The Best Cesarean Possible by Penny Simkin

Ideas for the Best Cesarean Possible

By Penny Simkin

If you have learned that you must have a cesarean (a “planned cesarean”) for your

safety or the baby’s, you may feel disappointed that you cannot have the birth you

had hoped and planned for. Here are some ideas for tailoring the cesarean birth of

your baby to make it very special and personally satisfying for you, your partner,

and your baby.

Before the surgery:

*  Be sure you understand and agree with the reasons for the cesarean (i.e.,

malposition of the baby, a medical problem for you or the baby).

*  Learn about the procedure. Read about it in Pregnancy, Childbirth and the

Newborn or the Birth Partner and discuss it with your caregiver.

*  Learn about your anesthesia choices and how each is administered. General

information is available in the books mentioned above. If possible, however,

meet and discuss medications with an anesthesiologist along with any

concerns you have. A spinal or epidural block is the most common type of

anesthesia when a cesarean is planned in advance, but there are other

possibilities. (See “Anesthesia and medication issues below).

*  Learn the layout of the operating room, particularly where the baby will be

taken for initial care. Will she be in the same room or an adjacent room? Will

you be able to see her? Can your partner move back and forth between your

side and your baby’s?

*  Discuss the possibility of waiting until you go into labor and then going to the

hospital to have the cesarean. The advantage is that the timing for birth is

more likely to be optimal for the baby. The disadvantages are that you might

not know the doctor on call who will do the surgery, and that you cannot plan

ahead (which is the same as with most vaginal births).

*  If you do not decide to await the onset of labor, make your appointment for

the surgery. If there is a choice of times, you may want to consider having

the first appointment of the day for two reasons: there is less likely to be a

delay (from earlier surgeries taking longer than expected); and you will not

be as hungry if you do not have to wait all day. You will probably have to

avoid eating from the night before.

During the surgery and repair:

For your personal comfort, consider these ideas:

* Have your partner put some pleasant-scented (lavender and bergamot

are popular) lotion, massage oil, or cologne on your cheeks. He can also

put it on his wrist for you to sniff. This is soothing and may

counteract the “hospital smells.” Because some staff members may be

allergic to some scents, you’d better ask if this is okay.

* Ask if at least one arm can be left unrestrained.

* Bring your own CD or tape of music to be played during the surgery.

Music that is familiar and that you love improves the ambience. Many

operating rooms have CD players.

*  Plan to use relaxation techniques and slow breathing (like sighing)

during the surgery. Hold your partner’s hand.

* Ask that they lower the screen when the baby is lifted from your body so

that you can see the birth.

* During the repair procedure, there is one technique that some doctors do,

while others believe it is unnecessary and possibly problematic. This is to lift

the uterus out of the abdomen to inspect it and then replace it. This

procedure may cause considerable nausea while it is being done, and later gas

pains. You might wish to discuss this with your doctor beforehand. If he

customarily does it, ask for the advantages.

* Ask about picture taking during the surgery or afterwards. There sometimes

are policies restricting picture taking. A digital camera has the advantage of

allowing pictures of the baby to be shown to you within seconds. If your

baby is out of your sight, it may be possible for your partner (or a nurse) to

take a picture and show it to you.

* Once your baby is born, your partner might go to the baby and talk or sing to

him. A familiar voice often calms the baby at this time, and seeing the baby’s

response is a poignant moment for the partner. Some couples have sung a

special song (i.e., “You Are My Sunshine”) aloud to the baby frequently

before birth. The baby seems to be soothed when hearing that song.

* The partner may be able to bring the wrapped baby back to you for your

first contact. You can nuzzle, kiss and talk to your baby, but it is unlikely you

will be able to hold her or breastfeed until you leave the operating room,

because the operating table is narrow and you may feel quite weak.

Spinal or epidural anesthesia and other medication issues:

* The spinal block has many advantages for a planned cesarean, which make it

the usual choice. It is quick to administer and to take effect. It usually

involves only a single injection, and does not require a catheter in your back.

