8/3/2019 Cytotec is a Man Made Pros Tag Land In

http://slidepdf.com/reader/full/cytotec-is-a-man-made-pros-tag-land-in 1/16

  Cytotec is a man made prostaglandin.It is approved by the FDA for ulcer prevention by people

taking nsaid. It is not approved for a labor induction. It can cause uterine ruptures, severe

vaginal bleeding, retained placenta, shock and even fetal and maternal death. It softens the

cervix and stimulates uterine contractions. It can cause hyperuterine reaction. If given in pill

form and can’t be reversed should there be a problem. All induction agents cause uterine

contractions – this can affect the blood supply to the fetus, especially if contractions become

very frequent. Induction agents therefore need to be used with great care and with close fetal

monitoring. One of the problems with induction using prostaglandins (such as dinoprostone or

misoprostol) is that once given, the process is difficult to reverse. In contrast, oxytocin has a

half-life of about 10 minutes and is administered via intravenous drip, which can be stopped

immediately in the event of adverse reaction.[2]

 

 

  Be aware that death and serious adverse reactions, including increased heart rate, transient

hyperglycemia, hypokalemia, cardiac arrhythmias, pulmonary edema, and myocardial ischemia

have been reported after prolonged administration of oral or injectable terbutaline to pregnant

women.

  Treatment with terbutaline administered by injection or by continuous infusion pump should not

be used beyond 48 to 72 hours. In particular, injectable terbutaline should not be used in theoutpatient or home setting.

  There are certain obstetrical conditions where the healthcare professional may decide that the

benefit of terbutaline injection for an individual patient in a hospital setting clearly outweighs the

risk.

  Oral terbutaline is contraindicated for the treatment or prevention of preterm labor.

  Report adverse events involving terbutaline to the FDA MedWatch program using theinformation in the "Contact Us" box at the bottom of this page.

Cervidal is a product inserted in and can be take out at any timeCervidil may increase the risk of uterinerupture, which leads to fetal death about 1 in 4 cases. It may cause uterine hyperstimulation, which cancause abnormal fetal heart rate. The use of Cervidil requires the constant monitoring of your baby's heartrate, which greatly decreases your mobility during labor. Cervidil Vaginal Insert (dinoprostone, 10 mg)is indicated for the initiation and/or continuation of cervical ripening in patients at or near term inwhom there is a medical or obstetrical indication for the induction of labor. 

Pitocen is IV and can be stopped. Pitocin is indicated for the initiation or improvement of uterinecontractions, where this is desirable and considered suitable for reasons of fetal or maternalconcern, in order to achieve vaginal delivery. It is indicated for (1) induction of labor in patients with amedical indication for the initiation of labor, such as Rh problems, maternal diabetes, preeclampsiaat or near term, when delivery is in the best interests of mother and fetus or when membranes are

prematurely ruptured and delivery is indicated; (2) stimulation or reinforcement of labor, as inselected cases of uterine inertia; (3) as adjunctive therapy in the management of incomplete orinevitable abortion. In the first trimester, curettage is generally considered primary therapy. Insecond trimester abortion, oxytocin infusion will often be successful in emptying the uterus. Othermeans of therapy, however, may be required in such cases. Severe allergic reactions (rash; hives;itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); bloodclotting problems; changes in heart rate; heavy or continued bleeding after childbirth; irregularheartbeat; pooling of blood in the pelvis; ruptured uterus.

8/3/2019 Cytotec is a Man Made Pros Tag Land In

http://slidepdf.com/reader/full/cytotec-is-a-man-made-pros-tag-land-in 2/16

Fetus: Bleeding in the eye; irregular heartbeat; seizures; slow heartbeat.

Anaphylactic reaction Premature ventricular contractions

Postpartum hemorrhage Pelvic hematoma

Cardiac arrhythmia Subarachnoid hemorrhage

Fatal afibrinogenemia Hypertensive episodes

Nausea Rupture of the uterus

Vomiting

Excessive dosage or hypersensitivity to the drug may result in uterine hypertonicity, spasm, tetaniccontraction, or rupture of the uterus.

The possibility of increased blood loss and afibrinogenemia should be kept in mind when

administering the drug.

Severe water intoxication with convulsions and coma has occurred, associated with a slow oxytocininfusion over a 24-hour period. Maternal death due to oxytocin-induced water intoxication has beenreported.

