Author: Kathy's Notes

Dr. Michel Odent is one of the first MD/OB/GYN’s to help move us back towards Normalizing Birth: A long piece, but so worth it.

Can someone with HPV, but no warts, have a home birth?

Human papillomavirus (HPV) infection is extremely common. It does not influence the way women give birth.

What are the risks associated with a vaginal birth after an abdominal myomectomy? I am in my first pregnancy and my doctor is suggesting a C-section as the safest method. Is it possible to attempt a vaginal birth and how significant are the risks?

It is difficult to answer your questions because there are many types of myomectomies (surgical removal of fibroids) according to the location of the fibroid(s). If the doctor is suggesting a C-section to prevent a possible uterine rupture, it is probably because the fibroid was ‘intramural’ (inside the wall of the uterus). If the fibroid was ‘subserous’ (outside the wall of the uterus) or ‘pre-unculated’ (connected to the uterus by a stalk), you should not hesitate to try to give birth vaginally. You need a detailed report of the operation.

I would love to have a water birth, but there are not many people in our area who do them. Do you have any advice on how to pick a good midwife for a water birth? I am 28, healthy, and in great shape. Is there anything I need to do to prepare for our little arrival’s water birth?

Your midwife does not need any special training. She does not need any previous experience of the use of birthing pools. She just needs to be aware of a small number of recommendations. All these recommendations are based on the fact that immersion in water at the temperature of the body tends to make the contractions more effective during a limited length of time, which is in the region of an hour or two. The first practical recommendation is to give a great importance to the time when the laboring woman enters the pool. If she is patient enough to wait until the middle of the dilation, if she does not feel observed or guided, and if the room is dark enough, there is a high probability that she will reach complete dilation in an hour or two, even for a first baby. The second recommendation is to avoid planning a birth under water. In general it is better when a pregnant woman has no precise pre-conceived script of what the birth of her baby will be. When a woman has planned a birth under water she may be the prisoner of her project; she is tempted to stay in the bath while the contractions are getting weaker, with the risk of a long second stage followed by difficulties for the delivery of the placenta. There are no such risks when a birth under water follows a short series of irresistible contractions before the mother feels the need to get out of the bath. A birth under water can happen. It should not be the primary objective. The primary objective is to reduce the need for drugs.

Of course you need a deep enough birthing pool, so that your body can be completely immersed. Today it is easy to rent such birthing pools. You also need a way to check that the temperature of the water is never above the temperature of the body (37 degrees Celsius). A too hot bath is dangerous for the baby. It is better if your husband, or partner, has to prepare the bath while you are already in hard labor. Remember that a century ago the secret for an easy home birth was to make the husband busy: he was spending hours and hours boiling water. Are we rediscovering the value of old rituals?

Dr. Odent, it is an honor. I am in the USA, studying to become a midwife and noticed a peculiar quote in my Anatomy & Physiology textbook. It states that “The pain of human childbirth, compared to the relative ease with which other mammals give birth, is an evolutionary product of two factors: the unusually large brain and head of the human infant, and the narrowing of the pelvic outlet, which adapted hominids to bipedal locomotion.” (Kenneth S. Saladin, Third Edition). Do you agree with this statement, or is this merely an assumption made due to the high levels of intervention and passivity of the woman during childbirth? Thank you for your time; I truly respect all that you have done.

We cannot deny that human beings must overcome several handicaps in the period surrounding birth. The main handicap is not mentioned in your textbooks. It is the huge development in our species of that part of the brain called the neocortex. The neocortex is not basically different from what we might call the brain of the intellect. The point is that during the birth process (and during any sort of sexual experience), if there are inhibitions, they come from the powerful neocortex.

Nature found a solution to overcome this human handicap. The maternal neocortex is supposed to be at rest, so that primitive brain structures supporting our survival instincts can more easily release the necessary hormones. That is why women who give birth by themselves, with their own hormones, tend to cut themselves off from our world, to forget what they read or what they have been taught; they dare to do what a civilized woman would never dare to do in her daily social life (daring to scream, to swear, to be impolite, etc.); they can find themselves in the most unexpected, bizarre, primitive, often quadrupedal postures; I heard women saying afterwards: ‘I was on another planet’. When a laboring woman is ‘on another planet’, this means that the activity of her neocortex is reduced. This reduction of the activity of the neocortex is an essential aspect of birth physiology among humans.

This aspect of human birth physiology implies that laboring women need to be protected against any sort of neocortical stimulation. This helps us to understand the importance of quiet (since language is a powerful stimulant of the neocortex) and of a dim light. It explains also the importance of privacy (when we feel observed our neocortex is stimulated) and the need to feel secure (when we perceive a possible danger we must be attentive and alert). Because the most important aspect of birth physiology is not understood in our cultures, there is no reference in your textbooks to the handicap related to a highly developed neocortex.

It is commonplace, on the other hand, to focus on the mechanical difficulties of the birth of Homo sapiens. In fact, these difficulties are also related to brain development. Today Homo sapiens is classified as a chimpanzee with an enormous brain. At term, the smaller diameter of the baby’s head (which is not exactly a sphere) is roughly the same as the larger diameter of the mother’s pelvis (which is not exactly a cone). The evolutionary process adopted a combination of solutions in order to reach the limits of what is possible.

The first solution was to make pregnancy as short as possible, so that, in a sense, the human baby is born prematurely. Furthermore we have realized recently that the pregnant mother can, to a certain extent, adapt the size of the fetus to her own size by modulating the blood flow and the availability of nutrients to the fetus. That is why small surrogate mothers carrying donor embryos from much larger genetic parents give birth to smaller babies than might have been anticipated.

From a mechanical point of view, the baby’s head must be as flexed as possible, so that the smaller diameter is presenting itself before spiraling down to get out of the maternal pelvis. The birth of humans is a complex asymmetrical phenomenon, the maternal pelvis being widest transversally at the entrance and widest longitudinally at the exit. A process of ‘molding’ can slightly reshape the baby’s skull if necessary.

When mentioning the mechanical particularities of human birth, one cannot help referring to and comparing ourselves with our close relatives the chimpanzees. The head of a baby chimpanzee at term occupies a significantly smaller space in the maternal pelvis, and the vulva of the mother is perfectly centered, so that the descent of the baby’s head is as symmetrical and as direct as possible. It seems that since we separated from the other chimpanzees, and all along the evolution of the hominid species, there has been a conflict between moving upright on two feet and, at the same time, a tendency towards a larger and larger brain. The brain of the modern Homo is four times bigger than the brain of our famous ancestor Lucy. There is a conflict in our species because the pelvis adapted to the upright posture must be narrow to allow the legs to be close together under the spine, which facilitates transfer of forces from legs to spine when running. An upright posture is the prerequisite for brain development. We can carry heavy weights on our head when we are upright. Mammals walking on all fours cannot do the same. That is apparently why the process of evolution found other solutions than an enlarged female pelvis in order to make the birth of the ‘big-brained ape’ possible: the faster our ancestors could run, the more likely they were to survive.

