Labor Support(Doula) for waterbirth in chennai

Met Vilasini in the  Happymom Antenatal around 34 weeks. It was a short time for both of us to know each other .After attending the birth choice session she preferred to have her husband with for the next session. So next session her husband came , vilasini was finding difficult to do exercise with GDM and less physical activity from the beginning of her pregnancy made it difficult for her to do exercises, but still she tried a lot. That weekend we had planned for Aquanatal session, Vilasini and her husband was little hesitant to come but they made it as reassured to them that they will luv the session. After the Aquanatal session their perspective towards birth choice changed, her husband was so confident to go waterbirth, I didn't promise them but told them we will decide during that time.

That day night vilasini called me saying of slight discomfort, around 2.00 am, her mom got panicked as no one is there to accompany them I told them to come to hospital.Around 3.00 am Ganapathy called me from Hosur, I assured him that things are fine no need to worry.
Around 8.00 am I reached hospital, I aasked her whether she wants to go to pool, than after 1 hour she was shifted to Birth pool.

She was intermittently on and off the pool, she was having food and water and tender coconut water in the pool itself , she was progressing slowly we ere taking time. Around 6.00 pm Gynaec came and did internal examination she 7 cm dilated and in -2 pelvic station.
She was shifted out of the pool and wanted to stay in the rest room for some time.She was comfortable in birthing while lying on the stomach , back labor. Everytime contractions comes she will lean forward, sac broke and saw grade 1 meconium stain, Foetal Heart rate been monitored consistently , baby was fine so we progressed,.

Around 8.00 pm she delivered baby girl , Meconium stain and cord around the neck. Baby was completely fine , than shifted her to the bed and breastfed in the labor bed itself.

One thing I told them I was ready to be their doula is just because of her husband who was so confident.She kissed me in the labor bed saying tons of thanks.
It was so emotional for me

vedic birth in WaterBirth with 2 hrs delayed cord clamping in Bloom Birthing Centre chennai

Its is a mom of 6 year old boy who had a Instrumental delivery in their previous pregnancy was highly disappointed with the delivery system that for their second pregnancy they were in search for a perfect place were they could experience Natural Birth.
She was already in her 37 weeks when in first met her in Happymom Pregnancy clsses. I was late that day to the claases I could see everyone waiting in the hall , among them was arti, she was bright when I saw her first time.
That day I gave an insight on Birth Options and ways to choose, she was so much into it and started to ask questions based on her previous birth experience. When she was receiving which is favourable to her she got to be excited.
As that day was too hectic for me I was not able to talk to her privately on birth options and it almost crossed lunch time and I was in a hurry to go the next hospital . I promised her that I will her for sure in my next visit, during that she asked I am interested in waterbirth, I was not in a position to reply as I don't know much about her , told her that we can take a call in the next session and I left.
Next session , I was speaking to them on their physical exercises and how far they are prepared for waterbirth and their knowledge on it. They were far above to my thoughts on their knowledge which gave me confident on them. They were also desperate on delayed cord clamping which I promise it will happen depends on the circumstance at the time of labor say for example if there is excessive bleeding,passed meconium cord around the neck means I can't promise for 2 hour wait to cut the cord. They do agreed to everything I told them.
They were pre planned about their labor process, No edema, they preferred to go natural edema,no pelvic examinations only if it is atmost necessary, no IV infusions and inductions and want to the hospital as delayed as possible.I was so happy to see a couple who has been well planned on their Birth.

she was on her due date I was worried and I called to know if there is any sign , she was relaxed and no worries mam I am completely fine. I told her to visit the hospital to check on Foetal Heart rate and have a word with her gynaec. So she went the next day, I was been informed from the gynaec that she didn't allow to do pelvic examination and after explaining the requirement she agreed.
She was almost 3 cm dilated and she was informed to go home and come next week until and otherwise if there is a requirement to come no need to come.

Anyway I informed the hospital to keep the birth pool ready as she may go anytime by nexy day. Next day morning around 4.00 am I received call from arti saying contractions every 5 - 10 minutes once. Informed them to wait for sometime and leave to hospital.
From the hospital I received call informing they have reached , I was there by 6.30 am.She was quiet relaxed and then I told her to get into the pool if she wants to.
she got into the pool after sometime , she started to do acupressure stimulation to trigger labor progress and was taking homeopathic medicine kal phosporicum to trigger childbirth. I was supportive to her options. 1 hour later she started to say its time now I am going to give birth.
I informed the gynaec Dr.kavitha to come till than instrusting her not to push but let you give way for the baby to descend so breathe slowly she was just following the instruction.
By the time gynaec she was completely crowning and around 8.20 am she delivered beautiful baby girl with no tear and meconium stain.

