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...

1 comment:

  1. I have been thinking about you! I hope you are doing okay! I will be waiting to hear about how the bith goes!