Nature found several other solutions to overcome the mechanical difficulties. One of them is that when the neocortical control is reduced, the laboring woman can spontaneously—instinctively—find postures that are usually complex, asymmetrical, and adapted to the different phases of the process of rotation. Another solution is the capacity human mothers have to give birth thanks to a powerful ‘fetus ejection reflex’, that is to say a series of irresistible contractions without any room for voluntary movements… on the condition that the neocortex is at rest.

We must add that Nature found solutions to compensate the physiological pain of labor. One of them is an appropriate release of natural morphine’s. Another one is the reduced activity of the new brain, so that the painful stimuli are not processed and imprinted in the upper parts of the nervous system, and so that the memory is depressed.

We cannot deny the human handicaps in the period surrounding birth. The point is to understand the many solutions the evolutionary process found to overcome a great diversity of difficulties. Understanding these solutions is the prerequisite to rediscover the basic needs of laboring women. It is a difficult task after thousands of years of culturally controlled childbirth and a recent proliferation of theories that have mislead most schools of “natural childbirth.” What a responsibility for the generation of midwives you belong to!

Conventional pregnancy magazines are full of ads and articles on banking cord blood. Is this just a profit-driven trend or is there value to it?

Women who are supposed to give birth to the baby and to deliver the placenta without any drug should be reluctant to bank cord blood. When the physiological processes are not disturbed, human mothers have the capacity to reach a very high peak of the hormone oxytocin soon after the birth. This peak of oxytocin is vital, first because it is necessary for a safe delivery of the placenta without any blood loss, and also because oxytocin is undoubtedly the main hormone of love. This release of oxytocin is possible (in a warm place) if the mother, who is still ‘on another planet’, is not distracted at all and has nothing else to do than to feel the contact with the baby’s skin, to look at the baby’s eyes, and to smell the baby. Imagine a mother who has just given birth and who has forgotten the rest of the world while discovering her newborn baby. Then a practitioner arrives with clamps and scissors to collect a sufficient amount of blood from the cord. What a dangerous distraction! The risk is a difficult and bloody delivery of the placenta. Furthermore the baby will be deprived of a certain amount of precious blood. Well-informed women would not take such risks, while the odds that the average baby without risk factors will ever use his banked cord blood are negligible.

It is another matter in the case of medicalized births (cesarean-section, drip of Pitocin, or drugs injected routinely to deliver the placenta). In such cases, the cord is clamped anyway soon after the birth of the baby. Then the risks are mostly financial. The point is that until now there has been little experience with transplanting self-donated cells (stem cells from bone marrow are currently given by relatives or strangers). Some experts have hypothesized that an ill baby who receives his or her own stem cells during a transplant would be at risk of repeating the same disease. Long-term studies are needed. Meanwhile we must be cautious.

My planned natural birth turned out to be very traumatic. I had severe abruptio placenta. I was 24, I don’t smoke or have any of the risk factors for it, I was very healthy, I ate right and was not overweight. It happened while in the early stages of labor at home and things didn’t seem right to me. My husband rushed me to the hospital. I was in severe pain and only 4 cm dilated, my baby’s heart rate was at 70, I was hemorrhaging. They rushed me to perform an emergency C-section. My daughters had to be intubated for a short time and spent a few days in the NICU. I thought I could never be thankful for such medical intervention, but I am for it saved our lives. My daughter is two now and we are thinking about having another child. I have not found much information on what happened to me. Is it because they aren’t sure why it happens? Is it likely to happen again? Should I still try for a natural birth? How can I find out more information on it?

Abruptio placentae means that the placenta separated from the uterus before the birth of the baby. It can happen before the labor starts or during labor. The separation may be complete or partial. In your case it was probably a quasi-complete separation. Your daughter was rescued thanks to an emergency C-section. Abruptio placentae is an important chapter of the program of ‘first aid in obstetrics’ we include in our information sessions for doulas. We understand why your doctors could not give you much information on what happened to you. More often than not it is impossible to find a cause for such an accident. It is noticeable that a previous abruption placentae is not usually mentioned as a significant risk factor for the advent of a similar accident at the end of the following pregnancies. The conclusion is that when you give birth to your second baby, you’ll be in the usual situation of a mother trying to give birth vaginally after a previous C-section. This means first that labor induction will be an absolute contraindication. Because you cannot extinguish in your memory the dramatic complication you previously had, you’ll probably prefer to labor in a hospital. The point is to find a hospital where they accept your project of a trial of labor and at the same time where they understand the meaning of the word privacy.

Is taking castor oil for inducing labor okay for both the unborn child and mother?

Castor oil is one of the most unpleasant ways to induce labor. It makes the mother nauseous and it often causes diarrhea. Furthermore its safety has not been evaluated by large randomized controlled studies. I personally know about several cases of fetus distress during labor obviously related to the use of castor oil. I use this opportunity to mention that women often ask me about ‘natural’ methods of labor induction. My answer is that there are no natural methods of induction. If a method is effective, it means that it is not natural, because it has preceded the signals given by the baby. We understand today that the fetus participates in the initiation of labor by sending messages that mean: ‘I am ready’. (For example the mature baby’s lungs can release in the amniotic fluid factors that play a role in birth physiology). Whatever the method, an induced labor is usually longer and more difficult (therefore more dangerous) than a labor that started spontaneously. Instead of being impatient and taking castor oil, it would be wiser to rely on ultrasound scans in order to check that the amount of amniotic fluid is still normal. This is the best way to reassure the health professionals. Today we routinely offer mothers-to-be a great number of useless scans. We must realize that the most useful ones are those done ‘on demand’ when the pregnancy is longer than usual.

Can artificially rupturing the membranes contribute to fetal distress? I know that it can speed up labor, and that shorter labors can be less distressing, but my daughter’s heartbeat dropped considerably not long after my doctor broke my water.

We cannot be sure that, in your particular case, there was a cause and effect relationship between the artificial rupture of the membranes during labor and the changes in your daughter’s heartbeat. However it is well understood that, after a rupture of the membranes and therefore after an acceleration of labor at a time chosen by the doctor (or the midwife!), the baby’s head is suddenly subject to greater pressure during contractions and the cord is more likely to become compressed. The baby must protect herself by releasing in particular the hormone noradrenaline, which tends to slow down the heartbeat. The best way to prevent the common temptation of breaking the bag of water is to avoid assessing the progress of labor with vaginal exams. This is easier when the laboring woman has complete privacy and does not feel guided. In this case an experienced birth attendant can more often than not follow the progress of labor thanks to the noise the mother-to-be is doing, the way she is breathing, and the complex postures her body can find spontaneously.

Regarding water birth, I have two questions: 1.  Is there a point at which it is too early to get in the pool?  2.  Is it really possible to get so relaxed that labor can stop?  I wouldn’t say I was relaxed – just removed from the present and in a deep state of concentration.

1. Entering the bath too early is the most common misuse of the birthing pool. Originally we introduced the concept of birthing pool in a French hospital in order to replace drugs when the first stage is long, difficult, very painful, and when the dilation of the cervix is already well advanced. It is essential to understand that immersion in water at body temperature makes the contractions more effective during a limited period of time, which is in the region of an hour and a half. Helping the laboring women to be patient and to avoid entering the bath too early is a new aspect of the art of midwifery. However, in some cases, a bath can be useful to stop the contractions of a painful pre-labor, and therefore to make the difference between labor and pre-labor.

