It's time for another rant as I am now 40 weeks and 3 days along, and there is very little action from my uterus. Well, there's still a great deal of action in my uterus (thank goodness), but not much from said bag of muscles.
I am scheduled to be induced on the 17th if this baby doesn't come spontaneously before then, and the closer that date comes the more I'm slightly wishing I could run and hide in a desert or something. I do not want to have to be induced again (though my previous inductions were for medical, not "due date" reasons).
I hate obstetrics in America. Despite the fact that the average gestational age is just short of 42 weeks, and I've known moms expecting their 8th child who've carried them that long, my uniquely natural-oriented practice of midwives still has pressure to induce me just before I hit 41 weeks. It's just ridiculous! Why do they have to rush our babies out with Pitocin when our bodies could literally be a day or two from naturally delivering?
Yes, I know I've delivered naturally with Pitocin, but it was no walk in the park. Also, I've sometime analyzed the decision the midwives made to blast me through the labor the way they did. I mean, when we decided to induce, the plan was to start me on Pitocin, and then once my contractions really got underway (remember, I was starting at 5 centimeters) the Pitocin was to be shut off to allow my body to labor naturally. Unfortunately, once the Pit started, my son's heart-rate seemed to get a little messier. I have a sister-in-law whose baby didn't love the Pitocin in her induction, and so they shut off the Pit and used a different induction method (some kind of balloon thing against the cervix).
In my case, however, they just decided to up the Pitocin levels until it was full blast for most of the labor. It made for a short but very difficult labor. I guess the big difference between my induction and my sister-in-law's induction was that my baby started with variables in the heart-rate, and her baby was simply "overdue." Oh well! All's well that ends well, I guess.
That doesn't make me more excited about the prospect of another induction or about the practice of doctors and midwives to set expiration dates on pregnancies. In my opinion, as long as the baby is doing well, Mom should be allowed to ride out the pregnancy unless she doesn't want to.
Since I love stories, here are three stories that illustrate why I'm afraid of Pitocin and would prefer not to have another induction with it - one happy story and two... not so happy stories. I have a friend who recently had a VBAC, and what a blessing it was that she could have a VBAC! It was her third pregnancy, and in her second pregnancy she had placenta previa, which makes a cesarean medically necessary for the safety of Mom and Baby. In her third pregnancy, she was informed that if she wanted to deliver vaginally, she would have to spontaneously begin labor before the "expiration date" (probably set at 41 weeks minus a day), because she was required to birth her baby by that date, and they could not induce her with Pitocin.
Now let's examine that last statement: They could not induce her with Pitocin. Why was that? Now, considering a VBAC is a perfectly reasonable possibility for most women, and yet a Pitocin induction is not, could this be an indicator that Pitocin is not a perfect replica of the body's natural oxytocin? Is it an indication that a constant drip of contraction inducing hormone might be tough on someone's body? Is it possible that Pitocin could overdue it on the uterus and is not a completely safe option at all times? I think so. Well, these risks are completely known (and they stand for non-VBAC contenders as well), and yet Pitocin is used all of the time to induce and augment labor.
The good news is this mom did go into spontaneous labor just before the set expiration date, and she was able to deliver vaginally. What a blessing it was for her! (Though she ended up having some other health problems soon after, but that's another story and one that I don't think was actually related to the VBAC. I'll have to look it up though...)
Here's story #2: I have a friend who has three children but was never able to deliver vaginally? Well, I have a few friends like this, but this one had this experience for the most interesting reason - her babies "never dropped." In other words, her doctors set an expiration date on her pregnancy, and she never delivered spontaneously before the expiration date. So they attempted to induce her with Pitocin, and because the the cervix was not ripe and there was not sufficient dilation, they had to deliver her babies via cesarean - all three pregnancies!! Yikes!!! Can you hear me screaming at the top of my lungs at this?
What I am totally convinced about this situation is that my friend's babies wanted to gestate a little longer than the average baby. They were probably good solid 42-weekers, but their mom was never given the chance to carry them to their full gestational age. They were not facing distress requiring induction, either, nor were they particularly huge babies. They just weren't allowed the come when they wanted to come.
Here's story #3. Are you ready? A friend of mine has a sister overseas whose bag of waters leaked with her second baby. She went to the hospital after some time, and the law required that she be allowed to wait awhile longer before they induced with Pitocin. (I think having a waiting period is smart, by the way. Waiting usually works for labor to start, though I guess that sitting in a hospital bed might make it a little useless, but I digress...) The labor didn't start spontaneously, so they induced her with Pitocin. Shortly after the delivery of the baby, who was fine, they became concerned about Mom's bleeding. They checked out the condition of the uterus, and it was practically in shreds. After having just two children (when the couple had planned on more), Mom was given a hysterectomy.
I haven't done the research on this last one, but here's my only slightly educated theory. I think they inadvertently overdid it on her uterus with the Pitocin.
