The medical view of pregnancy and childbirth has permeated our culture so that we have forgotten how our ancestors were born, thanks to which our species has survived for thousands of years. With the intention, presumably, to protect mothers and babies from misfortune and death, modern western obstetrics has forgotten Mother Nature, whose complex and elegant systems of birth are disturbed by obstetric interventions, although we are aware our inability to understand or control these elemental forces.

The medical interference in pregnancy and childbirth is well documented, and its negative consequences have been well studied. However, the medical management of birth-the time between the birth of the baby and delivery of the placenta-is, for me, the most insidious. At the time that Mother Nature has provided awe and ecstasy, we make shots, we examined the baby, umbilical cord clamping and throw it. Instead of body heat and skin to skin, we separated the baby from his mother and put her clothes. When the weather should be detained in the eternal moment of first contact, as mother and son learn to love, we hurry to remove the placenta and clean to go "next."

The medical management of childbirth in the last decade's taken a step further with the popularization of the "active management of birth" (see below) carries some risks for mother and baby. Although many of the interventions aimed at reducing the risk of maternal postpartum hemorrhage (PPH), which can be a serious matter, it seems that, as with the active management of labor, can actually bring many of the problems that supposedly wants to avoid.

Active management also creates specific problems for the mother and baby. In particular, the baby is deprived of half the blood volume that would be sent. This extra blood that should flow into the lungs, which begin to function at this time, and other vital organs, is discarded with the placenta, with possible consequences such as respiratory problems and anemia, especially when it comes to vulnerable babies.

The drugs used in the active management are documented risks to the mother, including death, and we know its long-term effects for the baby, especially given its importance, since they apply at a critical period for brain development.

The hormones in birth

As mammals we are, because we have mammary glands that produce milk for our babies, we share almost every type of birth with other mammals. We share the complex orchestration of hormones of childbirth, which occur in the depths of our mammalian brain to help us and ultimately ensure the survival of our offspring.

At birth, they help themselves three hormonal systems of mammals, each of which plays an important role in the delivery. The hormone oxytocin causes the uterine contractions of childbirth, while helping us to launch our instinctive maternal behavior. Endorphins, the body's natural opiates, produce an altered state of consciousness and helps us to transform the pain and the hormones adrenaline and noradrenaline (epinephrine and norepinephrine, also known as catecholamines or CAs), responsible for our fight or flight reflex, We provide the peak power we need to push and give birth to our babies during delivery, or second stage of labor.

During the third stage of labor-delivery-strong uterine contractions continue at regular intervals, under the strong influence of oxytocin. Uterine muscle fibers shorten, or retract with each contraction, gradually reducing the size of the uterus, which helps to detach the placenta from the uterine wall. The third phase is completed when the mother lights the placenta that nourishes the baby during pregnancy.

For the mother, birth is the moment he receives the reward of his labor. Mother Nature gives you a peak of oxytocin, the hormone of love, and endorphins, hormones of pleasure, that bathe both mother and baby. The skin to skin contact and early attempts to entrench the baby to the breast increases maternal oxytocin levels, strengthening the uterine contractions that will help it to loosen the placenta and the uterus to contract. In this way, oxytocin acts to prevent bleeding and to establish, in concert with other hormones, the close bond that will ensure care and protection by the mother and child survival.

At this time, high levels of adrenaline in the second phase, which have kept mother and baby with eyes wide open, ready for your first contact, will fall, and it takes a very hot environment to counter the cold , and chills, the woman feels when their adrenaline levels drop. If the environment is not well heated, or something distracting or annoying to the mother, high adrenaline levels will be maintained and will counteract the beneficial effects of oxytocin on the uterus, increasing the risk of bleeding.

Also, the baby is essential to reduce adrenaline and noradrenaline, which had risen to a peak at birth. If you separate the baby from his mother, these hormones can not be softened by contact with the mother and the baby can fall into a psychological shock, according to Joseph Chilton Pearce, will prevent the activation of specific brain functions nature had planned for this moment. Pearce believes that the separation of mother and baby after birth is "the most devastating event in life, and leaves us emotionally and psychologically maimed."

One wonders if the modern epidemic of stress, a term invented by researchers at the beginning of the twentieth century-and stress-related diseases in our culture, could be a consequence of these common practices at birth. It is plausible from a scientific standpoint that our hypothalamic-pituitary-adrenal (HPA) which regulates long-term responses to stress, immune function, and the reflection of fight or flight in the short term, is disrupted by the continued high level of stress hormones that occur when babies are removed from their mothers through routine.

Michel Odent, in its review of existing research on the "primal period" (the time from conception to the first year of life), concludes that interference or dysfunction at the time affects the development of our capacity to love, which is particularly vulnerable around the time of birth and is connected hormone oxytocin system. Jacobsen's research and Raine, among others, suggests that contemporary tragedies such as suicide, drug addiction and violent crime may be related to problems in the prenatal period, such as exposure to drugs, birth complications and breaking rejection of the mother.

Those who attend the birth in these moments have the crucial role of ensuring that women's reflections mammals are protected and reinforced during pregnancy, childbirth, and beyond. Ensuring unhurried and uninterrupted contact between mother and child after birth, adjust the temperature to comfort the mother, provide skin to skin contact and breastfeeding, and not take the baby for any reason, are impractical sensitive, intuitive and secure and help synchronize our hormone systems with our genetic fingerprint, so as to provide maximum success and pleasure for both mother and baby in the important role of parenting.

The baby, the cord and active management

Adaptation to extrauterine life is the main physiological task to be performed by the baby at birth. In the uterus, the placenta performs the functions of the lungs, kidneys and liver for our babies. Blood flow to these organs is minimal until the baby's first breath, when they are initiated major changes in the organization of the circulatory system.

The baby's body, blood flows from the umbilical cord and placenta and, while the lungs fill with air, blood enters the pulmonary circulation. Nature reserve ensures the cord and placenta, which provide the blood necessary for the pulmonary system and other organs.

The transfer of this pool of blood from the placenta to the baby occurs in a stepwise progression: the blood flows with each contraction the baby's birth, and some of this blood returns to the placenta between contractions. Crying slows the receipt of blood, which is also controlled by constriction of blood vessels in the cord. This indicates that each baby may be able to regulate the transfusion based on their individual needs.

The gravity affects the transfer of blood, which will be optimal if the baby's body remains at the level of the uterus, or below, until the umbilical cord to stop beating. This process of "physiological camplaje" usually lasts about three minutes, but can last longer or can be completed in just a minute.

This elegant, proven system that guarantees the transfusion of a blood volume optimal, but not the same for all babies, can not act if done the usual practice of clamping the cord within 30 seconds of birth.

Immediate clamping of the umbilical cord has been widely adopted by Western obstetrics as part of the complex known as "active management of birth." Active management includes the use of an oxytocic agent-a drug that, like oxytocin, causes the uterus to contract forcefully - usually administered by injection in the thigh as the baby is born and the camplaje immediate cord and "controlled cord traction"-that is, pull the cord to remove the placenta as quickly as possible.

Will inevitably act in haste, and that after a few minutes the oxytocic injection will produce very strong contractions that can trap the placenta if it has not yet risen, so have to remove manually. Also some believe that if the cord is clamped before the oxytocic begins to take effect, the baby will be at risk of receiving too much blood, pumped from the placenta by the powerful contractions caused by the drug. Research on methylergometrine indicates that the use of an oxytocic accelerates placental transfusion to the baby, but babies in this study did not receive too much blood. (9)

While the purpose of active management is to reduce the risk of bleeding of the mother, "acceptance and widespread application has not been preceded by studies evaluating the effects of depriving the newborn babies of a significant volume of blood." (10)

It is estimated that immediate clamping deprives the baby from 54 to 160 ml of blood, (11) which makes up half its total blood volume at birth.

Clamp the cord before the baby is breathing by itself does need to use blood from other organs to establish pulmonary perfusion (blood supply to the lungs). If the child was hypovolemic (have low blood volume), this limitation could be fatal.

If the baby is left above the uterus before clamping-for example, during a cesarean ¬ - the blood will flow back to the placenta by the action of gravity, so it is likely that these babies receive less blood volume than would be expected. The consequence of this may be an increased risk of respiratory distress. Many studies have shown that this common complication in babies born by Caesarean section could be eliminated if they facilitate placental transfusion.

Babies who are also clamps the cord immediately lose iron in the blood that are deprived. Immediate clamping has been associated with an increased risk of anemia in childhood.

These immediate aftermath of impingement were known in 1801, when Erasmus Darwin wrote:

"Another thing very harmful to the child that is tied and cut the cord too soon, there would always be left not only until the child has breathed repeatedly until the cord stops beating. Otherwise, the child is much weaker than it should be, because part of the blood that should reach the child remains in the placenta. "(17)

In one study, premature babies who were clamped the cord within 30 seconds needed fewer transfusions, less severe breathing problems, better oxygen levels, and indications of likely better in the long term, compared with babies who are had the cord clamped immediately. (18)

Some studies have shown an increased risk of polycythemia (more red blood cells in the blood) and jaundice when the cord is clamped later. Polycythemia may be beneficial, since if there is more red blood cells means more oxygen reaches the tissues. The possibility that polycythemia can return the blood too thick (hyperviscosity syndrome), which is sometimes used as an argument against delayed cord clamping, seems to be invaluable in healthy babies. (12)

Jaundice is almost certain when a baby gets its full quota of blood, and the reason is the collapse of the normal excess of blood to produce bilirubin, the pigment that causes yellowish appearance of a baby with jaundice. However, there is no evidence that this has adverse physiologic jaundice. (12) Indeed, jaundice, which is present in almost all human infants to a greater or lesser degree, can be beneficial for its antioxidant properties. (19-20)

The other disadvantage early clamping carries over, as it deprives the baby of oxygen-rich placental blood which nature has provided to supply the baby until breathing is well established. In situations of extreme distress, for example, if the baby takes several minutes to breathe, this reservoir of oxygenated blood can save your life, but paradoxically, it is customary to cut the cord immediately when it is necessary to perform neonatal resuscitation.

