Effects on the fetus and newborn of maternal analgesia and anesthesia: a review

Click here for the full review, published in the Canadian Journal of Anesthesia.

Here is one paragraph of interest:

All opioids have the potential to decrease baseline FHR and reduce variability, making interpretation of fetal CTG recordings potentially problematic. It has been documented from observational studies that parenteral narcotics can be associated with neonatal respiratory depression, decreased neonatal alertness, inhibition of sucking, and a delay in effective feeding. When evidence related to the use of parenteral opioids for labour pain relief was subject to a systematic review,54 it was noted that none of the studies was sufficiently powered to address the primary outcome measure of neonatal resuscitation, a measure of safety. Intramuscular opioid was compared to placebo, different im [intra-muscular] opioid, same im opioid but different dose, and same opioid given intravenously. Intravenous opioid was compared to different iv opioid and same iv opioid but different modes of administration. There was insufficient pooled information to draw conclusions regarding any of the secondary outcome measures, including fetal distress, administration of naloxone, Apgar score < 7 at five minutes, neonatal mortality, admission to a special care setting, feeding problems, and problems with mother-baby interaction.

Medical Abbreviations

As a pharmacy tech for five and a half years, I got quite familiar with certain medical abbreviations. Obviously, there are numerous ones we didn’t use much if at all in a pharmacy, and I’ve not worked in a pharmacy for nearly six years now, so this is not intended to be a comprehensive list (although here is a link to some common medical abbreviations, which I would suggest bookmarking, for future reference if need be). There are also numerous abbreviations (why is that such a long word?!) that are birth-specific, that I’d never heard of until I became pregnant, or even after I had given birth. Here are some common ones, in no specific order — mostly just as I think of them — that may be useful in general and particularly in birth. Some of these may not be “official” but you might see them popping up in some forums.