It causes numbness that lasts a few hours. You remain awake and aware. It

hardly affects your baby. The injection may also contain some long-acting

narcotic such as morphine that provides good postpartum pain relief without

grogginess for up to 24 hours after the surgery. An epidural is very similar

and has these advantages, but is more complex to administer and takes

longer to provide adequate pain relief. There are, however, some concerns

about spinal and epidural blocks that might be frightening:

- It is not uncommon to have a period during which you feel breathless

or as if you cannot breathe. It can be scary. It happens because the

anesthetic may numb the nerves that let you feel your breathing,

while the nerves to the muscles that make you breathe are not

blocked. In other words, you are breathing, but cannot feel it.

- What to do: Say that you cannot breathe. The anesthesiologist, who

is at your head, will check and reassure you. Your partner should

coach you with every breath, watching closely and saying, “Take a long

breath in -- yes you are doing it, and now breathe out. Good.” He

might hold your hand in front of your mouth so you can feel your

breath, and reassure you, “You are breathing, even though you can’t

feel it.” This feeling does not last for the entire surgery.

- On very rare occasions, the level of anesthesia rises high enough to

involve the muscles of breathing, so that you really are not breathing.

You cannot talk either. The anesthesiologist, who is watching the

monitors closely, discovers this and takes measures to assist your

breathing. You and your partner should also have a signal. If you can’t

breathe and can’t talk, blink your eyes many times. That means, “I

can’t breathe!” Your partner should be watching you, and if you blink

in that way, says, “I think she can’t breathe!” This may alert the

anesthesiologist a few seconds before he would pick up the problem.

- On other, even more rare occasions, the anesthesia is not adequate,

and you feel the surgery. This is very scary. The doctors will probably

want to make sure your reaction is not an anxiety reaction to the

surgery, and may seem not to believe you at first. If you are feeling

the surgery, tell them to stop. Your partner must help you with this.

Make them give you better anesthesia before proceeding. This might

mean repeating your block or giving you a general anesthetic.

* During the repair, you may feel nauseated and shaky for a period of time.

These are normal reactions to major surgery and vary from feelings of

queasiness to vomiting and from trembling to shaking and teeth chattering.

There are medications to ease these symptoms. They are often put into your

IV without you knowing, which may be okay with you. They may, however,

cause amnesia (e.g., Versed), or make you very sleepy. They can keep you

from being able to nurse your baby (or to remember that you did), and to

remember the first hours of your baby’s life. If you want to stay awake for

this time, discuss this with your anesthesiologist ahead of time. You might

ask the anesthesiologist not to give you anything for nausea or trembling

unless you ask. You may very well be able to tolerate the symptoms, but if

you find you cannot, then you can ask for the medication.

* Post-operative pain medications are available to help you during the days and

weeks after the birth. Some women try to avoid using them due to worries

about possible effects on the baby. However, since very small amounts reach

the baby, the effects to be minimal. The baby nurses and remains awake and

alert for periods of time. The downside of avoiding pain medications is

extreme pain, which greatly reduces your ability to move about and to care

for, nurse, and enjoy your baby. With adequate pain relief, you can have

more normal interactions with your baby.

The first few days:

* Most hospitals have a bed available for the partner so he or she can remain

in the hospital with you. This is lovely for many reasons. You are together

as a family. Your partner can share in baby care. If your partner is there,

your baby can probably room in with you the entire time. If he or she is not

there, you will need help from the nurse to change the baby’s diapers, move

him from one breast to the other, and carrying him, even for short

distances. In some hospitals, the baby spends more time in the nursery if

the partner is not there.

* Breastfeeding is definitely possible, but presents some challengs after a

cesarean. Nursing positions such as sidelying, and the “football” or clutch

hold avoid painful pressure on your incision. Using a pillow over the incision

also reduces pain while holding your baby on your lap. Ask for help from the

hospital’s lactation consultant in getting started with nursing.

