Eating, Drinking in Labor and IV

Not allowing food or drink in normal labor because of risk of rare aspiration in case you need general anesthesia isn’t evidence based care, but based on outdated hospital policy and is harmful. People in labor need and want to stay well nourished and hydrated if given the choice, instead of being then connected to an IV for at least the fluids. You are running your marathon in labor. The uterus like any muscle requires nutrients to meet its energy needs. According to research from sports medicine, it is well known that for example eating carbohydrates during exercise improves performance, reduces fatigue, and prevents ketosis. Power bars and nutrient dense snacks and hydrating fluids are given out to runners along their journey. No athlete or coach would advise performing while fasting.

When supported to labor normally and naturally, risk of emergency cesarean needing general anesthesia is very low in the healthy population. This policy of fasting before surgery began in the 1940s when general anesthesia was not as safe as today and dangerous aspiration of stomach contents was more common. These days anesthesia and airway management are much more sophisticated and improved, most cesareans don’t use general anesthetics, fasting in labor doesn't guarantee an empty stomach anyway and could lead to harmful acidic stomach juices if aspirated, and aspiration causing severe lung disease & death is extremely rare today in healthy people. Free standing birth centers and homebirth midwives do not have this no intake by mouth ’NPO’ policy.

But if you are healthy and birthing in the hospital, you can absolutely allow yourself the food and drink you need. It's your body, your birth and they don’t have authority over you. Best to discuss your preferences with your provider beforehand, in pregnancy, for if they don't support you, they may not support your other plans and you might want to change providers to those who practice evidence based care & are more in alignment with your philosophies. If you choose to stay with a provider and setting that does not allow food and drink, next option is to sneak it in, and ingest them in privacy (which might mean when you are in the bathroom).

Got to stay well nourished and hydrated in labor like running your marathon.

Best labor foods are basically - whatever you want that’s nourishing and easily tolerated! Mamas tend to prefer more bland foods but not always. But you do need lots of extra quality fuel in your tank for your journey. Some favorites include organic eggs, whole grain toast and dairy or nut butter, whole grain crackers and cheese, whole grain cereal or oatmeal and dairy or nut milk, maple syrup/honey, power and granola bars, nuts and dried fruit, trail mix, dark chocolate, frozen fruit bars, fruit that’s not messy to eat.

Best drinks include water, fruit juices, herbal tea with honey, bone or miso soup broth, coconut water, smoothies, organic Gatorade, homemade labor-aid - recipe in my Natural Birth Secrets book 2nd edition.

Many who labor in hospitals that don’t allow food and drink, need IV to prevent dehydration which can cause complications needing more interventions….unless you are sneaking enough food and drinking plenty orally. If you’re pregnancy and labor are healthy are proceeding naturally, IV fluids aren’t at all necessary and may cause harm. Even the American College of Obstetricians & Gynecologists, the American Society of Anesthesiologists and of course the World Health Organization all recommend encouraging oral fluids instead of IV.  Why is this not happening?  Routine IV can over hydrate and decrease newborn weight and blood sugar and cause maternal swelling - even in the breasts which impairs breastfeeding, can be uncomfortable, get inflamed, infiltrated or cause infection. IV restricts needed movement in labor, undermines mama’s confidence and sense of feeling empowered and healthy. I’ve posted before on the harmful practices of restricting needing nourishment and hydration. As long as you are keeping well hydrated by drinking, you can absolutely feel no qualms about declining that routine IV.

There is also no evidence to support the IV access called saline lock for low risk laboring mamas because in case of postpartum hemorrhage. The risk of that in this population is low, & needing treatment beyond natural remedies & medications without IV even lower. An excellent practitioner can start an IV in that rare emergency.

More details in my Online Guide to Pregnancy, Childbirth & Postpartum- sold separately or discounted bundle. I’ve taken everything I’ve learned, trained, and supported women locally for over 28 years in my private practice and I’ve poured all of my love, passion, knowledge, and experience into creating something truly special for you… my new and updated Pregnancy, Birth & Postpartum Guides. Same Beloved Content Plus Over 40 Added Bonus Videos! Buy Here Now!

They can be used via the mobile App or on your desktop! It’s the most up to date combination of Love Your Birth and Walk With Anne for Mamas online courses at a cheaper price! And they have an option for direct access to me for your questions and concerns!!

Whether you’re an experienced or new parent, there are hours of videos, workbooks, and PDFs to answer all of your questions. Everything is searchable, so you can just type or talk and it’ll bring you right to the exact moment in the video where I answer your question. It’ll blow your mind! If English is not your strongest language, you can even change the captions or even the audio to the language you prefer. The Prenatal, Birth & Postpartum Guides can be sold separately or in a bundle to buy only the section you need or get ALL of the guides for a limited-time offer of 50% off -> RIGHT HERE!

