VBAC.com

Time 2020-09-12 18:03:27

Web Name: VBAC.com

WebSite: http://www.vbac.com

ID:44745

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The Centers for Disease Control and Prevention (CDC) acknowledges that COVID-19 is a new disease andwe are still learning how it spreads, the severity of illness it causes, and to what extent it may spread in the United States. Birthing families are looking for guidance and maternity care professionals, including childbirth educators, breastfeeding specialists, and doulas, want to know how best to care for them. Resources about pregnancy, birth, and breastfeeding in relation to COVID-19 are quickly becoming available. Leading U.S. maternity caregivers say, We are listening to the people we care for and share their concerns about the impact of this pandemic on their intended plans for labor and birth. We stand in solidarity with our patients and are committed to working tirelessly to deliver evidence-based, respectful, patient-centered care to ensure parents and their families are supported during this time of pandemic.” Professional associations and birth practices are sharing what knowledge they have acquired so as to provide the best care for birthing families during this pandemic. Information about COVID-19 and its impact on birthing families is changing as new information is acquired, so be sure to revisit the websites of interest to you for updates. American College of Obstetrics and Gynecology, American College of Nurse Midwives, American Academy of Family Physicians, Society of Maternal-Fetal MedicineCOVID-19 Resources for Maternal and Infant Health https://caperinatalprograms.org/Coronavirus Disease 2019 (COVID-19) Update—Information for Clinicians Caring for Children and Pregnant Women (March 12, 2020). https://emergency.cdc.gov/coca/calls/2020/callinfo_031220.aspCoronavirus (COVID-19) Infection in Pregnancy Information for healthcare professionals Society for Maternal-Fetal Medicine/Society for Obstetric and Anesthesia and PerinatologyRevised SOGC Infectious Disease Committee Statement on Health Care Workers during the COVID-19 Pandemic (March 27, 2020)If you find these resources helpful and you would like to submit others for a future update, please contact me, Nicette@vbac.com. #COVID-19guidance, #COVID-19guidelines, #COVID-19pregnancy, #COVID-19birth, #COVID-19breastfeeding, #COVID-19parenting, #COVID-19midwives, #COVID-19physicians, #COVID-19nurses, #COVID-19birthcenter, #COVID-19childbirtheducators, #COVID-19doulas, #COVID-19hospitalsFailure to progress (dystocia) is the main reason for performing a cesarean section in low-risk mothers who labor for the first time. Evidence suggests that some physicians recommend a cesarean too soon during the labor process when in fact labor has not “failed and the surgery could have been avoided. Many caregivers still follow guidelines from the 1950s when considering a cesarean for failure to progress. However, based on current medical guidelines for dystocia from the California Maternal Quality Care Collaborative (CMQCC), women themselves can ask key questions of their caregivers if a cesarean is recommended during labor or birth to make an informed decision about continuing to labor or to have a cesarean. The California Maternal Quality Care Collaborative, affiliated with the Stanford University School of Medicine has developed guidelines to help physicians avoid unnecessary cesareans and improve health outcomes. One of the key evidence-based tools developed for maternity care professionals is the Labor Dystocia Checklist. If followed, the recommendations would help caregivers to avoid performing an unnecessary cesarean section. The key questions that mothers can ask are based on this checklist. The cesarean rate for failure to progress for low-risk, first-time mothers varies widely among physicians and hospitals. So mothers may want to take an active role in deciding with their care providers if they want to proceed with a cesarean or continue to labor. For all women, if you are experiencing labor contractions, here are the key questions to ask if a cesarean is recommended: Have my membranes (bag of waters) ruptured?Has my cervix dilated to 6 centimeters or more?Have I labored at least 4 hours with strong uterine contractions but have not made any progress?Since I was first given oxytocin to augment labor, have I been laboring for at least 6 hours without making progress? If the answer to any one of these questions is No , it may be too soon to have a cesarean for failure to progress. The CQMCC suggests that as long as progress is being made women laboring for the first time may need more than 20 hours and women who have had a vaginal birth before may need more than 14 hours to reach the active phase of labor ( 6 centimeters). If the mother and baby are not at risk, a cesarean for failure to progress is considered inappropriate if labor has not yet reached the active phase. The second stage of labor (pushing the baby through the pelvis) begins at full dilation (10 centimeters). Again, many physicians recommend moving ahead with a cesarean without giving mothers enough time to complete the pushing phase. If this is your first labor and you are pushing without an epidural, here is the key question to ask if a cesarean is recommended:Have I been pushing for at least 3 hours without progress? (Progress is being made if the baby is gradually moving down through the pelvis and is making the internal rotations necessary for birth.) If this is your first labor and you are pushing with an epidural, here is the key question to ask: If you have had a vaginal birth before and you are pushing without an epidural, you should ask: If you have had a vaginal birth before and you are pushing with an epidural, you should ask:If the answer is No to any one of these questions, it may be too soon to have a cesarean for failure to progress. If you and your baby are not at risk, discussing these questions with your caregivers may help you to avoid a cesarean. If you had a cesarean for failure to progress, and you are thinking about planning a VBAC, go to the VBAC Education Project and download the resources for free. Module Five is part of Deciding If A VBAC Is Right for You: A Parent’s Guide, slide set. A cesarean can be emotionally difficult or traumatic for fathers/partners. After a long and difficult birth that ended with a cesarean, partners may feel that a repeat cesarean would be safer than planning a VBAC. Some partners may not be sure they can meet the challenge of another possibly long birth.Each partner is different and needs to prepare in his or her own way for the coming birth. Partners should take the time to talk about the prior cesarean and define for themselves how they can best support their partners for a VBAC.What advantages do you see for your partner, yourself, and your family if you plan a VBAC?What are the disadvantages?What issues do both of you agree and disagree on?Can you think of ways of working through these issues?Have you thought about accompanying your partner to a prenatal appointment?Would you consider going with her to a VBAC support