The Umbilical Cord

I’ve gotten several hits on my blog about this subject, so thought I might as well go in depth with this a bit more.

The umbilical cord is what connects the baby to the mother. Soon after conception, the baby (embryo may be the “correct” term for this stage of development) burrows into the lush uterine lining, and part of the embryo becomes the placenta while the rest of it becomes the baby, inside the amniotic sac. The placenta grows along with the baby, and although the mother’s and baby’s blood never mix, the placenta is where the oxygen and waste exchange happens–the mother’s circulatory system gives the baby oxygen and nutrients while taking away the baby’s carbon dioxide and waste.

Generally, there are no problems with this wonderful system; but occasionally, the placenta does not grow very big, or the umbilical cord can develop a knot, or wrap around the baby. Many home-birthing midwives will testify that maternal nutrition plays a vital role in a well-developed placenta, which only makes sense–“you are what you eat.” Check out The Brewer Diet for more information on a healthful diet. The umbilical cord can develop a knot if the baby moves through a loop in the umbilical cord. This happens very early in pregnancy, when the baby has ample room in the womb for these free movements; later, the baby is much more squished in the confines of the uterus. Most of the time, a knot is not a problem, but a “true knot” can actually be so tight that it compromises blood flow through the umbilical cord to the baby. This is extremely rare, and usually cannot be known before birth.

Probably what most people worry about when it comes to umbilical cords is that they will be wrapped around the baby’s neck. This is called a “nuchal” cord (from the Latin word for “neck”). This is much more common, occurring in up to 20% of all births, but only rarely causes problems. My first son, for example, had the cord wrapped around his neck once, and the midwife couldn’t get it off before his body was fully born, but the cord was kept intact and my baby had no problems whatsoever. In fact, I did not even know it had happened until a few years later when I was looking through my copy of the birth records. What might cause problems is if the cord is wrapped around the baby’s neck and cuts off or diminishes circulation to the baby’s brain either in utero or as the baby is being born. But again, this is rare. 

The typical response to a nuchal cord is to unloop it from the baby’s neck after the head is born and prior to full birth if at all possible; and if it’s too tight, to cut the cord and unwind it. (The cord will be clamped in two places, and the cut will be made between, to minimize blood loss to the baby, and mess on the floor from the placenta side of the cord.) Some birth attendants will instead “somersault” the baby out of the birth canal, keeping the baby’s head close to the mother’s body. This allows the baby to be born while still keeping the cord intact (occasionally, a nuchal cord might prevent the baby from coming out because it makes the cord too short). With the baby fully out, the cord can then be unwound from the baby’s neck or body, thus allowing the full amount of oxygen that sustained the baby inside to keep coming to the baby on the outside, while he makes his transition to breathing.

It may be possible to identify a nuchal cord with ultrasound, but there are some considerations you should have. First, most nuchal cords do not cause problems. There are fetal tests that can be done if a nuchal cord is suspected or known that can reassure you as to fetal well-being (including you doing “kick-counts” to make sure your baby is moving adequately). Second, ultrasound is not 100% reliable, and you have to judge the benefits vs. risks of this or any other procedure. And finally is a story one of my online friends shared with me (she is a doula at a birth center, as well as childbirth educator). A couple discovered via ultrasound that their baby had a nuchal cord (after the woman was at term, but prior to onset of labor). The woman was terrified of the baby strangling herself, so she decided to have a C-section right then. The birth center offered to keep her overnight and continue to monitor the baby, and let her see that the baby was just fine, but she was too scared to accept. Within a couple of hours, she had had the C-section, and the doctor said there was no nuchal cord. Babies move in utero; they twist and turn. It is easily understandable that the baby could wrap herself up in the cord, and then unwrap herself just as easily.

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Why I am Pro-Life

Explore this website.

Among other things, abortion kills women, increases their risk of future problems in pregnancy including but not limited to future infertility, increased risk of miscarriage and stillbirth, and preterm labor. Then there are the mental side effects, which are less visible but no less harmful.

Excellent Blog Award

By accepting this Excellent Blog Award, I have to award it to 10 more people whose blogs I find Excellent Award worthy. I can give it to as many people as I want but please award at least 10. Thank you out there for having such great blogs and being such great friends! You deserve this! If chosen, you agree to the same information above. If chosen, also feel free to award people who have already been awarded…

This is a really cool idea, and I feel so honored to have received two. I really appreciate that someone has found my blog worth recommending. 🙂

Ok, so passing this on to ten more blogs (in no particular order)…..