When the cord is intact, placental circulation acts as a conductor of any medication that is given to the mother, either during pregnancy, childbirth or delivery. Garrison (personal communication) reports that naloxone, sometimes the baby needs to counteract the sedative effect of analgesics administered to the mother during labor such as pethidine or meperidine (Demerol ® or dolantina ®), can be administered through mother during childbirth, so that the newborn baby wakes up in seconds.

The recent discovery of the amazing properties of cord blood, including stem cells it contains, stresses the need to ensure that all infants get their share in full. These cells are unique to this stage of development, and will migrate to the bones of the baby (bone marrow) shortly after birth, transforming himself into various types of hematopoietic stem cells, ie, generating new blood cells.

The collection of umbilical cord blood, which is being promoted to supply cord blood banks for the future treatment of children with leukemia, involves immediate cord clamping, and the baby was destined to be deprived of up to 100 ml of this blood belonged extraordinary. Perhaps this could be justified if it is practiced active management of childbirth, and if the umbilical cord blood cast off, but unfortunately, the donation of cord is incompatible with physiological birth (natural).

Active management and the mother

The active management of birth (oxytocin, immediate impingement and controlled cord traction) Represents Another step in Interference That Were Introduced in the mid-Seventeenth Century, When Physicians empezar Some male births to Attend Women and confined to the bed. At That Time, cord clamping Was started practicing to Protect bedding.

The first to pull the cord recommend Mauriceau Was in 1673, for fear That the uterus might close Before the placenta HAD eat out spontaneously. (21) In Fact, lying down, Which Is When He Attended increasingly taking the delivery Was a doctor, Was Likely less Spontaneous delivery of the placenta. In contrast, the vertical positions Women and midwives That HAD ADOPTED Traditionally Facilitated the fall of the placenta with the help of gravity.

The first oxytocic drugs Were Used as the alkaloids derived from ergot, a parasite of the cereal fungus. Midwives are Known to Europe in the Seventeenth and Eighteenth Centuries Used These alkaloids Called "ergot" Their farrier limited by toxicity. In the 1930s, ergot Was ergometrine refined, and by the end of 1940 Some doctors empezar using a preventive or Treatment for postpartum hemorrhage. (21) The Potential effects of the alkaloids derived from ergot include the Following: blood pressure increaser, Vomiting, headache, palpitation, cerebral hemorrhage, cardiac arrest, seizures and death Even.

Synthetic oxytocin, Which mimics the natural effects of oxytocin on the uterus of the pregnant woman, Was First record in the fifties, and has Almost Completely Replaced ergometrine, although it is using a drug Still Combines Both That (syntometrine) for Serious bleeding. The synthetic oxytocin Causes an Increase in the Intensity of Contractions, wheres ergometrine causes large tonic contraction, Which Also Increase the odds of trapping the placenta inside the uterus. Also Ergometrine interferes with the detachment of the placenta, Increasing the Risk of detachment is only partial. (22)

Recently, active management has Become "routine management of Women expecting a single baby by vaginal delivery in the maternity ward of a hospital" (23) Mainly by the results of Recent Hinchingbrooke trial, active management Comparing Against management "expectant" (Physiological).

In this trial, low INVOLVING Only Women at Risk of bleeding, Was Associated with active management of postpartum hemorrhage (more Than 500 ml) by 6.8% Compared to 16.5% in the expectant management (Physiological.) There Were FEW cases of Severe bleeding (more than 1000 ml) in Both groups: 1.7% in the asset management group, and 2.6% in the expectant management.

The authors note that, according to this, ten women would have to undergo active management to prevent one case of postpartum hemorrhage, and add:

"Some women may find worth taking a small personal risk of PPH of little importance compared with intervention in an uncomplicated birth, while others may prefer to take all precautions to reduce the risk of postpartum hemorrhage. ( 25)

In reading this study, one wonders how it is possible that almost 1 in 6 women suffer bleeding after giving birth "physiological" and if one or more components of western obstetric practices might not influence the high rate of bleeding.

Botha served more than 26 000 Bantu women over 10 years, and states that "the retained placenta occurred rarely, and never had to perform a blood transfusion for postpartum hemorrhage. (26) Women Bantu give birth squatting, both the baby and placenta, and nobody takes care of the cord until the placenta comes out by itself by the action of gravity.

There is some evidence that the practice of cord clamping, not practiced by indigenous cultures, contributes both to postpartum hemorrhage as the retention of the placenta, because a quantity of 100 ml (as described above) is retained within the placenta. This increases the volume of the placenta, so the uterus can not contract effectively, and is more difficult to expel. (27)

Other Western practices can lead to a postpartum haemorrhage: use of oxytocin for inducing or accelerating delivery (28, 29), an episiotomy, or other perineal trauma, forceps delivery, cesarean section or cesarean section-because of problems with the placenta See Hemminki (30).

Gilbert notes that PPH rates in her hospital (UK) doubled between 1969-70 and 1983-85, which increased from 5% to 11%, and concludes that "Changes in birthing practices in the last 20 years have resulted in an increase in postpartum hemorrhage significant problem. "(31) In particular, Gilbert relates the increased risk of bleeding with the use of oxytocin to induce or accelerate labor, forceps delivery , a D or an extended expulsion, and the use of epidurals, which increases your chances of prolonging forceps delivery.

As we see, western practices do not facilitate the production of oxytocin from the mother herself, or paying attention to reducing the levels of adrenaline in the minutes following birth, with the physiological function of increasing uterine contractions and minimize bleeding.

Cord clamping, especially if it immediately, you can have the extra blood trapped in the placenta back to back, through the placenta into the maternal bloodstream. This may generate an immune reaction that can be reactivated in a subsequent pregnancy, destroying the baby's blood cells cusándole anemia or even death.

The use of oxytocin, which intensifies the expansion or contraction in the delivery of the placenta, has also been associated with an increased risk of maternal hemorrhage and problems of blood group incompatibility. (34, 35)

The World Health Organization in its 1996 publication Care in normal birth: A Practical Guide says:

"In a healthy population (as in most developed countries), postpartum haemorrhage of 1000 ml can be regarded as physiological and does not require treatment other than the administration of oxytocin. (36)

In relation to the housing management of routine oxytocic and traction cord, WHO shows his caution:

"The recommendation of a policy would mean the benefits of this management would offset and even outweigh the risks, including rare but serious risks that could manifest itself in the future."

Decide on a natural childbirth

Deciding to avoid preventive oxytocin, late cord clamping (if they do) and illuminate the placenta for yourself requires some forethought, commitment, and have professionals who are comfortable and have experience with these practices.

However, a natural birth is more than this: we must ensure respect for the emotional and hormonal processes of the mother and baby, without forgetting that this is a unique moment. Odent Michel underlines the importance of not interrupt this time, not with words, and believes that the ideal is that the mother can feel observed and inhibitions in his first encounter with her baby. The level of non-interference is little common, even in the home or the homes of delivery.

The birth of lotus (lotus birth), the central theme of this book gives us the opportunity to "drill incencio slow" after birth, as the Canadian midwife Gloria Lemay, and gives our babies all physical and metaphysical benefits prolonged contact with the placenta. The birth of lotus, a good midwife, also isolates the mother and baby during the first hours and days, ensuring rest and reduce visits to a minimum.

The birth is a first encounter, and creates a powerful impression on the relationship between mother and child. When both are comfortable and have received no drugs, are fully present and alert, discover more about themselves and discover more about the sacred origins of our capacity to love.

Lotus Birth is the practice of leaving the umbilical cord uncut, so that the baby is attached to its placenta until the cord naturally emerges from the navel, between three and ten days after birth, just like a umbilical cord has been cut at birth. This prolonged contact can be viewed as a transition time, allowing the baby away from her marriage to the mother's body in a smooth and gradual.

Although we have no written records of cultures that do not cut the cord umbilidal, many traditional peoples have the placenta in high esteem. For example, the Maori of New Zealand's placenta is buried in an ancient ritual meeting place, and the Hmong, a tribe of South East Asia, believe that the placenta must be retrieved after death to ensure physical integrity in the next life . The Hmong baby's placenta is buried inside the house where they were born.

Lotus birth is a new ritual, which before 1974 had been described only in chimpanzees. Clair was then Lotus Day, pregnant and living in California, began to question the routine cutting the umbilical cord. Her search led her to an obstetrician sensitive to their wishes. His son Trimurti was born in a hospital and returned home with the umbilical cord uncut. Lotus birth practice is named Clair, and his seed went on to Jeanine Parvati Baker in the U.S., and Shivam Rachana in Australia, who were strong advocates of this practice.

Since 1974, many babies are born this way, at home or in hospitals, land and water, and even by cesarean section. Lotus birth is a beautiful and logical extension of natural childbirth, an invitation to claim the so-called third stage of labor, delivery, for ourselves and for our babies, and to honor the placenta, the primary source of food for our children.