2. When a woman is so relaxed that apparently labor stops, it means that it was not labor, but pre-labor. In general the release of adrenaline (which induces the opposite of a state of relaxation) inhibits the release of oxytocin (the hormone necessary for effective uterine contractions).

How would you define “normal” birth?

The term ‘normal’ is useless when applied to birth. In ‘normal’ there is a cultural connotation. A birth can be considered normal in Rome, but not in Santa Fe. It is only in retrospect that a birth can be qualified ‘normal’ (the same about ‘natural’). What we need today is to qualify an attitude. That is why I suggested the concept of ‘biodynamic attitude in childbirth’. A biodynamic attitude (in farming, in childbirth, etc.) is based on a good understanding of the physiological processes. In other words it means: working with the laws of Nature.

Can you explain why water birth might be better than using the “traditional” route, i.e. drugs?

All drugs given to a woman in labor may have side effects for the mother and for the baby. When we introduced the concept of birthing pools in a French hospital in the 1970s, our primary objective was to reduce the need for pain killers and drips of Pitocin. When a labor is long, difficult and abnormally painful, it usually means that the mother-to-be is not in the right hormonal balance.

It means in particular that the pituitary oxytocin is not being released in an effective way, more often than not because the level of stress hormones is too high. Immersion in water at the temperature of the body is a way to reduce the level of stress hormones and therefore to facilitate the release of oxytocin, the main hormone that makes uterine contractions during labor effective.

Since the 1970s we learnt that obstetric medications may also have long term side effects. Visit our data base www.birthworks.org/ and click, for example, on the key word ‘drug addiction’. You’ll find a series of studies suggesting that when the mother has used certain drugs when in labor, her child is – statistically speaking – more at risk than others to become drug addicted later on in life. It is probably not by chance that, in the US, the age of ‘twilight sleep’ was followed by the ‘drug culture’ generation. Furthermore we learnt recently that the complex cocktail of hormones released by laboring women is a cocktail of ‘love hormones’. All pharmacological substitutes block the release of the natural hormones and don’t have the same behavioral effects: they are not hormones of love. So the questions must be raised in terms of civilization.

Birthing pools will seriously compete with drips of Pitocin plus epidurals on the day when a simple fact will be widely divulged. It is that immersion in water at the temperature of the body tends to the make the uterine contractions more effective for a limited period, which is in the region of an hour and a half. This implies that a new aspect of the art of midwifery will be to help women to be patient enough not to enter the bath too soon, ideally not before the middle of the dilation of the cervix. It also implies that a birth under water should not be the goal and should not be planned, although it is a possibility. When the mother-to-be is the prisoner of her project, she may be tempted not to listen to her body and to stay in the birthing pool at a time when the contractions are already becoming weaker and less effective.

What are the risks/benefits to letting your baby have a shot of vitamin K after birth?

Today there are many reasons to de-dramatize the topic and to reassure at the same time the parents who are inclined to refuse the shot and also those who prefer to do it.

To the parents who refuse the injection, we can say that they don’t take a great risk, since the chances of their breastfed baby having a hemorrhagic disease related to vitamin K deficiency is in the region of one in 15,000. It is even probable that the risks are still lower if the birth and the initiation of lactation were undisturbed. My view is that vitamin K deficiency of breastfed babies is probably no more physiological than the weight loss in newborn babies. After thousands of years of culturally controlled childbirth and lactation, we usually underestimate the amount of ‘colostral milk’, and therefore of vitamin K, a human baby has been programmed to consume during the first days following birth.

A well-constructed Japanese study showed that babies who consume 350 ml of breast milk in the first three days following birth are protected against vitamin K deficiency. Let us also remember that vitamin K deficiency is unheard of among formula fed babies.

Some parents who accepted the injection might feel guilty or anxious afterwards when hearing about two British studies suggesting that vitamin K injected at birth (not vitamin K given orally) is a risk factor for cancer in childhood. These parents must be reassured as well because the British findings have not been confirmed by other studies, particularly a huge authoritative Swedish study involving more than one million children. However one cannot hide the fact that the routine injection of 1 mg of vitamin K at birth is always associated with the injection of 10 mg propylene glycol and 5 mg phenol, the effects of which are unknown.

Would you advise a home birth or water birth when attempting a VBAC?

In an ideal world, we should not contrast home birth and hospital birth. When an effective communication has been established between the home birth midwife and the obstetrical team, it should be possible to combine what the privacy of the home can offer and what the hospital facilities can offer. If a laboring woman feels secure in her own “nest”, if an experienced, motherly and silent midwife is available, and if the first stage is easy and straightforward, it may be risky to change the environment in hard labor: a transfer to hospital can induce inhibitions. On the other hand, if the first stage is slow, difficult and very painful, it is probably better to change the environment and to go to the hospital. The point is not to be the prisoner of a project. Such strategies are valid for almost all births, but still more when attempting a VBAC.

When I introduced the concept of hospital birthing pools in the 1970s, our first objective was to reduce the need for drugs when the labor was long and difficult. Originally, we used it in particular in the case of a woman attempting a VBAC, if the contractions were becoming less effective around 5 centimeters. At that phase of labor, immersion in water at the temperature of the body is usually a way to reach complete dilation within an hour or two. Once more, it is important not to be the prisoner of a project, such as the project of giving birth under water. Many women feel the need to get out of the pool for the very last contractions.

What are the risks associated with routine ultrasound for low-risk pregnancies?

In general the most authoritative studies of the long term effects of being exposed to ultrasound during fetal life are reassuring. A Swedish study, for example, involved 19 prenatal care clinics and more than 4000 children.(1) After randomization (after drawing lots) only the pregnant women belonging to the ‘screening group’ were offered a scan at 15 weeks. After follow-up of the children, no statistically significant differences in body weight or height at 1, 4, 7 years of age between exposed and unexposed children were found. There were no differences either in terms of impaired vision or hearing during childhood.

However there are studies suggesting that exposure to ultrasound during fetal life is not completely neutral. This is the case of a large Australian study. It appeared, after analyzing thousands of cases, that frequent exposure to ultrasound tends to restrict fetal growth.(2) Such results confirmed the results of studies with pregnant monkeys scanned with doses used in human medicine.(3) This is also the case of several Scandinavian studies showing that exposure to ultrasound tends to slightly modify the proportion of right-handed and ‘non right-handed’ children.(4,5)

Since exposure to ultrasound during fetal life is not completely neutral, the selective use of scans should be preferred to routine scans. There are reasons to be cautious but, in the scientific context of 2003, one cannot refer to documented real complications.

-1- Kieler H, et al. Routine ultrasound screening in pregnancy and the children’s subsequent growth, vision and hearing. British Journal of obstetrics and gynaecology. 1997; 104: 1267-72.
-2- Newnham JP, et al. Effects of frequent ultrasound during pregnancy: a randomised controlled trial. Lancet 1993; 342: 887-91.
-3- Tarantal AF, Hendrickx AG. Evaluation of the bioeffects of prenatal ultrasound exposure in the cynomolgus macaque. Teratology 1989; 39 (2): 137-47.
-4- Savelsen KA, et al. Routine ultrasound in utero and subsequent handedness and neurological development. BMJ 1993; 307: 159-64.
-5- Kieler H. Routine ultrasound screening in pregnancy and the children’s subsequent handedness. Early Human Development 1998; 50: 233-45.

