DAUBA, LOWIE JAY M.

BS NURSING 3B

DELIVERY ROOM TRENDS

By Amanda Ciani

FAMILY CENTERED/GENTLE CESAREAN SECTION

• Cesarean sections are the most common surgery in the U.S. In fact, the CDC estimates one
in three babies are born this way. The goal of a gentle C-section is to make the mother’s
delivery feel less like a surgical procedure, and more like a birth. Doing so simply takes
forethought. First, you can request a clear drape, so you can see baby come into this world.
Second, your labor and delivery team can place medical equipment beside you, instead of
on your chest, which will allow Baby to be placed on your chest as soon as possible to
promote bonding and breastfeeding, if desired. Other modifications include minimizing
medical chatter and having soft music playing to create a calm environment.

HYDROTHERAPY & WATER BIRTHS

• At least one local hospital now offers moms experiencing low-risk pregnancies the option
to deliver in water. Atrium Medical Center in Middletown currently offers two portable
Jacuzzi tubs for moms to labor and deliver in as well. This year, Atrium will open the
Natural.
• Beginnings Birth Center. Their programs support women wanting to experience natural
childbirth, and will include the addition of two new birthing tubs.

LABORING TOOLS
With my most recent labor two months ago, I was focused on experiencing a labor without the
administration of an epidural. Thankfully, I was prepared to ask for laboring tools once I arrived
to my LDR room. Remember, if you do not see them in your room, that does not mean they are
not available for use — simply ask!
• Birthing Ball. Sitting and swaying on a birthing ball helps open up the pelvis. For me, the
birthing ball was a big help!
• Peanut Ball. Ideal for moms in bed due to exhaustion, choice, or epidural. This tool may
help shorten labor duration and help rotate babies who are in unfavorable positions.
Women can use the ball in a reclining position or on their side; there are a variety of ways
to place the ball under and between the legs to help baby move along.
• Birthing Bar. This tool helps Mom get in an ideal position during the pushing phase of
labor. It may shorten the duration of pushing, as it helps baby descend into the birth canal.
• Nitrous Oxide. Laughing gas is used in many countries as a pain reliever during labor. Mom
breathes in a mix of 50 percent nitrous oxide and 50 percent oxygen through a mask 30
seconds before contractions, to help ease the pain. This option is on the rise in the U.S.

SEEDING
• When babies are born vaginally, they are exposed to beneficial bacteria as they descend
through the birth canal. Good bacteria gives baby immunities to the outside world to help
keep them healthy. Seeding is the process of exposing babies born via Cesarean section to
their mother’s vaginal cultures in the hopes that they too benefit from their mother’s good
bacteria. Absorbent gauze is placed inside Mom as she’s being prepped for surgery. Once
the baby is delivered, the gauze is removed and swiped over the newborn baby’s face.
Gillian Foreman, MA, IBCLC, offers courses through her business, Modern Breastfeeding
 + Education. In one such class, “Happy, Healthy Cesarean,” Gillian explores many topics
concerning Cesarean sections including family centered/ gentle Cesareans and also
seeding. “Seeding can help women have control over their birth to benefit their baby,”
Foreman says. If you have a desire to have seeding be a part of your C-section, talk to your
medical provider to make it a part of your birth plan.

DELAYED CORD CLAMPING & CUTTING

• Most umbilical cords are clamped and cut anywhere from 10 – 15 seconds after birth,
however, even waiting twice that long could potentially have a lasting impact in your
child’s life. Experts from The American Congress of Obstetricians and Gynecologists and
the American Academy of Pediatrics advise waiting 30 – 60 seconds (others suggest
waiting one to three minutes) to clamp and cut the cord, to allow blood to flow from the
placenta back into the newborn. The suggested benefits of delayed cord clamping and
cutting include reduced risk of anemia, higher deposits of iron (which is important in
brain development), and higher blood volume level for the infant.