The key to a positive birth is feeling confident, strong, relaxed, and empowered during the entire process, regardless of the twists and turns it may take. I give my full heart and all I know in everything I do to support Mommas.

Gestational Diabetes Screen & Alternatives

Gestational diabetes is rare in the healthy population. Occurring in about 6% of pregnancies, it’s incidence is increasing largely due to the growing obesity, insulin resistance and adult onset diabetes, poor diet and lifestyle habits in the United States. There is much controversy around gestational diabetes, how it is screened for and diagnosed, and whether universal screening improves outcomes as opposed to testing when there are risk factors. If you do have it, however, treatment that includes appropriate actions like maintaining ideal weight, enhancing nutrition and exercise habits does make a significant difference in reducing the serious health consequences for both you and your baby.

In the US, it is standard of care that all women are screened for gestational diabetes at 24-28 weeks of pregnancy, although in some other European countries, only women with risk factors are screened. Screening that is most common involves giving pregnant women a “Glucola” drink that has 50 grams of sugar in the form of dextrose, and then testing blood sugar an hour later. Many holistic providers and the families they serve are concerned about this potentially toxic drink laden with chemicals that may make them feel sick, harm them and their babies, and can be associated with false positives that label them unnecessarily as high risk. This increases stress and angst, leads to more testing, monitoring and potentially other risky interventions. They want alternatives.

While it is within your right to refuse the test, you may want to consider screening for gestational diabetes in another way and discuss your concerns and options with your provider. If your provider is unwilling to work with you on this, consider switching providers to one who will. Although we do not have enough evidence that alternative screens are as accurate as using the more extensively studied Glucola drink to screen for diabetes of pregnancy, alternatives are not to be easily discounted, and may be a viable option in the low-risk healthy population. 

It is recommended according to evidence based care, but you have the right to make an informed decision to decline. The evidence does support screening for diabetes of pregnancy (GDM), as the benefits of accurate diagnosis and treatment outweigh any potential risks of the screening blood test.  Treatment does impove health and birth outcomes, whereas untreated abnormally high blood sugar levels in pregnancy carries substantial risks to mamas and babies. In the early 2000s, the US  only screened those with risk factors, but since the rates of GDM are increasing, and rarely found in those without risk factors, it has become standard to screen everyone. In the UK, only those with risk factors are advised to get the one 3 hour glucose tolerance diagnostic test. There is disagreement on the best screen to use, and what numbers are diagnostic. In the US, standard of care is to use a two step process in which the pregnant mama drinks 50 grams of a Glucola drink made of dextrose and blood is drawn 1 hour later.  Some practitioners and labs use 140 as the cutoff blood sugar level indicating a positive screen others use 135, and some use 130. The lower the cutoff number, the increased number of false positives along with a slight increased ability to diagnose true GDM, whereas the higher the cutoff number the opposite effect can result.  So it depends on the cutoff number your provider and lab uses, each showing different degrees of sensitivity and specificity. Levels of 135-140 are considered normal according to the Mayo Clinic, ADA, ACOG and other highly medical sources.

There is an option for screening for gestational diabetes by home testing. This involves checking your fasting blood sugar at home when you wake up in the morning, and then again 1 hour after eating your usual breakfast, lunch and dinner. While approved for monitoring blood sugar once diagnosed with diabetes, this method of screening is less studied and without clear standards. It is also more cumbersome and costly, as you need to get the supplies to do it, then take the time to get it right and keep records to discuss with your provider at your next prenatal visit. 

I discuss natural alternatives to the chemically laden Glucola drink in my Natural Birth Secrets book 2nd edition….but here are some basic tips if you want a more natural approach.

Alternative Gestational Diabetes Screening Options to Glucola

Starting three days before your appointment, increase complex carbohydrates such as whole grains, sweet potatoes and winter squash.

The meal before the test should only contain protein, vegetables, and unsweetened dairy. A veggie cheese omelet is a great choice! Avoid sweetened foods, fruit, and carbs. If this last meal before the test is lunch or dinner, you can eat a normal breakfast, but avoid carbs or sweets for the rest of the day.

Fresh Test is a new organic alternative that is also said to taste good, with only three ingredients. It has exactly 50-grams of glucose yet is void of unnecessary artificial additives, and is laboratory tested to be virtually equivalent to the Glucola without the unhealthy ingredients. To make your own drink that is most equivalent to Glucola without the chemical additives, dissolve 50 grams of organic dextrose in 8 ounces of water. You will need to do some math. If there are 20 grams of dextrose in 2 Tbsp for example, then you need 5 Tbsp of the powder. You ideally want dextrose, as it is the sugar made from corn that makes up the Glucola drink, and it is most bioidentical to the sugar in your blood called glucose. Therefore, it is the best alternative to screen for gestational diabetes as the standard Glucola drink does, according to the laboratory parameters designed and tested for this purpose.