The following adverse reactions have been reported in the fetus or neonate:

Due to induced uterine motility: Due to use of oxytocin in themother:

Bradycardia Low Apgar scores at five minutes

Premature ventricular contractions and other arrhythmias Neonatal jaundice

8/3/2019 Cytotec is a Man Made Pros Tag Land In

http://slidepdf.com/reader/full/cytotec-is-a-man-made-pros-tag-land-in 3/16

Permanent CNS or brain damage Neonatal retinal hemorrhage

Fetal death

Neonatal seizures have been reported with the use ofPitocin.

The genesis of amniotic fluid embolism is described in Williams Obstetrics : "Vigorous uterine contractionscombined with a long, firm cervix and a birth canal that resists stretch may lead to uterine rupture orextensive lacerations of the cervix, vagina, vulva or perineum. It is in these latter circumstances that therare condition of amniotic fluid embolism most likely develops."(8) Misoprostol is known to causeunusually vigorous contractions of the uterus, and in the autopsy reports in the four cases of amniotic fluidembolism in this paper, microscopic examination showed hemorrhages and lacerations in the cervix andmyometrium. (Wagner, 2009)

Medical literature "indicated that either ether or chloroform could increase the danger of hemorrhage,could lead to protracted labor, could decrease uterine contractions, and could cause a newborn breathingdifficulty."[ the use of choloform or ether for relief of pain, during mid 19

thcentury. Not all doctors used,

many were concerned about the effects on women and fetus.

Twilight-sleep was a combination of scopolamine and morphine What doctors had not yet realizedthat twilight-sleep was the first step to complete control by the physician. Twilight-sleephad to be administered in a hospital and the birth had to be overseen by physician andstaff. Women were completely unconscious and so did not experience birth. Thewidespread use of twilight-sleep also paved the way for other anesthesia. Byencouraging women to go to sleep, women were further distanced from their bodies.They lost control over a process as natural as any other bodily function.

1957: Thalidomide, a drug developed to help women overcome the symptoms of morning

sickness during pregnancy, is first marketed in West Germany. Forty-six countries approve its

use before thalidomide's terrible side effects become apparent.

Thalidomide is a powerful synthetic tranquilizer, originally developed by Ciba, a Swiss

pharmaceutical company. Unable to make it commercially profitable, Ciba gave up on the drug.

 A German company, Chemie Gruenenthal, took over and eventually began marketing

thalidomide as a "completely safe" method for warding off morning sickness.

8/3/2019 Cytotec is a Man Made Pros Tag Land In

http://slidepdf.com/reader/full/cytotec-is-a-man-made-pros-tag-land-in 4/16

 

Inadequate testing procedures were to blame for what followed. Had the pharmaceutical labs

done a  better job of testing thalidomide, they would have discovered that the drug's molecules

 were able to penetrate the placental wall, especially during the first trimester of pregnancy when

the fetus is largely unformed.

This invasion of the womb resulted in a variety of profound birth defects, including deformed

and missing limbs, deafness, blindness, cleft palate and a slew of internal problems.

The story of thalidomide in the USA is very different from the European experience. Fortunately, Dr.Francis Kelsey of the US Food and Drug Administration was more alert and would not accept that thedrug had been adequately tested for manufacture and distribution there.

As a result, only about 20 malformed babies were born in America and these were as a result of limitedclinical trials that were carried out.

Hypnotic doses of barbiturates do not appear to impair uterine activity significantly during labor. Fullanesthetic doses of barbiturates decrease the force and frequency of uterine contractions.Administration of sedative-hypnotic barbiturates to the mother during labor may result in respiratorydepression in the newborn. Premature infants are particularly susceptible to the depressant effectsof barbiturates. If barbiturates are used during labor and delivery, resuscitation equipment should beavailable.

Data are not available to evaluate the effect of barbiturates when forceps delivery or otherintervention is necessary or to determine the effect of barbiturates on the later growth, development,and functional maturity of the pediatric patient. Seconal, abien, benzos(valium(diazepam)

versed(midazolam) reversal flumazenil

The use of flumazenil to reverse the effects of benzodiazepines used during labor and delivery is notrecommended because the effects of the drug in the newborn are unknown.

 What are the potential side effects of opiates?