What are the potential dangers of Pitocin? Babycenter gives a pretty bland explanation that Pitocin sometimes overdoes it on the uterus and on the baby. Birthing naturally has a decent breakdown on some of the risks, which include uterine rupture and fetal distress as well. And finally, this article from Associated Content actually mentions potential links between the increase in cases of autism in recent decades in congruence with the increased use of Pitocin to induce or augment labor. I'm not saying they're linked, but it's an interesting thought.
I think that the fact that, once a woman is given Pitocin, she automatically has to receive continuous (not intermittent) fetal monitoring is an obvious indication that the drug is not without risks. And yet, tons of my friends are induced with most of their labors, and they look forward to it.
I'm not saying that Pitocin should go away. It helped me get my last son here safely, and it gave me a fantastically tight tummy afterward with minimal post-partum bleeding. :) It's just a shame that medical providers aren't more cautious about their use of Pitocin, and women would do well to educate themselves about the drug before embracing it whole-heartedly.
So I need to get going with the walks, pineapple, accupressure, or whatever else it takes to have this baby soon. I have just three days if I'm to avoid another encounter with Mr. Pit. Please pray for me and my little one!
Sunday, February 14, 2010
Sunday, February 7, 2010
The Power of Suggestion
So I am now 39 1/2 weeks along, dilated to 4 centimeters, and 90% effaced. Though I consistently wake every night many times and have at least one stretch of 90 minutes plus of wakefulness (this is really getting to me, by the way), I had two nights last week where I woke to a good 1 1/2 - 2 hours of steady, real contractions. These weren't killer contractions by any means, but they were definitely more than "Braxton Hicks." I felt that familiar tug in my lower back that has come with each labor. (By the way, this tug is often due to a ligament in the lower back which attaches the uterus to the back muscles. When the uterus contracts, the ligament gets pulled on, and voila! - back pain. Just a little FYI.)
Considering I've had 3 babies already, I thought it might help for me to know where my starting point is when I begin to labor actively so we can be sure to get to the hospital on time. A car birth sounds like an adventure, but it's probably not the safest option.
While I would have been very happy to have had my baby by now, however, I had a couple of reasons for wanting the pregnancy to last a little longer. First of all, my oldest daughter was scheduled for baptism on Saturday, and I was concerned that if the baby came too close to the baptismal date then we would have to reschedule the baptism. That probably sounds silly, but between the fact that where we live rescheduling would mean having to wait an entire month to be baptized and the concern that it might put a small damper on the two sisters' starting relationship, I wanted the baptism to go through as scheduled. Also my oldest son has been coughing like crazy, and I wanted to see his cough settle down a little before we brought a baby into the house.
But really, these are kind of silly excuses to want to talk your baby out of coming at an inconvenient time. What was really concerning me on the first night was this - I didn't like the midwife on call. I know, it sounds very neurotic, but it's just a fact.
You see, I live in a relatively small town that is located at least 20-30 minutes drive to my midwives' practice. Between here and the practice, there are probably dozens of OBs and at least one other practice of midwives. The reason I travel so far is because these midwives have a reputation for being very supportive of natural childbirth. In fact, I birthed my 3rd child (Mr. Rambo who ties knots into his cord) with this group of midwives. The fact that I was able to labor unmedicated though I was induced with Pitocin is owing largely to the fact that the midwives who attended my labor were very supportive of a natural birth. I even knew a woman whose husband was allowed by one of these midwives to assist in the delivery of their 5th baby. These are rare midwives.
The thing is, even in a practice like this, not all midwives are created equal. Midwife M, who oversaw Mr. Rambo's birth, left a year or so ago, and the midwife who they hired is - shall we say - an interesting fit. Or maybe she just doesn't fit with the practice at all.
I'll call her midwife JB. She's a very pretty lady, apparently a mother herself, and fairly nice. Alas, it sounds like she has a few issues with the whole natural thing. For one thing, I understand (from another midwife) that she tends to cut more episiotomies than all of the other midwives. This bothers me. She is apparently fairly uncomfortable with tears. That's sad and frankly outdated. If someone like that is delivering my baby, I'll have a hard time trusting them to just let me tear (as I'm likely to do with my large babies and considerable scar tissue from birth #1). I don't mind tearing. Now I don't know if she tends to cut without permission (as do so many OBs), but just knowing that she has the "Oh no, she's tearing!" issue makes me a little uncomfortable.
There is something I consider worse, however - much, much worse. Apparently she has a habit of suggesting epidurals to patients. (sigh) (deep breathe)
I have such issues with care providers suggesting epidurals to women. First of all, from everything I've read and heard in classes, there are very few situations where an epidural might make a birth safer. Unless mom has skyrocketing blood pressure and is about to go into cardiac arrest from the pain, there aren't many other medical indications for epidurals. I will concede that, should there be a good likelihood of emergency cesarean, it might make providers more comfortable knowing that mom is hooked up to the anesthesia in advance. If, however, a quick vaginal delivery is feasible, it's more likely with an unmedicated birth. The epidural might inadvertently make a cesarean more necessary if stage 2 of labor is too prolonged.