* Rolling over in bed can be very painful, if you don’t know how to do it. The

least painful way uses “bridging.” To roll from back to side, first draw up

your legs, one at a time so that your feet are flat on the bed. Then

“bridge,” that is, lift your hips off the bed, by pressing your feet into the

bed. While your hips are raised, turn hips, legs, and shoulders over to one

side. This avoids strain on your incision.

* Help at home is essential to a rapid recovery. If possible, someone in

addition to your partner should help keep the household running smoothly.

If that person knows about newborn care and feeding, all the better. All

three (or more) of you need nurturing and help during the first days and

weeks to ease and speed your recovery and help you establish yourselves as

a happy family.

As you can see, there are many possible options for a cesarean birth. Some are

personal touches and personal self-care measures that will improve your

satisfaction and self-confidence. Others are measures that involve the support of

the hospital staff and your doctors. After thinking about your own preferences,

prepare a birth plan, review it with your caregiver, and bring it to the hospital for

the nurses to read.

I hope these suggestions will help you have the best cesarean ever!

Placenta Encapsulation

Mothers have been consuming their placentas since the beginning of time. All mammals, even herbivores, eat their placentas. Wise women are looking at this practice with new eyes, returning to a ritual that is older than human memory. Consuming the placenta returns valuable nutrients and life-force to the mother. Birth can sometimes leave a woman feeling drained physically and emotionally, which are risk factors for postpartum depression. Eating the placenta is one way to reduce those risks to promote a joyful postpartum.

There are many ways to eat a placenta, but some are afraid to try it. Placenta encapsulation is an answer to this problem. It is the process of preparing dehydrated, powdered placenta and putting it in capsules for swallowing in pill form.
 

The Placenta for Postpartum Healing

Today, approximately 80% of women experience some level of postpartum depression. Using the placenta for its medicinal properties during the postpartum period is a natural & healthier way you can help avoid these symptoms and the costly treatments that usually accompany them, such as medications and counseling.

Benefits of Placenta Capsules

The placenta has amazing abilities during the postpartum period; it can heal, sustain, and strengthen.

Traditionally Placenta Capsules are used to help:     - balance your hormones     - enhance milk supply     - increase your energy.

Placenta Capsules may also help:     - You to recover more quickly from birth
     - To bring the body back into balance
     - Prevent the "baby blues"
     - Shorten postpartum bleeding
     - Assist the uterus to return to size
     - Increase postpartum iron levels

The Process

Before being dried, the placenta is prepared using herbs that lend their healing properties to the placenta and benefit a postpartum mother. The placenta is then ground and encapsulated, and when properly stored, the capsules can be used long-term. 

Why Hire a Professional Placenta Encapsulation Specialist?

Ideally, the placenta is encapsulated within 48 hours after the birth.  While you bond with your new baby, she will come to you and take care of your placenta in your own home.  She is basically “on call” for you and will make every effort to come to your home within the 48-hour time frame to encapsulate your placenta.

Even if mama and baby are recovering in the hospital, she can encapsulate your placenta at home with your partner or other relatives present and get the capsules to you right away. 



Where Do I Go For Placenta Encapsulation?

Here in Sacramento we have a placenta encapsulation specialist, Tamara Morales. She is the owner of PlacentaMom. Click Here to view her site. 

Or contact her at: 
 916-934-3333
tamara@PlacentaMom.com


Not located in the Greater Sacramento Area?
Visit www.avoidthebabyblues.com for a directory of Independent Placenta Service Providers.

Natural Methods of Labor Induction

As an alternative to the traditional hospital route for induction, many modern mom's are looking to the past for tried and true old-fashioned methods of induction. Natural ways to induce labor may be chosen for many reasons, such as avoiding invasive medical ways to induce labor or for maternal or fetal risks that have medical induction on your care provider's mind.

It's important to note that none of these methods for inducing labor at home will work if your cervix is not ripe. These methods may help ripen your cervix-making it soften, efface and dilate.

It is also extremely important for me to remind the reader that before any at home method of induction is tried mom should be at least 40 weeks and needs to discuss it with her care provider before she attempts it.