Baby was with her and her husband , we all were silently waiting for the placenta to expel till than baby was intact with the cord. After 30 minutes without any syntocin injection placenta came out, we kept the placenta in the bowl with the cord intact for 2 hours. Her husband was literally holding the bowl for 2 hrs to drain blood from cord to baby . Till than baby was not been taken away for suctioning or wiping and no Vitamin K injection as the couple had chosen to avoid vaccinations completely, we respected their choice.With Placenta intact we breastfed the child and arti was also having idly as she was in hunger she had her breakfast on labor bed.

Around 10.20 we clamped the cord and I said thank you for letting me to be a part of this birth. As this is dream birth for me. I was so happy that day and in the hospital all the staffs was so surprised to see the confidence what the mother had.



around

How are the couples been prepared for delayed cord clamping

In Happy Mom Pregnancy/childbirth classes been prepared for delayed cord clamping.
But not everyone were able to establish delayed cord clamping.
Delayed cord clamping is at least 2-3 minutes delay in clamping.
Unfortunately there are many reasons , listed some to my experience
Due to delivery process like
Cord around the neck: baby been rushed to the Neonatal Intensive Care Unit
Baby passed Stools/ Meconium
Forceps/Vaccum Delivery
Delay in baby cry
Fundal pressure / pressure given over the mother stomach to expel the baby
Episiotomy; mother would be bleeding no time to wait

Than how can to have Delayed Cord clamping to happen
If there is a Natural birth/water birth is happening , delayed cord clamping is more possible
Like no fundal pressure, no episiotomy, no rush to deliver the baby ie no push push while delivering its a natural expulsive reflex were it will happens on its own.

Medical emergencies like meconium stain,baby didn't cry than delayed cord clamping is delayed.

All this requires prior preparation for the couples to decide according to the circumstances. 

Lotus Birth, Placenta intact with cord after delivery

A new trend in natural birthing methods strives to ease a baby's transition into the world by not detaching the cord and placenta immediately following birth. Unsurprisingly, reactions are mixed.
There is a new trend in the world of natural birthing methods. Some mothers are opting for “lotus births,” where the umbilical cord is not cut immediately after birth. Instead, the baby remains attached until the placenta and cord dry up and fall off on their own, usually after 3 to 10 days. The cord detaches at the navel on its own.
The placenta is stored in a cloth bag, often placed on a pillow for easier transportation, and the cord is wrapped in silk ribbon. Apparently the placenta is odorless for the first day and then has a “slightly musky smell” in the following days (unless you seal it up in an airtight container, in which case it smells bad).

What are the benefits of a lotus birth?

According to a website called Lotus Birth: A Natural Birthing Practice, keeping the umbilical cord intact allows for a greater transfer of iron- and oxygen-rich blood to the newborn baby:

“The infant obtains 40 to 60 mL of ‘extra blood’ from the placenta if the cord is not tied until pulsations cease. Common practice of immediate cutting of the cord before pulsations cease deprives the newborn of a possible 60 mL of blood, the equivalent to a 1200 mL hemorrhage in an adult. This is a likely explanation of the strange phenomenon of weight loss that most newborns seem to endure. The new organism is put immediately under undue stress to reproduce the blood it was denied.”

The Royal College of Obstetricians and Gynaecologists objects to the practice, citing increased risk of infection in the blood-saturated placenta, which could spread to the baby. Lotus birth supporters counter this by saying that risk of infection is actually reduced because there is no wound at the navel.
Hilda Hutcherson, a professor of obstetrics and gynecology at Columbia University, said there is no scientific evidence that waiting days for the cord to detach has any benefits, but that delaying clamping the cord may help:

“There has been research in the past few years which found that when doctors delay clamping the cord for three minutes, the baby receives higher levels of iron which prevents anemia, but beyond that time frame, leaving the cord attached to the baby serves no purpose because it no longer feeds nutrients to the baby.”

