You may also want to make several copies of the plan: one for you, one for your chart, one for your doctor or nurse-midwife, and one for your birthing coach or partner. And bringing a few extra copies in your labor bag is a good idea, especially if your doctor ends up not being on call when your baby is born.

Although you might not be able to control everything that happens to you during your baby's birth, you can play a role in the decisions that are made about your body and your baby. A well thought-out birth plan can help you to do that.

491.

Chapter 61.Banking Your Newborn's Cord Blood 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.

"Cord Blood Banking: What's It All About?" Journal of Midwifery and Women's Journal of Midwifery and Women's Health, Health, March/April 2008. 2008 American College of Nurse-Midwives (www March/April 2008. 2008 American College of Nurse-Midwives (www .midwife.org). Reprinted with permission.

493.

Pregnancy and Birth Sourcebook, Third Edition 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."

494.

Banking Your Newborn's Cord Blood How do I decide?

The following are some questions to ask yourself as you decide whether to bank your baby's stem cells in the cord blood bank.

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.

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.

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.

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.

Are you willing to donate your baby's stem cells for some- one 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 495 Pregnancy and Birth Sourcebook, Third Edition 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.

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!

496.

Chapter 62.Natural Childbirth Some women choose to give birth using no medications at all, relying instead on relaxation techniques and controlled breathing for pain. With natural childbirth, the mother is in charge, usually with a labor a.s.sistant gently guiding and supporting her through the stages of labor.

For many moms-to-be, having a natural childbirth isn't about being "brave" or a "martyr"-it's about treating labor and delivery as a natural event, not a medical problem. Many women find the experience, despite the pain, extremely empowering and rewarding.

What is natural childbirth?

Natural childbirth is a "low-tech" way of giving birth by letting nature take its course. This may include: * going through labor and delivery without the help of medications, including pain relievers such as epidurals; * using few or no artificial medical interventions such as continuous fetal monitoring, cesareans (C-sections), or episiotomies (when the "Natural Childbirth," June 2006, reprinted with permission from www .kidshealth.org. Copyright 2006 The Nemours Foundation. This information was provided by KidsHealth, one of the largest resources online for medically reviewed health information written for parents, kids, and teens. For more articles like this one, visit www.KidsHealth.org, or www.TeensHealth.org.

497.

Pregnancy and Birth Sourcebook, Third Edition area between the v.a.g.i.n.a and a.n.u.s, called the perineum, is cut to make room for the baby during delivery); * allowing the woman to lead the labor and delivery process, dealing with it in any way she is comfortable.

Many women with low-risk pregnancies choose to go au natural to avoid the risks that medications may pose for the mother or baby.

Pain medications can affect your labor-your blood pressure may drop, your labor may slow down or speed up, you may become nauseous, and you may feel a sense of confusion and lack of control.

But many women choose natural childbirth to feel more in touch with the birth experience and to deal with labor in a proactive manner.

Where is it done?

Many women who opt for natural childbirth choose to deliver in a non-hospital setting such as a birth center, where natural childbirth is the focus. Women are free to move around in labor, get in positions that are most comfortable to them, and spend time in the Jacuzzi. The baby is monitored frequently, typically with a handheld Doppler. Comfort measures such as hydrotherapy, ma.s.sage, warm and cold compresses, and visualization and relaxation techniques are often used.

The woman is free to eat and drink as she chooses.

A variety of health care professionals may work in the birth center setting-registered nurses, certified nurse midwives, and doulas (professionally trained providers of labor support and/or postpartum care) that act as labor a.s.sistants.

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 cesarean, and a more positive feeling about the labor when it's over.

These days, it's also possible to have a more natural childbirth in some hospitals. Many have modified their approach for low-risk births.

They may have rooms with homelike settings where women can labor, deliver, and recover without being moved. They may take their cues from the laboring woman, allowing labor to proceed more slowly and without intervention if it all seems to be going well. They may use alternative pain medications if requested and welcome the a.s.sistance of labor a.s.sistants like midwives or doulas.

In addition to the father, children, grandparents, and friends may be allowed to attend the births (which is also common practice at birth centers). After birth, babies may remain with the mother longer. In 498 Natural Childbirth its fullest form, this approach is sometimes called family-centered care.