  • ROM — rupture of membranes, breaking the amniotic sac, “My water just broke!”; also SROM and AROM, for “spontanous” and “artificial” ROM, respectively — the first is when your water breaks on its own; the second is when somebody else breaks your water
  • PROM — can mean either “preterm” or “prelabor” ROM; or PPROM which is both
  • VBB — vaginal breech birth
  • u/s — ultrasound
  • c/s — c-section, cesarean section
  • pph — postpartum hemorrhage — losing too much blood after giving birth, may be mild or severe, even deadly
  • pit — pitocin, artificial oxytocin (aka syntocin in some countries), given either as a single shot after birth to help prevent pph, or given to induce labor or augment it
  • hbp, HTN — high blood pressure, hypertension
  • GD — gestational diabetes
  • DM — diabetes mellitus (but on a cough syrup, it’s dextromethorphan)
  • pih — pregnancy-induced hypertension
  • p/e or p-e — preeclampsia (may also be used in some discussions to indicate hbp, maternal hypertension, eclampsia, pih, toxemia, and probably a few other terms which are similar, outdated, or synonymous — not everyone uses clinical terms properly)
  • BOW — bag of waters, amniotic sac, the membranes which surround the fetus and are filled with amniotic fluid
  • pp — postpartum
  • ppd — postpartum depression
  • ppp — postpartum psychosis
  • ctx– contractions
  • sx — symptoms
  • abx — antibiotics
  • rx — prescription or treatment (may occasionally be used as a shorthand way to say pharmacist or pharmacy, depending on how hurried someone is)
  • tx — treatment
  • fx — fracture
  • hx — history
  • epi — may be short for either epidural or episiotomy, depending on the context
  • PO — by mouth
  • npo — non per os, nothing by mouth
  • PR — rectally (per rectum)
  • PV — vaginally (per vagina) [not to be confused with…PNV]
  • PNV — prenatal vitamins
  • pt — patient
  • d/c or dc — discontinue
  • t/f or tf — transfer (either meaning the mother planned a homebirth and went to the hospital, or was moved from one room in the hospital to another)
  • L&D — labor and delivery
  • LDR — labor and delivery and recovery room (the mom stays in one room for labor, birth, and the immediate postpartum; may also mean that she stays there until hospital discharge, but she may be transferred to a “postpartum” room)
  • LDRP — labor, delivery, recovery, and postpartum room — the mom stsays in the same room her whole hospital stay
  • NICU — neonatal intensive care unit
  • FTP — failure to progress (also called by many natural-birthers, “Failure to be patient”, or not giving the laboring mom enough time to dilate completely or birth naturally)
  • GTT — glucose tolerance test
  • HA — headache
  • fht — fetal heart tones
  • fhr — fetal heart-rate
  • EFM — electronic fetal monitoring (may also mean external fetal monitoring), usually continuous, with belts across your belly, one to hear the baby’s heartbeat, the other to feel your ctx
  • IFM — internal fetal monitoring — a sharp wire is sort of screwed into the fetus’s head; you must have ROM prior to this; sometimes done because the EFM isn’t picking up the fhr correctly
  • LMP — last menstrual period, used for dating the pregnancy, which officially starts about two weeks before the child is even conceived
  • NKDA, NDA — no (known) drug allergy
  • OP — occiput posterior, (a.k.a. “sunny side up” — but only if the mom is on her back — if the mom is standing, the baby won’t be facing “up” towards her abdomen; and if she is hands-and-knees, the OP baby will be facing down towards her tummy. That’s why both my babies were born facing up, although they were not OP — my position was not “stranded beetle” or lithotomy or any other lying-on-my-back position, so my “face-down” babies were actually born face-up). The back of the fetal head is towards the mom’s posterior, which is typically associated with a longer and/or harder labor; typically even when the mom labors with the baby in a posterior position, the baby will rotate and be born anterior (OA — back of the head towards the mom’s front). Since the back of the head, or the crown, is the smallest diameter (and has fontanels which can be squeezed together to be smaller), it facilitates the easiest birth; the front of the head, forehead, or brow are all much bigger and cannot be squeezed smaller. Other variations include adding an L or R or T to designate left or right or transverse — LOA, LOP, ROA, ROP, etc.
  • SGA/LGA — small/large for gestational age
  • IUGR — intrauterine growth restriction/retardation
  • SOB — shortness of breath; occasionally used on some email lists to refer to obstetricians, especially OBs who are SOBs
  • DOB — date of birth
  • MOB/FOB — mother/father of baby

Now for some that are more specifically prescription-related — since Latin was the language of the learned, many, many medical abbreviations are derived from Latin, or are acronyms from the original Latin words. If you’ve learned French, Spanish, Italian, or some other Latin language, you’ll probably have a leg up in these; otherwise, you’ll just have to muddle through.

