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Alternative Birthing Methods

Alternative Birthing Methods Erin Cook January 19, 2006 THRS Presentation Alternative Methods Lamaze Waterbirth Acupuncture, Acupressure, & Moxibustion Hypnobirthing Yoga Ginger for N/V Massage Reflexology for edema Perineal massage Red raspberry leaf & Chanlibao to shorten labor

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Alternative Birthing Methods

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  1. Alternative Birthing Methods Erin Cook January 19, 2006 THRS Presentation

  2. Alternative Methods • Lamaze • Waterbirth • Acupuncture, Acupressure, & Moxibustion • Hypnobirthing • Yoga • Ginger for N/V • Massage • Reflexology for edema • Perineal massage • Red raspberry leaf & Chanlibao to shorten labor • Cabbage, tea, jasmine flowers for breast engorgement • Home birth / Midwives / Doulas

  3. Lamaze • Techniques developed by Dr. Fernand Lamaze (Paris, 1950’s) • American Society for Psychoprophylaxis in Obstetrics founded as a nonprofit in 1960 by Elisabeth Bing and Marjorie Karmel • Emphasis on activity during labor, breathing techniques to assist contractions, and relaxation methods to separate muscle groups

  4. Lamaze™ Philosophy of Birth • Birth is normal, natural, and healthy. • The experience of birth profoundly affects women and their families. • Women's inner wisdom guides them through birth. • Women's confidence and ability to give birth is either enhanced or diminished by the care provider and place of birth. • Women have the right to give birth free from routine medical interventions. • Birth can safely take place in homes, birth centers and hospitals. • Childbirth education empowers women to make informed choices in health care, to assume responsibility for their health and to trust their inner wisdom.

  5. Lamaze • No longer just a “breathing” technique • Classes taught by a Lamaze Certified Childbirth Educator (some hospitals provide them) • “affirms the normalcy of birth, acknowledges women’s inherent ability to birth their babies, and explores all the ways that women find strength and comfort during labor and birth”

  6. Lamaze • Encourages many techniques to respond to contractions and find comfort • Emphasizes emotional and physical support during labor but not “coaching” • Goal: “every woman gives birth confidently, free to find comfort in a wide variety of ways, and supported by family and health care professionals who trust that she has within her the ability to give birth”

  7. Waterbirth • Waterbirth International founded in 1988 by Barbara Harper • Currently avaliable in 250 US Hospitals and 70% of birthing centers • Birthing tub at 95-100°F • May be used for labor • and/or birthing

  8. Waterbirth Benefits • Water is relaxing, soothing, and calming • Buoyancy decreases body weight and promotes circulation and efficient contractions • Lowers BP by reducing anxiety • Allows for increased endorphin production • Promotes elasticity of perineum • Provides a sense of privacy • Eases transition for baby

  9. Risks of Waterbirth • Theoretical risk of water embolism • Water aspiration • Cord Avulsion Contraindications • Herpes • Breech • Bleeding disorder • Multiples • Preterm • Severe Meconium • Pre-Eclampsia ACOG: “insufficient data to render an opinion”

  10. Waterbirths compared with landbirths: an observational study of nine years; Verena Geissbuehler*, Sonja Stein and Jakob Eberhard: J. Perinat. Med. 32 (2004) 308–314 • Compared 3617 waterbirths and 5901 landbirths (all spontaneous singltetons with cephalic presentation) in one hospital to assess differences in maternal and neonatal morbidity and mortality • Limited use of episiotomies in waterbirths (8.3% in waterbirths versus 25.7% in landbirths) does not lead to more third and fourth degree perineal lacerations • Landbirths show higher rates of episiotomies as well as third and fourth degree perineal lacerations. • After a waterbirth, there is an average loss of 5.26 g/l blood; this is significantly less than landbirths where there is an 8.08 g/l blood loss on average. • Waterbirths are not associated with increased risk of infection

  11. Unanswered questions • Effect of water on contractions • Degree of analgesia provided by warm water

  12. Acupuncture • Chinese in origin • Used for 4 main purposes • Induce labor • Relief of Nausea/vomiting • Turn breech presentation • Pain control

  13. Acupuncture • Nausea and vomiting • Acupoint 6: 3 fingerbreadths proximal to distal wrist crease and 1cm deep • 3 Studies • No significant difference between experimental and control • Decrease nausea but no change in emesis frequency • Decreased vomiting episodes in hyperemesis gravidarum