VERNIX
• Vernix is a protective coating on the newborn baby’s skin. Some babies are covered in it,
others have very little at all. Henry T. Akinbi, M.D., and the late Steve Hoath, M.D., from
Cincinnati Children’s Hospital suggest leaving the vernix on the baby, or even massaging
it into the baby’s skin. Akinbi has found the substance has antimicrobial characteristics,
and that it is an ideal first moisturizer for babies skin.

PLACENTA ENCAPSULATION
• The placenta provides the baby with absolutely everything it may need during its in-utero
stay: oxygen, nourishment, waste removal, and protection from the outside world. After
delivery, some women choose to have their placenta encapsulated so they may benefit
from the nutrient dense organ. Molly Murray is a mother of three, childbirth educator,
doula, placenta encapsulation specialist, and owner of Cincinnati Birth and Parenting,
LLC. Murray has encapsulated 45 placentas. “Anecdotal evidence suggests that women
who consume placenta capsules experience improved postpartum healing, fewer mood
issues, and an increased milk supply. I’m happy to provide this service to families in the
Cincinnati and Northern Kentucky area,’’ she says.

TRENDS IN LABOR & DELIVERY

By Chera Prideaux

Midwife-Attended Births and Doulas

• The roles of a midwife and doula can easily be confused, but there’s a distinct difference
between the two: A midwife is a certified health care provider who can be used in place
of an OB for prenatal care and to deliver a baby. A doula is like a support system for a
laboring mom during childbirth and can also offer postpartum assistance.
• Midwife-attended births are steadily increasing. The National Center for Health Statistics
reports a 12 percent increase in the last decade. In Colorado, nurse-midwives attend 10
percent of all births, which is higher than the national average. Jacque Northrup, program
coordinator and birth concierge at Castle Rock Adventist Hospital, reports that 20 to 25
percent of the births there are attended by a midwife.
Birth Center-Hospital Hybrids
• The rising interest in independent birth centers has prompted hospitals to create natural,
home-like environments situated within a hospital campus. These centers allow women
who want the best of both worlds to have a natural birth with the services of a hospital
right outside their door if needed.

Nitrous Oxide
• Nitrous oxide has been around for a while, but it is increasingly used as a relaxer for moms
during labor. Inhaled through a mask, the mixture of 50 percent nitrous gas and 50
percent oxygen provides relief during contractions. Three hospitals in Colorado now offer
nitrous oxide, or laughing gas as it’s also known: Castle Rock Adventist, Littleton
Adventist, and University of Colorado Health Science Center. Northrup says about 10
percent of their deliveries now use nitrous oxide. Although many of those moms do still
end up getting an epidural, nitrous oxide allows them to labor longer without it.

HypnoBirthing
• As mothers search for more natural options during labor, the use of HypnoBirthing
techniques have increased. “HypnoBirthing has taken the world by storm—or by calm as
they like to say—over the last few years,” says Colleen Newton of Into Loving Arms
HypnoBirthing in Colorado Springs. Newton started teaching classes a little over a year
ago after she had a great experience with HypnoBirthing during her own delivery.
• Adherents of HypnoBirthing use breathing, relaxation, visualization, and meditative
techniques for a calm, natural birth. Though the mother is deeply relaxed, she is also an
active participant in the labor process. The concept has been around for perhaps
centuries, but the actual term and specific techniques were popularized by Marie Mongan
in her 1989 book, Hypnobirthing.
• Rose Medical Center has embraced this philosophy by offering HypnoBirthing classes
taught by a certified HypnoBirthing instructor who is also a doula. “Our nurses and
doctors are very familiar with and support this method,” says King.

Water, Tubs, and Hydrotherapy

• Immersion in a tub for the relief of pain during labor is not new, but the number of
hospitals that are including tubs in their birth suites is definitely growing. Many hospitals
now offer this option.

Birth Slings, Bars, and Balls

• Birthing balls, bars, and slings allow women extra support and mobility during labor and
may contribute to a shorter, less painful labor, possibly reducing the need for medical
interventions. Birth slings (fabric attached to a carabiner which attaches to the ceiling)
have been used in Europe for a while, but are growing in popularity in the United States.
Currently, Castle Rock Adventist is the only Colorado hospital equipped for birth slings.