  • sig — literally means to write on the label; as a pharmacy tech, we used it to refer to the directions as written on the prescription — for instance, if I couldn’t make out what the doctor had scrawled or scribbled, I’d say that I couldn’t understand “the sig”
  • x — for
  • n/v — nausea and vomiting
  • prn or ad lib — as needed
  • ud/tud/tad — (take) as directed — please when you see this on a prescription, make sure that you know from the doctor how to take it, unless the Rx is for a dose-pack (pills that are dispensed in the necessary quantity with the directions written on the packaging — some pills, such as corticosteroids for inflammation are given with 4 pills the first day, 3 the next, and so forth); it was not uncommon for us to give a prescription to somebody with the label “take as directed” — which was all the info we had — and for them to ask us how they were supposed to take it. The doctor didn’t tell us how the patient was supposed to take it. So, we’d have to call the doctor’s office and get the instructions — if we were lucky, it wouldn’t take too long. Often, we were not lucky. “An ounce of prevention is worth a pound of cure” — make sure you know the directions before you leave the doctor’s office, and have it either written down or in a voice memo or something
  • ac — before eating
  • pc — after eating (I remembered this as “post consumption” and ac as “ante [or before, like to ante up in a poker game] consumption)
  • c — with (probably where the Spanish con or “with” comes from — the Latin may be con too, but I’m not sure)
  • s — without (think of the French sans)
  • iv — intravenously
  • im — intramuscularly
  • sq — subcutaneously
  • sl — sublingual (under the tongue); [I’ll put in here “buccal” which I rarely saw, but understood it to mean that it was dissolved in the mouth or cheek]
  • bid — twice a day
  • tid — three times a day
  • qid — four times a day
  • hs — at bedtime — the Hour of Sleep
  • achs — before meals and at bedtime
  • q — every
  • h — hour(s)
  • d — day
  • so… qh = every hour; q4h = every four hours; q6h = every 6 hours; qd = every day; qod = every other day, etc.
  • ml — millileter (an eye drop bottle may contain 20ml of fluid in it)
  • mg — milligram (Keflex is dispensed in 500 mg capsules); some people may use mgm, but that is unusual, and may be confusing as it might make some believe it’s micrograms
  • mcg — micrograms (sometimes also written with the “m” in a funny script almost looking like a “u”; this is the Greek letter “m”; can be very confusing if written hastily… as most prescriptions are. The good news is that most drugs dispensed in a pharmacy will not be confused by milli- or micro- because they only come one way. “Micro” means one-millionth of a gram; “milli” means one-thousandth of a gram. Cytotec, for example, comes in micrograms — in tablets of 100mcg or 200mcg. If a doctor inadvertantly writes that his patient is to take 200mg of Cytotec qid, that would definitely be an overdose because 1mg is 1000mcg (or 5 200mcg tablets), so 200mg qid would be 5000 tablets four times a day. No pharmacy in the world would dispense that, so that is one safeguard. Unfortunately, when a medication has to be prepared by adding a certain amount of medication into an IV solution, and each person gets a different kind, and an infant may receive the same medication than an adult would — only in a much smaller strength, of course — then it becomes much easier for human error to creep in — whether through the doctor who scribbled the Rx, the pharmacist or pharmacy tech who read it and prepared it, or the nurse who was to run it into the IV. I forget who it was, but in this past year, a Hollywood actor’s premature twins were given an overdose of some medication (I think it was Heparin, a blood thinner), because of a clerical or human error like this, in which it is possible that a decimal point was misplaced or overlooked entirely. If I remember correctly, they were given an adult dose, although they only weighed a few pounds. In their case, there was no known permanent harm done, but not everyone is so fortunate.
  • gt, gtt, gtts — drop, drops (don’t ask me why a word as small as “drop” needs an abbreviation — especially one that is hardly any smaller, and makes no sense whatsoever!)
  • OS/OD/OU — left eye/right eye/both eyes (lovely Latin again — the S is similar to or is “sinister” [sorry all you lefties! think “Southpaw,” if it makes you feel better]; and the D is something like “direct” — I know in Spanish right is “derecha” or something similar); while we only used S or D with eyes and ears (AD/AS/AU — right ear, left ear, both ears), it could presumably be used for anything that has “left” and “right.” However, it is possible that they would use R or Rt for “right” and L for “left.” (OD can also, of course, mean “overdose”, so it depends on the context)

And don’t forget the elemental abbreviations:

  • Fe — iron
  • K — potassium
  • O2 — oxygen
  • CO2 — Carbon Dioxide (yeah, I know, not an element, but close enough)

And of course, good ol’ Roman Numerals! — i = 1; ii = 2; iii = 3; iv = 4; v = 5, etc.; also used for numbering Olympic events and Super Bowls. Often Roman numerals will be used as an additional safeguard (as well as to help keep a druggie from altering a prescription). The number “4” could easily be changed to “40”, but “IV” is not so easily changed into “XL”; and a doctor may scribble so sloppily that a digit may be difficult to read, but having the Roman numerals beside it makes it more understandable. Sometimes.

