module 8: section 1 - bebo mia€¦ · module 8:birth plans, prenatal visits & ﬁrst 2 hours....

Emotional responses right after the baby is born will vary in degree and not everyone experiences the same feelings. Some of the more common feelings are: tired, excited, sore, overwhelmed, happy, nervous, euphoric, or even not interested in the baby. All of these responses are regular and normal feelings.

Delivery of the Placenta

Active Management vs. Spontaneous Placental Delivery

Spontaneous placental delivery takes anywhere from 10 - 45 minutes after the baby is born. In this time, the uterus continues to contract and clamp down, encouraging the placenta to peel away from the uterine wall after the blood vessels have closed themselves off. Natural ways to encourage this process include ways to keep a woman's oxytocin levels elevated, such as skin-to-skin with baby, nursing the baby,

© 2017 by bebo mia inc. All rights reserved �1

You may see active management more often than SOGC recommends.

Section 1: Immediate Postpartum and Newborn Assessment

Module 8:Birth plans, Prenatal Visits & first 2 hours.

being close with her partner (if there is one) and baby as a family unit, also known as family centred care. Another natural method is uterine massage, where the care provider would use his/her fist to manually massage the uterus through the woman's abdomen to encourage it to contract. The birthing parent can also opt for an injection of pitocin after the birth, usually routine and injected in the thigh or a pitocin drip is left on for a few minutes after the birth, to keep the uterus contracting until the placenta is delivered.

Active management of the birth of the placenta is when the care provider intervenes to speed up the process. The theory behind this is that the faster the uterus clamps down and the placenta is delivered, the less likely a woman is to have postpartum haemorrhage. Active management can include the injection of pitocin and some uterine massage (both very minimal in terms of intervention) and can also include cord traction and manual removal of the placenta. Cord traction occurs by putting a bit of tension on the umbilical cord to either test to see if the placenta is ready to be delivered. In some cases the placenta detaches and then sits at the base of the cervix and with some tension on the cord, they are easily delivered. Pulling on the cord has risks of a premature delivery of the placenta; if the placenta is not ready to come out and has not fully detached, pulling on the cord can cause the placenta to come out in pieces (ideally we want it in one whole piece) or the woman can haemorrhage because the blood vessels between the placenta and the uterine wall have not closed themselves off yet and then bleed more than they should. Pulling on the cord also carries the risk of breaking the umbilical cord. Manual removal of the placenta is when a care provider reaches up into the uterus to scrape out, or detach the placenta from the uterine wall with his/her hand. This is rare, and performed if a placenta is not detaching in a reasonable amount of time, or has come out in pieces and the care provider has to ensure that there is no retained placenta, which can cause a the birthing parent to postpartum haemorrhage (PPH).


SOGC notes on Active Management of the third stage of labour:

• Active management of the third stage of labour (AMTSL) reduces the risk of PPH and should be offered and recommended to all women. (I-A)

• Oxytocin (10 IU), administered intramuscularly, is the preferred medication and route for the prevention of PPH in low-risk vaginal deliveries. Care providers should administer this medication after delivery of the anterior shoulder. (I-A)

• Intravenous infusion of oxytocin (20 to 40 IU in 1000 mL, 150 mL per hour) is an acceptable alternative for AMTSL. (I-B)

• An IV bolus of oxytocin, 5 to 10 IU (given over 1 to 2 minutes), can be used for PPH prevention after vaginal birth but is not recommended at this time with elective Caesarean section. (II-B)

SOGC notes on Active delivery of the placenta:

• There is no evidence that, in an uncomplicated delivery without bleeding, interventions to accelerate delivery of the placenta before the traditional 10 to 45 minutes will reduce the risk of PPH. (II-2C)

• Placental cord drainage cannot be recommended as a routine practice since the evidence for a reduction in the duration of the third stage of labour is limited to women who did not receive oxytocin as part of the management of the third stage. There is no evidence that this intervention prevents PPH. (II-1C)

• Intra-umbilical cord injection of misoprostol (800 g) or oxytocin (10 to 30 IU) can be considered as an alternative intervention before manual removal of the placenta. (II-2C)


See more: http://sogc.org/guidelines/active-management-of-the-third-stage-of-labour-prevention-and-treatment-of-postpartum-hemorrhage/

Delaying Cord Clamping:

What is it?