The birth of Zoe Lotus

I experienced Lotus birth with my second daughter and my children following after I have been fascinated by it during my second pregnancy through my contact with Shivam Rachana and its Center for Human Transformation (Centre for Human Transformation-CHT), in Yarra Glen, near Melbourne, Australia. The Lotus nacmiento sense to me at that time, because I remembered my experinecias in hospital obstetric services, and the strange and uncomfortable sensation of cutting fleshy and cartilaginous cord connecting the baby to the placenta and mother. For me, the feeling was like cutting a finger without bones, and I loved the idea of avoiding the court when my baby was born.

Thanks to the CHT, I talked with women who had decided not to cut the cord of their babies, and had lived a beautiful postnatal period. Some women also described their children born and full of serenity and fulfillment. Others described it as a challenge, from the emotional point of view and practical. Nicholas, my partner, was worried that it might interfere with the magic of those early days, but agreed with my wishes.

Zoe, our second daughter, was born at home, September 10, 1993. Her placenta had oval shape, something unusual was perfect for the red velvet bag that I had sewn for storage. Shortly after birth, the placenta wrapped in gauze fabric, then the velvet bag, and then with the baby wrapped in a shawl. Every 24 hours, we watched the placenta, dried ourselves with taps, and she poured generous amounts of salt and a few drops of lavender oil. Emma, aged two, was delighted to participate in the care of her sister's placenta.

A few days later, Zoe's cord dried from the navel area and became thin and brittle. He formed a 90 º turn very timely to be filtered through his clothes, and not scratched or irritated skin. The placenta also dried up and wrinkled with our salt treatment, and developed a juicy smell our cat was really interesting.

Zoe's cord fell off at six days old, without any fuss. Other babies were crying inconsolably or grabbed their cord tightly before separation. When Zoe turned one, plant the placenta under a mandarin that our dear friend and neighbor Annie later dug up and planted again in a pot in his garden when we moved to another state. Annie told us later that the mandarins of the tree were the sweetest she had never tried.

Lotus Birth of Jacob

Our third child, Jacob Patrick, was born at home on December 25, 1995, in the water. Jacob and I stayed a while in the water, so while I nursed him, picked up the placenta in a plastic container, ice cream with lid and a hole through which we pass the cord. This time, during the first day we put the placenta in a sieve to drain. Not dressed for Jacob, but I stayed in physical contact with him in a quiet place while Nicholas cared for Emma (four years) and Zoe (two). Jacob cord fell off after four days, and felt that he was deeply imbued with the tranquility of the moment.

It was perfect, because my parents came from New Zealand the next day to help with domestic commissariat. Later, Jacob chose to bury a jacaranda its placenta in our new home in Queensland.

Maia Lotus Birth

My fourth daughter, Maia Rose, was born in Brisbane, where Lotus birth is still very new, on July 26, 2000. We had a beautiful home birth, and intuition told me that this time the cord would follow soon. I decided not to apply any treatment to the placenta, but put it in a sieve over a bowl during the day, and our red velvet bag at night.

Maia's cord fell off just past three days, and though it was winter and it was pretty cool, had become brittle and smelled enough (if he had treated with salt, could have prevernirlo). We buried the placenta in our garden, and planted a rose on top. I cut a piece of cord and dry, he had formed a very curious and beautiful turns to save it for her.

Children remember

My older kids have blessed me with stories of his experiences in pregnancy and childbirth, and agreement is unanimous in favor of not cutting the cord. Emma, above all, remember the unpleasant feeling that he cut the cord (after it had stopped beating), which, she says, "He was grieved in his heart." Zoe, when she was five, told me that was linked to "a loving thing" in my belly. You may remember your placenta as a source of food and love in the uterus.

Lotus birth has been, for us, an exquisite ritual which has heightened the magic of the first days after birth. I felt a wholeness and serenity in my children born in this way, and I think that love, fusion and harmony with nature, and the confidence and respect for the natural order, have left a mark on our family to honor the placenta, the Tree of Life.

A study published in February 2010 in BJOG: An International Journal of Gynaecology and Obstetrics, one of the most prestigious medical journal, shows that women with three or more previous cesareans attempting vaginal delivery success rate and have similar risks Maternal morbidity (of possible complications for the mother) than women with a single previous caesarean birth, and a similar morbidity (combined vaginal deliveries and emergency caesarean sections) to those who deliver by repeat cesarean.

The planned vaginal birth after cesarean (VBAC) refers to any woman whom he has performed a Caesarean section previously and try to deliver vaginally, rather than repeat cesarean. Although the rates of complications among women with two previous cesareans, low transverse incision (Pfannenstiel), who attempt a vaginal delivery are relatively low, including the possibility of serious complications such as uterine rupture, the data on outcomes in women with more than two previous cesareans were very limited.

The American College of Obstetricians and Gynaecologists (ACOG) and the Royal College of Obstetricians and Gynaecologists (RCOG), the societies of obstetricians and gynecologists U.S. and Britain, respectively, did not recommend VBAC after 3 previous C-sections. (1) case of the Spanish Society of Gynecology and Obstetrics, only encourages the PVDC when there has been only one previous cesarean delivery.

In this study, researchers wanted to estimate the rate of success and risks of maternal complications in women with three or more previous cesareans that proved a VBAC. The study reviewed data from different centers in 17 maternity hospitals in the northeastern United States between 1996 and 2000. in total, included data from 25 005 women who had had at least one previous cesarean delivery.

The results indicate that women who had three or more previous cesareans showed no differences in morbidity when tried a VBAC and when they opted for a new caesarean section. The 89 women included in the study who had three or more previous cesareans and who opted for a VBAC had the same chances of success that women with one or two previous cesarean: 79.8%, compared with 75% and 74 % respectively. Furthermore, none of them experienced a significant maternal complications such as uterine rupture, uterine artery laceration, or damage to the urinary bladder. These success rates are extremely positive, they indicate that women with more than three previous caesarean sections would have about a 25% chance of completing a new pregnancy with a new C-section. 25%, approximately the percentage of caesarean sections being made to women as "low risk", with normal pregnancies, with no previous cesarean delivery.

They suggest that, given the results, discard VBAC for women with three or more previous cesareans may not be based on scientific proof. Women with a history of three or more previous cesareans, if another pregnancy, experience no major complications in case of opting for vaginal birth or repeat cesarean. The risks associated with multiple C-sections include, complications related to surgery and abnormal insertion of the placenta in subsequent pregnancies.

The lead researcher Dr. Alison Cahill, Department of Obstetrics and Gynecology, Washington University (St. Louis School of Medicine) stated that "These data suggest that women with three or more previous cesareans who try VBAC have rates of success and risks similar to those with 1 or 2 previous cesareans, and along with other publications, suggests that it may be time to review the current recommendations for testing vaginal delivery in women with more than one previous cesarean delivery. "

"Many had proposed a conservative approach PVDC tests, and we agree that this is prudent. But our evidence does not suggest that a conservative approach, which we interpret as an approach that seeks to reduce morbidity, and specifically the risk of uterine rupture ¬ - necessarily pass PVDC allow only women with one previous cesarean delivery. With proper selection of patients, the VBAC after 2 or 3 previous cesareans, in some cases it may be reasonably safe. "

Philip Steer, BJOG editor in chief, said: "While confidence in the results of the study is limited by small sample relativametne women who had had three previous caesarean section, these results provide additional information for women and contribute to the evidence available on success and safety of VBAC in mujers with more than one previous cesarean delivery. "

"As labor does not always conform to the plans, the results can serve as a reference for doctors when a woman with three or more previous cesareans goes into labor spontaneously."

In a study presented at the annual meeting of the Society for Maternal-Fetal Medicine (SMFM-Society for Maternal Fetal Medicine), the Pregnancy Meeting ™ in Chicago, a research group has shown results that indicate that in case of intrauterine growth retardation (IUGR), spontaneous labor can be expected to be equally effective to induce.

Intrauterine growth retardation (IUGR) implies that the unborn child is substantially smaller than usual, and affects approximately 10% of pregnancies.

At birth, IUGR infants are more likely to experience hypoglycemia (low blood sugar), difficulty maintaining body temperature, and an abnormally high number of red blood cells. They are also prone to neonatal jaundice, infections and cerebral palsy. As they grow, babies who had CIR may be more likely to have behavioral disorders, obesity, heart disease, type II diabetes and hypertension.

Due to lack of sufficient studies, obstetricians are two different policies in pregnancies with suspected intrauterine growth retardation. Some doctors prefer to induce labor, while others prefer to wait for spontaneous labor to avoid the high incidence of operative delivery (forceps, vacuum, spatulas) related to the inductions. Researchers at the obstetric research consortium in the Netherlands conducted a randomized controlled clinical trial of 650 women in 52 hospitals, to compare both strategies.

Pregnant women with one baby, with suspicion of IUGR after 36 weeks of gestation were randomly assigned to a group of labor induction or expectant management group. The mean birth weight was significantly lower in the group which underwent labor induction, 2.420 kg, compared to 2.560 kg in the group where they waited for spontaneous labor. Adverse neonatal outcomes (babies with any kind of difficulty at birth) were similar in both groups. The results show that waiting is a strategy at least as effective for inducing labor.

"We now have evidence-based reasons to identify the attention we pay to every delivery, and to invite women to take the decision that they feel most comfortable," said Dr. Kim Boers, of the University of Leiden (Netherlands Netherlands).