My second issue with the "suggesting" epidurals thing is that even the most prepared couples usually get to a point where mom is feeling unsure that she can handle much more. If she's only dilated to 2 centimeters, she might understandably say, "Forget this!" and get the meds (and I can understand why she'd choose that). But if mom is at a 7 or more, she is likely looking at another 30 minutes or less of dilation. Most women who are deeply committed to the idea of natural birth would consider it worth it to refocus their energy and finish out stage one so that they can push unhindered by an epidural.
Actually, just as another FYI, there are some women who can literally dilate from 2 to 10 centimeters in less than an hour. It sounds pretty darn tough, but it happens. One case sighted in my favorite natural birth book Childbirth the Bradley Way is a labor just like that. Mom hit a point where the labor started to get pretty strong. She and her husband arrived at the hospital, but in triage she was turned away because she was only dilated to two centimeters. On the way home, she announced that she didn't think that she could keep going. Her husband recognized the "self-doubt" signpost and turned back around. Alas, the baby came before they could reach the hospital. Yikes!! All was well in the end, but the triage nurse might have done well to pay more attention to the woman than to the dilation.
So, when mom hits this milestone, typically at transition, the last thing she needs to hear is "There's nothing wrong with an epidural." There is nothing wrong with an epidural, but it's not necessarily the right choice for every woman in labor who starts to get discouraged. Yet most women are very susceptible to suggestion at a time like that, and as I've said in the past, such a suggestion would not only be tempting but might feel like an indication that she's not "doing well enough" with her contractions.
Here are two stories, both of which infuriate me: First, a friend of mine was delivering with the more local midwives in the area (notorious among natural birthers for being intervention minded). After several hours of my friend laboring unmedicated with a Pitocin induction, her midwife announced to her that she wasn't dealing well enough with the contractions, and she should get an epidural. Now I don't know if my friend's blood pressure was spiking, but from what I understand, the midwife just wasn't satisfied with how well my friend was doing. She had an epidural, and her labor went fine. But my friend really wanted a natural birth and was disappointed with how things went. She still says that she wants "another go" at it. I would feel the same.
My second story makes me think that castration might not be an unreasonable punishment for some people. A friend of a friend had had a terrible experience with her first epidural labor. I don't know how prepared or trained she was, but she was determined to birth naturally the second time around. During her second labor, however, the nurse was dissatisfied with how well she was coping with her labor. The nurse repeatedly suggested an epidural, but the woman refused. Finally the nurse brought the anesthesiologist in with her. He stood there offering the patient the procedure, but she refused explaining that her previous epidural was awful. He explained that it often depended on the anesthesiologist. She replied that he had been the anesthesiologist, and she didn't want an epidural. So he stood there and argued with her (through her contractions) until she consented. She hated her second birth experience as much as the first.
Am I the only person who is disgusted by that story? Just wondering. Also, I've always wondered where the heck her husband was. My husband might've knocked the man off of his feet!
The biggest qualm I have with this issue is that the birth does not belong to the provider. It's not their baby or their body. They don't know what mom is feeling. They don't know exactly how she's interpreting the physical sensations in her body. She might just be starting to think that it's getting tough. It's HER decision, and SHE should be the one to request the meds if she wants them.
No woman should ever feel bad for getting epidural. It's her right to decide, but it's no one else's right to suggest one.
Back to this midwife who I was afraid of: I was discussing her today with another woman in the practice. I shared that I didn't trust JB and explained my concern about her suggesting epidurals to patients. She (my friend) explained that JB told her that with one of her own births, she was unable to get an epidural and it was so painful that she had difficulty bonding with her baby.
I don't mean to sound insensitive, but I would suggest that JB should consider talking to someone and working through this experience she had with her labor. There is a huge difference between the birth of a woman who plans on meds but can't get them and another who plans for and has a natural birth expecting to face pain. It's a night and day experience, in fact. Again, it brings me to my previous rant on the "painless childbirth" expectation.
A woman who prepares (or even just plans) to birth naturally and expects some (or lots of) pain will perceive the labor very differently. She may even experience tremendous pain in her labor, but she is less likely to be traumatized by it because SHE CHOSE IT. It's amazing what some "crazies" will choose, but when we get what we choose, we often feel good about it. We might feel a sense of accomplishment, of peace. And we might be so glad that we stuck out that hard part so that we could enjoy the satisfaction of more capable, controlled pushing, less tearing, a better recovery, etc. Labor is a hugely difficult task, but the difficulty (and, yes, usually pain) of that task should not nullify every pre-labor decision a woman makes. And if a woman has decided in advance that she wants to go unmedicated, whatever choice she makes should be honored.
