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...
Showing posts with label epidural. Show all posts
Showing posts with label epidural. Show all posts
Sunday, February 7, 2010
Tuesday, October 20, 2009
Bradley Births and Epidurals
Before I charge into describing my son's delivery, I should probably explain what the Bradley method is. If you are interested or just curious, I highly suggest that you check out the Bradley website. In short, however, the Bradley method involves comprehensive childbirth education, specific nutrition and exercises during pregnancy, discussion and practice of the various pushing positions, and the use of deep breathing and relaxation as a means of having a drug-free labor. An ideal Bradley birth involves as little medical intervention as possible, but Bradley teachers take the time to discuss the various complications which may occur as well as the medical interventions mothers may be offered. Bradley couples come out understanding childbirth and it's various stages in great detail, have a good understanding of what is normal in childbirth, and are well prepared for any difficulties that may arise.
I think Bradley training is so cool, by the way. :)
Bradley births occasionally, but do not always, involve a doula (a paid childbirth coach). In fact, Dr. Bradley, who fostered the Bradley method, probably didn't think doulas were that great. (This is pure speculation, by the way). He referred to his method of birthing as "husband-coached" childbirth. He felt that the coaching experience between a husband and his laboring wife can be a powerful, emotionally intimate bonding experience for both. In his book entitled Husband-Coached Childbirth, he relates a story about when a husband was unavailable during the labor, and Dr. Bradley stepped in as the coach as well as the delivering doctor. While he was happy for how well the mother had done and how well her labor went, he expressed a feeling of almost embarrassment that he'd been playing a role that belonged to the woman's husband.
As a wife who has had two Bradley births, I can attest that having your husband coach you through such a challenging job is a great bonding experience. That's not to say that epidural births aren't great bonding experiences too. A loving husband's support and being able to share in witnessing this wonderful person's arrival can bring couples very close together. But a Bradley mom depends upon her husband's emotional and even physical support, and the husband essentially becomes the woman's "knight in shining armor." Trauma bonding, you might ask? Not really. Just equal involvement.
The biggest reason a woman needs her husband's support so much is because natural childbirth is very difficult to do, especially in this day and age. Even if a woman has done all of the research, taken a class, and goes in prepared to have an unmedicated birth, there is bound to be a point (usually when the woman goes into "transition") when she feels unsure that she can do it anymore. At this point, there is often a nurse ready to offer meds at Mom's request. If, however, the husband has also done all of the research, taken the class with Mom, and prepared and educated himself, he can offer reassurance and moral support through the difficult, and usually brief, period of discouragement. He becomes her advocate in a challenging time.
It might sound insensitive for a husband (who is not in labor) to discourage his wife from getting an epidural when she's in pain. It is very compassionate for a man to not want his wife to suffer needlessly. But epidurals bring with them risks and challenges as well, and when a woman has decided that she wants to avoid those risks and challenges, she needs that kind of positive encouragement. Again, from my own personal experience, once it starts to feel too difficult, the pushing stage is usually only minutes away. I've now had two epidural free labors, one of which was very painful at times, and I've never regretted avoiding the epidural. I am acquainted with a number of women who've also had at least 2 or 3 Bradley births, and they have been grateful each time that they avoided the epidural.
I was thinking to put off an epidural vent for another post, but it feels necessary to explain why I personally feel so strongly about avoiding an epidural. First, I'd like to include links to the American Pregnancy Association and Babycenter on epidural. Both of these articles seem to be pretty objective - neither completely for or against. A third article, which I thoroughly enjoyed as well, is from iVillage. This one is quite good, because it acknowledges the variance between studies and the hot emotions surrounding the debate. Most of all, I appreciate the conclusion it makes that epidurals are an "excellent option for some women." Notice the use of the word "some." Not "most." Not "all."