Another alternative is to drink an equivalent amount of pure corn syrup dissolved in your tea, since the sugar in corn syrup is dextrose. You can find organic non GMO varieties in the health food store, but you still need to do some math, to get 50 grams of sugar total. 

Reputable research indicates that you can instead, eat 28 all natural organic jelly beans or enough that equals 50 grams of sugar, which is studied to be a reliable alternative to the 50 gram glucose beverage. It is not standardized as is the Glucola drink, amounts and types of sugars vary with each product, so you need to do the math and make sure you are eating 50 grams of sugar. The study was relatively small but results can certainly be considered.

Other less ideal options are iced tea, organic Gatorade or a cola drink that has 50 grams of sugar added in the form of added table sugar or dehydrated cane juice (sucrose) - similar to the kind of sugar in jelly beans. They are not a first choice because they are not as extensively researched, the form of sugar is different than dextrose, and thus may have a different effect on your blood sugar levels and test results, designed to screen for diabetes based on your response to dextrose. 

The blood test to screen for gestational diabetes was studied and formulated to test your reaction to ingesting 50 grams of dextrose. Sucrose is made up of 50 % glucose and 50 % fructose. You will need to read ingredients and nutrition labels to use an alternative, an important skill to develop anyway. And you still need to do some math, as the nutrition label might say something like 23 grams of sugar per 8 ounce serving. 

When going for sugars that are not dextrose extracted from corn, you can choose any sugar sweetened drink without added fruit juice. Fruit contains a different type of sugar called fructose that makes the test less accurate as it has a different effect on your blood glucose levels than does dextrose and sucrose. If you can not find or have no time to figure it out and have low risk of gestational diabetes, Snapple 16 oz raspberry peach drink is second choice. Although it is mainly sweetened with sugar (sucrose), it does have a little fruit juice, which again is mostly fructose.

Coconut water is another, but less than ideal option, as it contains sugar in the form of mostly sucrose and glucose, and it does have some fructose as in fruit. ZICO coconut water 16.9 ounces has 20 grams of sugar, so you would need to drink 2 ½ bottles. Honey is another alternative, but it is also not made up of an equivalent sugar - it is sucrose and fructose. Again, you need to read the label. Different honeys have different amounts of sugar per serving size. 

Hopefully there will be more studies on these alternatives, but for now, are listed here to consider with your provider, if for some reason you can not take the dextrose or corn syrup equivalent and you are healthy, with healthy weight and lifestyle, with low risk for diabetes. 

45 minutes before your appointment, eat the jelly beans or drink an amount that equals 50 grams total of sugar, then nothing until the blood test, which will be drawn 1 hour after you consumed the drink or candy.

If you have time, do some form of exercise like taking a brisk walk for 20-30 minutes after drinking, but before the test.

Bring a high protein, whole carbohydrate and healthy fat snack to eat after the test if needed, to keep blood sugar stable. This will help you avoid unpleasant symptoms once your blood sugar drops, like shakiness, lightheadedness, fatigue, anxiety and irritability.

Rest assured, most healthy pregnant women (about 94%) do not have gestational diabetes. A positive screen simply means you need more testing to confirm it or rule it out. And if you do have it, you can learn how to keep your blood sugar normal throughout the rest of your pregnancy and life. 

If you need more guidance,  schedule a coaching call with me.

Be informed, empowered & educated with my online course Guide to Pregnancy, Birth & Postpartum - sold separately or in a bundle.

Routine Labor Interventions Needing to be Abolished

Routine interventions in healthy labor and birth that need to be abolished when all is well include not allowing food and drink, IV, laboring and pushing in bed on back, artificially breaking your bag of water, continuous electronic fetal monitoring - including the admission and periodic strip, using the outdated Friedman curve to asses progress, forced coached pushing during the resting phase before the fetal ejection reflex - during the resting phase once diagnosed as fully dilated, episiotomy, immediate and premature cord clamping.

Many labor in hospitals that don’t allow food and drink, and need IV to prevent dehydration which can cause complications needing more interventions….unless you are sneaking food and drinking plenty orally. If you’re pregnancy and labor are healthy and proceeding naturally, IV fluids aren’t at all necessary and may cause harm. Even the American College of Obstetricians & Gynecologists (ACOG), the American Society of Anesthesiologists (ASA) & of course the World Health Organization (WHO) all recommend encouraging oral fluids instead of IV fluids.

