Do I Need Cervical Checks in Late Pregnancy?

vaginal exams in pregnancy

If you’ve had a baby before or even talked to friends who have, it’s likely you’re aware that many prenatal healthcare providers routinely perform cervical exams in the last few weeks of pregnancy. Questioning this practice could very well have never even crossed your mind. Maybe you’ve even been led to believe that the results of these cervical checks are an important piece of the information needed to determine how your pregnancy is progressing and how soon you may deliver your baby. The truth of the matter is though that while yes, a cervical exam can assess effacement and dilation, it is not a reliable predictor of when you may go into labor. Instead, these cervical exams are more of a relic of prenatal care of the past and are done out of routine rather than out of true clinical need. While cervical checks can be useful in the case of an upcoming induction to determine how favorably one’s body would respond, there’s no true evidence-based reason to do repeated routine cervical exams in a typical pregnancy. 

Aside from the lack of necessity, cervical checks do also hold some level of risk. The risks associated with cervical checks include possible infection as well as the potential for premature rupture of membranes (breaking of water prior to labor-onset). 

When any foreign object, in this case, the gloved finger(s) of a healthcare provider, is inserted into the cervix, there is a risk of infection. The act of entering an area that otherwise is biologically sealed off and meant to dilate in its own time, can be problematic. Bacteria from the provider’s hand or even from your own vagina can be pushed into the cervix and create an infection. Infection is obviously something one would want to avoid at any time but certainly during the last weeks of pregnancy.

The premature rupture of membranes or PROM, the breaking of your water prior to the onset of labor, is another risk that cervical checks introduce. PROM can lead to longer labor, infection for the parent and/or baby, and possibly the need for induction. Cervical checks have been linked to PROM. In fact, a study done on this exact issue, revealed that people who had routine cervical checks starting at 37 weeks were three times as likely to experience PROM as those who did not have the routine cervical examinations. A second study (mind you, shockingly, only two studies have been done on this specific subject) showed that there was no risk nor was there a benefit to routine cervical checks. The potential reasons for the discrepancy are beyond the scope of this post but it certainly indicates the need for more research to be done on this topic and should act a red flag for this procedure. 

Whether there is truly a significantly higher risk of PROM and infection when having routine cervical checks or not, a procedure that carries no benefit should always be considered a potential risk and deserves to be weighed thoughtfully by the patient. If your provider does not need the information to plan a potential induction or for a valid reason that goes beyond simple routine, you may want to ask questions and consider if it’s a procedure you’re confident in having done. You always have a choice in the matter. Refusing a cervical exam is your right and a healthcare provider cannot compel you to consent to such an exam (or any other medical procedure for that matter). Informed choices only exist when “no” is an acceptable response. 

For more information, visit Evidence Based Birth.

 

Birth Trends & COVID-19 Pandemic

birthing during covid

Many expectant couples are facing a decision that is changing the way they envision their births unfolding. Deciding between continuing through with their original hospital birth or beginning to shift their mind to a planned homebirth is at the forefront of many couples’ minds these days. As hospital protocols are shifting and units are becoming coronavirus battle stations, couples need to decide if this is, in fact, the safest and best choice for their families. These changing policies and tightened restrictions leave many families unsettled and anxious. As a result, homebirths are appealing to a greater number of couples.

Homebirth midwives only care for and attend the births of low-risk parents. The following criteria explain who may fall into this category. 

Low-Risk Homebirths (These can vary among care providers.)

  • Pregnant people without pre-existing conditions, such as Type 1 diabetes or hypertension
  • Pregnant people with previous uncomplicated births
  • Pregnant people having a single birth
  • Pregnant people without pregnancy-related conditions, such as preeclampsia and gestational diabetes 

Midwives also stress that birthing at home is not just a variation of a hospital birth but it is a completely different experience altogether. No pain medication or doctors are available, so preparating mentally and physically for an unmedicated birth is crucial.  Aleksandra Evanguelidi, a Los Angeles based midwife, said she has received 30 calls in the previous six days where women were rethinking their birth plans. Michelle Palmer, chair of the Home and Birth Center Committee of the American College of Nurse-Midwives, said that with COVID, it has brought an opportunity to bring home birth and midwifery care into the health care system where more people will have access. 