I was told I have the strep b virus, I don’t know if I had it with my 5 other children or not. I am planning on another home birth, as my others have all been, but my doctor says that 40% of babies can die or have damage from this at birth. My mid-wife says that’s not accurate and that many woman carry strep b and is not even aware of it. Do I need to take antibiotics during labor, and will the baby need drops in its eyes after delivery? I have never had either done to any of my 5 babies. If you could please give me advise or direct me to issues that would answer these questions, I would really appreciate it. I am 43 years old; this is my 6th delivery coming up app. 6-20-03.

It is exceptionally rare that a baby born at term with a normal birth weight dies from a B strep infection. Those who are more vulnerable are premature babies and small-for-date babies. Three studies published in authoritative medical journals suggest that the use of a vaginal spray of chlorhexidine is as effective as antibiotics. For mysterious reasons these studies are not well known. I include the abstract of the most recent one. It is better not to give eyes drops to the baby at birth and to rely on the results of an antibiogram (in the unlikely occurrence of an eye infection).

Abstract: -1- Facchinetti F, Piccinini F, Mordini B,Volpe A J Matern Fetal Med 2002 Feb;11(2):84-8 Chlorhexidine vaginal flushings versus systemic ampicillin in the prevention of vertical transmission of neonatal group B streptococcus, at term.

OBJECTIVE: To investigate the efficacy of intrapartum vaginal flushing’s with chlorhexidine compared with ampicillin in preventing group B streptococcus transmission to neonates.

METHODS: This was a randomized controlled study, including singleton pregnancies delivering vaginally. Rupture of membranes, when present, must not have occurred more than 6 h previously. Women with any gestational complication, with a newborn previously affected by group B streptococcus sepsis or whose cervical dilatation was greater than 5 cm were excluded. A total of 244 group B streptococcus-colonized mothers at term (screened at 36-38 weeks) were randomized to receive either 140 ml chlorhexidine 0.2% by vaginal flushing’s every 6 h or ampicillin 2 g intravenously every 6 h until delivery. Neonatal swabs were taken at birth, at three different sites (nose, ear and gastric juice).

RESULTS: A total of 108 women were treated with ampicillin and 109 with chlorhexidine. Their ages and gestational weeks at delivery were similar in the two groups. Nulliparous women were equally distributed between the two groups (ampicillin, 87%; chlorhexidine, 89%). Clinical data such as birth weight (ampicillin, 3,365 +/- 390 g; chlorhexidine, 3,440 +/- 452 g), Apgar scores at 1 min (ampicillin, 8.4 +/- 0.9;chlorhexidine, 8.2 +/- 1.4) and at 5 min (ampicillin, 9.7 +/- 0.6; chlorhexidine,9.6 +/- 1.1) were similar for the two groups, as was the rate of neonatal group B streptococcus colonization (chlorhexidine, 15.6%; ampicillin, 12%). Escherichia coli, on the other hand, was significantly more prevalent in the ampicillin (7.4%) than in the chlorhexidine group (1.8%, p < 0.05).Six neonates were transferred to the neonatal intensive care unit, including two cases of early-onset sepsis (one in each group).

CONCLUSIONS: In this carefully screened target population, intrapartum vaginal flushings with chlorhexidine in colonized mothers display the same efficacy as ampicillin in preventing vertical transmission of group B streptococcus. Moreover, the rate of neonatal E. colicolonization was reduced by chlorhexidine.

Previous references:
-2 – Burman LG,et al. Prevention of excess neonatal morbidity associated with group B streptococci. Lancet 1992; 340: 65-69
-3 – Taha TE, et al. Effect of cleansing the birth canal with antiseptic solution. BMJ 1997; 315: 216-20.

How serious are the consequences if meconium shows up in the amniotic fluid during labor? Is this necessarily an emergency?

When the meconium shows up in the amniotic fluid during labor, it means that the baby is releasing a hormone of the adrenaline family called noradrenaline. This hormone is released when the baby must adapt to a low supply in oxygen. The effect of a release of noradrenaline is to provide enough blood to vital organs having priority (such as brain, heart, and kidneys) by reducing the amount of blood going to organs that are not yet vital such as the bowels. That is how the green-brown tarry sterile substance that fills the bowels is eliminated into the amniotic fluid.

In other words, meconium staining during labor does not mean fetal distress and is not necessarily an emergency. It means that a physiological system of protection of the fetus is at work. That is why it is always a particular case that should be interpreted according to the phase of labor, the progress of labor, the duration of pregnancy, the number of babies the mother had previously, the place of birth, etc. Let us mention that a tainted liquid during labor is almost the rule in the case of a breech presentation and is not usually related to the release of noradrenaline.

Amniotic fluid inhalation occurs in 2% to 5% of babies with tainted liquid. Among them, some will develop meconium aspiration pneumonia and will go on mechanic ventilators. Very few of them will have residual health problems. The practice of suctioning the mouth and throat of the baby just before the delivery of the shoulders is now considered useless. The routine intubation and suction of the trachea just after birth in the case of meconium staining is also considered useless according to recent studies. It does not improve the outcome.

What might be some reasons that a woman would have low or high amniotic fluid levels in pregnancy? What effects can these levels have on the well-being of the baby? and what, if anything, can be done to increase her chances of having “normal” amniotic fluid levels?

When a woman has too low levels or too high levels of amniotic fluid, the point is not to wonder what can be done to modify the amount liquid surrounding the baby. The priority is to detect a possible cause for such a deviation from what is considered ‘normal’. It is impossible, within a paragraph, to analyze all the possible causes for a polyhydramnios (more than 2 liters of liquid) or an oligohydramnios (less than 300 mL at term). I must underline that there is a common tendency to over diagnose polyhydramnios. In other words, many women are wrongly told that there is too much liquid.

How often does ultrasound find something wrong that can be fixed before birth? I would like no ultrasound but still want to be safe.

Apart from discovering a gross abnormality that leads the doctor to offer a late abortion (and exceptionally a very risky intrauterine operation), ultrasound scans rarely find something wrong that can be fixed before birth. In the case of a pregnancy that started while a mother is still breastfeeding and has no menstruation, the scan can give an idea of when the baby had been conceived (this is not exactly something wrong that can be fixed!). When the baby is really overdue an ultrasound scan can demonstrate that there is still a normal amount of liquid. Such a scan can be effective to reassure the doctor and therefore to postpone and even to avoid labor induction.

An experienced practitioner does not usually need a routine scan to suspect a breech presentation at 37 weeks or after, or to suspect a real placenta praevia. It is well known that ultrasound scans are not accurate to evaluate the size of the baby in the womb. Anyway if the baby seems to be too small, the recommendation should be: “Eat well and be happy”. Such recommendations can be given without the help of ultrasounds.