You see, I want to make it clear that I don't believe that epidurals are evil or something. They just aren't for every woman, and yet so many women who desire to avoid them are mocked by other women when the subject comes up. I am unabashed about sharing my enthusiasm for a mom-to-be who is contemplating unmedicated childbirth. But I have learned that, in a group of women who have epidurals with all of their labors, if you make the mistake of saying that you prefer unmedicated childbirth, the word "crazy" often comes up. So many women who've had epidurals in labor feel the need to defend their choice. I think that's so unfortunate, because I'm going to let you in on a little secret: You don't ever have to defend an epidural to me. I've had three babies - one with epidural and two without - and I get how painful and scary it can be at times. I've just enjoyed my unmedicated births (and recoveries) better than my epidural birth.
The problem I have with the epidural is how much they are encouraged in the medical community with very little discussion about the risks and challenges that often come with an epidural. I thought of including a link to Web MD about epidurals, but the one minute video of a MALE doctor arguing that MOST women have a more satisfactory experience with epidural just bugged me too much. :) Who is he to argue how satisfactory a woman's birth experience is? What is a woman, who has just brought a baby she already loves into the world (possibly in a very miserable way), going to do when she sees her little bundle of joy? Yell at the doctor because she tore badly or because she came down with a fever?! (Imagine incredulous look on my mysterious face) Doctors don't know exactly what is going through a woman's mind or how well a woman is going to recover after he leaves the hospital. I remind you of my labor with my daughter. When it was over, I felt euphoric - that is until the recovery stage began. Then I felt awful. So, this man's "testimonial of the epidural in labor" (which he has never actually received) means nothing to me.
Okay, I'm backing off a little now and am going to try and be objective. For the record, I'm laughing and smiling, and I hope you are too. :)
Epidurals bring risks. Not everyone reacts the same to an epidural. Not every anesthesiologist is the same. Compared to how much pain medication was once used during labor, epidurals use much less; but it's still medication in labor, and some studies indicate that babies might not latch on as well if they were born in an epidural labor. Other studies disagree. My daughter was a sleepy little slug and latched terribly from day two (because she wouldn't latch on during day one). But who knows why that was. I personally think it might have had something to do with the epidural (and the fact that I was in too poor condition to hold her during the first hour of her life).
One thing that I believe it is completely irresponsible to deny is that pushing is more difficult with an epidural. Pushing out a baby is tough work. It requires a lot of strength, and the better the pushing position, the easier and more doable it is. The best positions require you to pull your knees all the way up to your armpits - no joke. This is not easy when your legs are warm, numb blobs of flesh. It is tough.
You also cannot feel the muscles that you are pushing with very well (or maybe not at all). Don't worry, the baby still comes out with an epidural, especially if he/she is in a good position, isn't too big, and if the body is pushing some great, heavy duty contractions behind that baby. BUT, you may end up needing an episiotomy if that baby is crowning long enough to worry the doctor, and you don't want to get me started on episiotomy.
But I must get started on episiotomy, so my apologies. Episiotomies are not a bad thing. You can even find an article on website as recent as 2007 which argues that episiotomies "prevent tearing." I didn't include this link either, because I again found it annoying. When we took our Bradley class in 2004, I did extensive research on episiotomies and was amazed and impressed to find that the current consensus (and again, this was back in 2004) was that episiotomies are best saved for babies in distress. If you read the above babycenter link (on "episiotomy") you'll find the same kind of information.
Episiotomies involve cutting the perineum, and muscle which separates the vagina and the anus, to enlarge the vaginal opening and ease the birth of a baby. It used to be routine, especially when many moms were knocked out at birth and babies were routinely delivered by forcep extraction. In recent decades, they have still been used fairly routinely because doctors have wanted to prevent Mom from tearing. Now doctors are realizing that, unless we have a baby in distress who needs to be born NOW, it's better to give Mom some more time. For one thing, she just might not tear. For another thing, if she tears, it is not any worse, and it's usually better, than if she has an episiotomy. When a woman tears naturally, it might be a pain for a doctor to sew up (to which I respond, "I'm paying you big bucks to catch a baby. Shut up, and sew me." Too intense?). In a naturally occurring tear, however, less tissue tends to tear, and Mom usually recovers a little better than if she had an episiotomy. Believe it or not, it's true.