Considering all of this, if birthing at home isn’t the right choice for you, below are some tips to help you have a safer hospital birth in the time of COVID-19. 

Is homebirth the only option? How can you minimize the risk of exposure?

  • Birth education classes to learn relaxation and coping measures to avoid unnecessary interventions and a longer hospital stay. 
  • Laboring at home as long as possible with the presence of a doula (since additional support in most areas are not allowed into the hospital room during the pandemic). 
  • Video conference your doula or support person once you arrive at the hospital.

As couples wrestle with these thoughts, they must know that what they decide for their family is the best choice. Allow your parental instincts to light your path. This time is unprecedented and overwhelmingly challenging. Warrior on, parents. Bringing in a new life in the time of a global pandemic is an act of heroism. 

A Sample Birth Plan

a sample birth plan

I vividly remember someone asking me if I had a birth plan when I was pregnant with my first baby and immediately googling what this was exactly. I had no idea this was a thing. I mean how would I know? You don’t know until someone tells you. This blog is me passing along information that I did not once know, but now believe helped me achieve my birth goals. Feel free to modify and make this sample plan your own. Wishing you a beautiful birth and a peaceful postpartum.

Sample Birth Plan

Name:
Care Provider:
Pediatrician:
Birthing Team:

  • Partner:
  • Doula:
  • Midwife/OB:
  • Other:

To all present at the birth of our baby, we are so grateful. Without you, we know these preferences would not be possible. We appreciate your advocacy and commitment in providing the most natural delivery possible for the mother and baby.

ENVIRONMENT

Requested room with birthing tub, if available. Please help us keep the room restful by:

  • Closing the door
  • Dimming the lights
  • Minimizing noise

LABOR

  • I wish to be able to move around (including walking) and change positions at will throughout labor. Please do not restrict positions unless absolutely necessary.
  • I would like to use a birthing ball, moist heat wrap, massage ball, essential oils and affirmations throughout labor.
  • I would like to eat and drink as needed, including ice chips.
  • I would prefer to keep the number of vaginal exams at a minimum. Please ask for consent.
  • I do not want a hep-loc.
  • I do not wish to have continuous fetal monitoring. Intermittent checks are preferred.
  • I do not wish to have my membranes ruptured.
  • I would prefer to be allowed to try changing positions and other natural methods if the labor seems to stall. (walking, nipple stimulation, etc.)
  • I have been educated on the available pain medications. I will ask for them if I need them. Please do not offer them to me.
  • I prefer to tear and do not want an episiotomy.
  • Please do not verbally guide pushing. I would like to push when I feel the urge.

DELIVERY

  • I would like to be able to choose the position in which I give birth.
  • I would appreciate having the room lights turned low and having the room as quiet as possibly for the actual delivery.
  • I would like to have the baby placed on my stomach/ chest immediately after delivery.
  • Please delay the cutting of the umbilical cord until it has stopped pulsating.
  • I wish to keep the placenta. Cooler has been brought for transport to home.

 IMMEDIATELY AFTER DELIVERY

  • My partner wishes to cut the cord. In an event s/he is unavailable, the doula will cut it.
  • I plan to keep the baby near me following the birth and would appreciate if the evaluation of the baby can be done with the baby on my abdomen, with both of us covered by a warm blanket, unless there is an unusual situation.
  • I do not want eye ointment on my baby.
  • Please delay Hep B shot. We will discuss this with our pediatrician at our first visit.
  • Please administer Vitamin K.
  • If the baby must be taken from me for medical treatment, it is requested that my partner be with the baby at all times.
  • I would like to hold baby for one hour before he/she is examined.
  • In case of emergency, please do not cut the cord during resuscitation.
  • I do not wish to be separated from baby. Please speak with my partner or me first if required for health reasons.