group?Supporting a woman in childbirth is hard work. Are you worried you won’t be able to give her what she needs? . How do you feel about advocating for your partner during labor?Have you thought about having a doula that can guide and support you both during labor and birth?What information or resources do you need to make you feel comfortable about planning a VBAC?You feel strongly that a scheduled repeat cesarean is the safest and easiest way to have this baby. Can you understand why your partner feels strongly about planning a VBAC?An unexpected cesarean can be emotionally difficult for both mothers and fathers. Providing support for a mother who is planning a VBAC can be challenging. As couples think about their next birth,  fathers/partners should take the time to share their feelings, their concerns, and their differences so that they can provide the best support they can in pregnancy and birth. “The desire to avoid unnecessary interventionsduring labor and birth is shared by health care providers and pregnant women.Obstetricians-gynecologists, in collaboration with midwives, nurses, patients,and those who support them in labor, can help women meet their goals for laborand birth by using techniques that require minimal interventions and have highrates of patient satisfaction.” In their recently updated (February 2019), evidence-based Committee Opinion, Approaches to Limit Intervention During Labor and Birth, the American College of Obstetrics and Gynecology (ACOG) recommends that “caregivers should be familiar with and consider using low-interventions for low-risk women who go into labor on their own.” ACOG affirms that many commonly used obstetric practices are of limited or uncertain benefit for low-risk women who go into labor on their own. For women with a single fetus in a head-down position who go into labor on their own at term (37 to 41 0/7 weeks) and do not experience complications, “providers should carefully select and tailor labor interventions to meet safety requirements and the individual woman’s preference.” Approaches to Limit Intervention During Labor and Birth (Committee Opinion Number 766) encourages the following low-intervention practices. A woman should be given the choice to wait until labor begins or be induced after having been given information about the benefits and risks of each option unless she is GBS positive (Group B Strep). Many caregivers recommend that labor be induced soon after the bag of waters has broken (amniotomy) although most women will go into labor within 12 to 24 hours.Admission to the birthing unit may be delayed for women in latent labor (before 5-6cm of dilation) if their vital signs are stable and the status of the fetus is reassuring. Women admitted to a birthing unit in early labor have higher rates of labor augmentations and epidurals. They spend more time in labor and delivery and are less satisfied with their birth. At prenatal visits, women and their caregivers should discuss a personal plan for self-care, early labor pain coping techniques, and activities to help them at home or in an early-labor lounge, until formally admitted to the labor unit. While laboring at home, women can benefit from frequent contact and support from their caregivers. In the absence of medical complications, women do not need routine continuous electronic fetal monitoring (EFM) or a continuous IV infusion. Caregivers should be trained to use a hand-held Doppler for intermittent auscultation for women who wish to have this option during labor. Continuous EFM does not significantly affect perinatal death or cerebral palsy when used for women with a low-risk pregnancy but does increase the odds for a cesarean and instrumental delivery when compared with intermittent monitoring. When labor isprogressing normally many caregivers routinely break the bag of waters to “speedup labor.” Evidence shows that the procedure does not make much difference nordoes it lower the risk for a cesarean. Women should be free to drink (clear liquids) during labor and use any of the following options that meet their needs; water immersion, massage, relaxation and breathing techniques, acupuncture, sterile water injections, TENS (transcutaneous electrical nerve stimulation), aromatherapy and audio analgesia. Women should be encouraged to use any comfortable upright position in labor such as walking, sitting, standing, or kneeling. Compared to laboring on the back, upright positions reduce the risk for maternal hypotension and abnormal fetal heart rate. By using upright positions women can shorten their labor by about 1 hour and 22 minutes and they are less likely to end up with a cesarean. For women who choose an epidural for pain relief in labor the evidence suggests that women push at the start of the second stage of labor. With an epidural delayed pushing increases the odds for maternal infection, hemorrhage, and neonatal acidemia. Women should not be restricted to any specific breathing or pushing method for second stage. They should be supported in their own choice of breathing patterns and pushing positions that work best for them. In addition to nursing care, continuous one-to-one emotional and physical support provided by non-medical experienced personnel such as a doula is associated with improved outcomes for women and babies. Labor is shorter, women are less likely to use drugs for pain relief and less likely to have a cesarean. Babies tend to have a higher Apgar score and are more likely to establish successful breastfeeding. Overall mothers are more satisfied with their birth experience. Hospitals are encouraged to integrate trained support personnel in their maternity care staff. For both vaginal and cesarean births, women value the presence and support of family members. Whenever possible, hospitals are encouraged to integrate family-focused  practices for cesarean births such us lowering the drapes or using surgical drapes with a viewing window for parents to see the birth of their baby, lowering the lights, reducing extraneous noise, adding music, delayed cord-clamping, and skin-to-skin attachment of mother and newborn. It s worth noting that these guidelines to avoid unnecessary interventions are the most comprehensive to date. They also endorse women s freedom to choose how they want to give birth. Disclaimer: The information and the links provided on the VBAC.com website are for educational purposes only. Mothers-to-be are encouraged to obtain relevant information, to discuss their options with their maternity care providers and to make safe and informed choices. We welcome all inquires, but will not suggest any medical course of action. This site is privately funded. No advertisements are accepted. Confidentiality: Confidentiality of data relating to individual patients and visitors to a medical/health Web site, including their identity, is respected by this Web site. The Web site owners undertake to honor or exceed the legal requirements of medical/health information privacy that apply in the country and state where the Web site and mirror sites are located.

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