Finally, women who labor naturally should not have to feel like they are being auditioned going into labor. There shouldn't be this criteria of "Well, if you want to go natural, you'd better not complain during it." Yet I see that as being the case when nurses, OBs, and midwives suggest epidurals when they think a woman isn't doing well enough. Women should be allowed to complain as much as they want. I don't know that it helps with the pain (it probably doesn't), but it's their right to moan, cry, or even scream if they'd like. Again it is their birth and their choice. If we are so determined to respect a woman's right to request an epidural (which we should), then we ought to show the same respect for a woman who chooses not to request an epidural.
So as I sit here ignoring my mild, thankfully occasional contractions, I'm hoping to give birth to this little girl sometime in the next 4-5 days. Only I don't want her to come before 8:00 AM tomorrow morning and the next midwife is in. You see, right now JB is on call. :)
Update on 2/10/10 - I had my 40 week check-up with JB today. She's a lovely person, and I think that we'll be fine if she's the provider on call. I'd still prefer another provider, though. I have a feeling that she is more relaxed in clinic (duh!) and might still have an intervention trigger finger during labor. In the meantime, I'm sending vibes to this little one to come and join our family soon...
Considering I've had 3 babies already, I thought it might help for me to know where my starting point is when I begin to labor actively so we can be sure to get to the hospital on time. A car birth sounds like an adventure, but it's probably not the safest option.
While I would have been very happy to have had my baby by now, however, I had a couple of reasons for wanting the pregnancy to last a little longer. First of all, my oldest daughter was scheduled for baptism on Saturday, and I was concerned that if the baby came too close to the baptismal date then we would have to reschedule the baptism. That probably sounds silly, but between the fact that where we live rescheduling would mean having to wait an entire month to be baptized and the concern that it might put a small damper on the two sisters' starting relationship, I wanted the baptism to go through as scheduled. Also my oldest son has been coughing like crazy, and I wanted to see his cough settle down a little before we brought a baby into the house.
But really, these are kind of silly excuses to want to talk your baby out of coming at an inconvenient time. What was really concerning me on the first night was this - I didn't like the midwife on call. I know, it sounds very neurotic, but it's just a fact.
You see, I live in a relatively small town that is located at least 20-30 minutes drive to my midwives' practice. Between here and the practice, there are probably dozens of OBs and at least one other practice of midwives. The reason I travel so far is because these midwives have a reputation for being very supportive of natural childbirth. In fact, I birthed my 3rd child (Mr. Rambo who ties knots into his cord) with this group of midwives. The fact that I was able to labor unmedicated though I was induced with Pitocin is owing largely to the fact that the midwives who attended my labor were very supportive of a natural birth. I even knew a woman whose husband was allowed by one of these midwives to assist in the delivery of their 5th baby. These are rare midwives.
The thing is, even in a practice like this, not all midwives are created equal. Midwife M, who oversaw Mr. Rambo's birth, left a year or so ago, and the midwife who they hired is - shall we say - an interesting fit. Or maybe she just doesn't fit with the practice at all.
I'll call her midwife JB. She's a very pretty lady, apparently a mother herself, and fairly nice. Alas, it sounds like she has a few issues with the whole natural thing. For one thing, I understand (from another midwife) that she tends to cut more episiotomies than all of the other midwives. This bothers me. She is apparently fairly uncomfortable with tears. That's sad and frankly outdated. If someone like that is delivering my baby, I'll have a hard time trusting them to just let me tear (as I'm likely to do with my large babies and considerable scar tissue from birth #1). I don't mind tearing. Now I don't know if she tends to cut without permission (as do so many OBs), but just knowing that she has the "Oh no, she's tearing!" issue makes me a little uncomfortable.
There is something I consider worse, however - much, much worse. Apparently she has a habit of suggesting epidurals to patients. (sigh) (deep breathe)
I have such issues with care providers suggesting epidurals to women. First of all, from everything I've read and heard in classes, there are very few situations where an epidural might make a birth safer. Unless mom has skyrocketing blood pressure and is about to go into cardiac arrest from the pain, there aren't many other medical indications for epidurals. I will concede that, should there be a good likelihood of emergency cesarean, it might make providers more comfortable knowing that mom is hooked up to the anesthesia in advance. If, however, a quick vaginal delivery is feasible, it's more likely with an unmedicated birth. The epidural might inadvertently make a cesarean more necessary if stage 2 of labor is too prolonged.
My second issue with the "suggesting" epidurals thing is that even the most prepared couples usually get to a point where mom is feeling unsure that she can handle much more. If she's only dilated to 2 centimeters, she might understandably say, "Forget this!" and get the meds (and I can understand why she'd choose that). But if mom is at a 7 or more, she is likely looking at another 30 minutes or less of dilation. Most women who are deeply committed to the idea of natural birth would consider it worth it to refocus their energy and finish out stage one so that they can push unhindered by an epidural.