I love the idea of easing a baby’s transition into the world and, as a home birth veteran, I understand the appeal of making the birthing process as calm and stress-free as possible. The lotus birth model encourages new mothers to stay home, relax, and heal quietly in the days following delivery, because it’s inconvenient both to entertain guests and leave the house with a newborn and placenta-bag in tow.
I do find it difficult, however, to imagine handling a placenta-bag on top of all the other hassles of newborn life, from incessant diaper changes to breastfeeding agony, as well as managing older siblings. There comes a point when what’s easiest for the mother becomes best for the baby because those first few post-partum days are extremely challenging. A lotus birth is not something I’ll be doing when my baby arrives in April, but that doesn’t mean it wouldn’t work well for someone else.

First time in Chennai Delayed Cord Clamping , leaving placenta intact with the cord for 2 hours in Bloom

Delayed Cord clamping is something which is not been practiced actively in day to day births which are been seen. Leaving even for 2 minutes shows to have large benefits to baby.
For the first time in Chennai Bloom Natural Birthing Centre and HappyMom Pregnancy to Motherhood are working together to bring this awareness.
We in HappyMom pregnancy classes reinforce the importance of delayed cord clamping make sure leave the cord intact for atleast for 2 minutes.

Delaying Cord Clamping May Offer Years Of Benefits, Study Finds

By Sam McCulloch in Birth. Last updated on August 1, 2015

After a baby is born, it’s common practice to immediately clamp and cut the umbilical cord, before passing the baby to her mother.
After all, the placenta and umbilical cord are unnecessary once the baby has arrived, right?
Due to a plethora of studies telling us that waiting before clamping the cord does offer benefits to newborns (after 10 years of lobbying, the UK are finally set to make delayed clamping to be standard practice), some of us have started to open our minds to the possibility of leaving the cord alone after the birth.
It seems that we’ve been thinking incorrectly in the past.
New research just out suggests that waiting before cutting the cord has more far-reaching benefits than we realised, with impacts well past infancy.
Researchers suggest that waiting at least three minutes before cutting the umbilical cord after the birth may help to improve children’s fine motor and social skills at four years of age. This is in addition to the huge benefits already discovered.
Globally, clamping and cutting the umbilical cord immediately after birth is standard practice. In 2011, researchers demonstrated that leaving the cord intact for at least three minutes decreases the risk of iron deficiency in babies for up to 4-6 months after birth. Now we are learning that delayed clamping provides long-term benefits too. Delaying clamping of the umbilical cord allows the volume of blood from the placenta and cord to transfer to the baby. This increases the baby’s blood volume by up to a third, providing valuable red blood cells and boosting iron stores. It also contains precious stem cells that belong to your baby. Why cut off this valuable source of goodness? What The Researchers Found In their investigation, the researchers followed up on babies from their earlier study. The children were now four years of age. Of the original 600 infants, 263 children took part in the study. Of these children, 141 had cord clamping delayed by three or more minutes after birth. The other 122 had cord clamping within 10 seconds of birth. The researchers completed developmental assessments, including IQ and cognitive tests. Parents completed a questionnaire regarding social and personal care skills. The results of the tests and questionnaires showed there was no difference in IQ or development between the children who had immediate cord cutting and those whose cords were left intact for three minutes after birth. - See more at: http://www.bellybelly.com.au/birth/delaying-cord-clamping-years-of-benefits-study/

But what the test results did show is that the boys who had delayed cord clamping (DCC) had better fine motor skills, such as gripping a pen, and more pro-social behaviour, compared to those boys who had immediate cord clamping after birth. Girls generally have better iron stores from birth, and are better protected against iron deficiency. Why Does Iron Matter? Iron deficiency has long been associated with poor behavioral, motor and intellectual development in children. The World Health Organisation (WHO) recommends leaving the cord intact for one minute as a general practice, with a target of at least three minutes if possible. Other peak groups as the UK National Institute for Health and Care Excellence (NICE) also recommend delayed or deferred cord clamping for at least one minute. The practice is not widespread, but is growing as the evidence showing the clear benefits grows. Doctors vary in their understanding of the current evidence showing that delayed cord clamping is beneficial to babies for the first 6 months following birth. This new research has long term implications for how maternity care providers proceed with the management of the third stage of birth. Iron deficiency in toddlers has become prevalent in developed countries. Statistics showing countries such as Australia, the US and UK have an average 10% of children aged between 1-3 with iron deficiency. During early infancy, the brain is rapidly growing and developing and iron is essential to that process. Limiting the amount of iron that is available to a baby during this time of rapid brain growth clearly impacts future brain development. While iron supplements are an option, natural sources of iron are more gentle to tummies (much less likely to cause constipation) and are more readily absorbed. - See more at: http://www.bellybelly.com.au/birth/delaying-cord-clamping-years-of-benefits-study/

Optimal timing of cord clamping for the prevention of iron deficiency anaemia in infants

Full set of recommendations*

WHO recommendations (1)

In summary:
Delayed umbilical cord clamping (not earlier than 1 min after birth) is recommended for improved maternal and infant health and nutrition outcomes.

