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

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Alternative Birthing Methods

Erin Cook

January 19, 2006

THRS Presentation


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Alternative Methods

  • Lamaze

  • Waterbirth

  • Acupuncture, Acupressure, & Moxibustion

  • Hypnobirthing

  • Yoga

  • Ginger for N/V

  • Massage

  • Reflexology for edema

  • Perineal massage

  • Red raspberry leaf & Chanlibao to shorten labor

  • Cabbage, tea, jasmine flowers for breast engorgement

  • Home birth / Midwives / Doulas


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Lamaze

  • Techniques developed by Dr. Fernand Lamaze (Paris, 1950’s)

  • American Society for Psychoprophylaxis in Obstetrics founded as a nonprofit in 1960 by Elisabeth Bing and Marjorie Karmel

  • Emphasis on activity during labor, breathing techniques to assist contractions, and relaxation methods to separate muscle groups


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Lamaze™ Philosophy of Birth

  • Birth is normal, natural, and healthy.

  • The experience of birth profoundly affects women and their families.

  • Women's inner wisdom guides them through birth.

  • Women's confidence and ability to give birth is either enhanced or diminished by the care provider and place of birth.

  • Women have the right to give birth free from routine medical interventions.

  • Birth can safely take place in homes, birth centers and hospitals.

  • Childbirth education empowers women to make informed choices in health care, to assume responsibility for their health and to trust their inner wisdom.


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Lamaze

  • No longer just a “breathing” technique

  • Classes taught by a Lamaze Certified Childbirth Educator (some hospitals provide them)

  • “affirms the normalcy of birth, acknowledges women’s inherent ability to birth their babies, and explores all the ways that women find strength and comfort during labor and birth”


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Lamaze

  • Encourages many techniques to respond to contractions and find comfort

  • Emphasizes emotional and physical support during labor but not “coaching”

  • Goal: “every woman gives birth confidently, free to find comfort in a wide variety of ways, and supported by family and health care professionals who trust that she has within her the ability to give birth”


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Waterbirth

  • Waterbirth International founded in 1988 by Barbara Harper

  • Currently avaliable in 250 US Hospitals and 70% of birthing centers

  • Birthing tub at 95-100°F

  • May be used for labor

  • and/or birthing


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Waterbirth Benefits

  • Water is relaxing, soothing, and calming

  • Buoyancy decreases body weight and promotes circulation and efficient contractions

  • Lowers BP by reducing anxiety

  • Allows for increased endorphin production

  • Promotes elasticity of perineum

  • Provides a sense of privacy

  • Eases transition for baby


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Risks of Waterbirth

  • Theoretical risk of water embolism

  • Water aspiration

  • Cord Avulsion

Contraindications

  • Herpes

  • Breech

  • Bleeding disorder

  • Multiples

  • Preterm

  • Severe Meconium

  • Pre-Eclampsia

ACOG: “insufficient data to render an opinion”


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Waterbirths compared with landbirths: an observational study of nine years; Verena Geissbuehler*, Sonja Stein and Jakob Eberhard: J. Perinat. Med. 32 (2004) 308–314

  • Compared 3617 waterbirths and 5901 landbirths (all spontaneous singltetons with cephalic presentation) in one hospital to assess differences in maternal and neonatal morbidity and mortality

  • Limited use of episiotomies in waterbirths (8.3% in waterbirths versus 25.7% in landbirths) does not lead to more third and fourth degree perineal lacerations

  • Landbirths show higher rates of episiotomies as well as third and fourth degree perineal lacerations.

  • After a waterbirth, there is an average loss of 5.26 g/l blood; this is significantly less than landbirths where there is an 8.08 g/l blood loss on average.

  • Waterbirths are not associated with increased risk of infection


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Unanswered questions of nine years; Verena Geissbuehler*, Sonja Stein and Jakob Eberhard:

  • Effect of water on contractions

  • Degree of analgesia provided by warm water


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Acupuncture of nine years; Verena Geissbuehler*, Sonja Stein and Jakob Eberhard:

  • Chinese in origin

  • Used for 4 main purposes

    • Induce labor

    • Relief of Nausea/vomiting

    • Turn breech presentation

    • Pain control


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Acupuncture of nine years; Verena Geissbuehler*, Sonja Stein and Jakob Eberhard:

  • Nausea and vomiting

    • Acupoint 6: 3 fingerbreadths proximal to distal wrist crease and 1cm deep

  • 3 Studies

    • No significant difference between experimental and control

    • Decrease nausea but no change in emesis frequency

    • Decreased vomiting episodes in hyperemesis gravidarum


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Acupuncture of nine years; Verena Geissbuehler*, Sonja Stein and Jakob Eberhard:

  • Breech Version

    • Utilizes acupuncture with moxibustion; heating of needles with burning Artemesia vulgaris

    • At 35 weeks, 75% of exposed fetuses were cephalic compared to 48% in controls, and at delivery 75% and 62%, respectively. This difference was significant despite 19 in the control group undergoing successful external cephalic version

    • Statistically significant results in 3 RCTs

    • In one RCT in a non-Chinese population in 1995 study interrupted due to compliance issues