I have been a type I diabetic since early childhood. I have no complications, and have consistently had an A1c (measure of diabetic control) close to that of a non-diabetic. I am on the heavy side, but otherwise in very good health. I currently work with type I diabetics, and they often report a snowball of interventions when they have their babies at the hospital due to being categorized as “high risk” (whether or not they have good control). I am planning to get pregnant soon and very fearful of how my birth experience will be affected by being treated as “high risk.” The OBs I have talked to are very eager to intervene in the natural course of my pregnancy. I have not, however, found a midwife who is willing to “risk” working with a type I (even CNMs doing hospital birth and working collaboratively with OBs). What can I do at this point?

If you have been diagnosed as diabetic in early childhood, you are probably the best person in the world to control your own metabolisms. As soon as you are pregnant try to evaluate as accurately as possible the day of conception (if your cycle is not always perfectly regular), taking into account details of your private life that will be easily forgotten later on in pregnancy. Apart from diabetic control (and detecting a gross abnormality if you are ready for an abortion), always wonder what the medical institution can offer to you. If you are offered a test, always ask questions about its immediate practical implications. For example: ‘Why an ultra-sound scan at 32 weeks? What can you do now if the baby is too big or too small? ‘Nothing’. At the end of pregnancy, avoid the usual misinterpretations of hemoglobin concentration that lead to give pregnant women iron supplements. Iron inhibits the absorption of zinc. When you are diabetic, you must not play with the absorption of zinc.

It is probable that after 37 weeks the doctors will start talking about the size of the baby. Whatever the method, it is always difficult to evaluate the weight of a fetus. If they say that the baby is too big and if you don’t feel comfortable with a scheduled C-section, try to obtain the principle of a trial of labor. It is a guarantee that your baby will have given the right signal, and that you and your baby will have released hormones that give a last touch to the maturation of the lungs. If you give birth in a hospital where CNMs work with doctors, if you don’t go to the hospital before being in really hard labor, and if you belong to a family where women give birth easily, why not a quasi-normal pregnancy and a birth by the vaginal route?

I am 35 weeks, one centimeter dilated and very uncomfortable. When is it safe to start naturally inducing labor at home and what are the dangers in using castor oil?

At 35 weeks, the point is to hope that labor will NOT start prematurely. It is not usual to ask questions about induction at that phase of the pregnancy. Labor induction cannot be ‘natural’. It is always a way to precede the signals given by the baby and by your own body. Castor oil is unpleasant (diarrhea) and potentially dangerous.

What are some of the possible health risk associated with induction?

An induced labor is more difficult than a labor that started spontaneously. The needs for drugs and intervention are increased.

Labor induction probably has lifelong consequences for the child. I suggest that you visit the ‘Primal Health Research Data Bank’ (www.birthworks.org/) via the key word ‘labor induction’. It will lead to several studies suggesting that labor induction might be a risk factor for autism.

My interest in autism started in 1982, when I met NikoTinbergen, one of the founders of ethology, who shared the Nobel prize with Konrad Lorenz and Karl Von Frisch in 1973. As an ethnologist familiar with the observation of animal behavior, he studied in particular the non-verbal behavior of autistic children. As a ‘field ethnologist’ he studied the children in their home environment. Not only could he offer detailed descriptions of his observations, but at the same time he listed factors which predispose to autism or which can exaggerate the symptoms (1). He found such factors evident in the period surrounding birth: induction of labor, difficult forceps delivery, birth under anesthesia, and resuscitation at birth. When I met him he was exploring possible links between difficulty in establishing eye-to-eye contact among autistic children and the absence of eye-to-eye contact between mother and baby at birth.

It is probably because I met Niko Tinbergen that I read with special attention, in June 1991, a report by Ryoko Hattori, a psychiatrist from Kumamoto, Japan.(2) She evaluated the risks of becoming autistic according to the place of birth. She found that children born in a certain hospital were significantly more at risk of becoming autistic. In that particular hospital the routine was to induce labor a week before the expected date of birth (and to use a complex mixture of drugs during labor).

There are many reasons why further studies about labor induction as a possible risk factor for autism (and other abnormal behavior) are urgently needed. The first one is that the authors of the oldest studies included in our database came across risks associated with induction, whereas the most recent studies did not take into account this variable. ‘Labor induction’ should be explicitly taken into consideration, because it can be associated either with birth by the vaginal route (with or without intervention such as forceps), or with caesarean birth. Another reason is that the epidemic of autism and the epidemic of induction seem to have developed side by side. Most importantly, a third reason is that the results of recent studies suggest that children with autistic disorder show alterations in their oxytocin system.(3)

Such findings are of paramount importance at a time when an accumulation of data from animal studies confirms the potent effects of oxytocin on social behavior, communication and rituals. Artificial induction of labor in general, particularly the use of drips of synthetic oxytocin, create situations that undoubtedly interfere with the development and the reorganization of the oxytocin system in such a critical period. This only fact is a reason for further epidemiological studies focusing on labor induction as a possible risk factor for a great variety of abnormal or subnormal behavior.

1 – Tinbergen N, Tinbergen A. Autistic children. Allen and Unwin. London 1983.
2 – Hattori R, et al. Autistic and developmental disorders after general anesthetic delivery. Lancet 1991; 337: 1357-8.
3 – Green L, Fein D, et al. Oxytocin and autistic disorder: alterations in peptides forms. Bio Psychiatry 2001; 50 (8):609-13..

I am researching early vs. late umbilical cord clamping. What is your opinion on the issue? any suggestions or more resources?

Clamping the cord before the delivery of the placenta is to interfere with the physiological processes.

Having been in charge of more than 10,000 ‘non-managed third stages’ of labor in the French state hospital of Pithiviers I cannot see any reason to interfere with the exchanges of blood between the newborn baby and the placenta. We must keep in mind that it is between the birth of the baby and the delivery of the placenta that a woman has the capacity to release the highest possible peak of the hormone oxytocin. The release of oxytocin is always highly dependent on environmental factors. The main condition, in the particular case of the third stage of labor, is that the mother has nothing else to do than to look at the baby’s eyes and to feel the contact with the baby’s skin…in complete privacy, without any distraction. Clamping the cord or trying to detect the time when the cord stops pulsating are powerful distractions that ‘brings back to our planet’ a woman who had ‘forgotten the rest of the world’.

Needless to recall that this peak of oxytocin is necessary for a safe delivery of the placenta and that this hormone has well-documented behavioral effects (it is the main ‘hormone of love’).

I have genital herpes and am pregnant. I want a natural childbirth, but have been told that a C-section may be necessary. I thought that I would pass antibodies onto my baby? If I have a lesion at the time of birth can I still deliver vaginally? What are my options?

I understand that you have recurrent herpes and that the first invasion preceded the current pregnancy. In this case you have probably developed low-weight antibodies (IgG) that cross the placenta, so that your baby is immunized: it is not unwise to give birth by the vaginal route. It would be different if the first invasion had occurred recently, while you are pregnant. In this case you would have developed only high-weight antibodies (IgM) that do not cross the placenta and that do not protect the baby in the womb.

I recently suffered a 4th degree tear, 1 centimeter into the rectum it was repaired by a surgeon. This began as a wonderful homebirth labor, the delivery was tough though, nuchal arm, shoulder dystocia, 10.6 baby. The doctor realized that it was out of his scope and I was transported to the hospital for repair. What are my chances of another natural birth?