From 2012 WHO guidelines on basic newborn resuscitation (2):

In newly born term or preterm babies who do not require positive-pressure ventilation, the cord should not be clamped earlier than 1 min after birth.
When newly born term or preterm babies require positive-pressure ventilation, the cord should be clamped and cut to allow effective ventilation to be performed.
Newly born babies who do not breathe spontaneously after thorough drying should be stimulated by rubbing the back 2–3 times before clamping the cord and initiating positive-pressure ventilation.

From 2012 WHO recommendations for the prevention and treatment of postpartum haemorrhage (3):

Late cord clamping (performed approximately 1–3 min after birth) is recommended for all births, while initiating simultaneous essential neonatal care.
Early umbilical cord clamping (less than 1 min after birth) is not recommended unless the neonate is asphyxiated and needs to be moved immediately for resuscitation.

Remarks

• The evidence base for recommendations on the optimal timing of umbilical cord clamping for the prevention of postpartum haemorrhage includes both vaginal and caesarean births. The WHO guideline development group considered this recommendation to be equally important for caesarean sections.
• Delayed umbilical cord clamping should be performed during the provision of essential neonatal care.
• Recommendations for the optimal timing of umbilical cord clamping apply equally to preterm and term births. The guideline development group considered the benefits of delayed cord clamping for preterm infants to be particularly important.
• Some health professionals providing care for an HIV positive pregnant woman and/or working in high HIV prevalent settings have expressed concern regarding delayed cord clamping as part of the management of the third stage of labour. These professionals are concerned that, during placental separation, a partially detached placenta could be exposed to maternal blood and this could lead to a micro-transfusion of maternal blood to the baby. The evidence shows that the benefits of delaying cord clamping for 1-3 minute outweighs the risks of transmission of HIV. HIV testing should be offered intrapartum, if not already done. WHO recommends that all HIV positive pregnant and breastfeeding women and their infants should receive appropriate antiretroviral (ARV) drugs to prevent mother to child transmission of HIV. Thus, the proven benefits of at least a 1–3 minute delay in clamping the cord outweigh the theoretical, and unproven, harms. Delayed cord clamping is recommended even among women living with HIV or women with unknown HIV status. HIV status should be ascertained at birth, if not already known, and HIV positive women and infants should receive the appropriate ARV drugs.
• Delayed umbilical cord clamping should not be confused with milking of the cord. The terms are not necessarily synonymous (milking refers to physically expressing blood from the umbilical cord). There are various recent studies assessing the effect of cord milking, practised at different times after birth, with a variety of “milking” times, associated with early or delayed cord clamping. These studies need further analysis, as cord milking has been proposed as an alternative to delayed cord clamping, especially for preterm infants.
• The WHO guideline development group considered that the package of active management of the third stage of labour includes a primary intervention: the use of a uterotonic drug. In the context of oxytocin use, controlled cord traction may add a small benefit, while uterine massage may add no benefit for the prevention of postpartum haemorrhage. Early cord clamping is generally contraindicated.
• Clamping “not earlier than one minute” should be understood as the lower limit period supported by published evidence. WHO recommends that the umbilical cord should not be clamped earlier than is necessary for applying cord traction to reduce post-partum haemorrhage and speed expulsion of the placenta (3), which the guideline development group clarified would normally take around 3 min.
• For basic newborn resuscitation, if there is experience in providing effective positive-pressure ventilation without cutting the umbilical cord, ventilation can be initiated before cutting the cord (2).

* This is an extract from the relevant guidelines (1-3). Additional guidance information can be found in these documents.

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References

1. WHO. Guideline: Delayed umbilical cord clamping for improved maternal and infant health and nutrition outcomes. Geneva, World Health Organization; 2014 (http://www.who.int/nutrition/publications/guidelines/cord_clamping/en/).
2. WHO. Guidelines on basic newborn resuscitation. Geneva, World Health Organization; 2012 (http://www.who.int/maternal_child_adolescent/documents/basic_newborn_resuscitation/en/).
3. WHO. WHO recommendations for the prevention and treatment of postpartum haemorrhage; 2012 (http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/9789241548502/en/).