Why is this not happening? Routine intravenous fluids can over hydrate and decrease newborn weight & blood sugar & cause maternal swelling - even in the breasts which impairs breastfeeding, can be uncomfortable, get inflamed, infiltrated or cause infection; IV restricts needed movement in labor, undermines mama’s confidence and sense of feeling empowered and healthy. It’s harmful practice to restrict needed nourishment and hydration during labor and birth. As long as you are keeping well hydrated by drinking, you can absolutely feel no qualms about declining that routine IV. There is also no evidence to support the IV access called saline lock for low risk laboring mamas because in case of postpartum hemorrhage. The risk of that in this population is low, and needing treatment beyond natural remedies and medications without IV even lower. An excellent practitioner can start an IV in that rare emergency.

Artificially breaking your water is another routine intervention that has no place in normal birth. The bag of amniotic fluid is intact for a reason. Let it break on its own. Most often that is late labor or during pushing. Occasionally it breaks before labor or rarely doesn't break at all, leading to an en caul birth with baby born in the amniotic sac.

If you’re told there is little to no risk - it's just nothing - you are not getting informed consent or evidence based care. Breaking it artificially without medical reason has drawbacks like causing more intense painful contractions and use of pain medication to cope, increased risk of infection and fetal distress from cord compression without the protective barrier around baby. It can also lead to malposition of baby which can lengthen labor. All this leads to a cascade of other interventions from IV Pitocon, continuous external or internal fetal monitoring using an electrode screwed into baby’s scalp, and c - section. If your cervix is not soft, thinned out or dilated much, the risks of all the above significantly increase. If baby is presenting other than head first, or not yet engaged in your pelvis, breaking the water can cause the cord to prolapse needing emergency cesarean to save your baby’s life. It's proposed benefit of speeding up labor is possible, but no guarantee. Is that worth the risks? Sometimes a provider tells you they want to do it to check for meconium - not uncommon, which baby at some time of stress in pregnancy or labor had its first bowel movement that mixes with amniotic fluid. If there are no signs of fetal distress and heart rate is reassuring, why create more stress? Knowing there is meconium stresses the team, then you, as they now treat you as having a complication that requires more intensive surveillance. There is no need for this when all is well. When there’s a problem, such as prolonged or stuck labor and you’re exhausted or not coping well, after trying all other more natural remedies, breaking the bag can help. But make sure you are well informed by preparing in advance with my Guide to Pregnancy Birth & Postpartum.

Continuous electronic fetal monitoring (EFM) is still routine despite the overwhelming amount of evidence against its use. Non reassuring fetal heart tones is the second most common reason for first time cesarean in the States, after “Failure to progress”’, many unnecessary as babies are born vigorous without any signs of it. Per the research there is no benefit for the admission and periodic 20 min continuous electronic fetal monitoring strip either, in healthy low risk pregnancies. It isn’t just ineffective, it’s uncomfortable, harmful, leads to increased continuous fetal monitoring, other risky interventions and cesarean without making any difference in baby outcomes. There is no evidence to show that this kind of fetal monitoring is safe or effective, and has contributed to huge increase in cesarean rate without improving Apgar scores, cord blood gases, admission to neonatal intensive care unit, low oxygen brain damage and cerebral palsy, stillbirth and newborn death. Even Obstetric professional organizations like ACOG acknowledges this and endorses intermittent fetal heart rate monitoring with a hand held doppler in low risk pregnancies and those laboring without complications. Furthermore, they encourage training of staff to its use to facilitate freedom of movement and increased comfort. NICE in the UK as well as SOGC in Canada agree there is no evidence to justify routine use of continuous EFM & that intermittent hands on listening to fetal heart rate is the preferred method of monitoring. NICE goes as far as opining that providers NOT even offer continuous EFM to laboring women low risk for complications. The ACNM says intermittent listening of baby’s heart rate with a hand held device should be the preferred method of fetal monitoring in those low risk for complications. Research is not clear & guidelines differ even regarding who does benefit from continuous fetal monitoring, when it comes to certain higher risk complications. This is not what is happening in reality of US hospitals due to a variety of factors from big business of EFM, understaffing, lack of training and equipment to outdated policies, providers not keeping current or practicing evidence based care.

I don’t like to disturb a laboring mama when all is well, just periodically need to check on baby. Some mamas prefer the fetoscope but it can best be assessed with mama on her back, & most in labor don’t want to get out of tub and be on their back. I love using it in pregnancy, but in labor, find most prefer the doppler so mamas can stay in the tub, shower or any position they want to, & everyone can hear that most often reassuring heartbeat. Distressed babies usually tell us whether we use hands on doppler or intermittent monitoring - which also allows for freedom of movement and the enormous benefits of upward mobile positioning plus more contact with and support from your provider. Research also documents the benefits of continuous labor support (which can involve plenty of privacy if that’s what you need!). Being a midwife fly on the wall is often the best intervention in normal labor, who can be there if needed, otherwise keep the fly on the wall role- with a huge heart.

