Thursday, January 23, 2014

How To Reduce Your Risk of Induction and C-section Without Medication

I meet soon-to-be-mothers all the time and they are always worried about one thing, delivering their baby
safely. With the rates of Caesarean section (C-section) on the rise over the past 15 years, they have every right to be concerned with reducing their risk factors. According to a study from the  World Health Organization, when a country's rate of C-section rises over 15% so does the maternal death rate. This means that our current C-section rate in the US (32%) is causing unnecessary death in women and it can be calculated that 45% of all maternal death is associated with C-section.

So what can you do to prevent C-section for your delivery? It's very important that you stay informed on ways to prevent pelvic misalignment that can cause delivery issues, the risks of induction, and natural methods to keep your labor progressing to prevent the need for an epidural. For natural methods of labor progression, talk to your provider about labor and breathing techniques, stretching, herbs and essential oils, and massage or setup a consultation in my office to discuss techniques you may not be familiar with. I can also help refer you to a great doula near you that can help make your birth experience amazing.

Pelvic misalignment can cause serious issues for the progression of labor because the uterus is attached to the bones of the lumbar spine, the ilium (hip bones), and the sacrum (tail bone); this means that if there is any misalignment of the pelvis or the lumbar vertebra the uterus can twist which can cause intrauterine constriction and make it hard for mom to push baby in the right direction. It is HIGHLY important for all soon-to-be-mothers to get their spine and pelvis checked by a chiropractor who is trained to treat pregnant women and to engage in regular pelvic and hip stretching exercises to keep the pelvis open. To the left find a picture detailing the small spaces in the pelvis outlet, as you can see the smallest misalignment of these bones can cause the pelvic opening to become oval shape which can cause issues with baby exiting the pelvis during delivery. If you'd like a handout of some great pelvic stretches to keep your pelvis open and aligned, shoot me an email at aschnowske@alignlife.com and I can make some recommendations and help you keep things moving in the right direction.

 The second prevention step I mentioned above is knowing risks of induction. In many cases today I see pregnant women coerced and forced into having an induction to speed things up for two reasons:
1) baby may be too big to fit through the pelvis
2) they are overdue and doctor is worried the placenta is aging
This makes me so angry, because in most cases these women don't need an induction and inducing labor when baby and mom aren't ready can increase risk of injury to mom and baby and can also increase risk of C-section.

To address the first we have to refer back to the pelvic picture above, see that little pink colored tissue between the bones at the top of the pelvis? This is called your pubis symphysis, it's a piece of cartilage which loosens with delivery hormones and allows the pelvis opening to expand a minimum of 3mm to allow for bigger babies to pass. Your body is designed to expand to allow baby to pass through! However if a women's pelvis is misaligned and does not allow for this tissue to expand as needed or in the case of induction when those hormones may not be at the right levels to allow this tissue to stretch, then there may be issues with baby getting hung up in the pelvis and causing baby's heart rate to drop. THIS is a case when C-section may be indicated so no injury is caused to baby, however I've also seen laboring women be adjusted by a chiropractor to realign these bones and get labor progressing along naturally again. Another issue that I find with telling mom that baby will be too big is the fact that ultrasound CAN NOT, I will repeat CAN NOT estimate your baby's weight and can be off by 2 lbs or MORE. So I empower you to be informed and talk to you provider about your concerns of induction if this is the reason they cite

To address the second, let's talk about the placenta. The placenta is designed to nourish baby throughout the pregnancy and keep the fluids inside at the correct level so baby can move around. Your due date is an estimate that can be off about 2 weeks, so in fact your placenta may have 2 weeks left of life after you reach your due date! One really great way to find out if your placenta is still on track, is to look at fluid levels on the ultrasound. If the fluid levels are in the normal range before or after your due date, changes are high that baby is still getting everything they need and still waiting to time their appearance for when they are good and ready. In rare cases there are some genetic factors that cause the placenta to deteriorate sooner than it is supposed to, but in these times not only will fluid levels be out of range but usually baby's growth with slow and your provider will let you know of the risks. This is a time when induction (provided baby's heart rate is ok) or C-section can be a viable option to keep baby safe.

So what is induction and what should you expect? When labor is induced, either the placental fluids are forcefully broken and/or a medication is given to force strong contractions to begin. When the placental fluids are broken, bacteria can be introduced into the womb which can increase risk of infection for baby and also take away the fluid cushion that can prevent head trauma to baby if they get stuck in the pelvis during labor. If medication is used, this causes abnormally strong contractions that first of all don't allow for mom's tissues to expand naturally and can increase the risk of pain and tearing for mom and these contractions can also occur so quickly that it doesn't allow baby to get into the right position to pass safely through the pelvis which can increase the risk for head trauma for baby.

These factors together can severely increase the risk of the need for C-section after labor induction. In fact a study from the women's health research unit at the Oregon Health and Science University in Portland, found that out of 281 pregnancies of 36 weeks or greater that had labor induced, 83% of these mothers received an epidural (this numbs the body from the waist down and if given too much medication can make it impossible for women to feel when to push or push effectively). They found that the C-section rate for these 223 women that received an epidural was 30% compared to 8% for the 48 that didn't receive an epidural. In addition, they found that the timing of the epidural, early (before 4 cm dilation) or late (after 4 cm dilation) was also a great indicator if mom would need a C-section. According to Ms. Rincon, a senior research assistant involved in the study, after adjusting effects of age, race, BMI, parity, and Bishop score, the risk for C-section was DOUBLED with early vs late epidural.

So what can we take from all this information? Well first of all, I am not trying to scare you into not getting an induction or having an epidural or avoiding C-section like a plague and putting yourself or your baby at risk. I am merely trying to give you information to understand when an induction or C-section may be indicated and ways you can get involved in INFORMED DECISION when it comes to your birth. If you aren't sure or don't understand explanations or procedures your provider is recommending, you need to ask questions until you feel comfortable to tell your provider if you want to proceed with this procedures. If your provider isn't willing to answer your questions or gets angry that you aren't following their recommendation, then you may need to question if you need to find a different provider that is willing to support you through your pregnancy and guide you to make the best and most informed decisions for your family. If you have any questions or concerns, please feel free to contact me by email aschnowke@alignlife.com or call 309-689-6200 to setup a consultation (phone consultations are also an option) to discuss your concerns.

Have a great and healthy day!!