Okay — which ones did I forget? — feel free to add them in the comments section!

Squatting

When I was pregnant with my first child, my childbirth instructor recommended squatting as an exercise (along with walking, pelvic rocks, etc. — start off slow and build up in either duration, frequency, or both), either as beneficial in general, beneficial in pregnancy, or to make us feel more comfortable about squatting which is a natural and effective position to give birth in. Later, I heard that squatting as a form of exercise may not be the best thing to do while pregnant. The reasoning behind this is that while squatting is normal and natural, most Westerners have lost the ability to do it since they just don’t squat much if at all. So, trying to learn how to squat when heavily pregnant may cause strain on muscles that are unaccustomed to bearing the weight or doing the activity… as well as being just plain awkward, or setting you up for a fall, or what-have-you. With the lovely pregnancy hormone relaxin kicking in, you can more easily over-extend yourself when stretching, and squatting is a form of stretching, so it is wise to be wise.

That said, it would be beneficial for all of us — men and women alike — to get more used to squatting. One precaution should be given, however, which I learned the hard way. I was having trouble getting into a squat (although my two-year-old does it easily and effortlessly — makes me jealous!), so “compromised” by keeping my heels off the floor, balancing on the balls of my feet and my toes (and I stayed there a while). Big mistake! For the rest of the week — and it is still a little sore on occasion — that area of my left foot was sore. Most likely, I had overstretched it, or just overused it, by my mini-marathon of squatting. So, start slow and build up. Don’t feel like you have to squat like a toddler straight off. Remember that your body is probably used to sitting in a chair and most definitely not used to squatting, so treat it like any other position or exercise. You wouldn’t go from being a gold-medal couch potato to running a marathon in a day, so go easy on squatting. Just as you would start with walking around the block and work your way up slowly to walking or running a mile or five or ten, so you should squat for a little while and build up.

If you’re already pregnant, be even more cautious. If you’re not pregnant, start now, so that you don’t have to start new while pregnant. Listen to your body; go slow. Remember that the muscles you use while squatting have probably not be used — at least in this exact way — for many years, and it may take some time for them to adjust to bearing your weight.

The problem with squatting — or not squatting, as the case may be — came from our history of chairs being “proper” and squatting being “primitive.” Girls are especially coached not to squat, if they’re wearing skirts that don’t come well below the knees, because otherwise they show their panties. Even if they’re wearing long skirts or even pants, it’s still not considered ladylike to squat. Maybe not very ladylike, but that’s too bad! When I injured my foot, as I mentioned above, I was squatting (deliberately) and feeding my younger son who was standing. It felt good to squat (very healthful and counter-culture, like eating something vegan at a steakhouse or something), but after a little while, my mother pulled a chair over to me, because I looked “uncomfortable” to her. How many times do we do something, or refrain from doing something, because it makes another person uncomfortable! (Although in this particular case, even though I was not uncomfortable, I was over-doing it, as I found out later.)

I can do the splits. Something made me decide to learn when I was about 16 years old. If on that first night it came into my head to do the splits, I decided to successfully do the splits, do or die, I would have definitely injured myself. Instead, I stretched my feet as far as I could (which wasn’t far) and got as low as I could (which wasn’t low). And every day I got a little more limber, was able to stretch a little farther and go a little deeper. One day (probably a month or two later), I was able to do the splits. And I’ve been able to ever since. I’m going to take that lesson in squatting, and start by doing supported squats, and not very deep, and not holding them for very long, and gradually work my way up until I can do them like my kids. As an adult, I’m used to doing everything better than children, so it’s a little humbling to look to them as my examples, but it’s the truth.

So, what do you think about squatting — do you squat on a regular basis? do you think it is good to do while pregnant? do you have reservations about doing it while pregnant? is there anything I’ve written that you disagree with? (I make no claims to perfection, and am always ready to learn) do you have any tips or other things to keep in mind?