Assessing progress by outdated rigid parameters needs to go. According to evidence based birth, the definition of a “normal” length of labor that has been used since the 1950s based on the biased, flawed Friedman curve is obsolete. The new, evidence-based definitions of normal labor should be used, and the vague term “Failure to Progress” should be abandoned. Yet still used in many hospitals.
If the laboring mama and baby are both healthy, and as long as the length of labor does not qualify as an arrested labor, laboring mamas should be treated as if they are progressing normally, even if what seems to be slow and prolonged for the mama. Pregnant mamas - especially first time vaginal birthers should be given more time in the early phase of labor, making sure they keep well nourished and hydrated, mobile and active but also rested, and also well supported with a doula or doula like care. I have many more suggestions in my online course Guide to Pregnancy, Childbirth & Postpartum, as this can be a challenge to mamas and their partners.

If you are wanting or needing an internal exam, six centimeters—not four centimeters—should be considered the start of the active phase for most people and caregivers should keep in mind that normal early labor (before six cm) sometimes includes a period in which there may be no change in dilation for hours. People may decide, together with their caregivers, to delay birth center/hospital admission until active labor. Similar with homebirth, but there is a more intimate relationship there between midwife and mama, with periodic contact in early labor being the norm.

Still, people are still being told to labor in bed, and give birth on their back. I can’t believe this is still happening despite not just common sense but loads of research about the harmfulness and risks to this practice.

Laboring and pushing your baby out on your back goes against gravity and trying to do so is more work and stress on your body and baby. Laboring and pushing with the force of gravity is less painful and all the more easier. Lying on your back also causes your heavy uterus to exert some compression on major blood vessels that go to the baby which can cause fetal distress, let alone to your upper body and head - why people don’t feel well on their back late pregnancy. It’s a position that was created by doctors not birthing mamas, who would be more comfortable in any other position when given the choice. As it’s a position best for the provider not the mama and baby. And that’s the best birthing positions - what feels best at the time to work your baby down and out. I go over these best positions to labor and help your baby come through your birth canal and into the world with demos in my Online Guide to Pregnancy, Birth and Postpartum - sold separately or bundled.

Mamas need to be moving asymmetrically as they need to move working with their body and baby as well as using the force of gravity to help them guide baby down and out. The pelvis is three bones connected by ligaments and it can stretch to accommodate baby. It’s at is smallest capacity on your back. Pushing on your back is much harder as you have to work against gravity. Occasionally some mamas need to rest and can lay on their side, and some do want to birth on their back and it works for them. But the routine practice of insisting all mamas labor and birth on their back is harmful.

Good bye to forced coached pushing when fully dilated. If and when you are told you are fully dilated, rest, eat and drink if you need, get up and dance…but wait for the fetal ejection reflex (FER). When you wait for the FER, and naturally feel the urge to push, instinctively push, working with your body. It is a bit similar to pooping - think of what it feels like and what happens when you try to push it out for a prolonged period of time when you don’t feel the urge. Then think of how easy it is when you just go after feeling the urge. Some may need or want a little gentle guidance to get started but avoid forced coached pushing. It’s not evidence based because it’s harmful, associated with such problems as more swelling, tearing, fatigue, fetal distress etc. Honor the FER!

It happens. The sensations of pushing and FER, fetal ejection reflex can be so intense that mamas initially may want to fight it, which makes it all the more harder. What we resist persists. When we dive in and lean into the sensations we birth.
Being in the water helps. Movement in asymmetrical positions & roaring like a lion helps, as does channeling your inner monkey, letting your primal take over. Relaxation & coping techniques to practice in pregnancy so you can just tap right in to them in labor are a huge help, as is bringing fun, joy, the primal & sensual, & enhancing pleasure using all your senses into the birth experience . But a complete change in mindset and perspective is key, as is my preparation. You can learn to use different language for the sensations of labor, instead of pain which implies illness and something that needs to be remedied, and to see them for what they are. You can learn to use other words for contractions, which imply tension and negativity, and the word contraction is not empowering, and does not fully explain what is happening. Yes, the top of the uterus contracts so the birth canal can open and expand, as well as push out your baby. So expansions are also happening in labor – that is really the goal of what you are doing – expanding so your baby can emerge from your womb to the outside world, and you can both be birthed as a new mother and baby.

Suffering is a choice. And you can chose to embrace your intense sensations for what they are, as healthy signs, what is needed to birth, what your baby needs to transition earth side - not that anything is wrong. I go cover this in much greater depth in my online Guide to Pregnancy, Labor & Childbirth.

Routine episiotomy in a normal birth is of the most harmful unnecessary procedures. It’s so not evidenced based care. And if you do tear despite prevention efforts (it can still happen), little tears heal fine on their own; if we have to do a repair we do try to put everything exactly or almost exactly how we found it. The perineal and vaginal area of a mom who has given birth vaginally before never looks exactly like it did prebirth. But we do our best! Sometimes there is some scar tissue that forms and definite changes from muscle stretching. These are our beauty marks and badges of honor.