1. http://rixarixa.blogspot.com/

2. http://enjoybirth.wordpress.com/

3. http://wonderfullymadebelliesandbabies.blogspot.com/

4. http://fearlessbirth.wordpress.com/

5. http://birthsupport.wordpress.com/posts/

6. http://birthingtouch.blogspot.com/

7. http://thinkmcfly.wordpress.com/blog/

8. http://mommiedaze.wordpress.com/

9. http://rebirthnurse.blogspot.com/

10. http://mceeharris.blogspot.com/

Coming to terms with a bad birth experience

One of the things that has spurred me on to become a childbirth educator is the sheer number of birth stories I have read in which the woman had a bad experience. Those experiences were varied, and some of the times couldn’t have been changed (like the woman whose C-section operation was started before the anesthesia took full effect); but most of them could. But when something happens during birth that you wished hadn’t happened, what do you do?

This is a very difficult question, and I want to tread lightly, because this is a sensitive and delicate subject. Most people just tell moms who are hurt emotionally or physically just to get over it and be happy the baby is okay. But is that all that there is to it? To me, that’s like telling a rape victim to just be happy she’s still alive. Yeah, there’s a positive side to it, but that doesn’t make that big dark cloud really that much smaller.

To me, processing this experience is like any other grief experience. For one thing, it’s different for everybody–no two people have the same way of dealing with any experience no matter how similar, and it isn’t right or fair for people to tell other people how to grieve. I’ve had sadness in my life; but my biggest experience with grief was with the unexpected death of my father. It was an extremely emotional time, and here 9 years later, I have just been able to put the bulk of the grief behind me and be able to look back at the good times without the pain of grief stabbing me every time. There are still difficult times (such as now when I’m talking about it, and reliving that time yet again), but for the most part, it is over. At the time he was killed, many people said things that they thought would make me feel better, but in reality, almost everything was a fresh wound, because it rubbed the raw, gaping wound that was my heart, and made it bleed again. I have struggled with anger and bitterness over what happened, even blaming people who were probably blameless, and trying to ignore the feelings I had because it hurt too badly.

If you think about dealing with a bad experience as a grief, things make a lot more sense. You give yourself time to deal with things; you accept as natural the negative feelings that come with grief–shock, denial, anger, bitterness, resentment and depression. I’m not saying it’s a good thing to give yourself over to these; but it is natural, and it may be beneficial to relieve your feelings through tears as you work through the sadness. You may seek answers (and not give up) to find out why things happened as they did. It may be beneficial to find out what could have been done differently; but then again, it may not–you have to decide that for yourself as it happens. And eventually, you heal.

As a Christian, I must look to the Bible for my answers, and look to God for help. I’m ashamed to say that I did not do this for nine years as I repressed the grief surrounding my father’s untimely death. Yet when I did, it brought immediate relief. (You can read more of this on my personal blog.) If you are a Christian, then I would urge the same to you–go to God and ask for healing and peace. If you resent the people who were instrumental in your birth experience, try to forgive them. I held onto bitterness for 9 years (although it obviously slackened over time); but it was gone in a day. I cannot promise the same to you, but I know that healing is possible. Bitterness does not have to rule your life. Accepting what happened does not mean that you like it–any more than accepting my father’s death meant I was glad to have him gone. That’s another way that viewing a bad birth experience as something to grieve can help. It can’t be changed; but accepting what happened actually frees you up to look forward, instead of always backward. Acceptance and forgiveness bring healing.

How to turn a breech baby

One of the more common reasons a woman is given for “needing” a C-section is that her baby is breech–that is, the head is near the top of the uterus, instead of at the cervix. Prior to the 1970s, doctors were trained how to matter-of-factly handle breech births. At the time, C-sections were much riskier than they are today, so they were reserved for truly necessary situations. Most doctors nowadays do not have the knowledge or skill necessary to attend a vaginal breech birth–they were taught how to perform surgery instead of attending breech births. If you have been told that you must have a C-section because your baby is breech, you need to know your rights, as well as the risks to you and your baby from either a C-section or a vaginal birth. I would suggest reading Henci Goer’s book The Thinking Woman’s Guide to a Better Birth for a fuller explanation of the risks and benefits.

There are many studies on breeches; but unfortunately, most of them are too small to draw firm conclusions. One study I recently read said that there are some definite factors that increase the risk of vaginal breech birth; but in the absence of these factors, vaginal breech birth is safe.