Humanity is facing a wide variety of "inconvenient truths." Al Gore, the Copenhagen summit and the concept of an "economy of low-carbon" has become one of them in a very topical issue. Other examples include the global overpopulation, the destruction of the ozone layer, pollution of the marine food chain, the biodiversity crisis, weapons of mass destruction and the dramatic increase in incidences of many diseases. All of these uncomfortable truths may be considered secondary after addressing the question of who is responsible for the current dilemmas. The "Homo predator"-type of Homo currently dominates all living creatures on the planet Earth is endowed with incredible potential of aggressiveness and is undoubtedly responsible for the many threats facing our species during the third millennium: this is the Main Inconvenient Truth.

Genesis of Homo predator

The basic question, therefore, have to do with the genesis of the main features of Homo predator. It is likely that genetic factors are important, since the potential for aggression in our closest relatives, Pan troglodytes (common chimpanzee), is well documented: these cousins our taking part in wars and rape has been observed that humans and chimpanzees are the only species that kill their fellow deliberately, with premeditation. However, from a practical point of view and to devise a hypothetical change to a renewed humanity, able to live peacefully and sustainably, we must consider the possible epigenetic factors reinforce these human traits.

To investigate such epigenetic factors, we must first refer to the moment when our ancestors began to domesticate other living beings. At that time human groups adapted their strategies for survival with the onset of agriculture and livestock. The construction of towns and cities provided a new dimension to the concept of territory. Reasons emerged renovated to territorial and economic conflicts. Since then, the strategy of survival of human groups has been based on domination of nature and the domination-even elimination, of other human groups. It's easy to understand that for thousands of years, successful human groups have been those that have been transmitted from one generation to the beliefs and rituals that amplify the human potential for aggression. The domination of nature and other human groups have implied the ability to destroy life and therefore influences the development of the capacity to love.

In 2010 we have some clues to the time when environmental factors appear to influence the development of the main features of Homo predator. At the same time that concepts such as gene expression, gene silencing and epigenetic modulation most commonly appear in scientific literature, we are learning to ask new questions about the genesis of pathological conditions and personality traits. In the past, this was primarily to compare the components of genetic and environmental factors and to identify the genes involved. Today we must think in terms of timing or the exact moment when something happens.

One of the functions of the Database Primal Health Research is to try to identify the critical moments for gene-environmental interaction in terms of personality traits and states of health. A vision of the entire database suggests that on the genesis of metabolic traits, significant critical periods occur during fetal life, while the period around birth could be crucial to the ability to love and potential aggression . Thus, an exploration of the database, using keywords that indicate metabolic types (such as obesity, type 2 diabetes, insulin resistance, or heart disease) are studies that detect risk factors especially during fetal life while keywords that are related to alterations in the ability to love (including self-love) are studies that detect risk factors particularly during the perinatal period. This is what happens with keywords such as criminality, autism, suicide, drug addiction and anorexia nervosa.

So we can assume that in societies where the potential development of aggression is crucial, is through perinatal beliefs and rituals cultural backgrounds can interact effectively, exactly the same way that all cultural backgrounds have interfered for thousands of years. Have amplified the difficulties of human birth, have challenged the aggressive-protective maternal instinct, separating the baby from the mother and have delayed the initiation of breastfeeding. (The aggressive-protective maternal instinct does not need a definition: one need only imagine the assault would be if someone tried to take the newborn to a mother chimpanzee).

It would take several volumes to review all the traditional ways in which it has interfered with the physiological processes during the perinatal period in different cultural settings. A review of all the beliefs and rituals more widespread, reveals, above all, the perineal scars that remain after the ritual genital mutilation, different aspects of the socialization of labor, the changing role of the midwife, beliefs regarding colostrum qualify as "bad" or the danger of eye contact between mother and newborn, rituals associated with the early cord cutting, authorization for which the mother has to wait before being able to touch your baby (approval that can be granted by the shaman, the godfather, the midwife or the father, for example). The cumulative effect of beliefs and rituals of this level of generalization, is a powerful cultural conditioning, resulting in a woman is incapable of giving birth without the help of assistants to the parties to work with their expertise and energy, and that the newborn requires an urgent care provided by a person other than the mother.

Del Homo Homo predator ecologicus

These considerations on the genesis of the main features of Homo predator assume paramount importance in a decisive moment in the history of mankind, when we realize that what is at stake is the health of the planet and the survival of our species. We are learning that the domination of nature has its limits. The need to create more unity in the global village is becoming more accepted. We must ask ourselves, how respect for Mother Earth, as aspect of love can develop. In other words, we understand that humanity has to invent radically new strategies for survival. This implies an evolution of Homo predator to a human being could be called Homo Ecologicus.

First we need to clarify concisely, what is the nature of this moment in the history of mankind. Even if, for thousands of years, has been an advantage for the survival of human groups to develop the potential of aggression, it is now essential to the survival of our species, we develop the capacity to love. Using as a reference to our closest relative, the common chimpanzee, we suggested that genetic factors may explain our potential for aggression. Similarly, using another of our close relatives, the bonobo (the bonobo, or pan paniscus, recently differentiated from the common chimpanzee), we can assume that our apparent ability to love also has a strong genetic basis: altruism and compassion that exists among the bonobos, are well documented and there is no evidence of lethal attacks, or among the wild population or in captivity, nor has any report forcing copulation males, adult females abusing or killing their young.

Is it utopian such a program?

In the current scientific context is theoretically possible to explore the concept of critical periods of development and evolution of Homo schedule a predator compatible with the survival of our species. First, scientific studies would be needed, from a physiological perspective on the basic needs of women in labor. Then we would have to digest this scientific data to get rid of a long history of beliefs and rituals, which are losing their evolutionary advantages and would have to abandon political correctness.

An important finding of the second half of the twentieth century, provides a telling example about the power of modern scientific disciplines can exercise to challenge aspects of deeply ingrained cultural conditioning. It was not until the 70s it was found that a newborn human baby needs her mother! As a student of medicine at a maternity unit in 1953, had never heard of a mother who asked to remain with her newborn baby in her arms, as if, at that time, everybody "knew" that a newborn baby need to routinely "care" provided by a third person. Suddenly, it was randomized controlled trials investigating the effects of skin contact immediately after birth. Such studies were inspired by the concept of a critical period for the mother-infant attachment, presented by ethologists investigating non-human mammals. At the same time there was a new generation of research on the behavioral effects of hormones that fluctuate in the perinatal period. Further studies were also conducted on the composition of early colostrum, the early manifestation of rooting and the ability of a newborn to find the chest during the hour of birth. From an immunological perspective, we learned that IgG (Immunoglobulin G) readily passes the human placenta, so that the microbes that are familiar to the mother also is familiar to the newborn germ-free. This led to the conclusion that, from a germ, germs that are transmitted from the mother, should ideally be the first to colonize the baby's body. Today we can say that during the twentieth century and thanks to the rapid development of various scientific disciplines, were discovered the basic needs of the newborn human.

Since it has been possible to make scientific discoveries of this magnitude on the basic needs of the newborn, we dare say that now would be unrealistic to a discovery on the basic needs of women in labor, despite facing similar difficulties. We expect in-depth studies, inspired by physiological concepts such as catecholamines, oxytocin antagonism neocortical inhibitions, open way for fruitful research. We await further studies on ways in which environmental factors influence the release of oxytocin, the "hormone shy."

It is anticipated that a difficult step will be digesting scientific knowledge and make them culturally acceptable. The obstacles are obvious in terms of the needs of the newborn. Cultural acceptance of the fact that a newborn baby needs his mother, has seen some practical implications: for example, made the concept of rooming-in became a familiar concept followed by the Kangaroo. Scientific data, however, were not readily accepted by the cultural environment. While scientists were focused on mother-infant interaction, the cultural environment interpreted the results saying that the newborn needed, immediately, to their parents. Suddenly he established the doctrine of father involvement in childbirth. It's like a mother-infant interaction without cultural interference is not acceptable. It is in this way that made the leap from one generation of people at birth, they had no idea what could be the mother-infant interaction, to another generation, accustomed to a new aspect of the socialization of labor and lacked knowledge about the way in which childbirth can elapse with no one around the woman in labor, in addition to an experienced midwife, mature, quiet and unobtrusive.

Such barriers probably delay a clear understanding of the basic needs of women in labor. The effect status of thousands of years of socialized delivery has been strengthened over the past two decades due to the accumulation of visual messages. There has been a veritable epidemic of videos of natural childbirth cases. The power of visual messages such enormous in terms of cultural conditioning. In most of these cases shows a woman in labor, surrounded by two or three people (including man), all looking at (besides, of course, the camera). These births are presented as "natural" because the scene takes place at home or because the mother is on all fours or because you are in a pool of labor. But the environment is unnatural. The message transmitted by these powerful images and vocabulary currently used is: "can not give birth without the participation of others who contribute their skills (coaching, management etc.) Or energy (support etc .). Can we overcome a cultural conditioning so strong?

An interaction between knowledge and awareness

In an age when scientific research is expanding at an unprecedented speed, all questions related to the survival of our species inspire questions about the human capacity to digest scientific knowledge. In other words, exploring the interaction between knowledge and consciousness is becoming more crucial than ever.

