Group Instructor

Rachelle Oseran
childbirtheducation.co.il

Group Instructor

 
 
 

Childbirth Tips


1. HOW TO CHOOSE A HOSPITAL:


The place where you choose to give birth, together with the caregiver of your choice, are the two factors that will most impact on the course of a normal labor and your satisfaction with your birth experience. These may be difficult choices for you and, while you may hear a variety of positive and negative experiences from friends and acquaintances, your choices are personal and reflect who you are and what you want out of your birth experience.


The following list contains suggested questions to ask the hospital on the tour. Before you use this list you should have an understanding of the pros and cons of these choices. While you may hear many of these issues addressed in the tour, if there are questions which still remain unanswered, make sure you ask them. Remember that the hospitals want your business. Obstetrics is a major source of income for the hospital and, while they will not tell you things that are not true, the reality is that you may be attended by a hospital midwife who doesn't share your philosophy of birth and who may deviate from the "sales pitch" you heard on the hospital tour – for good or bad. Decide what your "red lines" are, i.e. what points are most important to you and ask if all the attending midwives will respect your choice on those particular issues.


Remember, too, that all hospitals in Israel are subject to the "Patient's Rights Law", a law passed in the Knesset which gives you the right to refuse any treatment. If your labor is normal and you and your baby are healthy, you should ask for more information when an intervention is suggested and decide what choice is best for you.


Following are suggested questions to ask on the hospital tour. You may have additional questions which are not listed here.


LABOR:

Can I wear my own clothes?

Can my husband or the companion of my choice stay with me while I'm being monitored in the admitting room?

Will medical students attend to me or observe me in labor?

Can I eat or drink if I wish during labor?

Will I routinely be given a heparin lock?

Will I be monitored continuously during labor or will I be monitored intermittently?

Will the fetal heart rate be monitored by hand using a fetal stethoscope so that I can move around?

Will I have the freedom to choose positions in labor (such as walking, sitting, squatting, kneeling, using a birth ball, etc.)?

What is their policy regarding artificial rupture of membranes?

What is their policy regarding the use of the artificial hormone, oxytocin, to induce labor or stimulate contractions?

If my membranes rupture and I don't have contractions yet, after how many hours will I be induced?

Can I take lengthy showers for pain relief and for relaxation?

What percentage of women have epidurals for pain relief in labor? (e.g. if most women have epidurals, it is an indication of the hospital's attitude toward natural childbirth).

Do the midwives actively encourage women in labor to use pain-relieving drugs?

Can my husband or the support person of my choice be with me all the time?

Can I have an additional support person with me?

Does the hospital recommend a Cesarean birth (without an attempted labor) if my baby is over 4kgs? Over 4.5kgs?


BIRTH:

Can I have my husband with me during the birth?

Can I have an additional support person with me during the birth?

Can my husband be with me for a Cesarean birth?

Can I choose positions for pushing and for delivery?

Will I be able to push beyond the usual time limit if progress is being made?

Will every effort be made to try to avoid an episiotomy?

May I touch my baby during delivery?

Does the hospital practice late cord clamping (after the pulsating stops)?

Will the baby be allowed to take its first breaths unassisted (no immediate suctioning, etc.)?

May I have skin-to-skin contact with my baby immediately after birth?

Can the baby remain on me instead of being moved to the warming table?

Does the hospital routinely give an artificial hormone injection of oxytocin after the birth to expel the placenta?


POSTNATAL:

Can my baby be with me at all times (including nights)?

Is there breastfeeding help available if I need it?

Can I choose that my baby not be given vitamin K or certain immunizations (e.g. Hepatitis B)?

Are husbands restricted to hospital visiting hours? If so, what are those hours?

Can I be discharged early from the hospital if I wish?



2. ICE CHIP "PICK-ME-UP" FOR LABOR.


It is often suggested that a woman should bring a thermos of crushed ice for cool, refreshing hydration in labor. This is especially helpful if the hospital insists on "liquids only". An effective tool for accomplishing several goals – to hydrate the woman, to refresh her mouth, to give her energy during a possible long labor and to promote strong, effective contractions – is to prepare crushed ice using raspberry leaf tea sweetened with honey.


To prepare this refreshment: boil 1 cup of raspberry leaf tea with 4 cups of water until the quantity is halved (i.e. you have 2 cups of tea left). Sweeten the tea with honey. Strain the liquid and pour it into ice cube trays. In early labor, crush these into ice chips and take them to the hospital (or your place of birth) in a thermos. The honey will give you energy and the strong raspberry leaf tea can possibly avoid the need for pitocin if the contractions become sluggish. If the medical staff wants to stimulate your labor with pitocin, then these ice chips might be helpful.



3. SQUATTING IN LABOR – NEW UNDERSTANDING OF AN OLD POSITION.


For decades the squatting position has been recommended during pushing based on the belief that it opens the pelvis to its
widest dimensions. One of the first research studies to reach this conclusion was by Russell in 1969 when he found that the squatting position during the pushing stage in labor opens the pelvis an additional 2 – 3cms. Another popular tool to demonstrate the advantages of squatting in labor is the Brazilian film, "Birth in the Squatting Position".


Recently, however, many midwives and doulas have noticed that, while squatting is helpful with women who culturally use the position in their everyday lives, it actually closes the pelvises of western women.


While there may seem to be a discrepancy between the research and practical application, this is actually not the case. Women who squat culturally squat with their feet parallel, their knees over their feet and their knees not wider than their shoulders. This position does, indeed, open the pelvis to its widest dimensions as maximum leverage is exerted on the ischial tuberosities (the narrowest part of the pelvis), causing them to open up. However, when the feet and knees are turned out, the femur (thigh bones) push the ischial tuberosities closer together, thereby making the pelvis even narrower.


Some women will not be comfortable squatting with their feet parallel and their knees not wider than shoulder-width apart because their big bellies get in the way. These women should be encouraged to use the "dangle" position – a supported squat in which the hips are higher than the knees. The feet may be turned out in this position.



4. AVOIDING LEG CRAMPS IN PREGNANCY.


Pregnant women are prone to leg cramps during pregnancy because of insufficient levels of magnesium and calcium. While it is important to have adequate quantities of these minerals, leg cramps are governed by mechanics. They mainly occur at night when a woman stretches. When she stretches, she extends her legs and points her toes. In order for a woman to point her toes, the muscle at the front of her leg (the anterior tibialis) lengthens. In unison, the opposing muscle of her calf (the gastrocnemius) shortens and often cramps up. Avoiding toe-pointing during pregnancy will, in most cases, prevent leg cramps.


You may be reading this and saying, "But if I do it in my sleep, then how can I avoid pointing my toes?" Simply knowing that you shouldn't point your toes is sufficient to prevent leg cramps. Women usually stretch during their light sleep phase or upon waking. If  a woman is conscious of not pointing her toes, but rather stretching with her fleet flexed (bringing her toes towards to her knees), she can avoid shortening the calf muscle, thereby protecting herself against leg cramps.