Opiates may have the following side effects on the mother:

  Nausea

  Vomiting

  Itching

  Dizziness

  Sedation

  Decreased gastric motility

  Loss of protective airway reflexes

8/3/2019 Cytotec is a Man Made Pros Tag Land In

http://slidepdf.com/reader/full/cytotec-is-a-man-made-pros-tag-land-in 5/16

  Hypoxia due to respiratory depression

 

How will the opiates affect my baby?

Throughout pregnancy, you were probably aware that medications you consumed could potentiallyaffect your baby. Opiates also cross the placenta during labor and can cause the following sideeffects to your baby:

  Central nervous system depression

  Respiratory depression

  Impaired early breastfeeding

  Altered neurological behavior

  Decreased ability to regulate body temperature

For these reasons, your baby may need medication to counteract the opiate effects. Naloxone is a

medication that when given in small doses can reverse the respiratory depression that opiates maycause in the baby. This drug is usually given intravenously to your baby. The effects of naloxone canbe seen within a few minutes and can last up to 2 hours.

 What types of opiates are used during childbirth?

The most frequently used narcotic medications are:

  Morphine

  Stadol

  Fentanyl

  Nubain

  Demerol

Demerol:

Demerol is a popular choice for pain relief during labor. Demerol alters how you recognize the painyou are experiencing by binding to the receptors found in your central nervous system. Theadvantages of Demerol include:

  Can be given by injection into the muscle, the vein or by a Patient Controlled Analgesia(PCA) pump

  Demerol starts working in less than 5 minutes

How can Demerol affect me and my baby? Demerol can cause drowsiness, nausea, vomiting, respiratory depression, and maternal hypotension(low blood pressure). If injected within 2-4 hours of delivery, Demerol has been found to causebreathing difficulties in babies. Resp. depression in mom and baby, seizures, cardiovascularcollapse, cardiac arrest

Morphine:

8/3/2019 Cytotec is a Man Made Pros Tag Land In

http://slidepdf.com/reader/full/cytotec-is-a-man-made-pros-tag-land-in 6/16

In recent years, morphine has not been routinely used as a method of pain relief during laborbecause it has been found to depress the baby’s ability to breathe. Overdose, respiratory arrest,cardiac arrest.

Stadol:

Stadol has been found to relieve pain when given in the first stage of labor. This narcotic isconsidered more potent then Demerol. It is usually given intravenously in small doses, usually 1 to 2mg. The advantages of using Stadol include:

  Starts working in less then five minutes

  Is a sedative

  Has minimal fetal effects

  Cause minimal nausea

How can Stadol affect me and my baby? Stadol can cause the mother to have respiratory depression, dizziness and dysphoria (a state of

feeling unwell and unhappy). Stadol can cause respiratory depression in the baby.

Fentanyl:

Fentanyl is a synthetic opiate that provides mild to moderate sedation. The advantages of usingFentanyl include:

  Begins working quickly (although, usually only lasts 45 minutes)

  Minimal sedation

  Minimal fetal effects

How can Fentanyl affect me and my baby?You and your baby may experience some sedation and/or nausea. According to Danforth’s

Obstetrics and Gynecology , baby’s born to mothers who used Fentanyl to relieve pain during labor were less likely to need naloxone (medication to help with breathing) than babies born to motherswho used Demerol during childbirth.

Nubain:

Nubain is a opiate agonist-antagonist that is comparable to morphine. The advantages of usingNubain include:

  Begins working within 5 minutes of administration

  Minimal nausea

  Minimal fetal effects

How can Nubain affect me and my baby?Nubain can cause the mother to have sedation and dysphoria (a state of feeling unwell andunhappy). Respiratory depression

How will my pain medication be given?

8/3/2019 Cytotec is a Man Made Pros Tag Land In

http://slidepdf.com/reader/full/cytotec-is-a-man-made-pros-tag-land-in 7/16

Medication can be given in any of the following ways:

  A one time injection into the spinal column

  IV or Intravenous placement into a vein on the back of the hand or arm. A needle is insertedinto a vein with a plastic tube connected to a bag holding fluid that slowly drips into your body.In a hospital setting, an IV is typically placed to help you stay hydrated throughout labor andassure access to administer medications if they are needed.