Scientific knowledge can induce and stimulate a new awareness. The discovery that a baby needs his mother is a typical example of scientific data form the basis of a new consciousness. Moreover, a new awareness can lead to scientific knowledge or to help assess the importance of scientific data. In addition, too much information provided by a highly specialized discipline can become an obstacle to a new consciousness. A good example is the large number of women obstetricians who, according to British and American studies, schedule a caesarean for the birth of their children and accept the operation as a routine way to give birth. Their position is understandable, since they are highly specialized professionals and have in mind only the results of numerous randomized controlled trials suggest, according to the criteria used routinely in medical research to assess the practice of obstetrics, which is an option cesarean easier and safer. Other women, who have not been influenced by the same type of information, have reached a more advanced level of consciousness and consider the abdominal as unacceptable as the first option. Consciousness can be induced by the intuitive knowledge ("knowledge") precedence over the effects that can lead the scientific data.

The importance of being bilingual

Worldwide there are core people that have a cutting-edge special ability to reach a new consciousness before the others. Your responsibility is to help through the initiation and dissemination of new consciousness. While trying to pass on only their intuitive knowledge, while only speak the language of the heart "- his effort is unsuccessful. To have influence should rationalize "gut feeling." They have to train yourself to be "bilingual," meaning they have to learn to combine the language of the heart "or the transmission of their intuitive knowledge with scientific language. Every time it becomes easier to combine these two languages.

To illustrate this need to be "bilingual" let's start with the example of those who accepted the c-section as the preferred way of having a baby. How can we help them achieve another level of consciousness? In the current scientific context it is easy to explain that to give birth to babies and illuminate the placenta, all mammals, including humans, mammals would have to release a "cocktail of love hormones." It is also easy to remember that, until recently, despite cultural interference, a woman could not have a baby without being dependent on the release of a hormone flow of this type. Without presenting sophisticated statistical data, we can easily make it clear that, at the planetary level, the number of women giving birth and illuminate the placenta through the release of a natural flow of hormones are approaching zero, since many of the which still give birth vaginally, pharmacological substitutes need impeding the release of natural hormones without sharing their behavioral effects. This is a simple way to explain that the history of labor is at a decisive moment, it's an easy way suggest that hormones of love are being useless in the critical period around birth, is a simple way to inspire questions in terms of civilization, is a simple way to clarify what must be to our goals. Our goals should not be the elimination of CS, which in fact is a wonderful rescue operation. Our objectives should be to create conditions so that as many women as possible can give birth to their babies and the placentas light thanks to the release of its own natural hormones. This is only realistically be the day that the basic needs of women in childbirth are well understood. All those who, no matter their background, they realize that the highly intelligent Homo predator is able to do useless to the hormones of love, wonder what will happen to our civilization after several generations follow the same path.

In fact, scientific language helps us to realize and rationalize the need for us to reach a collective dimension. For this we can use animals as a model. Among non-human mammals the consequences of interfering in the process are dramatic and immediate delivery from a single perspective: In general the mother shows no interest in your baby. Among humans are needed long-term studies, with huge amounts of subjects to detect a significant effect. This is illustrated by exploring the database Primal Health Research. For example, a study of the whole Swedish female population, born during a period of ten years was necessary to demonstrate that the forceps and vacuum deliveries were statistically significant risk factors for developing anorexia nervosa later in life; just as was necessary to include more than 50,000 male subjects born in Jerusalem, during a period of eight years, to show that the average performance intelligence were significantly higher in those born by forceps or vacuum extraction. Especially need this branch in the development phase, belonging to the epidemiology, called Primal Health Research, to train us to expand our horizons to the necessary transition to Homo ecologicus. Is it possible to modify a deliberate and conscious the dominant features of Homo predator through what would be an epigenetic modulation process? It will be possible to dream of such a fundamental step in the history of mankind!

When you begin to suspect you're pregnant, your body and you will have sent some information. Usually the suspicions are confirmed with a pregnancy test or commercial blood tests. Both tests detect the presence (or absence) of chorionic gonadotropin hormone which confirms that the creation of the new being has already begun.

The first signs of pregnancy may include:

Fatigue: The changes that your body is producing much needed energy and prevent you from doing any strenuous activity, or simply resist sleep after dinner.
* Nausea and Vomiting: It is usual that morning not only cost you more get up, but you get Marees and not the bathroom to vomit. Even a cup of water can cause gagging. Tends to happen when you wake up, but can last all day. It is suspected that part of a system for protecting the woman's body during the most delicate stage of the formation of the baby.
* Blood spots: At times during the first months, continue to menstruate around the same dates that would have the period, causing some confusion.
* Refinement of smell: Another mechanism of protection of pregnancy is the refusal of certain smells such as snuff, coffee or pollution.
* Pecking: Food cravings are nothing more than having the body needs a certain nutrient that result in changes in diet. It also often makes malaise take more food with less food.
* Breast changes: The areola begins to darken, grow breasts and nipples protrude more. It is one of the first symptoms to note that women and suspicion of their new state.
* Discomfort in the area of the pelvis: It may be that the lower abdomen and pelvis are felt different, and even with some discomfort, but if you find a sharp pain, you should see a doctor.
* Frequent urination: Because of hormonal changes, you may be passing urine more often.

The mood may also vary, partly due to the action of hormones and in part by the liability or the satisfaction of creating a new life.

You may feel:

* Happy, especially if it has been a wanted pregnancy
* Incredulous, because in many cases not notice anything, even the blood test or even the first scan are not entirely convinced
* Ambiguous because the responsibility for training and then raise a baby can be wonderful but also very hard, especially if the kind of life taken so far is not very compatible with a baby
* Unstable hormones make the lives of pregnant is like a roller coaster, one day everything is great and the next depression is complete, and more with morning sickness (which, fortunately, is just around the fourth month)
* Full of doubt, life will change completely, even if the second child, nothing will ever be the same and sometimes the lack of confidence in oneself in to do my best assault makes us many questions. In the end, we advance step by step and confidence in one increases
* Nervous is very normal to fear the unknown: stories of births and long nights without sleep, problems with breastfeeding ... At the end everyone out of trouble with information and help, and if you feel too nervous, discuss it with your doctor.

At the time that the new state has been confirmed you must ask yourself a number of things to start changing your life. The nights of partying until all are finished for a while. Look at it as something positive, because you are making an extremely important task and magical. Take it easy and take care begins, it is the best way to care for your unborn baby. Cooperation with partners is essential. Now begin nine months where your partner should take care of some chores with which you shall not, by your state first, and then because the baby's care will not leave you time. Little by little, if by helping your partner, now both going to be a computer on which the two colaboraréis. So when the baby is born, he may perform household chores, while you rest and take care of the newborn.

In the same way that the baby is changing inside you, things abroad also must be adapted to the new situation to come. Sleep as much as possible; as fatigue take hold of you, beat you sleep. Listen to your body and all the messages you send: Changes in your tummy, swollen legs, heart, little by little have a greater burden because of pregnancy is generated about 1.5 more liters of blood, breasts growing, and so on. These signs are unique to pregnancy and only you will when you're brewing, or to enjoy them.

During the first month the exterior changes are minimal, but what happens inside is of paramount importance.

The time of delivery
Possible delivery date is calculated by adding thirty-eight weeks from the date of conception or forty at the time of the last menstruation. As it is quite difficult to know when the baby was conceived, most physicians make reference to that date. To avoid being sent each time telling which week of pregnancy you are, you can write on a calendar the number of weeks until week 40, and thus avoid telling you when you need to know. In cases of multiple pregnancy, it usually lasts less, because babies can not fit inside your mom. In other cases, both can go ahead as delayed, but not recommended a delay of two weeks.

How and when to say it?
Once you are sure of your new situation will be very difficult to remain silent. If you have not opened the envelope or blood test done together, you can prepare a meal or a romantic weekend, certainly not forget it, especially if the first child. Remember your own feelings when you found out and think you might not expect it. Maybe the doubts and fears assail him suddenly, give it time. Decide together when to say it to others to whom. There are people who can not hold back and start calling everyone you know, even the premium in Germany which never calls. Others wait in case there are any problems, saving you the annoyance of calling back to say he was not well. Most people expect it more intimate and hopes to go public by the third month. If you already have other siblings in the family, it is preferable depending on the age wait until the pregnancy is already quite visible, as toddlers do not have much sense of time, or be the first to know them as this makes them a very important role as bearers of the news.
The choice of medical equipment
It seems too early to decide what type of birth you have, but although you can always change doctors, gynecologist type you choose determines whether the delivery will be more or less interventionist, and even how much your opinion be heard at the crucial moment. All will give you a healthy pregnancy and baby, but the road to reach this target can be very different. You can interview you with several before you decide to visit one or longer and as your pregnancy continues to consider whether the type of doctor you want.

Advice
All the advice we gave you in preparing for pregnancy (smoking cessation, exercise, etc.) apply even more important once the baby is already growing in your belly. Remember that the first 14 weeks are vital to the development of your baby. Recently, investigations have revealed how and when diet, health, emotional state and exposure to environmental agents affect the formation of the fetus. According to one theory, fatigue and nausea that many women experience during early pregnancy, are a way to protect the embryo. When this phase is most vulnerable, the mother tends to decrease their physical activity and maintaining a simple diet. Apparently the cause of this situation is the hormone hCG begins to be detected on the first week after conception and has its maximum value to the tenth week, then decreased rapidly. Despite the cumbersome it is for many mothers discomfort early in the pregnancy, this is an indication that the placenta is developing well and there is less risk of abortion.

