Stem Cells Help During Labor

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Bay Area Birth Center Checklist for Birth

_____ I have read, understood, signed and received a copy of the “Informed Choice Agreement.” _____ I have read, understood, signed and received a copy of the “Financial Contract.”

_____ I have paid the deductible required by my insurance company. _____ I have met my financial agreements as agreed upon in the contract. _____ I have provided insurance data necessary to process my claim. _____ I do/don’t mind if a student midwife helps at my birth.

_____ If this is my first unmedicated birth, I have enrolled in appropriate birth classes.

_____ If I plan to have children attend my birth, adequate education and supervision will be arranged. _____ I understand smoking is not allowed in the birth center at any time.

_____ I have obtained all the appropriate items needed in the supply list.

_____ I have stocked my pantry with nutritious food to last at least 1 week after my birth. _____ A back-up plan has been discussed with my midwife.

_____ I have discussed pediatric care and will obtain someone to see my baby within 6 weeks after birth.

_____ I have discussed the use of Vit. K, eye ointment, Methergine, Pitocin, & Rhogam with my midwife.

_____ I have completed my personal birth plan and discussed it with my midwife.

Birth Items – The following items should be washed in hot water, rinsed twice, packed and ready at least 3 weeks before your due date.

Birth/Postpartum Optional Items To Have at Home

Cool gown or shirt to labor in Camera Sanitary pads

Clean breastfeeding gown Pair of socks for mom Diapers for baby

1 baby gown or Onesie Snacks/juice/ice Baby wipes

1 pair booties or socks Music CD’s Ibuprofen or Acetaminophen 3 receiving blankets Swimsuit top or sports bra Thermometer

Outfit to wear home Alcohol

Underwear, Nursing bra Q-Tips

WHEN YOU GO INTO LABOR

***If early labor begins at night, continue to rest between contractions if possible. Call your

midwife if things are progressing rapidly. If you need us at night, call as we might not hear text

messages.

***If labor begins during the day, call your midwife. Continue with your normal activities until

contractions become regular and strong enough to make you stop what you are doing. We want

you to come to the birth center when contractions are every 5 minutes, lasting 60 seconds, for 1

hour.

***Drink plenty of fluid. Eat food that is easy to digest when hungry (yogurt, soup, fruit,

popsicles, cereal, oatmeal, etc.)

***Take a shower or bath to be clean for the birth.

***If concerned about bowel movement during labor, use a Fleet enema at home.

***Clean your home before coming to the birth center if time permits.

Note: Showers or baths may help you relax throughout labor.

Someone can be reached 24 hours a day at the following numbers: (All can receive text messages as well. )

Jackie Griggs Camellia May Mona Lisa Ott Anna Caffrey

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AM I IN LABOR? What is labor?

Labor is the work that your body does to birth your baby. Your uterus (the womb) contracts. Your cervix (the mouth of the uterus) opens. You will push your baby out into the world.

What do contractions (labor pains) feel like?

When they first start, contractions usually feel like cramps during your period. Sometimes you feel pain in your back. Most often, contractions feel like muscles pulling painfully in your lower belly. At first, the contractions will probably be 15 to 20 minutes apart. They will not feel too painful. As labor goes on, the contractions get stronger, closer together, and more painful.

How do I time the contractions?

Time your contractions by counting the number of minutes from the start of one contraction to the start of the next contraction.

What should I do when the contractions start?

If it is night and you can sleep, sleep. If it happens during the day, here are some things you can do to take care of yourself at home:

● Walk. If the pains you are having are real labor, walking will make the contractions come faster and harder. If the contractions are not going to continue and be real labor, walking will make the contractions slow down.

● Take a shower or bath. This will help you relax.

● Eat. Labor is a big event. It takes a lot of energy.

● Drink water. Not drinking enough water can cause false labor (contractions that hurt but do not open your cervix). If this is true labor, drinking water will help you have strength to get through your labor.

● Take a nap. Get all the rest you can.

● Get a massage. If your labor is in your back, a strong massage on your lower back may feel very good. Getting a foot massage is always good.