  Patient Controlled Analgesia (PCA) pump is a way a mother can control when she receivespain mediation during labor by pushing a button. The advantage of having a PCA is that itprovides a sense of control and the mother does not have to wait for the nurse to bring painmedication. Fentanyl and Demerol are common narcotics that can be given through a PCApump. The pump is pre-programmed based on the drug dosage into amounts small enoughto relieve pain without releasing too much medication.

  Narcan for resp depression.

  Epidurals may cause your blood pressure to suddenly drop. For this reason your bloodpressure will be routinely checked to make sure there is adequate blood flow to your baby. If

this happens you may need to be treated with IV fluids, medications, and oxygen

  You may experience a severe headache caused by leakage of spinal fluid. Less than 1% ofwomen experience this side effect from epidural use. If symptoms persist, a specialprocedure called a “blood patch”, an injection of your blood into the epidural space, can bedone to relieve the headache

  After your epidural is placed, you will need to alternate from lying on one side to the other inbed and have continuous monitoring for changes in fetal heart rate. Lying in one position cansometimes cause labor to slow down or stop

  You may experience the following side effects: shivering, ringing of the ears, backache,soreness where the needle is inserted, nausea, or difficulty urinating

  You may find that your epidural makes pushing more difficult and additional interventions

such as Pitocin, forceps, vacuum extraction or cesarean may become necessary

  For a few hours after birth the lower half of your body may feel numb which will require you towalk with assistance

  In rare instances, permanent nerve damage may result in the area where the catheter wasinserted.

  Though research is somewhat ambiguous, most studies suggest some babies will havetrouble "latching on" which can lead to breastfeeding difficulties. Other studies suggest thatthe baby may experience respiratory depression, fetal malpositioning; and an increase in fetalheart rate variability, which may increase the need for forceps, vacuum, cesarean deliveriesand episiotomies.

  How can my epidural affect labor? Your epidural can cause your labor to slow down and

also make your contractions weaker. If this happens you may be given the medicine Pitocinto help speed up labor.

  How can an epidural affect my baby? As stated above, research on the effects ofepidurals on newborn health is somewhat ambiguous and many factors may be contributingto newborn health at the time of birth. How much of an effect these medications will have isdifficult to judge and could vary based on dosage, how long labor continues and individualbabies. Dosages and medications vary, so concrete information from research is lacking.Studies reveal that some babies may initially have trouble "latching on" among otherdifficulties with breastfeeding. While in-utero, they may become lethargic and have trouble

8/3/2019 Cytotec is a Man Made Pros Tag Land In

http://slidepdf.com/reader/full/cytotec-is-a-man-made-pros-tag-land-in 8/16

getting into position for delivery. These medications have been known to cause respiratorydepression, and decreased fetal heart rate in newborns. Though the medication may notharm the baby, the baby may experience subtle effects like those mentioned above.

However, as with any medication or procedure there are also risks. The major complication fromepidural anesthesia is a drop in the mother's blood pressure. Most hospitals will try to prevent this by

giving the mother IV fluids prior to the administration of the epidural. Sometimes an epidural canlead to fetal distress, fetal malposition, increased risk of forceps or vacuum extraction, episiotomy,and in some studies, and increased risk of cesarean section.

As if the risks these drugs pose on your unborn child are not enough, there are further side effects to themother. Pitocin has a black box warning stating that it should not be used unless medically necessary.Medically necessary means that there is a serious risk to the mother or baby's health. Most women whoare induced with Pitocin require an epidural as it makes uterine contractions unnaturally strong. Theseunnaturally strong and frequent contractions can also result in uterine tearing, vaginal lacerations andsevere postpartum bleeding. Side effects of Pitocin also include seizures, coma and maternal death.

What Happens When the Drugs Do Not Work 

More often than not, Pitocin induced labors do not work. Chances of an induced labor resulting incesarean section for a first time mother triple. For some mothers, the increased stress of frequent andstrong contractions puts much unneeded stress on herself and the unborn child. This will result in yourdoctor opting for a c-section whether you want one or not.

For example, Pitocin induced labors have demonstrated a decrease in blood flow to the woman's uteruswhich in turn gives the baby a low heart rate. Pitocin has also been proven to cause permanent centralnervous damage to the unborn child in some cases.