Happy Thanksgiving!

Thanksgiving is the best holiday — it really is. It’s not centered on gifts (so no headache or hassle trying to come up with the perfect gift for the in-laws, or making sure you don’t give them the same thing two years in a row, or getting your kids the gifts they want); it’s not just about candy (like Easter or Halloween or Valentines Day), although there is plenty to eat. It’s about taking a day off from the normal course of life to give thanks to God for the blessings He’s given. And they are numerous. We live in the best country on earth; and even if you don’t live in the United States, we live in one of the best, if not the best, times in life when quality of life, length of life, medical advancements, etc., are unparalleled. The richest king who ever lived never had toilet paper, air conditioning, cell phones, a car, the internet, or anything else we pretty much take for granted. And we should be thankful.

Breech Birth Study

Yesterday’s post about the breech birth books brought this study from 2004 to mind. I’ve known of its existence for several months, but haven’t blogged about it yet, so far as I can remember.

I have mixed feelings about it, as the conclusion perhaps will show:

Safe vaginal breech delivery at term can be achieved with strict selection criteria, adherence to a careful intrapartum protocol, and with an experienced obstetrician in attendance.

While this implies that any breech birth that goes outside of these parameters is “unsafe” (which may or may not be synonymous with “deadly”), it does not mean that these things must be observed for a breech baby to safely be born vaginally. This is why I have mixed feelings about the study — as long as a woman meets the selection criteria and consents to the “careful intrapartum protocol”, she may wish to present the study to her doctor in an effort to lobby him to allow her to have a vaginal breech birth. But it may be a death knell to her desires to attempt a vaginal birth if she or her baby lies outside of these parameters, or if she does not want to have her baby’s head manipulated or pulled out of her with forceps, instead of being allowed to birth it naturally.

The selection criteria were as follows (my comments in italics):

If breech presentation persisted or recurred, patients were offered a trial of vaginal delivery if the following criteria were fulfilled: 1) estimated fetal weight of 2,500–3,800 g13; 2) deepest amniotic fluid pool 30 mm or more; 3) normal fetal morphology and normal placental location; 4) absence of hyperextension of the fetal head (an angle exceeding 90°) [this head position is also called “star-gazing”]; and 5) flexed (complete) or extended (frank) breech presentation. Management of fetal anomaly depended on the type of malformation identified. Elective prelabor cesarean was advised, based on the following fetal indications; estimated fetal weight more than 3,800 g [about 8.5 lb.], footling breech, hyperextension of the fetal head or when fetal compromise was suspected (oligohydramnios or intrauterine growth restriction). Maternal indications for elective cesarean included maternal preference, previous cesarean, significant preeclampsia and placenta previa. [Also, no woman was allowed to go past 41 weeks.]

The study defined “careful intrapartum protocol” thusly:

Oxytocin was not used to augment labor in either the first or second stage; failure to progress in labor was considered an indication for intrapartum cesarean. If fetal distress was suspected, cesarean delivery was effected without fetal blood sampling; meconium staining of amniotic fluid alone was not deemed an indication for cesarean delivery [it is common for breech babies to pass meconium due to the buttocks presenting and being birthed first; while meconium staining may indicate a problem in vertex babies, it does not necessarily indicate a problem in breech babies]. Epidural administration was based on maternal request. An experienced obstetrician (senior resident with at least 4 years experience or consultant) conducted all vaginal breech deliveries, and a pediatrician was also in attendance. Breech delivery was spontaneous with active maternal pushing, but no intervention by the attending obstetrician, until the fetus was delivered to the level of the umbilicus. Lovset’s maneuver was used to deliver the shoulders if required, and episiotomy was performed routinely. Delivery of the head was then controlled with Mauriceau-Smellie-Veit maneuver or with Neville-Barnes obstetric forceps, depending on the obstetrician’s preference.