Actually, just as another FYI, there are some women who can literally dilate from 2 to 10 centimeters in less than an hour. It sounds pretty darn tough, but it happens. One case sighted in my favorite natural birth book Childbirth the Bradley Way is a labor just like that. Mom hit a point where the labor started to get pretty strong. She and her husband arrived at the hospital, but in triage she was turned away because she was only dilated to two centimeters. On the way home, she announced that she didn't think that she could keep going. Her husband recognized the "self-doubt" signpost and turned back around. Alas, the baby came before they could reach the hospital. Yikes!! All was well in the end, but the triage nurse might have done well to pay more attention to the woman than to the dilation.
So, when mom hits this milestone, typically at transition, the last thing she needs to hear is "There's nothing wrong with an epidural." There is nothing wrong with an epidural, but it's not necessarily the right choice for every woman in labor who starts to get discouraged. Yet most women are very susceptible to suggestion at a time like that, and as I've said in the past, such a suggestion would not only be tempting but might feel like an indication that she's not "doing well enough" with her contractions.
Here are two stories, both of which infuriate me: First, a friend of mine was delivering with the more local midwives in the area (notorious among natural birthers for being intervention minded). After several hours of my friend laboring unmedicated with a Pitocin induction, her midwife announced to her that she wasn't dealing well enough with the contractions, and she should get an epidural. Now I don't know if my friend's blood pressure was spiking, but from what I understand, the midwife just wasn't satisfied with how well my friend was doing. She had an epidural, and her labor went fine. But my friend really wanted a natural birth and was disappointed with how things went. She still says that she wants "another go" at it. I would feel the same.
My second story makes me think that castration might not be an unreasonable punishment for some people. A friend of a friend had had a terrible experience with her first epidural labor. I don't know how prepared or trained she was, but she was determined to birth naturally the second time around. During her second labor, however, the nurse was dissatisfied with how well she was coping with her labor. The nurse repeatedly suggested an epidural, but the woman refused. Finally the nurse brought the anesthesiologist in with her. He stood there offering the patient the procedure, but she refused explaining that her previous epidural was awful. He explained that it often depended on the anesthesiologist. She replied that he had been the anesthesiologist, and she didn't want an epidural. So he stood there and argued with her (through her contractions) until she consented. She hated her second birth experience as much as the first.
Am I the only person who is disgusted by that story? Just wondering. Also, I've always wondered where the heck her husband was. My husband might've knocked the man off of his feet!
The biggest qualm I have with this issue is that the birth does not belong to the provider. It's not their baby or their body. They don't know what mom is feeling. They don't know exactly how she's interpreting the physical sensations in her body. She might just be starting to think that it's getting tough. It's HER decision, and SHE should be the one to request the meds if she wants them.
No woman should ever feel bad for getting epidural. It's her right to decide, but it's no one else's right to suggest one.
Back to this midwife who I was afraid of: I was discussing her today with another woman in the practice. I shared that I didn't trust JB and explained my concern about her suggesting epidurals to patients. She (my friend) explained that JB told her that with one of her own births, she was unable to get an epidural and it was so painful that she had difficulty bonding with her baby.
I don't mean to sound insensitive, but I would suggest that JB should consider talking to someone and working through this experience she had with her labor. There is a huge difference between the birth of a woman who plans on meds but can't get them and another who plans for and has a natural birth expecting to face pain. It's a night and day experience, in fact. Again, it brings me to my previous rant on the "painless childbirth" expectation.
A woman who prepares (or even just plans) to birth naturally and expects some (or lots of) pain will perceive the labor very differently. She may even experience tremendous pain in her labor, but she is less likely to be traumatized by it because SHE CHOSE IT. It's amazing what some "crazies" will choose, but when we get what we choose, we often feel good about it. We might feel a sense of accomplishment, of peace. And we might be so glad that we stuck out that hard part so that we could enjoy the satisfaction of more capable, controlled pushing, less tearing, a better recovery, etc. Labor is a hugely difficult task, but the difficulty (and, yes, usually pain) of that task should not nullify every pre-labor decision a woman makes. And if a woman has decided in advance that she wants to go unmedicated, whatever choice she makes should be honored.
Finally, women who labor naturally should not have to feel like they are being auditioned going into labor. There shouldn't be this criteria of "Well, if you want to go natural, you'd better not complain during it." Yet I see that as being the case when nurses, OBs, and midwives suggest epidurals when they think a woman isn't doing well enough. Women should be allowed to complain as much as they want. I don't know that it helps with the pain (it probably doesn't), but it's their right to moan, cry, or even scream if they'd like. Again it is their birth and their choice. If we are so determined to respect a woman's right to request an epidural (which we should), then we ought to show the same respect for a woman who chooses not to request an epidural.