The origin of the word Doula
The prestigious medical journal New England Medical Journal published a study in the 80s made by Dr. Klaus and Kenon in a large public hospital in Guatemala (60 births a day) during the 70's. They found that the rate of interventions, caesarean section and was very high drug spending. To try to solve the problem by performing the following study: randomly assigned women to other women who were mothers, with experience in birth, so that will handle labor and other health personnel were assigned, as usual. They found that younger women had far fewer interventions stated.
Repeating the study in Houston, Texas, with lower-class women, mostly Mexican and Puerto Rican migrants, and the results were very similar. Surprisingly, it turned to be done with middle-class American women, with different results.

When published these studies did not find the right word to describe the woman who accompanied the birth, and chose the Greek word "doula." It is a word that comes from ancient Greek and means slave or servant in a big house, and that probably helped the woman of the house during the birth process. But in reality, since this word literally means servant in Greek environments prefer to use the name "paramana doula" which has a meaning closer to that being sought. Anyway, throughout the world is identified with the name doula to women, with knowledge of labor and birth itself, which accompanies the woman who will give birth.

What is a doula?
A doula is an experienced birth assistance provides ongoing support, information and emotional and physical support to pregnant women before, during and just after childbirth. Doulas attend women giving birth in hospitals, homes and at home births.

The first mission of the doula is to report positively on the experience of motherhood and childbirth for pregnant women and their families. The foundation of a doula care is based on the knowledge that the continuous emotional support and confidence during the birthing process enhances and facilitates all stages of motherhood greatly.

The important thing about a doula is not, then what she knows, but who she is, his personality, because that is what most influences to help women in labor.


Tasks you can perform a doula:

* During pregnancy:
Discuss your goals for the birth and any doubt and fear
It complements the information received in the childbirth preparation classes by the midwife
It reports the birth process and the pain and suggested ideas to improve comfort appropriate to the circumstances
Provides advice on a birth plan to consult with your doctor or midwife
* During labor
Accompanies you when you feel the need for their support, offering emotional support
He is with you to answer your questions and encourage you
Suggests ways to endure the pain and facilitate delivery in collaboration with the medical staff
It acts as a watchdog of the wishes of the mother during the birth process against unwanted interventions
Help creating a suitable environment for the mother (reducing noise and light, playing music, adjusting the heat or cold, answering the phone, etc.).
Help in a VBAC (vaginal birth after cesarean), if applicable
Works with a midwife in the care of a home birth
Respect the privacy of the woman in labor
Provides support and security to other family members
* After the baby is born
Help through postpartum procedures
It facilitates the early establishment of breastfeeding
Maintains telephone contact for any query
Help in the care of the house and the other brothers to reassure the new mother and free of charge

But really, what changes with a doula?
According to the book "mothering the mother, how a doula can help you have a shorter birth, easy and healthy" by Kennel, Klaus and Kennel (Mothering the Mother, How a Doula Can Help You Have a Shorter, Easier and Healthier Birth (1993)) a doula can provide the following differences:

* 50% reduction in caesarean sections
* 25% shorter labor
* 60% fewer requests for epidural
* 40% less use of synthetic oxytocin
* 30% less analgesic use
* 40% less use of forceps
* Improves parent-infant bond
* Less problems with breastfeeding
* Reduced incidence of postpartum depression

A study by Case Western Reserve University in Cleveland, USA, showed that while 63% of women who did not have the support of a doula needed a cesarean delivery after induction, only 20% of those who were in a doula with them the required.

Doulas, midwives and doctors
The midwife and the doctor can provide all the necessary care for a woman and her baby throughout pregnancy, birth and after it. They have all the knowledge and equipment necessary to advise of any deviation from normal and act accordingly. The role of the midwife is physical and emotional support during the birth experience by using their knowledge and skills in education, counseling and health promotion.

The doula provides emotional care and practical assistance to women and their families before, during and after delivery. It can provide information, advice and support, but is not qualified to engage in any clinical task. However, you can be knowledgeable about massage, reflexology, homeopathy and breastfeeding. Is the person chosen by women and / or partner to protect them in their birth experience and assist in their transition to motherhood and fatherhood. His work comes from the work traditionally done by other women of the family or neighborhood (as in many cultures yet). The doula is also the person who protects women to respect their wishes, facilitating communication between it and the midwives and doctors.

One aspect that differentiates the role of the doula is your ongoing care. As labor begins, she is with the woman until the end. All requirements have been established and has agreed beforehand how the doula can help women in childbirth and after him, with the new baby. There are no shift changes or other obligations. Not so in the case of the midwife, who often do not have time to listen, educate and guide women in their entry into motherhood. Instead, the doula can spend several hours a day helping with breastfeeding, preparing meals or taking older siblings. The doula can negotiate with the mother some flexibility to allow you to meet the needs of his own family, something that some midwives also would like.

According to the spokesperson of the American Academy of Obstetrics and Gynecology, the doula provides support to people in the delivery room "if they know what their role in the birth process ... and that its most important function is to support psychological mother. " But sometimes, due to lack of time and dedication of doctors and midwives, parents tend to ask more to the person you have had more relationship and contact, the doula, whose expertise may not be as comprehensive and accurate like a doctor or midwife, who have had several years of college.

Dr. Marshall Klaus, a professor of pediatrics at the University of California at San Francisco, is a pioneering researcher on the benefits of the presence of doulas, published in the Journal of the American Medical Association in 1991. It was he who helped found the association of Doulas of North America. The courses for doulas, the group strongly advised not face any medical decision. "Sometimes, even though they often say that doulas should be discussed with a doctor, they do," says Dr. Klaus.

The trouble is when doctors or midwives decide to do something, like a shaving, enema and episiotomy, the evidence-based investigations have proved unnecessary. Often hospital practices are more of a protocol established by a decision taken by the particular situation. The doula should be able to distinguish such situations from those where there is a real risk, without dealing with the medical staff, informing and giving constant support to the mother.


Are doulas the guardians of normal birth mass in front of the medicalization?
Traditionally, midwives were the guardians of normal childbirth, but if they can not, any alternative must be found. Even some midwives do not want to provide women the kind of support they need to have the greatest opportunities for a normal delivery. Women who are confident in preserving a normal delivery are beginning to increase the volume of their demands. This claim also includes some midwives do not conform to the current situation, pregnant women and doulas. Some doulas are old midwives or mothers who feel the need to do something to defend the normal physiology of pregnancy, childbirth and baby's first days, before the excessive medicalization and current intervention.

Do you feel the father moved to the presence of a doula?
Not at all. Normally, prospective parents receive this woman experienced with open arms. The doula does not displace the couple at birth, rather takes the pressure of having to take care of it (and its environment, or other children, home, extended family, etc.) So that he can do it does best: love.

Need help exercise during pregnancy?
As physical exercise promotes muscle tone, strength and endurance, can help carry the weight gain during pregnancy, prepare for the tough task of delivery, and facilitate the recovery of your figure when the baby is born. Unfortunately, there is evidence that regular exercise shortens the duration of labor. The activity during your pregnancy can reduce the physical discomfort of the back, constipation, fatigue and swelling of the legs. See our list of advantages.

Is there a case that should not exercise?
Sometimes, physical exercise during pregnancy is completely contraindicated to protect the health of the mother, baby or both. Check with your doctor or midwife before starting or continuing any exercise. See our list of contraindications.

I exercise every day. Can I maintain this level during pregnancy?
If you are healthy, you're in shape and you find yourself doing it, continue with it, but listen well to the messages you will send your body. According to the American magazine of the Association of Obstetrics and Gynecology, women who exercised before pregnancy may continue to do so without jeopardizing the health or development of your baby. Researchers at the University of Oslo, Norway, studied 42 women who exercised six times a week, some at a high level and others at a medium level. When they compared the length of confinement, weight gain and weight of the baby, found no differences between the two groups of women.

What kind of exercise is best for a pregnant woman?
Walking, running smoothly, yoga, gymnastics, dance, swimming, stationary cycling and skiing exercises are considered safe for pregnancy as long as you do not overdo it. Towards the end of gestation, swimming is probably the most pleasant feeling of weightlessness that provides the water.

If I have never exercised before, do I have to take any precautions now?
Whenever you have clearance from your doctor or midwife, you can gradually begin to practice a gentle exercise to reach a moderate level. Make low-impact exercises such as walking or swimming, and keep the sessions short.

I have to change my exercise routine during the different stages of pregnancy?
Yes, before pregnancy even if you were very active, you will feel heavier and it will be increasingly difficult to keep up as the uterus grows. In addition, you must follow specific safety guidelines for each phase. For example, during the first quarter, it is important that your body temperature does not increase. However, especially in the third quarter, limiting the exercises in a lying position on your back as you can reduce the blood supply to the baby.

What sports are not recommended?
Those with the possibility of falling or requiring a balance as horseback riding, skiing, water skiing, cycling and contact sports. Even those who are too hard for the ligaments and cross country running, jumping, weightlifting, athletics, football, basketball, tennis, squash, etc.

How I can know if I'm doing too much exercise?
In general, you should not get tired to exhaustion. As you have less oxygen to the exercise because the baby needs before, you should not spend 60% of the maximum rate of your heartbeat. Count the beats for 10 seconds and try not to exceed 25. If you can talk normally while exercising, you do it right. If not for or low intensity. To immediately if you feel dizzy, you have shortness of breath, you have vaginal discharge, it costs you walk, you notice something strange contractions and the baby.

Why is there danger of overheating during exercise?
Although no human studies have been observed in animals that an increase in body temperature, especially in the first trimester of pregnancy can cause malformations in the baby. Therefore, it is suggested to avoid saunas and hot baths in the early months of pregnancy, because they increase the temperature of the mother.