But many breech births which did not fall within these protocols — in babies whose feet were the presenting part, or who weighed more than 8 and a half pounds, or in women who did not have an episiotomy or forceps — have happened and the babies were perfectly fine. There have been good outcomes in women whose doctors and midwives had little or no experience in attending a breech birth, and even in women who have given birth unattended.

There was no allowance for the woman to give birth spontaneously — forceps or manipulating the baby’s head was done on every baby, whether it was needed or not. Because the woman was on her back, I have no doubt that these interventions were “needed” with some regularity or frequency; but I wonder how often they would have been needed — really needed — had the woman given birth in a squatting position, which allows her pelvic outlet to open widest, and also allowing gravity to assist in the baby’s birth.

I’m also concerned with the rather strict criteria for “progress” in labor:

When the diagnosis of labor was confirmed, amniotomy was performed to augment labor, provided the presenting part was fixed in the pelvis and continuous electronic fetal heart rate monitoring was initiated. Subsequent progress was assessed vaginally every 2 hours. Cervical dilatation at a rate of 1 cm/h or more was deemed acceptable. In the second stage, 1 hour was allowed if required for adequate descent of the breech to the pelvic floor; delivery of the fetus was completed within 1 hour of active pushing for nulliparas and within 30 minutes for multiparas.

Apparently, at the slightest derivation from these rules, the woman was wheeled off to the operating room for a C-section, as was evidenced by the number of women who actually had a vaginal birth: 23%. But we know that just because a woman does not dilate 1 cm every hour, that that indicates a problem, or is problematic in and of itself. And allowing only 1 hour for a first-time mom to push seems rather strict, as well.

So, all in all, while the study shows that vaginal breech birth is safe under certain parameters, and is therefore a benefit to some women who want to attempt to give birth to their breech babies vaginally, it seems far too quick to run off to the OR for a C-section. My hope is that by using this study, vaginal breech birth will become more normalized, and as it does so, that more women will be allowed to have a breech birth (at least an attempt!), and that the parameters will be more defined and refined to allow more and more women to have a vaginal birth, to save them from the trauma (if only medically and anatomically speaking, not necessarily mental or emotional) of a C-section or being given a big episiotomy and having forceps inserted; and also to save babies from being dragged out of the birth canal with cold steel or a doctor’s manipulating hands unnecessarily. My goal is for the fewest interventions as safely possible.

Breech Birth Books

Over on The True Face of Birth, Rixa has reviewed two books on breech birth. Quite interesting! Rather than repeat what she says, I’ll just link to it and highly recommend that you read them — you never know when the information may come in handy!

But one thing I noticed is that there are three schools of thought when it comes to breech: 1) all breech births should be Cesareans; 2) if a vaginal breech birth is attempted, it should be highly medicalized; 3) if a vaginal breech birth is attempted, the mother should avoid medication and be as mobile as possible.

When a woman finds out that her baby is breech, the most common thing that happens is that she is scheduled for a C-section (assuming the baby doesn’t flip to vertex, or cannot be turned by ECV). Occasionally, a woman may find a care provider who will allow her to have a vaginal birth; but much of the time, there are restrictions placed on the conditions of the birth: she must have an epidural in place, must give birth in the operating room, must have her legs up in stirrups, must have an episiotomy and forceps, etc. The idea behind the first two is that should a C-section be required (especially in an emergency situation), they will already be in the OR with anesthesia in place. (Probably she will need to have the epidural strengthened, but the tubing will be already in her spine to make it quick to add a stronger dose; although it may be that the epidural would already be C-section strength “just in case.”) The idea behind the latter two restrictions is that with her legs in stirrups, the doctor can see things better, and make whatever adjustments or interventions need to be made; and the episiotomy with forceps is to facilitate the birth of the head.