If you're having a high-risk pregnancy, it's usually best to give birth in a hospital, where you can receive any necessary medical care (especially in the event of an emergency).

How is it done?

How you choose to work through the pain is up to you. Different women find that different methods work best for them. Many are able to control the pain by channeling their energy and focusing their minds on something else. The two most common childbirth philosophies in the United States are the Lamaze technique and the Bradley method.

The Lamaze technique teaches that birth is a normal, natural, and healthy process but takes a neutral position toward pain medication, encouraging women to make an informed decision about whether it's right for them.

The Bradley method (also called Husband-Coached Birth) emphasizes a natural approach to birth and the active partic.i.p.ation of the baby's father as birth coach. A major goal of this method is the avoidance of medications unless absolutely necessary. The Bradley method also focuses on good nutrition and exercise during pregnancy and relaxation and deep-breathing techniques as a method of coping with labor. Although the Bradley method advocates a medication-free birth experience, the cla.s.ses do prepare parents for unexpected complications or situations, like emergency C-sections.

Some other ways you can handle pain during labor include: * hypnosis (also called "hypn.o.birthing"); * yoga; * meditation; * walking; * ma.s.sage or counterpressure; * changing position (such as walking around, showering, rocking, or leaning on birthing b.a.l.l.s); * taking a bath or shower; * immersing yourself in warm water or a Jacuzzi; * distracting yourself by performing an activity that keeps your mind otherwise occupied; 499.

Pregnancy and Birth Sourcebook, Third Edition * listening to soothing music; * visual imagery.

What will it feel like?

Although labor is often thought of as one of the more painful events in human experience, it varies widely from woman to woman and even from pregnancy to pregnancy. Women experience labor pain differently-for some, it resembles menstrual cramps; for others, severe pressure; and for others, extremely strong waves that feel like diarrheal cramps. First-time mothers are more likely to give their pain a higher rating than women who've had babies before.

How long will it take?

There's no magic timetable when you're giving birth. For some women, the baby comes in a few hours; for many others it may take all day (or longer). Whether you opt for medications or not, every woman's body reacts to labor differently.

What are the risks?

Natural childbirth is, in general, very safe. It only becomes risky when a woman ignores her health care provider's recommendations, or when she refuses medical intervention if everything doesn't go as planned.

It's important for the well-being of you and your baby to be open to other options if there are complications. In an emergency situation, refusing medical help could put your life and your baby's at serious risk.

What will I feel like afterward?

Like any woman who's given birth, you'll probably feel: * exhausted-both you and your baby will probably want to sleep as much as possible; * shaky or cold-many women shiver after delivery-this is a natural reaction; * sore-you'll probably feel cramping in your uterus, especially if you breastfeed, and you'll have some pain and discomfort in and around your v.a.g.i.n.a; 500.

Natural Childbirth * elated and empowered-you may feel an overwhelming sense of accomplishment knowing that you did it on your own.

What if I can't handle the pain?

Labor may hurt more than you had antic.i.p.ated. Some women who had previously said they want no pain medicine whatsoever end up changing their minds once they're actually in labor. This is very common and completely understandable.

You should be applauded for your willingness and enthusiasm to try to deliver naturally. But if it turns out that the pain is just too much to bear, don't feel bad about requesting medications. And if something doesn't go according to plan, you may need to be flexible as circ.u.mstances change. That doesn't make you any less brave or committed to your baby or the labor process. Giving birth is a beautiful and rewarding experience, with or without medical intervention.

501.

Chapter 63.Pain Relief during Labor Each Woman's Labor Is Unique The amount of pain a woman feels during labor may differ from that felt by another woman. Pain depends on many factors, such as the size and position of the baby and the strength of contractions.

Some women take cla.s.ses to learn breathing and relaxation techniques to help cope with pain during childbirth. Others may find it helpful to use these techniques along with pain medications. Some women need little or no pain relief, and others find that pain relief gives them better control over their labor and delivery. Talk with your doctor about your options.

This text explains: * types of pain medications for labor and delivery; * how they are given; * how pain relief methods work.

Types of Pain Relief There are two types of pain-relieving drugs-a.n.a.lgesics and anesthetics. a.n.a.lgesia is the relief of pain without total loss of feeling "Planning Your Childbirth: Pain Relief During Labor and Delivery" 2008, is reprinted with permission of the American Society of Anesthesiologists, 520 N. Northwest Highway, Park Ridge, Illinois 60068-2573.

