer to dilate. Some dilate faster. Some aren't in active labor until more like 6-7cm. The definition of active labor has to be flexible, because no two women are going to dilate at the same rate. Dilation in and of itself isn't the "be all, end all" deciding factor in labor. 
    • I blogged about this, and had some good sources in that post, so I'll just link it here as my source: http://mamadoulayourway.blogspot.com/2013/08/cervical-dilation-and-effacement-prior.html
  • Medications (epidurals, iv pain meds, pitocin, etc.) in labor don't affect the baby: FALSE
    • I have blogged about this one recently. Think about it this way: if you would avoid medications in pregnancy, because they might affect the baby, why are medications in labor any different? Labor meds like pitocin, morphine, stadol, demerol, and epidurals are much stronger than tylenol and the like, and carry more risks. Medications don't stop crossing the placenta and getting to baby just because you're in labor.
    • Just going to link my blog post here, because I had good sources cited there:  http://mamadoulayourway.blogspot.com/2013/08/medications-in-pregnancy-vs-medications.html
  • The pain of labor serves no purpose: FALSE
    • I'm not going to lie: birth hurts. There's no way of getting around that. I know that everyone has different perceptions of pain, and what might be the worst thing in the world for one is a breeze for another, but it is exceedingly rare for a woman to say that her labor didn't hurt, and that she experienced no discomfort or anything at all (and I don't really believe the ones who say it, either, do you?). But the pain really does serve a purpose, even if it just means that you're refusing medications and avoiding those risks.
    • Second (after avoiding the risks), natural labors tend to be shorter. Mothers refusing pain medications tend to move around more in labor, which (as discussed above) helps baby to put more pressure on the cervix, which facilitated dilation, and the pelvis has an easier time opening. Without the numbing effects of an epidural, women can push more effectively, which shortens the pushing phase, too.
    • Recovery tends to be faster. The endorphin and oxytocin release after a spontaneous, unmedicated labor plays into that, as does the lack of medications coursing through the body. Fewer interventions usually means less to recover from (iv's, effects of medications, episiotomies, etc.)
    • There are fewer effects on the baby, and babies born without medications are often more alert, have higher APGAR scores, and breastfeed sooner and more easily.
    • Sources:  http://news.bbc.co.uk/2/hi/8147179.stm , http://naturallysavvy.com/Nest/the-benefits-of-natural-childbirth
  • Medical interventions (in non-emergent situations) always improve outcomes for mom and baby: FALSE
    • Let's just refer back to that table I'm so fond of for this, shall we? 
 
    •  So basically, very very false. Modern interventions have gotten us a 1 in 3 induction rate (which is not supported by evidence), a 1 in 3 c-section rate (also not supported by evidence), and procedures that are also unsupported by evidence are routinely practiced, and they do more harm than good.

  • If your labor stalls or slows down, that automatically means something's wrong and you need a c-section ("Failure to progress"/The Friedman Curve: FALSE
    • Oh my, is this ever false! This goes back to the "one size fits all" box that care providers try to stuff women into regarding birth timelines. No two women will dilate at the same rate, and there are often natural "plateaus" in labor with little to no cervical change, and these women are often mis-diagnosed as a "failure to progress" and sent to the OR for a cesarean (even though mother and baby are still doing fine), when really, all they need is more time. The Friedman's Curve (which is the method most care providers adhere to when it comes to dilation) is over 60 years old, and based on a study that only included 500 women. 500. That is not a very big sample size, especially by today's standards, and the study is very outdated and frankly incomplete.
    • Here's my new favorite article on this matter. It contains lots and lots of other sources for good information:  http://evidencebasedbirth.com/friedmans-curve-and-failure-to-progress-a-leading-cause-of-unplanned-c-sections/
  • You have to do everything suggested to you, you don't call the shots in your labor and hospital policy trumps maternal autonomy: FALSE (mostly)
    • Sadly, this is becoming less and less of a myth. It should fall to the mother to call the shots when it comes to her body and her baby, but more and more moms are falling victim to hospital policies, insurance demands, and doctors who don't practice evidence-based care. Mothers should have autonomy when it comes to birth, but in some places, that is not the case. In an ideal world, this is a truly false myth.
  • L&D nurses/your midwife or doctor/your partner serve the same purpose as a doula: FALSE
    • No. Way. Labor and Delivery nurses, more often than not, will have other patients besides you to care for, and will not be able to stay in the room with you at all times and provide the individualized comfort measures that your doula can, nor will they know or be guaranteed to respect your birth philosophy. Even the very best of nurses may not agree with you, know the techniques you'd like used, or have the time to devote to you.
    • Your partner should be a good supporter, but it's a lot of pressure to put on someone who is also as invested in the experience as you are. A doula can be just as helpful to your partner as to you, the laboring mom. Your partner will most likely not have the experience and education that your doula will have, either, and therefore may not be as effective an advocate for your rights should anything go awry.
    • Your OB or midwife, like the L&D nurses, likely has other patients to tend to, and will not be able to give you constant support like a doula can.
    • The long and short of it is, your doula is there to focus on you and your partner, and do whatever you ask. She only has you to focus on; no other patients, nothing.  
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