The biggest concern with a breech vaginal birth is what if the body comes out, but the head does not. While the circumference of the buttocks (which is the typical presenting body part, rather than one or both feet) is generally about the same dimension of the head, once the baby’s body is born to the navel, it is prudent that the head be born without delay — not only could the cord be compressed and the oxygen supply cut off, but once the cord is exposed to air, it begins to gel and seal, which cuts off the oxygen supply. But in so many births, the baby’s head (which presents first in all but about 3-4% of term births) has ample time to mold, and can frequently take a few hours to move down the birth canal. My sister pushed for 4 hours with her first baby (who was posterior and had the worst cone-head of any baby I’ve seen) and my sister-in-law pushed for 5 hours with her first. It is an understandable fear that the head would not have enough time to mold and be born before the baby dies — the birth should be accomplished in minutes, not hours!

But what if these restrictions are wrong? What if the “hands-off the breech” midwives are right? I remember reading on some site (pretty sure it was British), that the midwife’s suggestions for a breech birth was, once the baby’s body was born, that she pour herself a beer, take it to the corner, and drink it very slowly. The idea being, of course, that she should allow the woman and baby to accomplish the birth without her interference, which might cause problems.

When a woman has an epidural, it will be very difficult for her to labor and birth upright (and the stronger it is, the more difficult it will be). If she is further required to give birth on a narrow operating room table with her feet up in the air, her pelvic outlet will be much less than it would be if she were upright and squatting. This means that head entrapment becomes more likely! So, while the restrictions ought to make vaginal breech birth safer, it makes me wonder if that is truly the case. I look at it this way — having a woman in the OR, on a narrow table, cold, and with her pelvis unable to open to its full dimensions makes it more likely for her to have a C-section, or for other interventions to become necessary. The way it is set up in the above scenario, all of these things are done routinely, not on an “as necessary” basis. If they were truly necessary all of the time (as some people believe), then no baby could survive a breech birth. But how often are they truly necessary?

It seems to me that so many hospital protocols (not just with breech birth, but with other things as well) cause problems that would not otherwise exist, and then they swoop in with drugs and interventions to correct those problems. Case in point — not letting women walk in labor to help strengthen the contractions, but making them have Pitocin instead. Or not letting women eat or drink in labor, but requiring them to have a glucose IV. The natural is to be feared, while the medical (because it can be measured in milligrams or lines) is to be revered. Regardless of how safe the natural is and how unsafe the medical is — the idea is that the medical is standardized so it is safe, while natural cannot be standardized, so it cannot be safe. Despite the fact that different people react to the same medication or protocol in varying ways. Because people are different, not standardized. Humans, not machines.

Why is it that home birth is as safe as it is, without all the protocols and restrictions and requirements and denials that are so frequently the norm of hospital birth? Why do so many women who give birth in the hospital “have to have” Pitocin or a C-section or AROM or an oxygen mask or to be told how to push and when to push and where to push and… and… and…? This isn’t the case at home. These things happen occasionally at planned home births; but the frequency with which they happen to low-risk women at hospital births is disconcerting, to say the least.

Vaginal breech birth is something to consider very carefully and very seriously. There have been babies who have died — in home and in hospital — during or because of a vaginal breech birth. Most babies will do just fine — there are many examples of women giving birth to breeches in all the “wrong” or “high-risk” categories (first baby, footling breech, etc.) and everything went just fine. One of my brothers-in-law was a first-born breech, “folded up like a taco,” his mom said — a hospital birth, back when vaginal breech birth was the norm, instead of having to be fought for, tooth and nail. That being said, it’s not for everyone, but I believe I would feel comfortable with it under most circumstances.

You learn something new every day

My new “something” today was from a birth story I just read, in which the mom said she had learned on “some birth list or other” that if the umbilical cord is still active, the baby will startle if you touch the placenta end. Of course, that is assuming the cord is not clamped and cut immediately, or “delayed” to all of 2 or 3 minutes, but rather is left to quit pulsating naturally. But I’ve never heard that.