    • No good data for success in Western countries


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Acupuncture of nine years; Verena Geissbuehler*, Sonja Stein and Jakob Eberhard:

  • Labor induction

    • Acupuncture one time on due date (German study)

      • The time from estimated delivery date (EDD) to labor was 2 days shorter in the acupuncture group. No differences in clinically significant outcomes such as Bishop’s score or length of different labor stages

    • 4h session 8days after due date (American study)

      • The number of contractions in the experimental group significantly increased from 63 at baseline to 116 in the fourth hour of stimulation, compared with a decrease in the control group from 84 to 75


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Acupuncture of nine years; Verena Geissbuehler*, Sonja Stein and Jakob Eberhard:

  • Labor analgesia (3 studies)

    • Acupuncture vs. sham-puncture

      • Recipients of the acupuncture had significantly lower reported levels of pain throughout labor, and lower oxytocin, epidural and narcotic use

    • Acupuncture vs. no acupuncture

      • no significant difference in pain intensity or delivery outcome, but observer-rated relaxation scores improved in the acupuncture group. Epidural use was 12% in the acupuncture group and 22% in the controls

    • Acupuncture vs. no-acupuncture

      • meperidine use was 11% in the acupuncture group compared to 37% in a no-acupuncture group


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Hypnobirthing of nine years; Verena Geissbuehler*, Sonja Stein and Jakob Eberhard:

  • Founded in 1989 by Marie Morgan

    • “There is no pathological reason for pain in childbirth. There is nothing that actually malfunctions. It’s tension and fear and interventions that cause the malfunctioning.”


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Hypnobirthing of nine years; Verena Geissbuehler*, Sonja Stein and Jakob Eberhard:

  • Trained therapists teach women to self-hypnotize and control breathing to match contractions

  • Allows women to remove themselves from the pain of childbirth

  • Techniques learned include self-hypnosis, deep relaxation, visualizations, positions and special breathing methods


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Hypnobirthing of nine years; Verena Geissbuehler*, Sonja Stein and Jakob Eberhard:

  • Benefits

    • A more relaxed and enjoyable pregnancy

    • Shortens the first stage of labour by several hours

    • Eliminates or greatly reduces the need for medical intervention

    • Fewer breech presentations and other special circumstances

    • Easier and calmer resolution in the event of special circumstances

    • A more enjoyable, peaceful birth experience rather than a tense, stressful ordeal

    • A special, integral role for the birth companion

    • Reduces risk of hyperventilation from “shallow” breathing methods

    • Promotes bonding of mum, baby and birth companion

    • Babies are calm at birth and really alert

    • More rapid postnatal recovery

    • Returns childbirth to a positive and beautiful experience that nature intended www.hypno-birthing,org.uk


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Yoga of nine years; Verena Geissbuehler*, Sonja Stein and Jakob Eberhard:


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Yoga of nine years; Verena Geissbuehler*, Sonja Stein and Jakob Eberhard:

  • Many prenatal yoga classes and videos avaliable

  • Benefits in prenatal period

    • Relief of aches and pains, swelling, insomnia

    • Strengthen pelvic floor muscles

    • Teaches deep breathing techniques

    • Contributes to general health and well-being


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Yoga of nine years; Verena Geissbuehler*, Sonja Stein and Jakob Eberhard:

  • RCT in India (2005)

    • birth-weight is significantly higher in the Yoga group, compared to the control (walking) group

    • Occurrence of complications of pregnancy (pregnancy-induced hypertension, intrauterine growth retardation, pre-term delivery) shows lower trends in yoga group

    • No significant adverse outcomes in yoga group


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Conclusions of nine years; Verena Geissbuehler*, Sonja Stein and Jakob Eberhard:

  • Many methods available to women

  • Alternative methods focus on putting women in control of birth environment and process

  • Controversy exists regarding need for fetal monitoring and psychological effects of invasive instruments


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References of nine years; Verena Geissbuehler*, Sonja Stein and Jakob Eberhard:

  • www.americanpregnancy.org

  • www.waterbirth.org

  • www.parenthood.com

  • www.hypnobirthing.org

  • www.lamaze.org

  • Anderson F, C Johnson: Complementary and alternative medicine in obstetrics. International Journal of Ob/Gyn (2005) 91, 116-124.

  • Cardini F, P Lombardo, A Regalia, G Regaldo, A Zanini, M Negri, L Panepuccia, T Todros: A randomized controlled trial of moxibustion for breech presentation. BJOG. June 2005, Vol. 112, 7453-747.

  • Geissbuehler V, S Stein, J Eberhard: Waterbirths compared with landbirths: an observational study of nine years. J. Perinat. Med. 32 (2004) 308-314

  • Hyangsook L, E Edzart: Acupuncture for labor pain management: A systemic review. American Journal of Ob/Gyn (2004) 191. 1573-9.

  • Lamaze International (2001). Position paper- Lamaze for the 21st century.

  • Narendran S, Nagarathna R, Gunasheela S, Nagendra HR Efficacy of yoga in pregnant women with abnormal Doppler study of umbilical and uterine arteries.J Indian Med Assoc. 2005 Jan;103(1):12-4, 16-7


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