However, the best thing you can probably do is to try to get your baby to turn head-down. A few years ago, I combed through the internet looking for different ways to turn a breech baby, and I’ve compiled them in one file (see below). The reasons for the baby being breech in the first place probably has a lot to do with the success rate. The main reason a baby is breech is unknown; other contributing factors include too much or too little amniotic fluid, twins, placenta previa, abnormally-shaped uterus, fetal abnormalities, prematurity (only 3-4% of term babies are still breech once labor starts), cord problems and entanglements, and maternal tension. This list by no means takes the place of medical advice. Most of the “techniques” I’ve listed have not been formally studied, and some are more or less anecdotal.

· Relax!

o Many times maternal fears lead to tense muscles (including those of the uterus), making the breech position the most comfortable one for baby, or the one in which it was stuck, and is then unable to move to vertex because of the confines of the uterus

o Necessary for other turning attempts to work—no amount of turning will get the baby out of breech if the uterine muscles are just too tense

· External Cephalic Version

o Basically, someone manually turns the baby head-down by pressing and pushing on the mom’s stomach

o This is typically done at 36+ weeks, and can be done during labor

o There is the possibility of cord compression or some other cause of fetal distress, so it’s typically done in the hospital, in case a quick C-section needs to be done

o Some other countries tend to do ECVs earlier (31 weeks or so); this tends to make it easier, because the baby is smaller, so there is more room in the uterus, but there is a higher possibility of the baby turning back breech in the intervening weeks

· Webster technique

o A chiropractic technique in which the body is manipulated to release stress on the mom’s pelvis and relax the uterus and ligaments

· “Breech tilt”

o Mom lays on something like an ironing board (or several large pillows) with one end on the floor and the other end propped up on a couch, with her head on the floor side

o Done three times a day for 10-15 minutes at a time

o Best done on an empty stomach and when baby is active

· Music

o Play nice relaxing music near your pelvis to induce baby to come closer to hear better

o Or play loud raucous music near your fundus so baby will move away

· Shine a light near your pelvis, or even between your legs

· Have the father talk to the baby, low on the belly, and tell him/her to move

· Hypnotherapy (helps to relax)

· Lots and lots and lots of pelvic rocking

· Elephant walking (walking on hands and feet, to get your rear-end up as high as possible)

· Swimming—diving into pool, doing somersaults, or walking on your hands in the water

· Acupressure

· Drink plenty of fluids

o This may help especially if low amniotic fluid is making not enough room for baby to move freely enough to turn

· Posture

o Keep your belly open by keeping spine straight and tall

o Sit “Indian style”, leaning slightly forward

o Watch out for “bucket seats,” recliners, and other types of seats that tip you slightly back

· Moxibustion (a Chinese herb that is rolled into a stick, then the end is lit and put on various acupressure points of your body)

· Various herbs

· An ice pack or frozen bag of peas where the baby’s head is, to encourage it to move

Update: please click here to read a second post about breech babies, including why some babies may be breech.

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And now for something completely different….

Tag surfing, I came across this blog, that I thought was just absolutely hilarious, so I’m sharing it with you. Enjoy!

More than words

Have you ever heard the saying, “The tension was so thick, you could cut it with a knife”? You’ve probably been in a situation like that, and you know what I’m talking about–there is this intangible something in the room–some combination of your feelings with the feelings of other people, and even without a word being said, you know that something is going on. This can be a good tension (like waiting for the “victim” of a surprise birthday party), or a bad tension (like waiting for your husband to come home after you’ve wrecked the car). Sometimes you can walk into a room and instantly sense that something has just happened there–the people already in the room are suddenly quiet, or the looks on their faces indicate that all is not right. Even if you don’t know what’s going on, you can pick up on that tension, and then suddenly your good mood vanishes and you become tense or nervous. You make small talk, trying to lighten the mood, but nothing really changes.

When you’re in labor, this same sort of thing can happen. It may be the unfamiliar surroundings of the hospital–weird beeps and noises, strangers coming in and out of your room, weird machines hooked up to you (or at least waiting in your room). Perhaps it’s the hospital staff themselves–always busy–maybe even too busy to talk to you and ask you how you are doing, and only checking the machines at intervals. Maybe your labor-support team isn’t quite as unified as you would like (your mother-in-law wasn’t invited but refuses to leave; your mom is still mad at your husband for that joke he pulled at Christmas; your sister is watching an annoying show on TV). If there is tension in the room, it is likely to increase your anxiety level, too. But when the people around you in labor are cheerful, upbeat and positive, then you are likely to feel better about your labor, feel better about how you are doing, and actually make faster progress.

Nonverbal communication is very important in labor. A lot of communication can happen in a touch. A cheerful smile or encouraging expression on the faces of those who are attending you in labor can calm you and make you feel better. Choose your birth attendants wisely and carefully, and make sure that they understand the power of words, and also nonverbal communication.