● Don’t panic. You can do this. Your body was made for this. You are strong! When should I go to the hospital or call my health care provider?

● Your contractions have been 5 minutes apart or less for at least 1 hour.

● If several contractions are so painful you cannot walk or talk during one.

● Your bag of waters breaks. (You may have a big gush of water or just water that runs down your legs when you walk.)

Are there other reasons to call my health care provider?

Yes, you should call your health care provider or go to the hospital if you start to bleed like you are having a period— blood that soaks your underwear or runs down your legs, if you have sudden severe pain, if your baby has not moved for several hours, or if you are leaking green fluid. The rule is as follows: If you are very concerned about something, call.

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LABOR? WHAT DO I DO NOW?

First . . . If your baby is due more than 3 weeks from today and you are having back pain or stomach

cramps, or there is fluid leaking from your vagina, or your baby has not moved for several hours, or you have other troubling symptoms, call your health care provider now!

Or . . . If you are overdue, be sure to see your health care provider at least once a week and talk with her

about a plan for your care.

Now . . . If your baby is due within the next 3 weeks, follow this decision path:

Flesch-Kincaid reading level⫽ 4.4

This page may be reproduced for noncommercial use by health care professionals to share with patients. Any other reproduction is subject to JMWH approval. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JMWH suggests that you consult your health care provider.

286 Volume 48, No. 4, July/August 2003

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Birth Options & Preferences

Just as you plan for the future, planning for your birth is valuable. And just as life’s path has many different roads, so does birth. You may be the kind of person who is open and embraces what life gives you or you may be a planner who finds it difficult to take a different path. Whatever your personality, you can have a good birth experience. After some research, questions, and prayer or meditation, choose your preferences. Realize you may change your mind during labor. Strive for what you want and graciously accept what comes.

Early Labor

Physical Labor Support □Hands & knees

□Continuing normal routine □Focal Point □Squat

□Being alone with partner □Imagery/Visualization □Stand

□Being with friends at home □Close eyes □Partner (behind, back to back)

□Support people around me □Relaxation □Reclined

Active Labor

□Breathing techniques □Side lying

Support Person (s) & Assistants □Counter pressure Birth Place

□ □Rolling pressure □Bed

□ □Massage/Reflexology □Bathtub

□ □Cold or ice packs □Birthing Pool

□ □Heat packs □Bedroom

□Present all the time □Shower, bathtub □Other:

□In the room only for □Birthing Pool Participation

□ □Pelvic rocking □Mirror for pushing

Children □Double hip squeeze □Mirror for birth

□ _{Maternal Positions} □Don’t want to see

□ □Stand □Touch baby’s head before birth

□Present during labor □Walk □Hands on head during crowning

□Present for the birth □Climb stairs □Partner to catch baby □Free to come and go □Sit (Chair, Rocker, Bedside) □Photographs of labor □Come in after the birth □Birthball □Photographs of birth

□Come in after baby is cleaned □Lunge □Photographer:

□Support person dedicated to supervising children

□Dangle

Food & Fluids □Squat Perineum

□Yogurt, cottage cheese, cheese □Supported squat □Massage

□Soups, broths □Slow dancing □Hot packs applied

□Water □Kneel □Prefer tear to episiotomy

□Recharge □Hands & knees Cord

□Tea(s) □Side lying □Cord cut after pulsing stops

□100% Fruit juice popsicles □Reclined □Cord cut after placenta birth

□Ice chips Comfort Measures □Mother to cut cord

Emotional Labor Support □Aromatherapy □Partner to cut cord □Attending to each contraction □Dim lights □Child to cut cord □Attention focusing □Sunshine (if daylight) □Other:

□Eye contact □Fresh air (windows)

□Touch □Pillows Baby

□Reassurance □Lotion/powder □Eye Care

□Verbal Reminders □Rolling pin/tennis ball □Metabolic screen (yes, no)

□ □Mouthwash If a C-Section becomes necessary

□ □Music (Tapes, CDs, Live) □Remain alert

□ □ □Breast feed in OR

□ □ □Describe events

Pushing & Birth

□Video/Photograph

Positions □Rooming in

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Information on Optimal Fetal Positioning

By Jackie Griggs

The purpose of taking this posture is to bring babies into the most optimal position for birth. Sometimes, changing the mother’s position can also change the infants’ position. When a mother takes the hands and knees position, her belly creates a hammock for the baby to lie in. When the baby is in this position, it is also in a good position for birth. It is best if the baby’s back is facing outward, not next to the mother’s back. We ask that you get on your hands and knees for at least 30 minutes. This can cause the heaviest part of the baby, which is its back, to come forward into the mothers’ belly.

