Alternative Birthing Methods

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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, 1950s)
• 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
  womens 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 95-100F

• 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) 308314

• 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

• Effect of water on contractions
• Degree of analgesia provided by warm water

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Acupuncture

• Chinese in origin
• Used for 4 main purposes
• Induce labor
• Relief of Nausea/vomiting
• Turn breech presentation
• Pain control

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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

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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

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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 Bishops 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

• 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

• Founded in 1989 by Marie Morgan
• There is no pathological reason for pain in
  childbirth. There is nothing that actually
  malfunctions. Its tension and fear and
  interventions that cause the malfunctioning.

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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

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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

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Yoga
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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

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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

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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

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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
  Jan103(1)12-4, 16-7