What body temperature is considered too high?
Exceed 38 º C (or 101 º F) temperature under the arm, after exercise began to be considered dangerous.
How to maintain the temperature at a safe level?

* Do not exercise for long periods if it's hot or moisture is adequate
* Wear clothes suitable for exercise
* Take all the liquids that you two hours before exercise and during practice. Carry a bottle of water than can be sipping as you need it
* Make sure you do not exercise too hard controlling your heartbeat

Is it proper swimming during pregnancy?
Swimming is the most complete exercise for pregnant women. Like any other exercise, warming and cooling before the end are essential. Swimming is ideal because it uses the large muscles of the body (legs and arms). Being a low-impact exercise is aerobic, with major cardiovascular benefits and a very low risk of injury. It also enables the weight of the pregnant woman is not noticed so much, thanks to the feeling of weightlessness that provides the water. Any type of aerobic exercise helps increase the body's ability to process and use oxygen, which is great for the woman and baby. It also improves circulation, increases muscle tone and strength and promote endurance. The special situation at aquatic exercise reduces pressure on the ligaments, because water covers part of the stretch, making the movement more smooth. Exercises such as jumps, impossible to make into the final months are possible in the water. And other exercises, like the movement of arms, found in the resistance of the ideal added water component out of the water would be too simple.

How I can feel comfortable?
* Lying: It is best to use a firm mattress. In some cases, a folded towel or small pillow between your knees and thighs can help. Try to lie down with knees bent, avoiding overstretching the back. To get up, lean with your hands and elbows, and do it from side to sit. Follow the reverse process to lie down. At the end your pregnancy is possible that a towel or a pillow on your back also help you feel better.
* Sitting: It is preferable to use a chair to a chair. The back line makes the baby is placed correctly in your pelvis, especially in late pregnancy. If your knees are slightly below your hips will be better. Avoid crossing your legs, because it can cause discomfort at the end of your back.
* Walking: Walking is a fantastic exercise, but to be standing too long can cause swelling of the ankles and back pain. Try to walk straight and look at your center of gravity as you walk. Shoes must be comfortable and secure to prevent tripping. If you have to stand for long periods, put one foot before the other and rock, or move your pelvis forward and backward with the help of your abdominal muscles. If you're still standing, such as ironing, use a small stool or a stack of books (such as phone message) to keep a foot high.
* Lifting weights: It is best not to lift anything heavy, but if you have to keep your back straight and bend your knees and hips. Being pregnant does not load you will bring your body, be careful. As the ligaments are more relaxed, it is easier injured, so do not try to make any effort with something that is easily loaded before. When you go shopping, balancing the load between both hands.

What I can do to relieve back pain?
The pain in the lower back is usually relieved with better posture. Balance the pelvis to focus your baby in your body. Keep your back straight on a wall by bending your knees, put your hand on the lower back and pelvis balanced so that now the back pressing against your hand. Repeat the exercise several times until the wall do not need to do so. Try putting your hands on your hips while doing so. Another version of the same exercise is as follows. Get on the floor on his knees, put your hands to shoulder height, separate the knees at the same distance, round the back and hold on for a few seconds with his head down. Replace the back straight with the head aligned. This exercise helps relieve back of baby's weight. It is a very suitable position in the phase of expansion at birth, decreasing much back pain. If the pain comes at the end of the back, around the back of the pelvis, you can try some stretches. Lie on your back and bring your knees spread to the shoulders, belly in the middle, stretching well all the vertebrae. Hold the stretch for 15 seconds. You can swing with your weight gently to make a massage on your back. Remember not to be more than a few minutes lying on her back, and be careful to lie down and stand up.

I just had a baby, and I'd like to get my previous figure. When I can start exercising?
It may be that after delivery you wonder why you still have stomach and raise you start exercising as soon as possible to eliminate it. Think of your uterus still has to reduce its size and, if he has taken nine months to become so great, will not shrink from night to day. Breastfeeding your baby helps to shrink before. If you do exercise during pregnancy, you'll feel better soon begin a very smooth workout. Gradually you will be increasing the amount and hardness up to regain your previous level. Always listen to your body, because although the baby is outside your body needs nine months to recover fully. If you notice an increase in vaginal discharge or some type of pain, take it easy and reduces the intensity and duration.

Many doctors will tell you to wait until the sixth week after birth, but others may suggest that, depending on how you are, the sooner you start doing light exercises. Basically depends on whether you have done exercise regularly or not. If you've been exercising almost to the birth, you may be able to immediately start a light stretching routine to go to grow as you meet with encouragement. But if you stopped exercising during pregnancy or you have never done, it is preferable to take it easier. You can start with the exercises recommended for the first six weeks or, if you have passed, consider the years after the first six weeks. Anyway, check with your doctor or midwife, and recalls that the ligaments will still be a bit lax during the first three to five months after delivery.

With the arrival of the baby, can not find time to exercise. Any suggestions?
The time and energy to exercise is very difficult to find when the baby has arrived. But you can always take the baby with you in your daily walk, or have it at your side while doing some exercises. You can even use it as weights!

What are the best exercises after delivery?
The first exercises you can do almost immediately is the Kegel exercises for pelvic floor recovery. Get used to them several times a day for life. Years from now you'll be glad not need to carry pads because of urinary losses.

The abdominal muscles will have been opened to give way to the uterus that contains your baby. It is necessary to wait until they are closed before doing any exercise with them, because you can prevent their recovery. To check, lie on your back with knees bent. Put the fingers of your left hand, palm touching your skin, just above the navel. Inhale through your nose while breathing out through your mouth, raise your head and shoulders off the floor and move your right hand over the thigh to the knee. This move will make the abdominal muscles to contract, so you can note their separation. If you notice three or more fingers between them, need to do the exercises recommended for the first six weeks. When the separation is less, you do abdominal exercises harder.

Avoid exercises that cause pain in your breasts. It is always better to breastfeed your baby before exercising. You'll empty the breasts will be more comfortable exercising. Moreover, recent studies have suggested that the baby prefers milk after about sixty minutes after finishing the exercise which occurs right afterwards. Anyway, as you do not get tired, the baby will not notice the change.

Is there any indication that I'm going through?
If vaginal discharge is excessive or if you have a cesarean section, you must be careful during the first weeks. Check with your doctor or midwife if the flow had stopped and re-occur.

What is the best way to lose weight?
Many mothers want to have the physical aspect prior to pregnancy as soon as possible. Indeed, the period after birth is the best time to lose weight, especially if breastfeeding is being established. Once it finds you well and the baby breastfeed without difficulty, you may consider losing about half a kilo every one to two weeks. Breastfeeding can help you break free of accumulated kilos, precisely because they are there for us to give your baby with your milk. The best approach is to eat healthy and balanced way, doing aerobic exercises like fast walking or swimming, 30 to 50 minutes, three to five days a week. If you do not do any exercise during pregnancy, start gradually increasing the intensity as your body and supports it.

Physical changes during pregnancy can do to change your exercise habits

* Breathing: The breathing rate increases, since the body works harder to provide enough oxygen to the baby. Thus, the amount of oxygen available for exercise decreases and can cause shortness of breath and less endurance.
* Musculature: As the abdomen expands to make room for the baby, the lower back is curved and the center of gravity changes of place. This can cause falls, and that the sense of balance is very upset. Thanks to the hormone relaxin, the ligaments are not as tense, leading to sprains and falls. This hormone will allow your pelvis to make greater, facilitating the passage of the baby.
* Metabolism: During pregnancy, your body uses carbohydrates more quickly, in the same way that physical exercise. This can cause low blood sugar during exercise.
* Cardiovascular: Blood volume increases by 40% and about 15 more beats per minute. Thus, nutrients and oxygen are transported to the baby better. But as the load is greater, for example being a long time lying on her back, the flow can be interrupted and cause dizziness.

Effects of exercise that can affect pregnancy

* Cardiovascular: When you exercise, blood is routed to the internal organs to the muscles, lungs and heart, so that they receive more oxygen. Strenuous exercise can cause a lack of oxygen in the uterus, which can cause problems in the baby.
* Neurotransmitters: During the year generated a number of chemicals that reduce depression and make the person feel better. One of the agents increases neurotransmitter produced contraction of the muscles and can cause uterine activity. Not known to induce labor, but in women with certain risk or sensitive, we recommend very gentle exercises.
* Body temperature: Exercise increases body temperature. Due to the risk of malformation due to high fever in the first trimester of pregnancy, it is preferable not to play sports (or take many precautions) when the air temperature is very high. In any case, remember to always drink plenty of fluids.

Complications of pregnancy which may affect the practice of the year

* Anemia: The transport capacity of oxygen in the blood is impaired, so it is likely to be short of breath, and fatigue and dizziness occur. Women with anemia who want to continue with the exercise should take a diet rich in iron, together with vitamin C to increase absorption and possibly a supplement if your doctor has prescribed.
* Contractions: Some women experience cramping during your pregnancy. Although not always imply an early delivery, yes that can increase the risk. If you're one of those women, you should not exercise very hard, but it is preferable to choose softer exercises like yoga, stretching, mild exercise or swimming instead of running, aerobics or dancing.
* Back pain and sciatica: pain is quite common because the distribution of the weight of your body varies and makes your position changes. Weight bearing exercise can increase it and make the ligaments suffer. Again, it is suggested exercises softer, especially swimming for their benefits back.