Delayed Umbilical Cord Clamping

• This fast growing trend is expected to continue to rise now that the American Congress of
Obstetricians and Gynecologists (AGOG) has given its stamp of approval. AGOG
recommends delaying the clamping of the umbilical cord for 30 to 60 seconds in vigorous
pre-term and term births, citing infant benefits such as increased hemoglobin levels and
iron stores and the reduced need for transfusions.
 • If you have a high-risk birth, you may need to opt for an in-hospital birth. Or, if after
studying all of your options, you still decide to have a conventional birth with an epidural,
you’re in good company. The majority of babies are still born this way.

From New to Nutty Birth Trends

• Crowd birthing. There was a time not so long ago when the father wasn’t even allowed
in the delivery room. Now, some women are inviting the whole family and more to be with
them when the baby comes into the world. Many more are documenting the birth on
social media for the world to see.
• Dolphin-assisted birth. At Hawaii Holistic Midwifery you can give birth with the
dolphins. According to the website, “We intentionally bring the dolphins” energy and joy
into the birth room, embracing the birthing mother with strength, joy, and relaxation. The
mother’s strength of spirit and body, achieved with the support of the dolphin swims,
provides power in the birth process.”
• Labor-pain simulator for men. Electronic waves simulate the pain of labor for dads who
want to know what it really feels like. (Or moms who want them to “feel their pain.”)
• Free birth. Three words: completely unassisted childbirth.

Policy Against Home Births. It's Not Playing Well In A Pandemic

October 25, 20208:32 AM ET
Xyza Cruz Bacani

• In 2008 the country passed the Maternal, Newborn and Child Health and Nutrition Strategy
policy — referred to as the "no home birth" policy. The goal was to reduce the country's
high rates of maternal mortality, from 203 out of 100,000 live births that year to 52 by
2015.
• It's a controversial law. Despite the good intentions, some local groups assert that it
impinges on the rights of women. What's more, the policy has not yet met its goal. In 2017,
the maternal mortality rate in the Philippines was 121 deaths per 100,000 live births.
• Nor has there been a significant change in the rates of infant mortality. In 2008, there
were 25.5 deaths per 1,000 live births. In 2018, the figure was 22.5. The pandemic of 2020
has made the policy even more controversial. In the past, women who live in remote areas
have had to arrange for transportation to the nearest appropriate health-care facility.
Now matters are even more complicated. With pandemic-related restrictions on
transportation options like cabs and motorized tricycles, women who do not own a car
have fewer choices.
• Then again, the policy was complicated even before COVID-19 struck. Some regions of the
Philippines will fine a woman who gives birth at home when she comes to a hospital to
register her baby. Other provinces do not fine the woman but may chastise her when she
brings in her newborn to be registered.
• Meanwhile, across the country, the law has had a chilling impact on midwives. If they
assist at a home birth, they risk losing their accreditation. As with many laws, those who
are well-to-do can get around the restrictions. They would have to hire a private doctor
to assist with a home birth, sterilize a birthing area in their residence and rent an
ambulance on standby. But for many women, this is hardly an option.
 Exploring barriers to antiretroviral therapy adherence among pregnant women
Mwamba Kalungwe,Scovia Nalugo Mbalinda,Thamary Karonga,Niza Rean Simwanza,Catherine M.
Mumba Mtambo,Mathew Nyashanu
First published: 05 February 2022

Background
• Antiretroviral therapy (ART) is one of the most effective ways of preventing HIV-related
maternal mortality. However, the rates of retention in care and long-term adherence
remain extremely low.
Main results
• Barriers to antiretroviral therapy adherence included side effects of the therapy and
financial constraints limiting access to food, transport, and medication. Other barriers
included cultural and religious factors, lack of spouse support, stigma, and
discrimination.
Conclusion
• There is need to support pregnant women undergoing antiretroviral therapy to mitigate
barriers associated with the uptake of the therapy.
Synopsis
• ART adherence barriers in pregnant women includes side-effects, efficacy doubts, social-
economic status, unsupportive partners, HIV status non-disclosure, stigma,
discrimination, domestic violence, cultural and religious beliefs.