BREASTFEEDING

  • I plan to breastfeed the baby and would like to begin nursing the baby right after birth.
  • I do not wish the baby to be given a pacifier.

 CESAREAN

  • If a cesarean delivery is needed, I would like my support team to be fully engaged in the decision making process.
  • I would like my partner to be present at all times.
  • If the baby is not in distress, I would like he/she to be placed on my chest immediately after delivery. If this is not possible, I would like baby to be given to my partner for skin to skin.
  • If baby is in distress, I would like my doula to be with baby at all times and my partner to remain with me.
  • I would like to attempt breastfeeding as soon as possible.

 

 

Building Your Birth Team in San Antonio

pregnant woman on the phone. Building your birth team

Congratulations on your pregnancy! As you prepare for your pregnancy, birth and postpartum, it’s important to build a supportive birth team to support you throughout this transformational experience.  Choosing care providers that align with your birth goals and values is essential to having the experience you’re hoping for, so research your options and meet a variety of providers to see who is the best fit.  There are so many decisions to make during pregnancy, but be assure, this is the most important one. 

Care Provider: A care provider is who you choose to do all of your prenatal care. This person/group focuses primarily on maternal and fetal health. There are two different models of care, the Midwifery Model of Care and the Medical Model of Care. It cannot be understated that this is the most important choice you will make your entire pregnancy as it will greatly affect your desired outcome. Fully trusting your care provider brings peace and confidence as you prepare to meet your baby, so it is important that your provider’s philosophy of birth aligns with your goals. Remember, it is also never too late in pregnancy to change care providers if you are unhappy with decisions and/or approaches to your care.

  • Midwifery Model of Care- Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle. Providing the pregnant person with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support. Midwifes can work in a variety of settings and generally utilize interventions less and only if they are indicated. The midwifery model is for low risk pregnancies and if a pregnancy is determined high risk, care will be transferred to an obstetrician.
  • Medical Model of Care- This model of care focuses on preventing, diagnosing, and treating the complications that can occur during pregnancy, labor, and birth. Prevention strategies tend to emphasize the use of testing, coupled with the use of medical or surgical interventions to avert a poor outcome. In many cases, low risk people find themselves having the same testing and interventions as their high risk counterparts.

Doula: A doula is a professional trained in childbirth who provides emotional, physical, and educational support to a mother who is expecting, in labor, or has recently given birth. The doula’s purpose is to help people have a safe, memorable, and supported birthing experience. The support of a doula has shown to have a 39% decrease in cesarean rates, shorter labors, less interventions, and a 31% decrease in the risk of being dissatisfied with their birth experience.  Because the doula is not medically trained, she does not attend to fetal/maternal physical health but more so focuses on mother’s emotional well being before and during labor.

Birth Educator: A birth educator is trained to teach childbirth education classes to expectant families, so they can be informed consumers. Childbirth educators are a resource for families providing information they may not have access to outside of a birth class. They help couples learn valuable coping skills and strategies to have an empowered, informed birth experience. While your birth educator may not be present at your birth, she is considered part of the birthing team.

Placenta Encapsulation Specialist: Placenta encapsulation is the process of turning your baby’s placenta into capsules to aid in your postpartum recovery. The placenta encapsulation specialist adheres to all OSHA & EPA guidelines regarding blood-borne pathogen transmission, infection prevention, standards for sanitation, and safe food handling. The encapsulation process happens within 72 hours of baby’s birth and is believed to help with increasing energy levels, lactation, postpartum anxiety/depression, increased levels of CRH (stress-reducing hormone), and restoration of iron levels in the blood.

