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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

Alternative Birthing Methods

Erin Cook

January 19, 2006

THRS Presentation

alternative methods
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
lamaze
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
lamaze philosophy of birth
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.
lamaze5
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”
lamaze6
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”
waterbirth
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
waterbirth benefits
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
risks of waterbirth
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”

slide10

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
unanswered questions
Unanswered questions
  • Effect of water on contractions
  • Degree of analgesia provided by warm water
acupuncture
Acupuncture
  • Chinese in origin
  • Used for 4 main purposes
    • Induce labor
    • Relief of Nausea/vomiting
    • Turn breech presentation
    • Pain control
acupuncture14
Acupuncture
  • 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
acupuncture15
Acupuncture
  • 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
acupuncture16
Acupuncture
  • 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
acupuncture17
Acupuncture
  • 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
hypnobirthing
Hypnobirthing
  • 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.”
hypnobirthing19
Hypnobirthing
  • 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
hypnobirthing20
Hypnobirthing
  • 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
slide22
Yoga
  • 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
slide23
Yoga
  • 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
conclusions
Conclusions
  • 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
references
References
  • 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