Immediate and premature cord clamping is another harmful routine intervention that needs to be stopped. Just think about it. We did not cut cords right away for most of history. No mammal cuts the cord after birth. They just allow the normal natural physiological process to proceed instinctively…or they would have not survived as species.

The number one best recipient for cord blood is baby. 1/3 of baby’s own blood backs up into the placenta during birth. Baby needs to get it back - it is loaded with blood volume oxygen, nutrients, stem cells, antibodies and ingredients essential for transitioning from womb to world and long term health. If you want to donate or bank the cord blood, if baby is doing well at least wait 10 - 15 minutes so your baby gets most of it and there is still enough to bank.

Don’t let them convince you to have it cut ever after a minute because they are in a rush or tell you some misinformation that it’s not good. Clamping right away was probably invented for the doctor but now we know it’s harmful. Delayed optimal clamping can even be done after cesarean until placenta is birthed if there is no other problem.

I have way more info on this in my Natural Birth Secrets book 2nd edition but make sure this is clearly communicated to your providers and written in your birth plan. Ideal is to wait until it stops pulsing completely, flat and white, and you can even feel and see that yourself. When all is well I don’t cut it until after the placenta unless they want a lotus birth.

The best intervention in normal labor and birth is no intervention. Beloved obstetrician Dr. Michel Odent goes further and says best intervention in healthy childbirth is to knit. Knitting keeps our hands occupied instead of trying to meddle and fix something that isn’t broken. Part of Hippocrates oath doctors have to take after training is “First Do No Harm.”

But knitting goes deeper. It is the calm presence of an experienced attendant who has seen it all, communicating to you with their body language to relax, all is well. Their calm is contagious and will make you feel more calm. Their heart, ears, eyes and mouth are open to listen, watch, support, encourage and help you as needed; and of course they can put the knitting down as appropriate, but the point is brilliant.

The ideal is birth attendants are there, so there with the laboring mama, especially towards later labor when sensations can get intense, but know that mama needs to feel private, safe and undisturbed to labor best, to not feel watched; so we try to leave her alone, on her own, until she needs us. Even then, we try to be in background so mama doesn’t feel watched, after doing needed assessments without causing much disruption, as a lifeguard just in case and there of course if more support is needed.

Prepare yourself to be empowered, have an advocate and birth YOUR way!

Premature Rupture of Membranes at Term

How do you know your main bag of water breaks? You feel a pop & fluid bursts out of your vagina like a river, making a large ~ 2 1/2 - 3 cup puddle on the floor, or it totally saturates your clothes or where you were sitting/lying. You keep leaking fluid throughout the day that’s not pee, saturating your maxi pad like the first morning baby diaper, or your poured at least a few cups in it. It looks clear, blood tinged with white specs of vernix, or it’s brown/green color of baby’s first poop meconium (let your provider know). It does not look or smell like pee or semen (no history of recent sex). Your provider sees it flowing out of your vagina, pooling in your vagina on sterile speculum exam or on microscope, or simply + Amnisure test.

And it’s not the few tablespoons of fluid between the two membranes that can release before labor making ~ pancake size stain on your underwear, seat, sheets. It is important to know that as main membranous bag is intact. When in doubt discuss with your provider. They can confirm or rule it out. The test strip that turns blue with amniotic fluid is not diagnostic by itself as it can also turn blue with other things, like blood and even the fluid in between the membranes. It is important to be certain of the diagnosis of PROM. You do not want to be falsely diagnosed as “ruptured membranes” with all the possible unnecessary potentially treatment that entails.

PROM - premature rupture of membranes means when the main amnion bag of amniotic fluid breaks at term, before labor. It happens 8-10% of the time. It’s important to know for sure it’s not just a crack in the inner chorion membranous bag, leaving the main bag intact, so you’re not on the “clock” unnecessarily. Babies are double wrapped with a few tablespoons of fluid in between the two membranes - enough to make a pancake sized stain on your underwear or whatever you’re sitting on if outer bag tears, but then no further leakage. If in doubt, I advise wearing a maxi pad & walking around a few hrs. If it becomes saturated like an overnight diaper that’s the main inner bag with lots more fluid just > 1/2 liter; if it remains dry PROM is unlikely.
But is this “clock” evidence based? No. Recommending to induce to avoid risk of infection & stillbirth is based on outdated low quality studies from 1959s-1960s. According to newer quality research, as long as mom & baby are doing well & meet certain criteria, induction is just as much an evidenced based option as waiting for mama to go into labor on her own up to 48-72 hours later, without increased risk newborn health problems or death. 77-95% will go into labor anyway by 24 hours.