So as I sit here ignoring my mild, thankfully occasional contractions, I'm hoping to give birth to this little girl sometime in the next 4-5 days. Only I don't want her to come before 8:00 AM tomorrow morning and the next midwife is in. You see, right now JB is on call. :)
Update on 2/10/10 - I had my 40 week check-up with JB today. She's a lovely person, and I think that we'll be fine if she's the provider on call. I'd still prefer another provider, though. I have a feeling that she is more relaxed in clinic (duh!) and might still have an intervention trigger finger during labor. In the meantime, I'm sending vibes to this little one to come and join our family soon...
Monday, February 1, 2010
Painless Childbirth, An Emotional Rant
So, I bet when you read "An Emotional Rant" you thought to yourself, "What else is new?" :) But I want to go off on a topic that I find intriguing and confusing.
What is "painless childbirth?" If you are at your midwife's office, you might see an advertisement for a class that can help you achieve "painless childbirth." In other childbirth camps, an epidural can supposedly give you "painless childbirth." When my husband and I first discussed the possibility of me birthing unmedicated, he questioned why I would want to deal with the pain if it wasn't necessary. In other words, why would I choose pain when I could have "painless childbirth?"
Where did we all get this idea that childbirth was supposed to be painless? Please please please don't get me wrong, I am not saying this in frustration toward laboring women. Who I'm really ticked at right now are the medical care providers and the childbirth educators who are setting this unrealistic standard by which we are supposed to measure our birth experiences.
"Painless childbirth" is a possibility with some women. But it takes a lot of factors to make it possible. Your baby needs to be positioned well. Your labor cannot be flying along at lightening speed. You have to reach an extremely deep level of relaxation and not have something disrupt it. You need to be well rested. It's not very likely with an extremely prolonged labor. It's more likely in a birthing center or in a home birth. You would need the right coaching or support from your birth partner and/or care provider. You need an absolute minimal amount of intervention. In fact, all of the "painless" births I've watched on youtube were tub births.
Another possibility is that you go to a hospital to be induced (before labor has started), and you are allowed to receive your epidural before the Pitocin kicks in. You have no negative reactions to the epidural, and you pop in a movie and wait out your dilation stage. When your nurse has determined that you've hit 10 centimeters, your baby just happens to be in the perfect position and is a lovely 7 pounds even. You have good strong arms or good helpers, somehow your legs get into the perfect position, and you push 3 times before your baby gently slides out with no tearing and no episiotomy. You hold your little one for nursing and a snuggle. And when your epidural wears off, you feel fabulous. There's another "painless childbirth" scenario!
Do either of these sound like one of your births? If so, you are one lucky lady!!
I'm not trying to be negative. Both of these pictures sound great, but there are so many variables in these two equations which can go wrong and make your would-be painless childbirth a real disaster (or at least, a painful childbirth).
Let's take the first unmedicated birth. Most women have their babies in hospitals, because they feel it is safer for them and for their baby. This automatically means a few things will take away from their comfort level. Either they will arrive early, but they'll be poked, prodded, checked, and disturbed enough that they can't stay relaxed enough for a painless birth. Or they will arrive late enough in their labors that they're headed right into or coming right out of transition, and being triaged and checked in at that stage is bound to make things painful.
What if there are some complications in your delivery? Got a posterior baby? A bigger baby? Something a little off in the heartbeat? Strep-B positive? There's no way to relax easily through these things.
What if, while you're trying to relax, you have a labor and delivery nurse trying to check your cervix every hour or suggesting you have an epidural now? That's no fun.
In other words, with a hospital birth it is practically impossible to experience painless childbirth, because there are too many distractions which will take away from your relaxation and increase your anxiety.
How about the epidural birth? Well, I know a lot of women who enjoy their epidurals and don't have negative side effects. But a huge percentage of them have episiotomies, vaccuum extractions, etc., at the end of stage two. Only some of them are lucky enough to have the perfect sized or positioned baby, and their pushing stage tends to be prolonged a bit. They might not experience a lot of pain during labor and birth, but they are likely to have a good deal of discomfort after birth with stitches and very strong uterine contractions, which typically seem stronger after epidural births. (Could it be that "painful" unmedicated births make postpartum cramping seem milder? I don't know.)
Don't get me wrong, I'm not thrilled about the fact that childbirth brings pain with it. I've never had what I consider a painless childbirth experience. I hope I haven't previously misrepresented myself on this blog. My second birth was more comfortable than the other two, and the contractions were mostly painful toward the end and during transition. Also crowning was painful. My third birth was very painful. The tension was high, my labor was fast and hard, the lip on the cervix was very painful to have pushed back, and crowning (again) was pretty darn ouchy.
How should I measure these two births which I compare? Were they failures? Should I even bring in my first birth? If I even ignore the feeling of helplessness and confusion that pervaded during that labor, should I reminisce yet again about the immediate postpartum hours when the epidural was wearing off and I practically went into shock? How about the weeks and weeks of pain from the 4th degree tear or the yeast in my milk ducts?