Medically necessary means that there is a serious risk to the mother or baby's health. Most women whoare induced with Pitocin require an epidural as it makes uterine contractions unnaturally strong. Theseunnaturally strong and frequent contractions can also result in uterine tearing, vaginal lacerations andsevere postpartum bleeding. Side effects of Pitocin also include seizures, coma and maternal death.

What Happens When the Drugs Do Not Work 

More often than not, Pitocin induced labors do not work. Chances of an induced labor resulting incesarean section for a first time mother triple. For some mothers, the increased stress of frequent andstrong contractions puts much unneeded stress on herself and the unborn child. This will result in yourdoctor opting for a c-section whether you want one or not.

Wait for Your Baby to Be Ready 

Yes, in today's fast paced world it may seem illogical to wait around for your child to be born. The fact is,

your baby will come when he or she is ready to be born. Labor is a natural event that will occur when thetime is right.

It is also worth noting, that women should extensively question their doctor if they suggest inducing labor.If you feel that your doctor has recommended Pitocin to help fit his schedule, then you need to voice yourconcerns and let him know how you want your labor to unfold.

8/3/2019 Cytotec is a Man Made Pros Tag Land In

http://slidepdf.com/reader/full/cytotec-is-a-man-made-pros-tag-land-in 9/16

 

A variety of health care professionals may work in the birth center setting — such as

registered Benefits for baby

  Baby may be less groggy and more alert after birth.

  Baby may have an easier time latching on and breastfeeding.

  Baby will not have narcotics or other medications in his system.

  Baby will have a lower risk of fetal distress during delivery.

  Baby’s APGAR scores may be higher.

Benefits for mom

  Mom can walk around, soak in the tub, go to the bathroom, and change positions during

labor.

  Pain can be beneficial to mom as it helps her to know what stage of labor she is in, when

she may need to shift positions, and when it is time to push.

  Mom does not lose sensation in her lower body should not need a catheter.

  Mom will not have to worry about having a post-epidural headache.

  Mom can get up and walk around shortly after birth.

  There may be less chance of having nausea, vomiting, dizziness or other side effects

associated with pain medications.

  Mother will be less groggy after birth.

  Although there is some debate on this, having a natural childbirth may reduce the chanceof needing a csection.

  Mom may have a more positive birth experience or feel empowered by having natural

childbirth. Some women compare natural childbirth with running a marathon. The sense

of accomplishment can be a rewarding ev 

nurses, certified nurse midwives, and doulas (professionally trained providers of labor support and/or

postpartum care) who act as labor assistants.

Studies indicate that getting continuous support during labor from a trained and experienced woman,

such as a midwife or doula, can mean shorter labor, less (or no) medications, less chance of needing a

C-section, and a more positive feeling about the labor when it's over.

8/3/2019 Cytotec is a Man Made Pros Tag Land In

http://slidepdf.com/reader/full/cytotec-is-a-man-made-pros-tag-land-in 10/16

6. Research has shown that in mothers who have natural childbirth, babies are more alert 

and show more interest in such as sucking and massaging the mother's breasts, as well as

the actual length of time they spend nursing within the first 90 minutes.

Benefits of Medicated Birth

pushing

1. Mothers who are having a very long labor can benefit from using pain medication to

get some rest before the stage.

2. If the mother is tensing up during contractions, pain medication can help her relax so

that her body is not fighting against the labor.

3. If the mother has a lot of fear about birth or issues from her past, it may affect the

progress of her labor. At times, medication may help to ease her anxiety.

Additional Thoughts

On a personal note, I can share my own experiences of natural childbirth twice. The pain was

intense, but it was not impossible to manage. My obstetrician was very supportive of natural

childbirth and his encouragement had a great impact on me.

I have also attended over 300 births as a birth doula supporting women during labor in the last 11

years. About 70% of those women had natural childbirth. In no specific order, I want to share

some of my additional thoughts with you based on what I have seen and experienced.

pain relief techniques 

Mothers have the ability to give birth naturally. Very often the things done or said to her

inhibit her ability to do this very important job (i.e., restricting her movement, restricting

, lack of support or encouragement as well as a lack of non-medical .)

Pain medication is a wonderful resource in very difficult and long labors when the mother

simply has no energy left to birth her baby. I have seen several births like this and would

have used an epidural myself had I had active labor last for days.

pushing 

Pain medication, such as , carry with them hefty sacrifices and intervention such as

restricting movement to bed, IV fluids and increasing her need for pitocin. Epidurals also

increase the mother's need for instruments to be used such as vacuum extractors or

forceps, since is more difficult.