Contraindications to Exercise During Pregnancy

* Hypertension: Women who have high blood pressure can benefit from regular exercise, but those who develop it during pregnancy should stop practicing. Toxemia, or high blood pressure because of pregnancy, is a major problem in the bloodstream that exercise may aggravate. Check with your doctor about your particular situation.
* Placenta previa or vaginal bleeding: Placenta previa occurs when the placenta grows from the bottom of the uterus and close the opening of the cervix. It can cause vaginal bleeding. It is preferable not to exercise, unless the doctor tells which are right.
* Previous preterm delivery: In cases of previous births before 36 weeks, you should be extremely cautious about exercising during the third trimester of pregnancy. The most suitable are stretching, yoga and soft gymnastics, and walking.
* Intrauterine growth retardation: It is possible that the baby is not growing at a pace that should by low oxygen supply, although there are other causes, such as smoking, drug use, infections and poor blood supply to the placenta . As the exercise gets the blood, and with it the oxygen are diverted to other parts of the body, it is preferable to limit its intensity as the baby can be seriously affected.
* Multiple Pregnancy: Due to the particular risk of such pregnancies, we recommend very gentle exercises such as yoga, swimming, light stretching and gymnastics relaxed.
* Heart problems: Since the amount of blood pumped by the heart is increased by 40%, and physical exercise increases the heart rate, it should only be done under the supervision of a cardiologist or specialist physician.
* Whenever there is vaginal bleeding, have vision loss during exercise (a symptom of preeclampsia), nausea, dizziness, fainting, shortness of breath, palpitations, swelling of the hands, feet or ankles, or a sudden change in temperature , rest and check with your doctor or midwife.

In the past pregnancy was considered as a disease. In cases where the family finances permitting, the woman was confined to an almost absolute rest. Now, with the existing control techniques, the possibility of exercising during pregnancy, not only is not contraindicated, but is recommended.

First of all, it is essential that you consult with your doctor if the type of exercise you want to do is recommend as your physical condition and the conditions of your pregnancy.

If you already exercise before getting pregnant, check with your coach or doctor of your gym to see if you change any habit or exercise. It is important that the monitor of the class or the caretaker of the facilities (pool, weight room, etc), know that you're pregnant, not only to advise to do the exercise, but also socorrerte if something goes wrong.

Because hormones widen your ligaments and will vary the behavior of your body, do not do the brave. Your body will gradually be the one who was and will have to adapt to it. Ligaments are bands of fibrous tissue and flexible designed to hold the bones together and give them some flexibility. By swell, the security mechanisms offered are not as reliable, so you have to be careful not to overreach.

If not exercise before becoming pregnant, now is the time to start practicing simple exercises and regular. First, determine at what level you are and think about what exercises you like to accomplish. It is best to start with a few short sessions to gradually increase its frequency and duration.
Benefits of exercise

The benefits of exercising during pregnancy are many:

* Increase self-esteem minimizing depression and anxiety
* Helps maintain a rate of adequate weight gain
* Reduces discomfort associated with pregnancy weight gain and volume, reduced coordination, apathy
* Reduce the possibility of caesarean section
* The recovery is faster delivery
* It speeds up the recovery of pre-pregnancy weight
* Increase your energy levels and wellbeing
* Improves sleep quality
* Help prepare for the marathon of labor

Important Considerations

You should bear in mind the following considerations when exercising when you're pregnant:

- Check with your doctor. At the first visit after learning that you're pregnant, your doctor will have performed a series of checks. Consult believes what type of exercise is more in line according to your current constitution and what is most recommended for the future.
- Dress for the occasion. At first, the clothes you wore will be alright, but as the waist extension is convenient to buy a special sports trousers for pregnant women, and big shirts. If you plan to swim, a bathing suit for pregnant is essential. Use an appropriate subject for the breasts that will grow. Footwear is also important, especially in late pregnancy when your legs and feet swell.
- Consider the exercise as a more routine in your life. Remember, it is very important to prepare for the last heavy months for the marathon of labor. The fitter you are during the first two quarters, more manageable will be the last, delivery and recovery.
- Be especially careful with the messages your body sends you. This is changing, and an exercise that was common two days ago, today can be dangerous.
- Drink lots of fluids before and during exercise, and make frequent stops.
- Avoid exercising when the ambient temperature is high and high humidity.
- Make stretching and warming at the beginning and end of the session, paying particular attention to the linkage.
- During the last two quarters, it avoids a long time to be lying on your back, and which can decrease blood flow to your baby.
- When getting up from a lying position, do it in stages. First get on your side, then lean on the elbow and hand the other side to withstand the weight of your body. Merge of both hands helping to the seated position and once so, put both feet on the ground, hands on knees, get up slowly.
- Measure the beat of your heart. Count them for ten seconds and multiply by six. They should not go from 150 per minute, or what is the same, 25 every 10 seconds.
- Do not lift weights too large.
- Never get tired to get out of breath. You should be able to have a normal conversation at all times. He thinks that if you lose your breath, the baby for a while that does not receive enough oxygen.

If a couple has decided to start a family, it seems that the next step is easy. In most cases yes, but in many other pregnancy is delayed. The wait makes every attempt is alive with nervousness, and sometimes can give the impression that it is the same nervousness that makes the happy event does not occur.

If pregnancy is planned with care, will be much richer and the responsibility of the new baby will be more pleasant. As a consequence, you may do not be negative feelings regarding the problems that may occur during pregnancy and sometimes so hard burden of parenting a new baby.

There are several things to consider when the decision has been taken or are expected to take it soon. Some of them can be changed on the fly, but sometimes it is better to set before you start.

Conception occurs about two weeks before the waiting period (not come). This means that you may not know you're pregnant until you're already at least three weeks. It is during the first eight weeks after fertilization when the baby is more delicate. So whatever you do can affect you without your knowledge. Therefore, it is best to begin to take care as if you were pregnant before they really are.

One of the first things you can do is visit your doctor. Your doctor:

* Consider your history to see if there is any possibility of diabetes, high blood pressure or a family genetic problem.
* It will take the tension to keep in mind if you can develop preeclampsia.
* You can Explorart to make sure everything is in order (uterus, ovaries and cervix).
* You ask for a urinalysis and complete blood with which verify several things: the existence of urinary tract infection or diabetes, as well as your blood type and group (and your partner also to see if there is any incompatibility).
* Hypothyroidism can cause a defect in the baby and future problems of breastfeeding.
* If the woman has had or will have contact with cats and their feces, it is best to check your blood detects antibodies to toxoplasmosis to know that she is infected during pregnancy, seriously affecting the baby.
* It is also important to assess whether there has been a rubella and, if not, whether to be vaccinated before pregnancy, and to pass this disease during pregnancy can cause abortion.
* It would also be prudent to get vaccinated for tetanus, but before these vaccines is always advisable to decide whether it is worth it or take the risk. It is a personal decision.

See your doctor if you take any special medication you can not quit during pregnancy, especially if medications are associated with asthma, epilepsy, thyroid or migraine. Some drugs can be taken without any problems.

It is also interesting to visit the dentist. During pregnancy, some women have very sensitive gums, so the dentist can perform a dental cleaning in depth to allow the teeth ready for the coming months.

If physical fitness is not the most appropriate (overweight, sedentary lifestyle, etc), would be useful to a healthy diet and try to lose some weight and especially exercise. Nothing strenuous, just get a little fit. They say that giving birth is like a marathon, so you have several months to prepare, because the event can delay or advance, but will not cancel! The sooner you start, the better you will find more livable you make pregnancy and childbirth. Walking an hour a day, and activities such as swimming, gymnastics and yoga are highly recommended.

Reduce the number of alcoholic beverages to take nothing. Coffee and other caffeinated drinks should be reduced from your diet, but not necessarily eliminate them. Now is the best time to quit and give up any other drug. Do not leave it for when you get pregnant. Think about that when you know you are pregnant, as will a few weeks you are. Imagine your baby with a cigarette in his mouth when you feel like a bit of smoke. Oh, and your spouse also must stop smoking!

Avoid steam baths or hot tubs. In the first quarter, a change in body temperature may be the cause of malformations in the baby, and even abortion.

A few months before the baby start looking is interesting to take folic acid, as it is shown that minimizing the risk of spina bifida, even if there were previous cases. You need to take about 0.4 mg or 400 micrograms per day. Foods rich in vitamin B are the juices of citrus fruits, dark leafy green vegetables, legumes, asparagus, peas, broccoli and cereals. But keep in mind that you should not take more than a thousand micrograms a day because it could mask an anemia.

The choice of whether pregnancy and childbirth will be under the control of a private or public must also be taken several months earlier. In some cases, private mutual do not take care of all expenses. Thus, even then may change their minds, it is always preferable to choose a mutual to allow the change if in doubt, with proper choice of doctors and hospitals, or public trust in medicine and supplement it with private support, as a doula.

During the months prior to pregnancy may be interesting to try to better understand female fertility. So, knowing which days a woman is most fertile, you can prevent pregnancy and promote it when the couple decides that it is time.

Most family planning methods are focused on preventing unwanted pregnancy, but few seek help. The sympto-thermal method allows nerves to know better and avoid unnecessary, since we have more certainty about when the time is right to find the baby wanted. Even some authors claim that can even choose the sex of the baby as when performing intercourse.

Françoise Soler was the person who introduced this method in Spain, Barcelona forming a Coordinating Association for the dissemination of Natural Family Planning (ACODIPLAN). She is the author of a book very enlightening on the subject. Anyway, you should check with an expert or an NGO to verify that it follows the method correctly.

We found several interesting links in Spanish on this topic can consult.