The methods I discuss are: Sex, Food, Nipple Stimulation, Castor Oil, and Acupressure. 

Sex

Sex is not necessarily associated with starting labor but may help to ripen the cervix. Semen is the highest source of prostaglandins. Prostaglandins cause the cervix to "ripen", or soften and prepare to open. Sex can help the cervix to dilate and efface by depositing these prostaglandins on the cervix.

Furthermore nipple stimulation may also have a role in that it is known to release oxytocin, the hormone that causes contractions.  In addition, orgasms produce oxytocin.   So, between these factors, there is a pretty good case for the stimulation of labor.

As an alternative to intercourse, you might consider collecting semen in a condom, a diaphragm or an Instead cup to hold the semen against the cervix. An Instead cup is designed for use during menstruation, but theoretically could be used in this manner.

Studies about the effectiveness of sex starting labor are very few. And it should be noted that nothing should enter the vagina once the bag of water has ruptured.  However unappealing sex might sound at 40+ weeks pregnant, it can for many be a better option than a pitocin induction at the hospital.

Food

In every female circle their are women who swear to have the secret to starting labor. Which is often eating X Y or Z. Often times it's an extra spicy dish that they claim brought them face to face with their baby.

Unfortunately, the statistics are out on this one - there is simply not enough research to support that any foods are effective in inducing labor.

Many women have sworn the following are foods that will induce labor:

•     Pineapple
•     Spicy Foods
•     Chinese Food
•     Eggplant Parmesan
•     Licorice

The most well-known of these would have to be spicy foods, like hot peppers or any other spicy Mexican dish. What the research is now showing is that these foods may be something to avoid prior to labor.

This is due to the fact that certain spicy foods release capsasins, which may be counterproductive in labor. When the baby descends down the birth path, the pressure exerted releases endorphins into the woman's body. These endorphins are a natural pain-killer. In effect, the capsasins counteract the endorphins and rob the mother of her natural ability to have a pain-free birth.

The Eggplant Parmesan was also in vogue for a time. While this dish may have been contributing to labor, it is probably not due to the eggplant but rather to the seasonings in the dish. Both basil and oregano are herbs contraindicated in pregnancy due to their potential ability to start labor.

Pineapple is not supposed to induce labor, but rather is thought to be a cervical ripening agent that stimulates prostaglandins, although this has not been proven.

Licorice, real licorice candy, the black kind, is thought to also stimulate the production of prostaglandins. This is due to the chemical, glycyrrhizin. Eating lots of licorice might also result in mild diarrhea, which causes intestinal contractions that may lead to sympathetic uterine contractions. This type of licorice can also be found in tablet form. Again, no definitive research suggests that licorice can induce labor.

When looking for foods that induce labor, only consume them if they are something you normally select. There's just not enough evidence to say they work for certain, and in some cases they may cause more harm than help. 

Nipple Stimulation

Using nipple stimulation to induce labor has been practiced by women for centuries. It is one of the most effective at-home induction methods there is. This stimulation brings about the release of oxytocin, which is the natural form of pitocin. Oxytocin causes contractions, which can lead into true labor. It's important to note that this will only happen if your body is already close to labor. As with all natural labor induction techniques, don't attempt this until you are over 40 weeks.

This practice is often recommended by midwives when a woman is long past due or when labor is stalled.  This can be done manually or with an electric breast pump.

When this is performed, the uterus sometimes becomes hyperstimulated, meaning that it gets too little rest between contractions, so use caution and consult your practitioner first.

Here is a guide to help you understand the process:

1. Only massage one breast at a time.
   
   
2. Grasping the areola, rub in a circular motion until a contraction begins. It's important to mimic the suckling action of a baby.
   
   
3. Stop after the contraction begins.
   
   
4. Wait 15 minutes, then repeat.

Stop using nipple stimulation  if the contractions are 3 minutes apart or lasting 1 minute or longer.