During labour and delivery, the placenta is still attached to the uterus and blood is still circulating from the baby to the placenta and back again. The cord and placenta contain 1/3 of the baby's blood volume immediately after birth; the cord continues to pulse and if left alone, the blood in the cord and placenta will be pumped into the baby, and not out again. It only takes around 2 minutes for the cord to stop pulsing the remaining blood into the baby, however, cords can pulse for longer. Often, cords are clamped and cut before they have stopped pulsating, and in this case, the baby does not receive 100% of its intended blood volume. 'Delayed cord clamping' is when the cord is allowed to fully stop pulsating before it is clamped and cut.

Positive outcomes to expect when cord clamping is delayed:

• baby receives 100% of its intended blood volume

• 30% of blood received from cord helps with oxygenation and stem cells which assists with regeneration of any damages from birth

• iron stores are higher, helping to reduce risk of anemia in the first 6 months of life


www.stfuparentsblog.com

Seen here is a lotus birth.

http://www.stfuparentsblog.com

http://www.stfuparentsblog.com

• higher APGAR scores due to better oxygenation and more blood = faster 'pinking up' (Appearance is the first 'A' in APGAR and refers to the baby's colour)

Here is an awesome article about cord clamping which debunks some of the myths around it.

http://www.scienceandsensibility.org/?p=5730

SOGC notes about cord clamping:

• Whenever possible, delaying cord clamping by at least 60 seconds is preferred to clamping earlier in premature newborns (< 37 weeks’ gestation) since there is less intraventricular haemorrhage and less need for transfusion in those with late clamping. (I-A)

• For term newborns, the possible increased risk of neonatal jaundice requiring phototherapy must be weighed against the physiological benefit of greater hemoglobin and iron levels up to 6 months of age conferred by delayed cord clamping. (I-C)

Cord blood is the blood remaining in your baby’s umbilical cord after delivery – a source of rich stem cells that are the building blocks for all of the cells in your body. These stem cells have the potential to develop into the various tissues of your body in order to replace damaged or abnormal cells for the treatment of various diseases.


Section 2: Cord Blood Banking

For example, stem cells can be transplanted to regenerate bone marrow in either a person who develops leukemia or lymphoma (cancer of the blood or immune system), or for someone who has undergone chemotherapy or radiation.

If your client chooses to preserve baby’s cord blood, it will guarantee a perfectly matched source of stem cells forever. These could be used, in the event that a life-threatening illness develops, to combat the disease. In addition, if the need arises and there is a close match, members of your family may also be able to use these stem cells to treat a serious illness.

Cord blood is collected after delivery, at the point at which the umbilical cord has been separated from the newborn infant. It will not interfere with the birth in any way; some delayed cord clamping can still be performed (about 1 minute compared to 2 minutes).

The physician, nurse or midwife collects the cord blood using a kit provided by the cord bank of choice. The cord blood is collected by extracting the blood from the cord with a syringe and putting it into a special collection bag. The collection takes only a few minutes to perform.

Some examples for which cord stem cells are used today are: the treatment of leukemia, lymphoma, Hodgkin’s Disease, anemias, various other cancers, blood diseases, hereditary/genetic conditions and immune system disorders. We are on the cusp of being able to use these stem cells to fight lung cancer, breast cancer, heart disease, Multiple Sclerosis, Lupus, AIDS, strokes, spinal cord damage, diabetes, cerebral palsy, kidney disease, and many other diseases.

Peristem stem cells are collected by taking some of the actual flesh of the umbilical cord, and could be used in the treatment of conditions such as degenerative arthritis, heart disease, traumatic injuries, birth defects, burns, liver disease, MS, autoimmune diseases (such as Crohn’s disease or rheumatoid arthritis) and some cancers. Together with Cord Blood stem cells, they could enhance the treatment of leukemia, lymphoma and other diseases.

*Information from CReATe www.createcordbank.com © 2017 by bebo mia inc. All rights reserved �6

Shortly after the birth, baby will undergo an assessment. It is up to your client(s) if they wish to have some or all of these things done at a later time. Your client(s) may also request that assessments are only completed in their presence.

1. APGAR

The Apgar score is determined by evaluating the newborn baby on five simple criteria on a scale from zero to two, then summing up the five values obtained. The resulting APGAR score ranges from zero to 10. The five criteria: Appearance, Pulse, Grimace, Activity, Respiration. The test is run at 1min, 5mins and if the results are poor at those intervals it is repeated at 10mins. The score is not an indicator of long term health.

