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Published on December 3, 2007

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

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