You can rest your head on a pillow if you like. It is possible that a mother will actually feel the baby shift positions. It is possible that your contractions will increase and become stronger during or after you have assumed this position. After being in this position for at least 30 minutes, you may change positions. One hour later, we may ask you to assume the position once again for 30 more minutes. Your midwife or nurse will continue to monitor your baby’s heartbeat from time to time while you are in this position.

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Practical steps to avoid posterior positions

The baby’s back is the heaviest side of its body. This means that the back will naturally gravitate towards the lowest side of the mother’s abdomen. So if your tummy is lower than your back, eg you are sitting on a chair leaning forward, then the baby’s back will tend to swing towards your tummy. If your back is lower than your tummy, e.g. you are lying on your back or leaning back in an armchair, then the baby’s back may swing towards

your back.

Avoid positions which encourage your baby to face your tummy. The main culprits are said to be lolling back in armchairs, sitting in car seats where you are leaning back or anything where your knees are higher than your pelvis. The best way to do this is to spend lots of time kneeling upright, or sitting upright, or on hands and knees. When you sit on a chair, make sure your knees are lower than your pelvis, and your trunk should be tilted slightly forwards.

 Watch TV while kneeling on the floor, over a beanbag or cushions, or sit on a dining chair. Try sitting on a dining chair facing (leaning on) the back as well.

 Use yoga positions while resting, reading or watching TV- for example, tailor pose (sitting with your back upright and soles of the feet together, knees out to the sides)

 Sit on a wedge cushion in the car, so that your pelvis is tilted forwards. Keep the seat back upright  Don’t cross your legs! This reduces the space at the front of the pelvis, and opens it up at the back. For

good positioning, the baby needs to have lots of space at the front

 Don’t put your feet up! Lying back with your feet up encourages posterior presentation.  Sleep on your side, not on your back.

 Avoid deep squatting, which opens up the pelvis and encourages the baby to move down, until you know he/she is the right way round.

 Swimming with your belly downwards is said to be very good for positioning babies not backstroke, but lots of breaststroke and front crawl. Breaststroke is particular is thought to help with good positioning, because all those leg movements help open your pelvis and settle the baby downwards.

 A Birth Ball can encourage good positioning, both before and during labor.

 Various exercises done on all fours can help, eg wiggling your hips from side to side, or arching your back like a cat, followed by dropping the spine down.

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CORD BLOOD BANKING—WHAT’S IT ALL ABOUT? What is Cord Blood?

After your baby is born and the umbilical cord is cut, the placenta—along with the rest of the cord—is usually thrown away. But there is still blood in the cord. Blood from the cord has lots of stem cells. Stem cells from the cord can be used to treat some serious illnesses that may occur later in the baby’s life. For this reason, some people think it is a good idea to save the cord blood stem cells— or “bank” them. What Illnesses Can Be Treated with Stem Cells?

Stem cells can be used to treat leukemia and other diseases that attack the immune system. Research is being done on using stem cells to treat illnesses like Parkinson’s disease, diabetes, or Alzheimer disease, but these uses are still unproven.

How are the Stem Cells Collected from the Cord?

After the cord has been cut, a member of the health care team will insert a needle into the part of the cord that is still attached to the placenta which has not been delivered yet. Blood from the cord is collected in a tube just like when you have blood taken from your arm. This process does not cause you or your baby any pain, because there are no nerves in the umbilical cord. The blood that is collected has thousands of stem cells in it. The stem cells in the cord blood are packaged, frozen, and sent to be stored in a cord blood bank. Are There Reasons I Wouldn’t Want to Bank My Baby’s Cord Blood?