I very seldom have clients in my doula practice who have natural childbirth with a firstbaby, choose to use pain medication with the next birth. Once they have realized the

benefits of natural childbirth, they do not tend to go back.

From what I have seen, pain medication solves one big problem - pain. However I

wonder when we take the pain away, if we are also removing helpful feedback for the

mother. (see #2 above - Benefits of Natural Birth) Is it not like a person who takes

medication for headaches (ie.. treating the symptom) instead of finding out why they are

getting headaches?

8/3/2019 Cytotec is a Man Made Pros Tag Land In

http://slidepdf.com/reader/full/cytotec-is-a-man-made-pros-tag-land-in 11/16

Though I firmly believe that women have the ability to have natural childbirth, it should

never be used as a scale to judge the woman either as a person or as a mother. How she

lives her life, treats others and raises her family tells us much more about who she is than

whether or not she used pain medication in labor.

So, this author and mother wishes to simply encourage every mother to take this decisionseriously and evaluate for yourselves the benefits and downsides to both natural birth and

medicated birth before you jump to any hasty conclusions.

I firmly believe that there are two valid sides to consider and that you should discuss this issue at

length with your spouse or birthing partner, family, doula and primary provider as well as factor

in the circumstances of your own labor before you decide. In one study, mothers who changed

positions frequently during labor and birth demonstrated a 50% reduction in time progressing from 3cm

to 10cm dilatation.(1) 

Research also demonstrates that birthing in a non-supine position can lead to lower levels of reported

 back pain, reduced pain during pushing, fewer perineal tears which also serves to reduce the need for

suturing or surgical repair of the pelvic floor and overall easier pushing.(2) When unrestricted birth

positions are available, mothers are better able to adapt to changes throughout the first and second stages

of labor. 

THE CURSE OF CONVENIENCE

While US hospital practices are beginning to come in line with research evidence regarding the

importance of mobility during both portions of first stage early labour and active labor , with 24% of

mothers reporting walking around or moving once they were admitted to the hospital and regular

contractions had begun,(3) , such is not the case for second stage labor.(3, 4) 

For the majority of US women giving birth in hospitals, the most-used birth positions for second stage

labor, the birth of the baby, remain lithotomy (flat-on-back with legs pulled back to either side) and semi-

sitting, also known as the C-position (resting on tailbone with body curled in the shape of a C) which are

used in 65.9% of vaginal births.(4, 5, 6) 

"More than half (57%) of women who gave birth vaginally reported that they lay on their backs while

pushing their baby out and giving birth. Slightly more than one-third (35%) indicated they gave birth in a

8/3/2019 Cytotec is a Man Made Pros Tag Land In

http://slidepdf.com/reader/full/cytotec-is-a-man-made-pros-tag-land-in 12/16

propped up (semi-sitting) position, while the remainder gave birth either on their side (4%), upright (e.g.

squatting or sitting) (3%) or in a hands-and-knees position (1%). "

Listening to Mothers II: Report of the Second National U.S. Survey of Women's Childbearing Experiences.(3) 

Unfortunately, the use of these birth positions is rooted in convenience for doctors, not research

evidence.(7) While they allow doctors easiest access to the birthing woman, they are detrimental for many

reasons. Foremost is that the pelvic outlet is up to 30% smaller; it forces the woman to put direct pressure

on her sacrum (tailbone) which flexes it upward, forcing it into a curved position which restricts the

diameter of the pelvic outlet and can inhibit the baby's descent through the maternal pelvis. The birth

canal is effectively placed in an "uphill" orientation, forcing the mother to push upward against gravity to

expel the baby.

When a woman's legs are held back, a woman is also at risk of developing or worsening symphysis pubic

dysfunction if excessive, unequal force is applied to either leg. The pubic symphysis is the location where

the two sides of the pelvis meet at the groin.