So do we need to become masochists to enjoy having babies? I hope not!!
What I really think is that we need to have reasonable expectations, and our health-care providers and childbirth educators should assist in this. If a woman is choosing to go unmedicated and is experiencing increasing pain, a provider or labor and delivery nurse should respect that woman's decision and not undermine her by suggesting an epidural as she hits transition. Having pain during childbirth is not a negative reflection of the care (unless the care is negligent and increases the pain). And childbirth educators should beware of promising that "if you're doing everything right" you'll experience "painless childbirth." That's like promising a sales-person that if they do everything right than they'll someday be rich, or that a truly talented actress will eventually become a celebrity. Such outcomes are possibilities, but there is no guarantee!
Where is all of this ranting coming from? Well I've now talked to two women who took hypno-birthing classes, and they both had great births and did terrific jobs in their labors. Unfortunately, their teachers had given them the expectation that, as long as they were doing everything right, they shouldn't experience pain in childbirth. While each of these women labored, they experienced considerable pain for different reasons, and it increased their frustration and pain and detracted a little from the experience.
It has been sobering to hear these stories (though I'm sure they are both dealing fine and have great attitudes just the same). I just feel that it was irresponsible for their teachers to instill such unrealistic expectations about labor and childbirth. Telling someone that it shouldn't hurt if they're doing everything right is only going to create feelings of self-doubt in a woman when it actually does hurt (for whatever reason - the position of the baby, the level of anxiety, etc). All the self-doubt will do is make it even harder for the woman. This isn't fair. She is doing a great job and should feel so.
And the same should go for the woman who labors with an epidural. In a small way, I actually admire my friends who are very accepting about the more difficult post-partum periods that tend to follow epidurals. I know so many women who think that episiotomies are not a big deal. They don't mind taking stronger meds for post-partum cramping. They are at peace with the idea that a slightly more "painless childbirth" yielded a slightly more painful post-partum. At least they have reasonable expectations. I was devastated to be in so much pain after my first birth. I'm sure that it only made things worse.
So if anything productive is to come of this rant of mine, I hope it's this: Childbirth is an incredible feat, and I hope that you and your provider don't ever try to measure how well you've done (or are doing) on how much pain you experience. If you had a killer labor, you are a rock star! If you had an easy labor, you are a rock star! Childbirth is not a contest to see who can suffer less.
If you want a positive labor, do all that you can to take care of yourself, get a respectful, supportive provider, choose a good location, take a good class, educate yourself, and make well-informed decisions about your labor. Then do your best and trust yourself. You may find that you are amazed at how comfortable you are, or you may find that the pain is stronger than you expected. But believe in yourself and your decisions. You are doing something amazing!
That is all. Happy birthing, Ladies!! :)
What is "painless childbirth?" If you are at your midwife's office, you might see an advertisement for a class that can help you achieve "painless childbirth." In other childbirth camps, an epidural can supposedly give you "painless childbirth." When my husband and I first discussed the possibility of me birthing unmedicated, he questioned why I would want to deal with the pain if it wasn't necessary. In other words, why would I choose pain when I could have "painless childbirth?"
Where did we all get this idea that childbirth was supposed to be painless? Please please please don't get me wrong, I am not saying this in frustration toward laboring women. Who I'm really ticked at right now are the medical care providers and the childbirth educators who are setting this unrealistic standard by which we are supposed to measure our birth experiences.
"Painless childbirth" is a possibility with some women. But it takes a lot of factors to make it possible. Your baby needs to be positioned well. Your labor cannot be flying along at lightening speed. You have to reach an extremely deep level of relaxation and not have something disrupt it. You need to be well rested. It's not very likely with an extremely prolonged labor. It's more likely in a birthing center or in a home birth. You would need the right coaching or support from your birth partner and/or care provider. You need an absolute minimal amount of intervention. In fact, all of the "painless" births I've watched on youtube were tub births.
Another possibility is that you go to a hospital to be induced (before labor has started), and you are allowed to receive your epidural before the Pitocin kicks in. You have no negative reactions to the epidural, and you pop in a movie and wait out your dilation stage. When your nurse has determined that you've hit 10 centimeters, your baby just happens to be in the perfect position and is a lovely 7 pounds even. You have good strong arms or good helpers, somehow your legs get into the perfect position, and you push 3 times before your baby gently slides out with no tearing and no episiotomy. You hold your little one for nursing and a snuggle. And when your epidural wears off, you feel fabulous. There's another "painless childbirth" scenario!
Do either of these sound like one of your births? If so, you are one lucky lady!!
I'm not trying to be negative. Both of these pictures sound great, but there are so many variables in these two equations which can go wrong and make your would-be painless childbirth a real disaster (or at least, a painful childbirth).