Castor Oil

The theory behind using castor oil to induce labor is that it causes intestinal cramping and diarrhea, which stimulate the uterus, thus producing prostaglandins, which then cause contractions.

Are there risks in using castor

There has been much debate over whether castor oil will cause the baby to pass meconium, or its first bowel movement.   If the meconium is aspirated, or inhaled into the lungs, it can lead to aspiration pneumonia, which can be fatal or lead to serious developmental delays.Meconium is deemed a signal of fetal distress. However, research has been conducted that has found no increased occurrence of meconium staining with this type of induction.

The mother, however, can be at risk of dehydration due to the resulting diarrhea. This tires the mother and less able to endure through physical activity. It could also potentially endanger her milk supply. Also, if effective diarrhea can make labor a less pleasant experience. I recommend using extreme caution when taking castor oil, and of course consult your practitioner first.

How do I take it?

The usual dose is 2 tablespoons.  However, I strongly advise against taking it straight-you may not get it down. It's pretty nasty stuff. If you do pursue using castor oil for labor induction, take it in the morning after a good night's sleep. If taken at night, you most likely will not sleep due to the resulting diarrhea.

Here are some recipes to make it more palatable:

•     Put it in 3-4 oz. of root beer, shake vigorously, and then gulp it down.
•     Add a couple of scoops of ice cream to the castor oil and orange juice.
•     Scramble it with 3 eggs.
•     Drink the oil straight followed immediately by hot apple juice

As an alternative to using castor oil to induce labor, you may use evening primrose oil to naturally ripen the cervix. It is an excellent source of prostaglandins. It comes in a softgel that can be taken orally or inserted vaginally before bed. Oral use can start as early as 34 weeks and cervical application at full term.The recommended dose is two 500mg capsules per day. At full term you can add two capsules vaginally before bed, at which time the entire capsules will dissolve.

Acupressure

Using acupressure to induce labor is one of the most pleasant methods of natural labor induction. It is similar to using reflexology to induce labor or even going to the chiropractor for an adjustment.

To use acupressure as a method to induce labor, there are two pressure points that can be stimulated to produce contractions.

They are located:

•     In the webbing of your thumb and index finger.
•     Four finger-widths above the inside of your ankle bone.

To stimulate the first pressure point, pinch the webbing of your hand and rub in a circular motion for 30-60 seconds at a time, taking a 1-2 minute break in between contractions.

For the latter point, press firmly on the spot. It should feel sore if you've found the right spot. Press and rub in a circular motion until you have a contraction. When the contraction is done begin again.

Both pressure points can also be very helpful in progressing a long and slow labor.

All about Induction Part 3 - Pitocin

By far the most commonly used drug on the maternity floor, Pitocin is a drug used to start labor contractions or increase their intensity. I doubt many women in America have deliver a baby in the last decade who haven't at least heard the word. Pitocin, for better or worse has become a part of childbirth in American hospitals. 

What is Pitocin?

Pitocin is a synthetic oxytocin.  Oxytocin is a hormone that a woman's body naturally produces that cause contractions to begin.  When oxytocin isn't doing the job to get labor going, for whatever reason, then hospitals frequently use pitocin to get this process started.  This medical intervention is usually used in order to get labor started and to speed up the labor process.

When a woman's body makes oxytocin, it is secreted in bursts.  This creates a natural flow.  When pitocin is administered in a hospital, the woman has to be placed on an intravenous pump that gives her a steady flow of pitocin.  These contractions are quantitatively and qualitatively different than the ones she would experience on her own.

Benefits of Pitocin

• Pitocin does tend to make labor shorter. This is a huge bonus for many women exhausted by labor.
• Using synthetic oxytocin to stimulate labor if the membranes have been ruptured has cut down on infection rates.
• Contractions can be "controlled" by adjusting the dose of medication.
• Can be vital in helping stop excessive bleeding post birth, and can assist with placenta delivery. 