  14. Acupuncture • Breech Version • Utilizes acupuncture with moxibustion; heating of needles with burning Artemesia vulgaris • At 35 weeks, 75% of exposed fetuses were cephalic compared to 48% in controls, and at delivery 75% and 62%, respectively. This difference was significant despite 19 in the control group undergoing successful external cephalic version • Statistically significant results in 3 RCTs • In one RCT in a non-Chinese population in 1995 study interrupted due to compliance issues • No good data for success in Western countries

  15. Acupuncture • Labor induction • Acupuncture one time on due date (German study) • The time from estimated delivery date (EDD) to labor was 2 days shorter in the acupuncture group. No differences in clinically significant outcomes such as Bishop’s score or length of different labor stages • 4h session 8days after due date (American study) • The number of contractions in the experimental group significantly increased from 63 at baseline to 116 in the fourth hour of stimulation, compared with a decrease in the control group from 84 to 75

  16. Acupuncture • Labor analgesia (3 studies) • Acupuncture vs. sham-puncture • Recipients of the acupuncture had significantly lower reported levels of pain throughout labor, and lower oxytocin, epidural and narcotic use • Acupuncture vs. no acupuncture • no significant difference in pain intensity or delivery outcome, but observer-rated relaxation scores improved in the acupuncture group. Epidural use was 12% in the acupuncture group and 22% in the controls • Acupuncture vs. no-acupuncture • meperidine use was 11% in the acupuncture group compared to 37% in a no-acupuncture group

  17. Hypnobirthing • Founded in 1989 by Marie Morgan • “There is no pathological reason for pain in childbirth. There is nothing that actually malfunctions. It’s tension and fear and interventions that cause the malfunctioning.”

  18. Hypnobirthing • Trained therapists teach women to self-hypnotize and control breathing to match contractions • Allows women to remove themselves from the pain of childbirth • Techniques learned include self-hypnosis, deep relaxation, visualizations, positions and special breathing methods

  19. Hypnobirthing • Benefits • A more relaxed and enjoyable pregnancy • Shortens the first stage of labour by several hours • Eliminates or greatly reduces the need for medical intervention • Fewer breech presentations and other special circumstances • Easier and calmer resolution in the event of special circumstances • A more enjoyable, peaceful birth experience rather than a tense, stressful ordeal • A special, integral role for the birth companion • Reduces risk of hyperventilation from “shallow” breathing methods • Promotes bonding of mum, baby and birth companion • Babies are calm at birth and really alert • More rapid postnatal recovery • Returns childbirth to a positive and beautiful experience that nature intended www.hypno-birthing,org.uk

  20. Yoga

  21. Yoga • Many prenatal yoga classes and videos avaliable • Benefits in prenatal period • Relief of aches and pains, swelling, insomnia • Strengthen pelvic floor muscles • Teaches deep breathing techniques • Contributes to general health and well-being

  22. Yoga • RCT in India (2005) • birth-weight is significantly higher in the Yoga group, compared to the control (walking) group • Occurrence of complications of pregnancy (pregnancy-induced hypertension, intrauterine growth retardation, pre-term delivery) shows lower trends in yoga group • No significant adverse outcomes in yoga group

  23. Conclusions • Many methods available to women • Alternative methods focus on putting women in control of birth environment and process • Controversy exists regarding need for fetal monitoring and psychological effects of invasive instruments

  24. References • www.americanpregnancy.org • www.waterbirth.org • www.parenthood.com • www.hypnobirthing.org • www.lamaze.org • Anderson F, C Johnson: Complementary and alternative medicine in obstetrics. International Journal of Ob/Gyn (2005) 91, 116-124. • Cardini F, P Lombardo, A Regalia, G Regaldo, A Zanini, M Negri, L Panepuccia, T Todros: A randomized controlled trial of moxibustion for breech presentation. BJOG. June 2005, Vol. 112, 7453-747. • Geissbuehler V, S Stein, J Eberhard: Waterbirths compared with landbirths: an observational study of nine years. J. Perinat. Med. 32 (2004) 308-314 • Hyangsook L, E Edzart: Acupuncture for labor pain management: A systemic review. American Journal of Ob/Gyn (2004) 191. 1573-9. • Lamaze International (2001). Position paper- Lamaze for the 21st century. • Narendran S, Nagarathna R, Gunasheela S, Nagendra HR Efficacy of yoga in pregnant women with abnormal Doppler study of umbilical and uterine arteries.J Indian Med Assoc. 2005 Jan;103(1):12-4, 16-7

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