Most obstetricians will advise you to have a C-section for the birth of the next baby; however the vaginal route might be possible if you are given the opportunity to give birth in complete privacy, for example with nobody else around than one experienced, motherly, low-profile and silent midwife. In such a context, if you don’t feel guided, it is highly probable that you’ll have a powerful ‘fetus ejection reflex’ and that you’ll find spontaneously a position that is not dangerous for the perineum (usually an asymmetrical kneeling posture).

I was interested in finding out more about the antibody called Rhogam and possible adverse effects before agreeing to take it for my RH sensitivity. With the birth of my other child I did not take it and everything was fine, is it really as important as they make it sound?

RhoGAM is the name of a trademark of anti-D immunoglobulin’s. It is injected (during pregnancy or just after the birth) to mothers who belong to the blood group Rh negative. An Rh negative woman may conceive an Rh positive child if the father is Rh positive.

The objective of this injection is to prevent the formation by the mother of ‘anti D’ (= anti RH) antibodies that might be detrimental for the babies in future pregnancies only. In other words it is a way to reduce the risks of accidents caused by a conflict between mother and babies. The most typical accident caused by this sort of blood incompatibility is a severe jaundice related to the destruction of fetal red blood cells. Today these accidents are exceptionally rare in developed countries, first because women don’t have many babies (only children who have older siblings are at risk), and also because the prevention is routinely recommended.

Such explanations are necessary, so that informed women can decide if the injection is really useful in their particular case. For example if a pregnant woman knows that the baby’s father is also Rh negative, she does not need the injection. Another woman might also decide not to have the injection because she knows that she will never be pregnant again (e.g. a ‘miraculous’ unexpected conception in her late forties).

Let us mention that today most anti-D products do not contain any mercury derivative, and that their viral safety is well accepted.

My sister delivered her third daughter on 11.25.03. The baby was 11 days post-mature. After two previous inductions on an unripe cervix, she made the informed decision to allow labor to begin naturally. On the Saturday before delivery, my sister felt an almost unbearable contraction while grocery shopping. Within hours she reported to me that the baby was not moving, and although we have not yet discussed it, I think she knew her baby was gone. We managed an almost completely natural hospital birth, the only intervention being use of the external monitor. Needless to say, the nurses were unable to find a fetal heartbeat. After 6 hours of un-medicated labor, her child delivered stillborn. Her death was blamed on the heavy presence of meconium. Her birth weight was 7lbs. 2oz. Can you offer me any information that I could pass on to my sister that would help her stop blaming herself for being stubborn and repeatedly not showing up for her scheduled inductions? This experience is shaking my belief in the natural approach to pregnancy and childbirth.

This ‘unbearable’ pain, followed by the death of the baby and the presence of heavy meconium, is highly suggestive of a ‘partial placenta abruption’. This means that the placenta stopped working properly because it was suddenly more or less separated from the uterus. This rare accident is unpredictable. It can occur at any time during the last months of any pregnancy. More often than not there is no obvious cause. It is more common among women who already had babies. It can follow an abdominal trauma. A previous intra-uterine intervention (e.g. a C-section) is a risk factor. The chances that this accident occurs again when your sister is expecting another baby are very small.

How can I get my baby to turn head down? I am 36 weeks pregnant and desperately want to birth this child at home. Methods we are currently trying are: manual version by the midwives, breech tilt (behind in the air on all fours and also on a tilt on my back), moxabustion, pulsatilla 200 in two doses, two days apart, headphones taped to my lower belly with lullabies softly playing, meditation, pleading! I have an appointment scheduled with my naturopath to try other options: osteopathic adjustments and/or acupuncture and later a higher dose of pulsatilla 1M after risk of preterm labor has passed. This is my second birth (9 years apart). My son was born without any complications in 6 hours. Is there anything else we can try?

Many babies turn by themselves after 36 weeks. This is probably why all the methods you mention have a high rate of immediate successes. As a last resource, why not trying the medical way, that is to say an experienced obstetrician doing a manual version under ultrasound scan control, while the uterine muscle is in a state of relaxation thank to the use of ‘tocolytic’ drugs? By the way, I would not be scared by a vaginal breech birth in your case, since your first baby was born in six hours.

Mirror Neurons to help turn baby  * Note from Kathy Welter follows

As a quick note here, I’ve had great success in babies turning, using Hypnosis, having mom and dad both visualize baby in right position, that is head down back on the left side. Babies are experienced at communications with mother and dad after the 34^th week, a time when Mirror Neurons are mirroring images between mother and baby constantly. What happens is mother keeps hearing about baby in wrong position and focuses on this. Talks about it, worries about it, and keeps seeing baby with the wrong position. Instead stop all this talk and start looking at images of the optimum birth position, when you visualize baby see baby in the right position

Visualize the midwife and doctors confirming to you, hear their voices saying, that baby is in perfect position. It’s very effective.

I had planned on a homebirth with my son (now 6 months old). When I was in the pushing stage, the Midwife discovered that he was in a frank breech position. I was uncomfortable with the idea of delivering at home in this case, so I elected to go to the hospital and got a cesarean. I have been told I will never be able to have a baby vaginally again. Is this true?

I have often been surprised by how easy a delivery can be after a previous caesarean in late labor. One of the plausible interpretations of such easy births is that when a woman is trying to give birth vaginally after a previous in-labor caesarean, this implies that she has already had an opportunity to develop her uterine receptors to the hormone oxytocin. In other words, the second time her uterus is more sensitive to the effects of the hormone that makes contractions effective.

According to the most authoritative studies, a trial of labor is successful among approximately 70 to 80 per 100 women. Several studies have established predictive scores for the success of such trials, so that women may be given an individualized answer. I don’t know everything about your story, but I assume that your chances are high. Of course, for obvious reasons, the published studies could not take into account the degree of privacy, which might be the most important factor for success. Electronic fetal monitoring probably has a strong negative effect that has not been evaluated in the particular case of a vaginal birth after cesarean.

I have met several women who were in a panic after telling their doctor that they would prefer to try a vaginal delivery in spite of a previous caesarean. The reaction of the doctor was to focus on the risk of uterine rupture. After this some of these women could not get rid of vague and terrifying bloody mental pictures. Today clinicians are in a position to provide a reassuring and individualized risk assessment. Thanks to a series of recent authoritative studies, it is easy to explain that the risk of uterine rupture during a vaginal birth after cesarean is in the region of 1 for 200 trials, if the labor has not been induced. The main risk factor for uterine rupture is induction. You also need to know that a rupture can be suspected if there is a failure to progress or if the baby’s heart rate is not reassuring. During the intervention a dehiscence (a ‘window’) may be found, more often than a complete rupture.

I delivered my first born in the water and had a wonderful loving experience. My plans were to deliver my second also using hydrotherapy. However, the hospital I where I planned to deliver has suspended all water births/labors due to rising cost of insurance. With only 10 weeks remaining in my pregnancy I am faced with finding another hospital, mid-wife or alternative birth plan. I know this is a personal decision, but I am confused about potentially having the birth I desire and leaving the midwife I trust. Any words of wisdom that might help me feel comfortable with my choice?