Drawbacks to Pitocin

Risks of Pitocin:
Contractions tend to be more painful and the mother is more likely to request pain medication or an epidural
Pitocin needs to be given by IV and the mother/baby will have to be constantly monitored, which makes it much hard to move around
Increases the chance of having a ruptured uterus
Increases the chance of the baby being in a bad position for delivery
Baby is more likely to have a depressed fetal heart rate pattern
More likely to need a cesarean
Increases risk of fetal distress, because there is less oxygen availableThe choice to utilize pitocin is a personal, and often controversial one. It is not a decision to be taken lightly, as it does carry significant risks, however it can also help women avoid infection and C-Sections. Be sure to talk openly with your care-provider before your birth about how and when he or she typically uses pitocin. If it is suggested as an option during labor, feel free to ask about alternatives so you can explore all of your options and make the best possible education decision.

*The information expressed here are my own views and are not intended to be substituted for medical advice. 

Cervidil

Cervidil

What is Cervidil?

Cervidil is the trademark name that Forest Laboratories, Inc. uses for prostaglandin E2 vaginal insert. It is a small rectangular pouch with a retrieval cord that looks similar to a tampon. It is inserted into the vagina.

Prostaglandin is one of the chemicals that play a part in ripening the cervix. A ripe cervix is soft and stretchy, ready to respond to uterine contractions. When given vaginally, cervidil may help to ripen the cervix.

Why choose Cervidil?

Cervidil is used to "ripen" the cervix when it is agreed that your baby is safer to be born than to remain in the uterus. Cervidil is the first step in a two part induction process when the cervix is not ready to respond to contractions.

Cervidil may increase the activity of non-productive contractions when no other labor stimulation agent has been used.

Cervidil allows the mother to use the medication for the prescribed amount of time an then remove it. In some cases a mother may be able to go home after administration to wait for labor to start. More often she will be admitted and the Cervidil will be administered overnight.

How effective is Cervidil?

Because prostaglandin E2 helps to make the connective tissue of the cervix more pliable while also stimulating contractions, it is more effective than synthetic oxytocin at inducing labor. The rates were similar for women giving birth within 12 hours, but more women had given birth within 24 hours with prostaglandin and the difference is even more pronounced at 48 hours. In addition, the rate of instrumental vaginal delivery is lower with women induced with prostaglandin E2.

This data sheet on Cervidil offers information from research trials about its efficacy.

Risks of using Cervidil

Risks for Mother


* Gastrointestinal effects such as nausea, vomiting and diarrhea.

* Small risk of uterine hyper stimulation.

* Requires continuous monitoring of baby's heart rate which decreases mobility.

* Another form of prostaglandin E2, Prepidil, cannot be removed if hyper stimulation occurs.

Risks for Baby

* Uterine hyper stimulation can cause abnormal fetal heart rate.

My Opinion

It's no secret that I am not a big fan of unnecessary induction. I really believe that most babies will come the exact time they are meant to and in most cases I lean towards trusting nature over science. With that said in times where induction is necessary Cervidil is a good option to get things going. I have often seen in used in conjunction with Pitocin (stay tuned for my Pitocin post). Typical administration is to inject the Cervidil and if contractions haven't started or increased to productive in 12 hours, add Pitocin. I always encourage Mom's to talk with there care providers and indpendlty research all of your options before labor and delivery begin.

Prostaglandin also occurs naturally in Seamen, and will be discussed further in my natural induction methods post.

References:
Goer, Henci. The Thinking Woman's Guide to a Better Birth. 1999. New York: The Berkley Publishing Group.
Enkin, Keirse, Nilson, Crowther, Duley, Hodnett and Hofmeyr. A guide to effective care in pregnancy and childbirth Third Edition. 2000. Oxford: Oxford University Press.

The Bishop Score - How you can decrease your chance of having a C-Section

This is my first post in a series about induction.

What is a Bishop's Score and How Does it Relate to Inducing Labor?