While in lithotomy, if too much pressure is exerted on the woman's legs, excessive hip abduction and

external rotation occur which can further distract the joint, forcing the sides of the pelvis apart, resulting

in excruciating postpartum pain as well as prolonged supra-pubic pain for the mother and lasting

complications after birth such as difficulty walking severe enough to require the use of crutches or a

wheelchair, or more rarely, bladder dysfunction.(8) Dorsal lithotomy also restricts a woman from freely

moving and puts greater pressure on the perineum, all of which can lead to other unnecessary

interventions or complications like tearing, episiotomy , forceps delivery, or vacuum extraction.(9, 10, 11) 

Mothers who elect epidurals are at higher risk for developing symphysis pubic dysfunction. If the dosage

of drugs is too high, she can lose all sensation below the waist, which may leave her unable to sense whentoo much force is being applied or whether she is pushing with excessive effort. Her mobility is also

greatly restricted which in turn further restricts her choice of birth positions, especially during second

stage labor, the pushing stage. 

8/3/2019 Cytotec is a Man Made Pros Tag Land In

http://slidepdf.com/reader/full/cytotec-is-a-man-made-pros-tag-land-in 13/16

8/3/2019 Cytotec is a Man Made Pros Tag Land In

http://slidepdf.com/reader/full/cytotec-is-a-man-made-pros-tag-land-in 14/16

 

SQUATTING POSITIONS

Squatting positions are helpful in opening the pelvis to allow a baby to find the optimal position for

 birth. Squatting can be performed through use of a birth companion or a tool such as a squatting bar.

SIDE-LYING POSITIONS

Lateral or Side-lying positions are beneficial for resting during a long labour, promoting body-wide

relaxation, and minimizing extra muscular effort. They are best used in the latter stages of labor since

gravity isn't able to speed the process.

UPRIGHT OR STANDING POSITIONS

Upright positions for childbirth use gravity to the mother's advantage. They help the baby drop into the

pelvis and prevent pressure from being concentrated in a particular spot. They also allow the birth

companions to apply other comfort measures easily. They represent the most under-used birth positions.

Top of Page 

Changing positions, and moving around during labor and birth, offers several

benefits. Some are obvious to the mother in labor: increased comfort / reduced pain,

distraction, and an enhanced sense of control: merely having something active to do

can relieve the sense of being overwhelmed and out of control. 

Beyond these advantages, there are equally important effects on the baby and on

the progress of labor. Changing positions during labor can change the shape and

size of the pelvis, which can help the baby’s head move to the optimal position

during first stage labor, and helps the baby with rotation and descent during thesecond stage. Swaying motions such as walking, climbing stairs, lunging, and

swaying back and forth are especially helpful with this. 

Movement and upright positions can help with the frequency, length, and efficiency

of contractions. The effects of gravity can help the baby move down more quickly.

8/3/2019 Cytotec is a Man Made Pros Tag Land In

http://slidepdf.com/reader/full/cytotec-is-a-man-made-pros-tag-land-in 15/16

Changing positions helps to ensure a continuous oxygen supply to the fetus, rather

than causing supine hypotension (low maternal blood pressure) by lying on your

back or even semi-sitting. 

Changing position can reduce the length of labor. Mendez-Bauer and Newton (1986)state: “duration of labor from 3 to 10 cm cervical dilation was about 50% shorter in

patients who alternated supine and standing, standing and sitting positions.” 

Rocking, Rhythmic Motion : In labor, it just feels better when mom rocks and sways in

rhythm to her breathing.

 Activity : Walking, climbing stairs, lunging. Activity helps baby to descend, helpsbaby to rotate into position for birth. In early labor, be active occasionally, but don’t

exhaust yourself by walking all through early labor. Walking is more effective inactive labor and transition when baby has descended far enough to put pressure onmom’s cervix and encourage the cervix to open. 

Positions for Back Labor (when mom has back pain, irregular contractions, or is

progressing slowly) 

Leaning Forward : Many women, especially those with back labor, find it mostrelaxing to lean forward during contractions.

Hands and knees / kneeling . Can relieve back pain, help a posterior baby rotate,allows easy access for backrubs / counterpressure massage; makes it possible tosway side to side, rock back and forth, or do pelvic tilts to aid rotation and increasecomfort. Having knee pads or kneeling on something soft will help knees. Can restupper body on pillows, chair, or birth ball. 

8/3/2019 Cytotec is a Man Made Pros Tag Land In

http://slidepdf.com/reader/full/cytotec-is-a-man-made-pros-tag-land-in 16/16