How lucky you are! You had a wonderful experience when your first baby was born and now, while expecting your second baby, you can still rely on a midwife you trust! When we introduced the concept of birthing pool in a French hospital in the 1970s our objective was to replace drugs in the case of a difficult and long labor. It was what you rightly call a sort of ‘hydro-therapy’. A ‘therapy’ is to treat what is abnormal. It is very probable that for the birth of your second baby you will not need any ‘therapy’, if you are in a situation of real privacy with a silent, low profile and experienced midwife. What is more important for you: a midwife you trust or a birthing pool available? I can guess your answer if the question is asked that way.

My sister and I were discussing childbirth. She is very influenced by her friend, a nurse, to have an intrusive, medicalized birth. What kind of resources can I share with her to show her that a natural childbirth is a wonderful and safe birth choice?

You might first explain to your sister and her friend that a natural childbirth is not a choice. This term can only be used in retrospect, when a woman has given birth without any drug and without any intervention. The environment where you give birth is the real choice. You must explain that your main objective is safety and that according to common sense an easy birth is safer than a difficult birth. So your priority is to make the birth as easy as possible thanks to an environment that can satisfy your basic needs when you are in labor.

Your basic needs are easy to explain in the current scientific context. Physiologists, scientists who study the body functions, tell us that adrenaline (the emergency hormone we release in particular when we are scared or when we are cold) makes difficult the release of oxytocin, the hormone necessary for effective uterine contractions. You can explain that you release a lot of adrenaline when you are in an unfamiliar and clinical environment. You can add that, in contrast, you can imagine yourself giving birth in a familiar environment, with – for example – nobody else around than an experienced, motherly, low profile and silent midwife knitting in a corner. It is probable that in such an environment your body will work well.

The second aspect of the safety preoccupation is: what to do if there is something wrong? In the age of the safe C-section and widespread cell-phones, there is usually an easy answer to this question, which should always be the second one.

Many health professionals need to learn to think in terms of ‘ratio of benefits to risks’. Where out of hospital births are concerned, they immediately ask: ‘what will you do if…’ instead of asking first: ‘how to make the birth as easy as possible’.

You are asking what kind of resources you can share. You might share data about the Dutch birth statistics. In Holland, where 82% of the midwives are independent primary care givers, about 31% of the births occur at home, and an autonomous midwife attends many of the hospital births. The rates of C-sections are around 10% for the whole country and more than 90% of the laboring women do not need an epidural anesthesia. The birth outcomes are much better than in the USA (number of babies alive and healthy at birth).

Do not recommend books about ‘natural childbirth’ because they are usually written for the converted. Instead you might suggest updated books focusing on one of the main aspects of industrialized childbirth, such as ‘The Caesarean. Free Association Books 2004’. In order to help your sister and friend to learn to think long term, you might indicate the ‘Primal Health Research Data Base‘ that is specialized in studies exploring the long term consequences of what happened at the beginning of our life. It appears that the way we are born has lifelong consequences and that, today, in spite of the safe caesarean, we have good reasons to try to rediscover the basic needs of women in labor and of newborn babies.

Can you tell me your opinion on herbs that initiate/prepare for labor, specifically blue and black cohosh?

Because they are obsessed by the date they were given for induction, if their labor has not started spontaneously, some women are tempted to use non-medical methods. These women don’t always realize that any effective method (from acupuncture to herbs, nipple stimulation and sexual intercourse) implies that labor may start before the baby has signaled its maturity. There is no natural way of inducing labor. The risks associated with the use of some methods are well documented.(1-5) This is the case of blue and black cohosh. Blue Cohosh (caulophyllum thalictroides) contains vasoactive glycosides and an alkaloid known to produce toxic effects.
Michel Odent

1 – Finkel RS, Zarlengo KM. Blue cohosh and perinatal stroke. N Engl J Med 2004; 351(3): 302-303.
2 – Lontos S, Jones RM, Angus PW, Gow PJ. Acute liver failure associated with the use of herbal preparations containing black cohosh.
Med J Aust. 2003 Oct 6;179(7):390-1
3 – Rao RB, Hoffman RS. Nicotinic toxicity from tincture of blue cohosh (Caulophyllum thalictroides) used as an abortifacient.
Vet Hum Toxicol. 2002 Aug;44(4):221-2.
4 – Vitetta L, Thomsen M, Sali A. Black cohosh and other herbal remedies associated with acute hepatitis.
Med J Aust. 2003 Apr 21;178(8):411-2
5 – Jones TK, Lawson BM. Profound neonatal congestive heart failure caused by maternal consumption of blue cohosh herbal medication.
J Pediatr. 1998 Mar;132(3 Pt 1):550-2.

Do you have any information about natural vaginal birth after a previous birth fistula injury? I’m being advised to plan a cesarean but I really want a natural birth. My fistula was vaginal/rectal and healed without surgery, but I would hate to have another, possibly worse one, with this birth.

If your absolute priority is to eliminate the risk of a recurrent vaginal/rectal fistula, everybody will advise you to plan an elective cesarean.

If your priority is to give birth vaginally, your particular case must be looked at in detail. It is noticeable that the opening between vagina and rectum healed without surgery. We might claim that it was not a real fistula, because the usual definition of the term vaginal/rectal fistula implies that the opening is lined with epithelial cells: this makes spontaneous healing almost impossible. If the healing was spontaneous, it is probable that there is now a high quality scar that cannot open again. All surgeons know this general rule.

I assume that this opening between vagina and rectum occurred after a long and difficult second stage of labor on your back, with a lack of privacy (several people around and somebody guiding you). Next time you might try to give birth in a different environment, ideally with nobody else around than an experienced, motherly, silent and low profile midwife. In such a context, you’ll reach more easily an ideal hormonal balance and your body will find the best possible postures to avoid a prolonged compression of the posterior wall of the vagina (for example complex asymmetrical postures on hands and knees).

Finally nobody can give you a precise advice. You must decide what your priorities are. You must take into account your intuition.

My wife and I are expecting our first child and would like a homebirth (preferably a water birth). My wife has tested positive for Group B Strep and she plans to avoid taking antibiotics in labor. Would labor/delivery in the water carry any increased risk?

Let us first recall that Group B Streptococci very rarely infect an average birth weight baby born at term. The risks are higher in the case of a premature or low weight newborn baby. Let us recall also that B Strep comes and goes, and that the test must be repeated as close to the due date as possible. It has been claimed that inserting in the vagina a crushed or cut clove of garlic during three to five nights usually makes a second test negative.

I share the point of view of your wife and I am not comfortable with the fact that a great part of the population is now exposed to antibiotics just before being born. There are already studies suggesting that early exposure to antibiotics might be a risk factor for allergic diseases later on in life. Furthermore such a widespread practice might explain the increased incidence, in some medical centers, of neonatal infections by antibiotic-resistant strains of e-colis.

There are therefore serious reasons to give a great importance to a series of studies suggesting that the efficacy of a local vaginal treatment with the antiseptic chlorhexidine is comparable to the efficacy of antibiotics in the prevention of such neonatal infections. You cannot discuss this issue with health professionals without providing the relevant references. For mysterious reasons these studies are not well known, although published in authoritative medical journals.