Let's take the first unmedicated birth. Most women have their babies in hospitals, because they feel it is safer for them and for their baby. This automatically means a few things will take away from their comfort level. Either they will arrive early, but they'll be poked, prodded, checked, and disturbed enough that they can't stay relaxed enough for a painless birth. Or they will arrive late enough in their labors that they're headed right into or coming right out of transition, and being triaged and checked in at that stage is bound to make things painful.
What if there are some complications in your delivery? Got a posterior baby? A bigger baby? Something a little off in the heartbeat? Strep-B positive? There's no way to relax easily through these things.
What if, while you're trying to relax, you have a labor and delivery nurse trying to check your cervix every hour or suggesting you have an epidural now? That's no fun.
In other words, with a hospital birth it is practically impossible to experience painless childbirth, because there are too many distractions which will take away from your relaxation and increase your anxiety.
How about the epidural birth? Well, I know a lot of women who enjoy their epidurals and don't have negative side effects. But a huge percentage of them have episiotomies, vaccuum extractions, etc., at the end of stage two. Only some of them are lucky enough to have the perfect sized or positioned baby, and their pushing stage tends to be prolonged a bit. They might not experience a lot of pain during labor and birth, but they are likely to have a good deal of discomfort after birth with stitches and very strong uterine contractions, which typically seem stronger after epidural births. (Could it be that "painful" unmedicated births make postpartum cramping seem milder? I don't know.)
Don't get me wrong, I'm not thrilled about the fact that childbirth brings pain with it. I've never had what I consider a painless childbirth experience. I hope I haven't previously misrepresented myself on this blog. My second birth was more comfortable than the other two, and the contractions were mostly painful toward the end and during transition. Also crowning was painful. My third birth was very painful. The tension was high, my labor was fast and hard, the lip on the cervix was very painful to have pushed back, and crowning (again) was pretty darn ouchy.
How should I measure these two births which I compare? Were they failures? Should I even bring in my first birth? If I even ignore the feeling of helplessness and confusion that pervaded during that labor, should I reminisce yet again about the immediate postpartum hours when the epidural was wearing off and I practically went into shock? How about the weeks and weeks of pain from the 4th degree tear or the yeast in my milk ducts?
So do we need to become masochists to enjoy having babies? I hope not!!
What I really think is that we need to have reasonable expectations, and our health-care providers and childbirth educators should assist in this. If a woman is choosing to go unmedicated and is experiencing increasing pain, a provider or labor and delivery nurse should respect that woman's decision and not undermine her by suggesting an epidural as she hits transition. Having pain during childbirth is not a negative reflection of the care (unless the care is negligent and increases the pain). And childbirth educators should beware of promising that "if you're doing everything right" you'll experience "painless childbirth." That's like promising a sales-person that if they do everything right than they'll someday be rich, or that a truly talented actress will eventually become a celebrity. Such outcomes are possibilities, but there is no guarantee!
Where is all of this ranting coming from? Well I've now talked to two women who took hypno-birthing classes, and they both had great births and did terrific jobs in their labors. Unfortunately, their teachers had given them the expectation that, as long as they were doing everything right, they shouldn't experience pain in childbirth. While each of these women labored, they experienced considerable pain for different reasons, and it increased their frustration and pain and detracted a little from the experience.
It has been sobering to hear these stories (though I'm sure they are both dealing fine and have great attitudes just the same). I just feel that it was irresponsible for their teachers to instill such unrealistic expectations about labor and childbirth. Telling someone that it shouldn't hurt if they're doing everything right is only going to create feelings of self-doubt in a woman when it actually does hurt (for whatever reason - the position of the baby, the level of anxiety, etc). All the self-doubt will do is make it even harder for the woman. This isn't fair. She is doing a great job and should feel so.
And the same should go for the woman who labors with an epidural. In a small way, I actually admire my friends who are very accepting about the more difficult post-partum periods that tend to follow epidurals. I know so many women who think that episiotomies are not a big deal. They don't mind taking stronger meds for post-partum cramping. They are at peace with the idea that a slightly more "painless childbirth" yielded a slightly more painful post-partum. At least they have reasonable expectations. I was devastated to be in so much pain after my first birth. I'm sure that it only made things worse.
So if anything productive is to come of this rant of mine, I hope it's this: Childbirth is an incredible feat, and I hope that you and your provider don't ever try to measure how well you've done (or are doing) on how much pain you experience. If you had a killer labor, you are a rock star! If you had an easy labor, you are a rock star! Childbirth is not a contest to see who can suffer less.
If you want a positive labor, do all that you can to take care of yourself, get a respectful, supportive provider, choose a good location, take a good class, educate yourself, and make well-informed decisions about your labor. Then do your best and trust yourself. You may find that you are amazed at how comfortable you are, or you may find that the pain is stronger than you expected. But believe in yourself and your decisions. You are doing something amazing!
That is all. Happy birthing, Ladies!! :)
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