503.

Pregnancy and Birth Sourcebook, Third Edition or muscle movement. a.n.a.lgesics do not always stop pain completely, but they do lessen it.

Anesthesia is blockage of all feeling, including pain. Some forms of anesthesia, such as general anesthesia, cause you to lose consciousness.

Other forms, such as regional anesthesia, remove all feeling of pain from parts of the body while you stay conscious. In most cases, a.n.a.lgesia is offered to women in labor or after surgery or delivery, whereas anesthesia is used during a surgical procedure such as cesarean delivery.

Not all hospitals are able to offer all types of pain relief medications. However, at most hospitals, an anesthesiologist will work with your health care team to pick the best method for you.

Systemic a.n.a.lgesics Systemic a.n.a.lgesics are often given as injections into a muscle or vein. They lessen pain but will not cause you to lose consciousness.

They act on the whole nervous system rather than a specific area.

Sometimes other drugs are given with a.n.a.lgesics to relieve the tension or nausea that may be caused by these types of pain relief.

Like other types of drugs, this pain medicine can have side effects.

Most are minor, such as nausea, feeling drowsy or having trouble concentrating. Systemic a.n.a.lgesics are not given right before delivery because they may slow the baby's reflexes and breathing at birth.

Local Anesthesia Local anesthesia provides numbness or loss of sensation in a small area. It does not, however, lessen the pain of contractions.

A procedure called an episiotomy may be done by your doctor before delivery. Local anesthesia is helpful when an episiotomy needs to be done or when any v.a.g.i.n.al tears that happened during birth are repaired.

Local anesthesia rarely affects the baby. There usually are no side effects after the local anesthetic has worn off.

Regional a.n.a.lgesia Regional a.n.a.lgesia tends to be the most effective method of pain relief during labor and causes few side effects. Epidural a.n.a.lgesia, spinal blocks, and combined spinalepidural blocks are all types of regional a.n.a.lgesia that are used to decrease labor pain.

Epidural a.n.a.lgesia: Epidural a.n.a.lgesia, sometimes called an epidural block, causes some loss of feeling in the lower areas of your 504 Epidural a.n.a.lgesia, sometimes called an epidural block, causes some loss of feeling in the lower areas of your 504 Pain Relief during Labor body, yet you remain awake and alert. An epidural block may be given soon after your contractions start, or later as your labor progresses.

An epidural block with more or stronger medications (anesthetics, not a.n.a.lgesics) can be used for a cesarean delivery or if v.a.g.i.n.al birth requires the help of forceps or vacuum extraction. Your doctors will work with you to determine the proper time to give the epidural.

An epidural block is given in the lower back into a small area (the epidural s.p.a.ce) below the spinal cord. You will be asked to sit or lie on your side with your back curved outward and to stay this way until the procedure is completed. You can move when it's done, but you may not be allowed to walk around.

Before the block is performed, your skin will be cleaned and local anesthesia will be used to numb an area of your lower back. After the epidural needle is placed, a small tube (catheter) is usually inserted through it, and the needle is withdrawn. Small doses of the medication can then be given through the tube to reduce the discomfort of labor. The medication also can be given continuously without another injection. Low doses are used because they are less likely to cause side effects for you and the baby. In some cases, the catheter may touch a nerve. This may cause a brief tingling sensation down one leg.

Because the medication needs to be absorbed into several nerves, it may take a short while for it to take effect. Pain relief will begin within 1020 minutes after the medication has been injected.

Although an epidural block will make you more comfortable, you still may be aware of your contractions. You also may feel your doctor's exams as labor progresses. Your anesthesiologist will adjust the degree of numbness for your comfort and to a.s.sist labor and delivery. You might notice a bit of temporary numbness, heaviness, or weakness in your legs.

Although rare, complications or side effects, such as decreased blood pressure or headaches, can occur. To help prevent a decrease in blood pressure, fluids will be given through a vein by a tube in the arm. This may increase the risk of shivering. However, a woman may shiver during labor and delivery even if an epidural is not given. Keeping a woman warm often helps to stop the shivering.