Fantastic Birth in Bangalore!

I want to share a little about a birth I attended a week ago. I'd been traveling up north and returned to have a prenatal visit with my clients . My client, who I will refer to as C, looked beautiful, felt good and was excited about the upcoming birth. As her due date was only three days away, she and her doctor had discussed her doc's induction protocol, which was that she would need to go in for induction six days after her due date. C had a feeling her baby would come late, as both she and her brother had been more than a week late. (The American College of Obstetricians and Gynecologists has a guideline of 42 weeks, or two weeks after the estimated due date; given that due dates are often so uncertain and most first-time babies come late, allowing only six days before inducing isn't giving the baby much of a chance!) She very much wanted to avoid being induced, so during our prenatal visit we talked about natural induction methods: sexual intercourse (prostaglandins in semen help ripen the cervix), nipple stimulation, acupressure and herbs.

Her husband, D, called me at 12:30 that night and said she was having contractions that were four minutes apart! I said I'd meet them at the hospital, got dressed and was on my way. Luckily, we arrived at the same time, and by the intensity and frequency of C's contractions, I could tell that she was in transition. We went straight to the delivery room, where we met the on-call doctor and a few nurses. The doctor checked C: fully dilated and ready to push! Of course there was no time for pain medication, and my clients had come prepared with a birth plan, which stated clearly that the doctor and medical staff should avoid common and often unnecessary interventions such as shaving, enema, IV, episiotomy, oxytocin, immediate cord clamping, separation of mother and baby, etc. C was amazing, listening to her body and following its natural urges to push, while D supported her in the most gentle and loving way until their baby boy was born at 2:19 am. He was placed on C's chest immediately and kept there, skin to skin, for 40 minutes. (It's extremely unusual for doctors/hospitals to allow this much time to pass before they take the baby away, but as long as a newborn is pink and breathing, all newborn procedures can and should be delayed for at least an hour so that mom and baby can be skin to skin and establish breastfeeding.)

Unlike in most hospital birth settings I've been a part of in Bangalore, the doctors and medical staff were kind, quiet (for the most part), calm, and respectful of C's wishes as stated in her birth plan. (That said, it was a very short labor, so it's impossible to know how much pressure for interventions there would have been if labor had slowed or did not progress as quickly.) She was not given an IV (just a hep lock) nor did the doctor cut an episiotomy. She tore naturally, and was extremely pleased to have a natural tear instead of an episiotomy. Both parents are very satisfied with the whole experience, and I'm so honored to have been a part of it!

CNN article: Avoid episiotomies

Here's an excerpt from a recently published article on CNN.com, entitled 5 operations you don't want to get -- and what to do instead.

Episiotomy

It can sound so simple and efficient when an OB-GYN lays out all the reasons why she performs episiotomy before delivery. After all, it's logical that cutting or extending the vaginal opening along the perineum (between the vagina and anus) would reduce the risk of pelvic-tissue tears and ease childbirth. But studies show that severing muscles in and around the lower vaginal wall (it's more than just skin) causes as many or more problems than it prevents. Pain, irritation, muscle tears, and incontinence are all common aftereffects of episiotomy.

Last year the American College of Obstetricians and Gynecologists released new guidelines that said that episiotomy should no longer be performed routinely -- and the numbers have dropped. Many doctors now reserve episiotomy for cases when the baby is in distress. But the rates (about 25 percent in the United States) are still much too high, experts say, and some worry that it's because women aren't aware that they can decline the surgery.

"We asked women who'd delivered vaginally with episiotomy in 2005 whether they had a choice," says Eugene Declercq, Ph.D., main author of the leading national survey of childbirth in America, "Listening to Mothers II," and professor of maternal and child health at the Boston University School of Public Health. "We found that only 18 percent said they had a choice, while 73 percent said they didn't." In other words, about three of four women in childbirth were not asked about the surgery they would soon face in an urgent situation. "Women often were told, 'I can get the baby out quicker,'" Declercq says, as opposed to doctors actually asking them, 'Would you like an episiotomy?'"

What to do instead

Communicate. The time to prevent an unnecessary episiotomy is well before labor, experts agree. When choosing an OB-GYN practice, ask for its rate of episiotomy. And when you get pregnant, have your preference to avoid the surgery written on your chart.

Get ready with Kegels. Working with a nurse or midwife may reduce the chance of such surgery, experts say; she can teach Kegel exercises for stronger vaginal muscles, or perform perineal and pelvic-floor massage before and during labor. Health.com: Me and my Kegels