Many leading professional organizations like ACNM, RCOG, NICE, AOM, & RANZCOG recommend offering both options as acceptable as long as certain criteria are met - like single term uncomplicated pregnancy, clear fluid, no fever, no GBS, & normal fetal heart rate. ACOG says induce immediately but that if mom declines, waiting for labor to start on its own (expectant management) is acceptable. Waiting for labor to start on its own has very good outcomes for moms & babies. Induction of labor has strong consequences like the cascade of interventions, cesarean & birth trauma, & many opine it can not be justified as standard of care for a normal physiological occurrence in healthy term pregnancy.
It’s important to know your rights to autonomy, & be educated to make an informed decision if this happens. Do avoid or minimize internal exams or anything internal as it increases risk of infection.

If you are interested in more gentle ways of bringing on labor naturally refer to my Natural Birth Secrets book second edition.
Be informed, empowered & educated with my online course Guide to Pregnancy, Birth & Postpartum - sold separately or in a bundle.

Induction of Labor: Invalid Reasons

According to the research, not many of the common reasons for induction are evidence based. People are feared into induction too often unnecessarily. For a surprising number of conditions, there has been no proof of the benefit or effectiveness of labor induction but actually have been shown to cause more harm - like suspected big baby, being labeled as high risk by your age alone, isolated ow amniotic fluid, and intrauterine growth restriction before term.

The benefits of imminent birth must outweigh risks of induction of labor and all that entails. That is when mama’s or baby’s life is in jeopardy and imminent birth is life saving as compared to possible dangers of continued pregnancy.

Thanksgiving, Christmas or any holiday are certainly not complications of pregnancy. Rates of induction continues to skyrocket, remarkably so in the days leading up to the holidays, with US rates in general, way above the rates from even 20 - 30 years ago, but our outcomes are continuing to get worse! A large amount of research demonstrates the risks far outweigh the benefits of induction especially when mom and baby are healthy. Elective induction without a well-supported medical reason clearly increases risks - for babies especially before 39 weeks. Induction before 41 weeks significantly increases chance of having a cesarean birth, major abdominal surgery with all its associated risks - especially for first time vaginal birthers and having a cervix that is unripe - not ready. Induction also greatly increases the chance of needing pain relief like epidurals which have their own risks for both mom and baby.

For example, induction of labor is absolutely appropriate in worsening gestational hypertension or preeclampsia, if mama or baby has a serious illness in which prompt treatment is needed after birth. But even in pregnancies that go beyond 41-42 weeks, there are pros and cons, potential risks and benefits to watchful waiting versus labor induction, which must take into account mama’s preferences, knowing that she has medical legal right to autonomy and declining induction of labor.

IUGR is not an evidenced based reason to induce labor. There are a variety of known causes of true IUGR (intrauterine growth restriction), like high blood pressure, heart/lung/kidney disease, diabetes, malnutrition, serious anemia, cigarette smoking, drug and alcohol abuse, certain infections, and fetal abnormalities. But do know that in well dated pregnancies, the majority (80-85%!) of babies identified as having IUGR are simply constitutionally small but healthy. They are just weighing below the tenth percentile. All of my four babies were off the growth charts diagnosed small for gestational age (SGA) but I and my husband are not tall and I simply make six pounders who consistently grew but stayed way below average in growth by height and weight even as kids.

Oligohydramnios - low amniotic fluid, by itself (not associated with other problems such as preeclampsia or birth defects) is also not a reason for induction as it is not associated with increased risk of poor outcomes, nor backed by the research. Actually, the main risk of low amniotic fluid at term in a healthy pregnancy is induction and cesarean as a result of the induction, and potentially the risk of lower birth weight of a baby born too early. There is no evidence that inducing labor for isolated oligohydramnios has any beneficial impact on mother or infant outcomes, but rather the risks of induction far outweigh the alleged benefits. A large body of research indicates that ultrasound measurement of low amniotic fluid is a poor predictor of actual amniotic fluid volume, so potentially inaccurate assessments dictate risky recommendations. Amniotic fluid in an otherwise healthy pregnancy lessens in the few weeks before birth, and post term related to decreased swallowing and urine output by baby. But it is often related to dehydration, seen more in summer months. If a mama drinks 2 - 2.5 liters of water daily she is likely to increase the amount of amniotic fluid volume, and she can up her amount if a low amount was detected on ultrasound.