Chiropractic Care: There are many hormonal and physical changes you’ll experience during your pregnancy. Some of changes will have an impact on your posture and comfort. As your baby becomes heavier, your center of gravity shifts, and your posture will adjust. This may also create added pressure and misalignment in the pelvis. A misaligned pelvis may pose complications during delivery. When the pelvis is out of alignment, it can make it difficult for your baby to move into the best position to be born, which is rear-facing and head down. In some cases, this could affect a person’s ability to have a natural, low intervention birth. A balanced pelvis also means your baby has a lower chance of moving into a breech or posterior position. When your baby is not in an optimal birthing position, it can lead to a longer, more complicated delivery. Evidence points to improved outcomes in labor and delivery for people who’ve received chiropractic care from a Webster Certified Chiropractor during their pregnancy. Chiropractic care can help balance the pelvis, allowing baby the room need to get in the most optimal position possible, while also allowing for a comfortable pregnancy. In fact, chiropractic care may even help reduce the length of time you’re in labor. Locate a Webster Certified Chiropractor, one who specializes in pregnancy and pediatric care, today!

Acupuncture: Many people sing the praises of acupuncture during pregnancy to ease some common discomforts such as back and pelvic pain, nausea, heartburn, swelling, and constipation. So how does it work exactly? Researchers have found that acupuncture points correspond to deep-seated nerves, so that when the needles are placed, the nerves are activated and the energy flow will regain balance. This, in turn, triggers the release of several brain chemicals, including endorphins, which block pain signals and help to relieve a number of pregnancy symptoms.

Clinical Psychologist: This support person cannot be encouraged enough. This particular birth team member will allow you to prepare for the birth as well as process and heal post birth as you enter into parenthood. Benefits of a mental health therapist encompass well being, which ultimately affect baby and partner’s well being. Becoming a new parent has the possibility of bringing in unexpected stress and anxiety. Having a safe space to process this can make all the difference.

Pelvic Floor Physical Therapist: This particular support involves biofeedback and exercises to encourage relaxation and strengthening of the muscles of the lower pelvis, which have the tendency to weaken in pregnancy and through postpartum. A physical therapist measures muscle tone and the strength of muscle contractions, which give you the information you need to proceed with tailored exercises. When necessary, the therapist may use a massage-like technique called myofascial release to help stretch and release the connective tissue between the skin and the muscles and bones in your pelvic region. Pelvic floor PT may strengthen your pelvic floor, re-training your abdominal function, help libido levels or painful intercourse, and treat incontinence.

Give yourself the gift of a well-rounded birth team, ready to support an expectant family every step of the way. Being uplifted and encouraged during labor makes all the difference prenatally and postnatally. Investing in getting information and support while you embark on one of the greatest (yet challenging) adventures in your life will have big pay outs in your wellness long term. Physical, mental, and emotional supports are vital in attaining the wellness you deserve.

Stay well and best wishes.

3 Ways to Encourage Labor

encourage labor

Hi! Kristie here. 39.3 weeks pregnant and searching all the ways to naturally encourage labor and give this babe a boost to exit utero. The days are long and uncomfortable and bending to pick up after my toddlers seems like the most impossible task. So on the blog today, I have some insight about encouraging your babe to make their grand entrance. Remember to speak to your care provider before trying these methods at home.

1. Sex– Yep. I said it. This is something any full-term pregnant person may cringe at the sound of, but I firmly believe it worked with my other two pregnancies. But why? Human semen is a biological source that has the
highest concentration of prostaglandins that can occur naturally. Prostaglandins are known to ripen the cervix and get it ready for labor. Also, an orgasm has been to shown to increase uterine activity in healthy pregnant people.

2. Acupuncture– This ancient Chinese practice has many benefits. One of the many is induction. Certain points are avoided during pregnancy when receiving acupuncture treatment because of this very reason. Pushing the
body into induction mode too early is an unwanted outcome. However, when a pregnancy has reached between 39-41 weeks, these particular points are treated. This treatment has been used to help soften and dilate the cervix
with the onset of labor contractions. It may provide a way of reducing labor pain and avoiding a medical induction.