EPIDURAL ANALGESIA IN LABOR

Lucy Halliday,Scott M. Nelson,Rachel J. Kearns
First published: 12 March 2022

DRUG DELIVERY SYSTEMS

• Epidural drug delivery systems affect the efficacy of analgesia. Intermittent bolus,
continuous infusion, patient-controlled epidural analgesia (PCEA), and computer
integrated patient-controlled epidural analgesia (CIPCEA) have been described. A meta-
analysis of 22 RCTs (2573 parturients) comparing intermittent physician bolus with
continuous infusion epidurals identified a significantly longer duration of labor in
patients receiving continuous epidural infusion (weighted MD 21.46 minutes, 95% CI
25.07–17.85). Intermittent bolus regimes were associated with a reduction in anesthetic
interventions for pain, reduced dose of local anesthesia, and improved maternal
satisfaction. There was no significant difference observed in adverse events nor mode of
delivery.
• PCEA may improve maternal satisfaction and reduce total dose of local anesthesia. It can
be used with or without continuous background infusion or intermittent clinician-
delivered boluses. The addition of a background infusion increases the risk of AVD and
prolongs the second stage of labor; however, it reduces the number of rescue doses
required when compared to PCEA alone. CIPCEA automatically adjusts a continuous
background infusion based upon PCEA requirements. Only small trials have been
conducted and more research into this delivery system is required.
• Lumbar epidural provides highly effective labor analgesia and has become the benchmark
against which other forms of analgesia are compared. Despite this, research into labor
epidural analgesia is heterogeneous with no universally agreed standard technique and
inconsistency in outcome reporting. Data on epidural hyperthermia, breastfeeding,
postpartum depression, and longer-term childhood developmental outcomes are lacking.
 Reduced fetal urine production rate—An early marker of fetal inflammatory response
syndrome in preterm premature rupture of membranes
Ankita Jain,Richa Aggarwal,Natasha Gupta,Mohit Mehndiratta,Priyanka Gogoi,Prerna
Batra,Rachna Agarwal
First published: 12 February 2022

• Out of 70 recruited patients with PPROM, 44 had evidence of FIRS (62.86%). Mean FUPR
at the time of delivery was significantly reduced in neonates with evidence of FIRS
compared with the Non-FIRS group (13.89 ± 8.06 ml/h vs. 25.89 ± 4.94 ml/h). Out of 41
patients with reduced FUPR, 39 neonates had FIRS whereas only five out of 29 neonates
with normal FUPR had FIRS (P < 0.001). Severe neonatal morbidity was found in 24 out
of 41 (58.54%) neonates with reduced FUPR prenatally. The occurrence of respiratory
distress syndrome, necrotizing enterocolitis, and sepsis was significantly high in neonates
with reduced FUPR.
• Reduced FUPR is strongly associated with FIRS in cases of PPROM and hence can be used
as an early predictor of adverse neonatal outcomes.

Effectiveness of ultrasound algorithm in prenatal diagnosis of hemoglobin Bart’s disease

among pregnancies at risk
Panwad Harn-a-morn,Chanane Wanapirak,Supatra Sirichotiyakul,Kasemsri
Srisupundit,Fuanglada Tongprasert,Suchaya Luewan,Theera Tongsong
First published: 12 February 2022

• A total of 237 fetuses were recruited, including 53 affected and 184 unaffected fetuses.
The algorithm has a sensitivity of 100% in the detection of fetal Hb Bart’s disease with a
false positive rate of 10.9%. Of the affected group, the mean gestational age at the time of
diagnosis was 15.5 ± 2.6 week. 30.8% of all pregnancies at risk underwent invasive
procedures. The algorithm had a 70% reduction in the rate of invasive procedures among
pregnancies at risk without missing the affected cases.
• The algorithm is highly effective in the early detection of fetal Hb Bart’s disease with a
detection rate of 100%, and invasive diagnosis can be avoided in about 70% of cases.
Thus, this algorithm should be used as a guideline for prenatal diagnosis of fetal Hb Bart’s
disease, especially in geographical areas of high prevalence.