It amazes me how many inductions are scheduled with out any mention of the bishop score. This is system which places numeric value on factors such as effacement, dilation, cervical position, station, etc. to provide a guideline to determine how effect an induction would be in resulting in a vaginal delivery. Obtaining a bishop score is painless, and takes virtually no time, since your physician or midwife is likely doing vaginal exams anyway. It is my opinion that before any elective induction is schedule the bishop score should be discussed. Read below to find out how they are determined and check out the C-Section rates for the various scores.

A Bishop's Score refers to a group of measurements used to determine whether a woman may have a successful vaginal delivery and whether labor ought to be induced. Bishop's Score is based on station, dilation, effacement, position and consistency.

Station is a term used to describe the descent of the baby into the pelvis. An imaginary line is drawn between the two bones in the pelvis (known as ischial spines). This is the "zero" line, and when the baby reaches this line it is considered to be in "zero station." When the baby is above this imaginary line it is in a minus station. When the baby is below, it is in a "plus" station. Stations are measured from -5 at the pelvic inlet to +4 at the pelvic outlet.

Dilation is measured in centimeters, from 0 to 10. Your cervix is fully open and you should be able to push when it is dilated to 10 centimeters. Occasionally, a physician will measure dilation in "fingers." Dilation often begins days or weeks before labor actually begins. At first, the progress may be very slow. Some women may be dilated 2 to 3 centimeters long before labor. Once active labor begins, you will begin to dilate more quickly.

Effacement refers to the softening and thinning of the cervix. You won't feel this happening; it may only be measure with a vaginal exam. Effacement is measured in percent. When your cervix is normal, it is considered to be 0% effaced. When you're 50% effaced, your cervix is half its original thickness. When your cervix is 100% effaced it is completely thinned out and you are ready for vaginal delivery.

Position refers to the positioning of the cervix. If the cervix faces front (anterior) it is more favorable, while posterior is less favorable.

Consistency of the cervix is measured on a scale of firmness from firm to soft. The softer the cervix is, the better the chance of vaginal delivery.

The Bishops Score generally follows this scale:

Score Dilatation Effacement Station Position Consistency

0 closed 0 – 30% -3 posterior firm
1 1-2 cm 40 -50% -2 mid-position moderately firm
2 3-4 cm 60 -70% -1,0 anterior soft
3 5+ cm 80+% +1,+2

A point is added to the score for each of the following:
Preeclampsia
Each prior vaginal delivery

A point is subtracted from the score for:
Postdates pregnancy
Nulliparity
Premature or prolonged rupture of membranes
Interpretation

cesarean rates: first time mothers women with past vaginal deliveries

scores of 0 – 3: 45% 7.7%
scores of 4 - 6: 10% 3.9%
scores of 7 - 10: 1.4% .9%

Induction is generally attempted when a mother has a favorable Bishop's score. A mother may be given misoprostol, cytotec or prostaglandin gel to help ripen the cervix and improve the score. A score of five or less is said to be "unfavorable." If induction is indicated, the mother would be a candidate for a cervical ripening agent. These are usually introduced one or two nights before the planned induction. A score of eight or nine would indicate that the cervix was very ripe and induction would have a high probability of being successful.

Your physician can assist you in understanding and interpreting your own Bishop's Score.

4 Sisters, 4 Babies, 4 Days

Wow, what and amazing week! I just love thinking about how close those 4 kids will be, what a fantastic bond....and just think about the joint birthday party potential! :) Congrats to all the new mommies and daddies!!

CHICAGO — Four sisters from one family have each given birth within four days.

That's four sisters, four babies, four days.

The same obstetrician delivered the babies of three of the sisters — 27-year-old Lilian Sepulveda of Franklin Park, 29-year-old Saby Pazos of Bellwood and 24-year-old Leslie Pazos of Stone Park.

The three sisters gave birth at Westlake Hospital in Melrose Park on Friday and Saturday. A fourth sister — Heidi Lopez — had her baby on Monday in California.

Family members say the women didn't plan the timing. Obstetrician Dr. Jean Alexandre, who delivered the three babies in suburban Chicago, calls the births "very unusual but wonderful at the same time."

http://www.foxnews.com/story/0,2933,599182,00.html