3. Massage– Studies show that a massage can raise your body’s level of oxytocin, that hormone that can bring on labor contractions. Some massage therapists swear by their ability to help jump-start labor when a parent-to-be
is overdue. Many may even focus on certain pressure points to move labor along. Not a fan of massages? Meditation and even just cuddling with your partner can help relax you, which might get your oxytocin levels pumping.
So if you’re anxious about that baby who doesn’t want to leave their cozy bed, try a stress-relieving activity like one of these discussed above. What’s the harm anyway in being in a fully relaxed state of mind for when labor
does decide to begin?

**While 40ish weeks may seem close to an infinite amount of time, it truly is just a blip in your and your babe’s life. Try your best (speaking to the choir here) to enjoy and bask in the miracle of pregnancy. Easier said than done, I know, in those final weeks. Baby will be in your arms soon enough. Trek on, you got this!

3 Quick Tips for Writing your Birth Plan

writing your birth plan

Writing your birth plan can feel like a daunting task. You want to make it concise and straightforward while still including all the necessary pieces. Before you even get to that though, be sure you have a care provider who is supportive and open to birth plans. If you have mentioned a birth plan to your care provider already and you felt disparaged, run, don’t walk, to a new, supportive provider. Providers who feel that they are the final authority regarding your birth, have no place on your support team. You deserve better than that, you deserve to be heard and collaborated with, not brushed off or made to seem less than.

The preparation that goes into creating a birth plan involves researching common practices in your choice of birthing location and then teasing out those things that are most significant to you and what learning what the potential alternatives may be. By educating yourself about the birthing process and the choices you have, prior to being in the throes of labor, you are increasing your chances of having the birth you desire. You will feel empowered and confident on the day of your child’s birth because you have informed yourself and you’re not simply at the mercy of the professionals and protocols surrounding you.

Marsden Wagner, doctor and author of the book entitled Creating Your Birth Plan: The Definitive Guide to a Safe and Empowering Birth, dives deeply into the details one may want to include in a birth plan. This book is highly recommended for you if you’re preparing to sit down and get your birth plan on paper so you can present it to your provider. The purpose of this post is to outline some quick tips from the book on how to best present your wishes and increase the likelihood of you and your care provider aligned regarding these wishes.

Keep your Birth Plan Flexible
Make it known in your birth plan that you fully understand your list of desires are a wish list for your ideal outcome. While you do anticipate having a smooth labor and delivery and you do expect your provider to respect your wishes, you’re also not blind to the fact that the process is not totally predictable. Wording such as “Unless there is an emergency…” or “If circumstances allow…” relay this message clearly.

Be Brief
A one page birth plan is the goal, but no more than two pages maximum is best. This helps to ensure that everyone on your birth support team will be able to read over and recall what you have listed. If you have specific details that go beyond what is necessary for your care provider/nurses to know, it’s a good idea to have a longer version with those details for your partner, doula, or other advocate to familiarize themselves with so that they can be addressed as needed throughout the labor process. A bulleted birth plan is best, making it easier to read.  Full paragraphs can be daunting for busy L&D staff.

State your Plan in the Positive
Rather than presenting your birth plan as a list of things you do not want done, phrase things in the positive. Keeping your phrasing positive helps decrease resistance from caregivers. Try stating what it is you do desire followed by the intervention or procedure you’re hoping to avoid. For instance, “I wish for my perineum to remain uninjured in the labor process; however, if the situation arises, I prefer to tear naturally rather than have a surgical cut.”

These three basic guidelines should really help jump start the creation of your birth plan. Having solid parameters for how to present your birth plan so it meets the least resistance among your care team is a huge step in the direction of a desired labor and delivery. While many considerations remain as far as what exactly you may want to include in your personal plan, knowing how to get those ideas on paper is the first phase of drafting your birth plan. You’re encouraged to purchase or borrow a copy of Dr. Marsden Wagner’s book, Creating Your Birth Plan: The Definitive Guide to a Safe and Empowering Birth for a full and detailed process for creating your birth plan.

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