Induction at 39 weeks of pregnancy is based on the Arrive study, which has flaws and goes against common sense as well as all the science & research up until now. The American College of Nurse Midwives does not support it and continues to advocate for spontaneous labor & healthy normal physiologic birth as well as a women’s right to self determination. For a thorough analysis of the the Arrive study on which these recommendations are based here are a few resources:

- evidencebasedbirth.com/arrive
- midwife.org/ACNM-responds-to-release-of-arrive-trial-study-results

- sarahbuckley.com/should-every-mother-be-induced-the-arrive-trial

- Lamaze.org/connecting-the-dots/parsing-the-arrive-trial-should-first-time-parents-be-routinely-induced-at-39-weeks.

Inducing labor or cesarean for suspected big baby in pregnancy isn't evidence based care and is potentially harmful. Estimated fetal weights based on ultrasound or abdominal assessment are notoriously inaccurate. They do not account for the ability of the pelvis to stretch, the power of mobility and gravity, baby's head’s ability to mould to navigate through the birth canal.

Especially because of the inaccuracy of estimated fetal weights, it is not evidence based care to induce labor or send you to the operating room for this alone. It is a fear based practice and has way more risks than benefits and again, not backed by the research. Time to stand firm. Don’t let them scare you. Fear increases your stress and negatively impacts your labor. You have the right to decline and even switch providers to those more calm, supportive of your choices and who practice evidence based care.

Even if baby is a good size, baby’s not yet fused skull bones can mould to fit through the pelvis which can stretch and increase capacity in asymmetrical upright and mobile positions, which also work with gravity. Plenty of mamas birth ‘big’ babies when given the opportunity and support. You have your provider there also as a lifeguard in case of need, like to relieve the uncommon but potentially serious complication of stuck shoulders called shoulder dystocia which can also happen in smaller babies. It’s certainly easier to push out smaller babies, and you can do your part by staying off sugar foods, refined carbohydrates, and juice. But no, don’t succumb to this routine practice of induction or scheduled cesarean for suspected big baby (macrosomia).

TRIGGER WARNING: With permission I share a tragic story of someone I knew who was having her first baby. She was told she needed to be induced before due date because they said baby’s weight was almost 10 pounds and she had a small frame. It was a top notch, highly esteemed medical center and hospital. Induction at 39 weeks no surprise didn't work, so birth was by cesarean. Baby weighed 7 1/2 pounds. Mom bled profusely during surgery. That is a risk of cesarean especially followed by medications for induction. She bled so much they removed her uterus. She ended up in a coma in the ICU and despite blood transfusions and intensive care she died. There is a patch for her in Ina May’s large Safe Motherhood patchwork quilt project, one patch devoted for every maternal death in the US.

For a more inspiring birth story of redemption, on a happier note, another mama came to my practice wanting a VBAC. Her first cesarean was done for suspected big baby over 9 pounds, but baby weighed only 7 pounds. She said her doctor told her no trial of labor as her pelvis was too small for her big baby and it would be too dangerous. She had a lot of trauma from her birth experience which propelled her to educate herself, prepare big time do things in a whole different way next baby. She took my online signature course Guide to Pregnancy, Birth & Postpartum & used my Natural Birth Secrets book 2nd edition as her “bible” she called it. She read lots of other books, took my prenatal yoga classes….and switched to midwifery care with me against her obstetrician’s warnings she and her baby might die. We worked closely together. She was so proud of her ability to have a beautiful VBAC at home (HBAC), and that a 9 pound baby slipped right through her birth canal without a tear. She actually wrote her obstetrician telling him that her pelvis grew.

Sometimes I have to get real with you to drive a point. Despite all the money and technology of modern US medical and hospital care, the United States ranks the worse among developed countries in terms of birth outcome statistics - our maternal mortality and morbidity rates are on the rise like no other country, and rates of neonatal morbidity and mortality and birth trauma are also horrendous. The countries who have best outcome stats are countries that have more midwifery care that services the low risk healthy population who benefits most by not disturbing physiologic birth when all is well, leaving the obstetricians to provide care to those who have higher risk conditions, complications and need lifesaving medical and surgical care. When high risk care is applied to healthy low risk people, we see more problems, we contribute to the horrid outcome stats of our country.

So let baby come when they are supposed to come and don't let anyone pressure you into an unnecessary induction. Even back in 2013, a listening to mothers survey showed that 4 out of 10 mothers (41%) said their care provider tried to induce their labor. You have the right to say no and switch providers to those who support the natural process of letting labor start on its own when all is well. Rates of routine unnecessary inductions are on the rise - from 9% of births in 1989 to 31.37% of births in 2020, which increases risks - including failed induction as the body is not ready, & unnecessary cesarean with all that entails.

Remember we are not in control or as wise as the greater intelligence that designed the process. Giving birth is such a lesson in surrendering to that greater power that transcends us all.

What can you do? Empower yourself with resources like my book & online course Guide to Pregnancy, Birth and Postpartum - bundled together or sold separately! Say No!! Prepare like a boss. Go to supportive providers. They are out there. We must be the change we want to see.