● If you choose to bank your baby’s cord blood, the cord will be clamped and cut right after the baby is born so the cord blood does not flow back from the placenta to your baby. Many health care providers think that it is best for your baby if you allow most of the cord blood to flow into your baby before cutting the cord. This can prevent anemia and may help your baby fight illness later.

● The chance that your baby will develop a disease that might be treated with cord blood stem cells is very low. Another concern is that if your child develops a disease that can be treated with stem cells, the cells collected and stored from birth may have the same disease and therefore they might not be recommended for use.

If My Child Needs Stem Cells, Can I Donate Some of Mine—Like Donating a Kidney?

Stem cells can be taken from the umbilical cord, from embryos, and also from adult tissues and organs, such as bone. There has been a lot of research done on adult stem cells and they are used to treat many diseases. If you or your child needs stem cells to treat a disease, the National Marrow Donor Program will help you find a donor if there is one available.

What is the Difference Between Public and Private Cord Blood Banks?

● Public cord blood banks like the National Marrow Donor Program offer stored stem cells to anyone who needs them. These banks have stored cord blood donated by parents who want their baby’s stem cells to be available to anyone who needs them. There is no fee to donate cord blood to a public bank.

● Private cord blood banks store your baby’s cord blood for possible future use for your baby or members of your immediate family. Private banks charge between $1000 and $2000 to collect the blood and about $100 a year to keep stem cells frozen in the “bank.”

How Do I Decide?

The reverse side of this sheet has some questions to ask yourself as you decide whether to bank your baby’s stem cells in the cord blood bank.

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Things to Consider About Banking Cord Blood Stem Cells

At this time, the American Academy of Pediatrics does not recommend cord blood banking for everyone. There isn’t a large enough chance that your baby will have an illness that can be treated with stem cells to justify the cost for every family. Below, you’ll find some things to consider as you make your decision. 1. Is It Very Likely that Your Child Will Need His Stem Cells in the Future?

Some families have illnesses that “run in the family”—inherited illnesses that can only be cured with stem cells. If you already know that your child is at risk for such an illness, you may want to bank the cord blood stem cells.

2. Do You Have Another Child Who Already Needs Treatment with Stem Cells?

If you have a child who needs a stem cell treatment but does not have his own stem cells available, you may want to bank cord blood stem cells from your next child. This child’s stem cells may be a match for the child who needs them.

3. Do You Want to Be Sure Your Baby’s Stem Cells Will Always Be Available Only for Her?

Private cord blood banks will store stem cells for future use in your family only. The charges vary from one cord bank to another cord bank. The services provided vary, too. You will want to shop around for the best service and best price.

4. Are You Willing to Donate Your Baby’s Stem Cells for Someone Else?

You can donate your baby’s cord blood stem cells to one of the public cord blood banks for free if there is one in your area. Another person who matches your baby might use the cells. If your child needs to be treated using stem cells someday, he might be able to get his own cells from the bank, but you run the risk that he might not.

5. Would You Like to Make Your Own Stem Cells Available to Someone Who Might Need Them for Treatment of Illness? If you would like to donate your own stem cells to help save someone’s life, consider signing up as a potential donor with the National Marrow Donor Program. In order to sign up, you will need to get your cells typed. Your type will then be kept in a registry of types. When someone needs a stem cell or bone marrow transplant, his or her type will be checked against the registry. If you are a match, you may be asked to donate. You could save a life!

FOR MORE INFORMATION

The National Marrow Donor Program

This program maintains a national registry of potential stem cell donors as well as some state banks of cord blood stem cells, and can be visited atwww.marrow.org

American Academy of Pediatrics

Frequently asked questions about cord blood banking from the American Academy of Pediatrics are available from

www.aap.org/advocacy/releases/jan07cordbloodfaq.htm

This page may be reproduced for noncommercial use by health care professionals to share with clients. Any other reproduction is subject to JMWH approval. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JMWH suggests that you consult your health care provider.