2. Vitamin K

The blood clotting factors of newborn babies are roughly 30 to 60 percent that of adult values; this may be due to the reduced synthesis of precursor proteins and the sterility of their guts. Human milk contains between 1 and 4 micrograms/litre of vitamin K1, while formula derived milk can contain up to 100 micrograms/litre in supplemented formulas. As a result of the occurrences of vitamin K deficiency bleeding, the Committee on Nutrition of the American Academy of Pediatrics has recommended that 0.5 to 1.0 mg vitamin K1 be administered to all newborns shortly after birth, by intramuscular injection.


Section 3: Newborn Assessments

3. Erythromycin

Eye drops at birth are given for the main purpose of helping to prevent any possible infection in your baby’s eyes from their trip down the birth canal during labor. Eye infections used to be a major cause of blindness in children and were often due to the same bacteria that causes gonorrhea or Chlamydia in women. When a woman is infected with these bacteria (about 20 percent of women with gonorrhea and 70 percent of women with Chlamydia do not have identifiable symptoms) they are present in her vagina. As a baby travels through the birth canal, s/he can pick up bacteria present in the mother’s vaginal secretions or fluids.

The eye drops are just a precaution. It is a practice that is accepted and done in much of the world, and was even a law in Ontario, Canada. The policies around this are changing.

4. Physical Assessment

• Body Temperature - normal is 97.8oC - 99oC

• Blood Pressure - normal is 80/46 mmHg

• Weight - normal is 5-9 lbs (2500-4000g)

• Length - normal is 18-22 in

• Head Circumference - normal is 13-14 in


The first few hours after birth are a sacred time for mom and baby. Our job is to facilitate skin-to-skin and quiet bonding time. These are a baby’s first moments in this whole new world, they want to hear, touch, see, smell the only thing familiar to them, their mother. They deserve a quiet, dark space for bonding and getting to know each other. Babies that are removed from their mother will show psychological signs of distress. Benefits of skin-to-skin:

• Regulation of baby temperature

• Baby’s heart and breathing rates are stable

• Blood sugars elevated

• Boosts immunity

• Gut colonized by bacteria similar to mothers

• Early start to breastfeeding

Doulas should stay approximately 2 hours after the baby is born in a ‘normal’ vaginal hospital delivery. Home births require more clean up, so you will be there longer most of the time. With operative births, you may stay closer to 3 hours after mom gets back to the recovery room. With any special


Section 4: Skin to Skin

Section 5: When do you leave the delivery space?

circumstances (i.e. an issue with the baby and/or mom) you may stay for several hours after, depending on how the mom/family is coping.

After the baby is born, make sure: mom has enough fluids to drink; that she is warm; provide support with her breastfeeding if she is choosing to do so; help take photos; explain what the options are for newborn assessment if they need help remembering, as the arrival of baby can wipe the best memories clean. It is highly recommended to tidy up the birth space and gather up the belongings for mom and partner (if there is one). In a home birth, during this time you can be taking all the dirty dishes to the kitchen, getting snacks for mom if she wants them, and starting the MANY loads of laundry that will need to be done. Soaking blood stained towels and sheets in salt, cold water and bleach (if they use it) is helpful to salvage some of their items.

Before leaving, explain what you have done to tidy and where you have put things (like the phone charger and the toiletries from the bathroom). In the case of a hospital birth, your client will need to move to a postpartum room, or will be checked out if they had a midwife.

Your doula package may include as many prenatal visits as you want. Typically, a reduced rate receives 1, standard is 2, and some larger packages may have 3.

The visits are recommended between 30-35 weeks. Each visit can take 2-3 hours.

We will be discussing what to include in your visit in the class video. We recommend that your prenatal appointments reflect your brand and your zone of genius. There are some important topics that you will want to ensure that you include:


Section 5: Prenatal Appointments

• Birth plan creation

• Comfort measures

• Stages of labour

• What they want from you as the doula

• When to call you when they go into labour

• Protecting the birth space

• The 3 Rs so they know what to expect

• Packing for the hospital

• Optimal fetal positioning

• Newborn care

• First 6 weeks for the birthing parent (including healing, fitness, sex, etc.)

• Mental wellness in the postpartum period

• Breastfeeding tips - if applicable

• Creating postpartum plan, prenatally

Your client(s) may have taken prenatal courses in some of these areas, in which case you do not need to go into too much detail.

Again, we suggest that you add anything that you specialize in so that you have a value add and a unique twist on your client care. Some specialties may include aromatherapy, nutrition, fitness, hypnotherapy, yoga, green living, etc.

Creating a Birth Plan

*See Handout


module 8: section 1 - bebo mia€¦ · module 8:birth plans, prenatal visits & ﬁrst 2 hours....

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