If the first stage of labor is long and difficult in spite of complete privacy, there is no reason why your wife would not try to reduce her level of adrenaline through immersion in water at the temperature of the body (I originally introduced the concept of birthing pool in a French hospital in order to avoid drugs when the labor is difficult). If your wife suddenly has a series of irresistible contractions and does not want (or has not the time) to get out of the pool, the baby may be born under water.

References:

1.      The Swedish Chlorhexidine Study Group. Burman LG, Christensen P, Christensen K, Fryklund B, Helgesson AM, Svenningsen NW, Tullus K. Prevention of excess neonatal morbidity associated with group B streptococci by vaginal chlorhexidine disinfection during labour. Lancet. 1992 Sep 26;340(8822):791; discussion 791-2.

2.      Facchinetti F, Piccinini F, Mordini B, Volpe A. Chlorhexidine vaginal flushings versus systemic ampicillin in the prevention of vertical transmission of neonatal group B streptococcus, at term. J Matern Fetal Med 2002 Feb;11(2):84-8

3.      Taha TE, et al. Effect of cleansing the birth canal with antiseptic solution. BMJ 1997; 315: 216-20.

4.      Stray-Pedersen B, Bergan T, Hafstad A, Normann E, Grogaard J, Vangdal M. Vaginal disinfection with chlorhexidine during childbirth. Int J Antimicrob Agents 1999 Aug;12(3):245-51

5.      Christensen KK, Christensen P, Dykes AK, Kahlmeter G. Chlorhexidine for prevention of neonatal colonization with group B streptococci. Effect of vaginal washing with chlorhexidine before rupture of the membranes. Eur J Obstet Gynecol Reprod Biol 1985 Apr;19(4):231-6

6.      Kollee LA, Speyer I, van Kuijck MA, Koopman R, Dony JM, Bakker JH, Wintermans RG. Prevention of group B streptococci transmission during delivery by vaginal application of chlorhexidine gel. Eur J Obstet Gynecol Reprod Biol 1989 Apr;31(1):47-51

How can I avoid an episiotomy? I had one with my first child (hospital birth, no anesthesia) and the memory of the pain while being stitched up and for months afterwards is terrible! My first arrived quite fast, after about 4 pushes and he weighed only 2.5kg. Looking back, I think my episiotomy wasn’t necessary. What can be done before and during labor to avoid this procedure? Should I have pushed ‘less’?

The best way to avoid an episiotomy or a dangerous tear is to give birth with nobody else around than an experienced, motherly, silent, and low profile midwife who does not guide you. If you don’t feel observed and guided, you can more easily ago to another planet, stop being rational, and just listen to your body. In such a context there is a high probability that you’ll find yourself in the best possible posture, for example on hands and knees. If the need for privacy was understood, ‘episiotomy’ would become a topic for historians.

I am 7 weeks pregnant with my second child and would like a natural birth. My first birth was long and my cervix did not open for several days. Realizing that I was depleted of food and energy, we opted for interventions to help the labor progress. Is it possible that the abnormally large amount of amniotic fluid I had over-stretched my uterus, causing the contractions to be ineffective? Is there a way to encourage my body to have less amniotic fluid this time around? Any input you have would be most appreciated!

The first important point is to avoid calling a midwife (or going to a birthing place) before the time when you are absolutely sure that it is really hard labor. During the night don’t switch on the light if you can stay in bed in the dark. Don’t walk if your body asks you to lie down. Eat and drink if your body asks you to eat and drink, but don’t eat and drink if you don’t feel hungry and thirsty.

When you are in hard labor, remember that the length of labor is usually proportional to the number of people around. Avoid the presence of anybody who might release adrenaline. The best situation I know for an easy birth is when there is nobody else around than an experienced, motherly and silent midwife who does not behave like a guide or an observer. The most common cause for a long and difficult labor is the presence of the baby’s father. I know that what I say is not politically correct. However, at a time when there is an epidemic of ‘failures to progress’, it is becoming acceptable to smash the limits of political correctness.

Meanwhile watch the moon, listen to the music you love, and avoid reading books about childbirth, particularly chapters about amniotic fluid.

Can you explain in detail “the accordion method”, or refer me to a book or other resource that does?

It would be premature to explain in detail what the accordion method is, because our research center is still in the process of evaluating its efficacy. The objective is to reduce the maternal body burden in man-made fat-soluble chemicals before the conception of a baby. We all have in our bodies hundreds of chemicals that would not have been there sixty years ago because they did not exist at that time. They belong to families such as PCBs, dioxins, etc. They accumulate over the years in our adipose tissues. Since the late 1990s we have gathered a sufficient amount of data to realize that one of the main threats for the health of the unborn generations is intrauterine (pre-birth) pollution by such molecules.

The basis of our program is to repeat short fasting sessions in order to mobilize the stored lipids. During such sessions there are more free fatty acids (and therefore pollutants) in the blood. This is the right time to combine all the possible routes to try to eliminate some of them. We rely mostly on sweat, bile and the intestinal route. Because women recover quickly their weight soon after each session our program is called ‘accordion method’.

My hemoglobin is now 11.4 in week of gestation 19. A friend of mine has 7.8. Do I have to take ferrum? Is there a hemoglobin-limit?

It is probable that from now on your hemoglobin concentration will decrease. The placenta – which is ‘the advocate of the baby’ – will send you hormonal messages so that you dilute your blood in order to make it more fluid. Your blood volume will increase dramatically (up to 40% to 50%). Although you’ll still have the same amount of hemoglobin available, its concentration in your blood will be lower if the placenta is working well. The most authoritative published study on this issue involved more than 150 000 thousands births (Steer P, Alam MA, Wadsworth J, Welch A. Relation between maternal hemoglobin concentration and birth weight in different ethnic groups. BMJ 1995; 310: 389-91). According to this huge study a hemoglobin concentration between 8.5 and 9.5 during the second half of a pregnancy is associated with the best possible birth outcomes. Furthermore, when the hemoglobin concentration fails to fall below 10.5 there is an increased risk of low birth weight, premature birth and pre-eclampsia.

The regrettable consequence of misinterpreting this test is that, all over the world, millions of pregnant women are wrongly told that they are anemic and are given iron supplements. There is a tendency both to overlook the side effects of iron (constipation, diarrhea, heartburn, etc.) and to forget that iron inhibits the absorption of such an important growth factor as zinc. Furthermore, iron is a powerful oxidative substance that can exacerbate the production of free radicals. The disease pre-eclampsia is associated with an ‘oxidative stress’. Pregnant women need antioxidants (provided in particular by fruit and vegetable) rather than oxidative substances.

You should print the abstract of the study I mentioned (you’ll find it via PubMed, for example) in order to be in a position to discuss with practitioners who might tell you that you are anemic and that you need iron supplements. Don’t take iron supplements as long as your iron deficiency has not been proven by specific tests (ferritine in particular).

I cannot comment on the hemoglobin concentration of your friend, first because I don’t know if she is at the beginning or at the end of her pregnancy, and also because data regarding her lifestyle and data provided by a clinical exam should prevail upon the results of one laboratory test; this test should probably be repeated and completed, according to the context.