But here's the worst thing about elective (and when I say elective, I mean "no baby in distress") episiotomy: There is always a chance that Mom will tear beyond the episiotomy. These are ugly tears, either to the anus or the even the rectum. Ouch!! (Believe me, I know.) You do not want to have to deal with a 3rd (anal) or 4th (rectal) degree tear unless it's in the name of saving your sweet baby. So, as you can tell, it KILLS me that most of my friends have episiotomies with ALL of their labors. I've wondered at this weird phenomenon. Why would all of these doctors keep cutting their patients, thereby guaranteeing that they'll HAVE to have stitches when there is a chance that they might not tear or that their tearing would be minimal and easier to recover from? I pondered this allowed to my husband the other night. I had an epiphany.
Well, actually I had two epiphanies. First, I think doctors in my area might not be keeping up with the times on episiotomy. I live in Utah where tons of babies are born every year, and doctors out here are very busy and probably have little time to consistently spare for medical journals (or bossy moms). In some ways, it's fabulous to have such experienced doctors. In other ways, it stinks, because they're SO busy. I don't want to be conspiratorial, but I think that a lot of doctors (and some midwives) are a little impatient with how quickly a baby should be born. I guess you could argue that getting them here quicker to avoid fetal distress is better than waiting for the fetal distress, but I still think Mom should be taken into consideration on this. I also think that some busy doctors might be rationalizing cutting for their own convenience and schedule. And finally, with so many patients and having delivered hundreds of babies already, some doctors are just used to cutting their patients in labor. Unfortunately, the only ones who have to suffer for it are the patients.
The other epiphany was this: It's pretty hard to push out a baby with an epidural. Maybe that's why most of my friends get episiotomies every time. Between their busy, slightly routined doctors and the slow progress that comes with an epidural, it might just seem necessary to cut the mom most of the time. It still makes me a little sad. I have a few friends who go naturally like me, and they sometimes don't tear a bit. Imagine not tearing during childbirth!!! What a wonderful thought!
I daydream about not tearing, but I'm afraid that once you've had a 4th degree laceration in labor, you have lots of scar tissue where you once might have stretched. The chances of not tearing are pretty slim. BUT, I still have an agreement with my midwives that if the baby has some time to spare, please let me get him/her out without cutting. I'll probably tear, but it's nothing to a 3rd or 4th degree (which practically never happens without an episiotomy). In fact, in my last delivery (baby #3), the baby did start to struggle while he was crowning. My wonderful midwife, who realized that I was tired and needed a second wind, gently asserted, "If he doesn't come out on this next contraction, we'll have to do an episiotomy." I was exhausted and wanted to make it clear that I would comply if needed. Then I heard the OB in the room ask her, "Why wait?" Her answer: "She's had a 4th degree laceration." It snapped me out of fatigue and back into reality. He was struggling. We could lose him. I doubled my effort. When he didn't come out on the contraction, I kept pushing, and a few seconds later he slid out in all his glory. I tore, but only - get this - 1st degree (less than/equal to an episiotomy). Cutting me would not have changed his condition, but it would have changed mine. And, I know that sounds selfish, but a healthier recovery blesses both the mom and the baby.
So before I return to epidurals and finish my little rant there, I just want to encourage you to discuss episiotomy with your doctor and see if they'll hold off on the scissors unless it's really necessary. And do a lot of kegels.
So though I haven't discussed the obvious benefits of epidural (do I need to?), I can say with confidence that it is not without it's risks and challenges, and not every woman loves her epidural birth. (You hear me, Mr. WebMD?) So it's possible that epidurals might not be the answer for everyone.
Now do I think that moms should suffer in anguish and agony in order to bring their babies into the world? Not if it can be avoided! Sometimes I meet women (typically older than myself) who had at least one or two babies without medication because they had been made to feel guilty about considering an epidural. This makes me just as sad for them as for one who is bullied into having an epidural and then has a bad experience. It should be a woman's choice when possible. They are the ones having the babies, and they are the ones having to recover. Their choice should be respected.
Of course, there is always a slight possibility that Mom's labor will fly by so fast that she'll have a car birth or the anesthesiologist won't get to her on time. That happens, and it honestly sounds pretty scary. Considering that possibility, I think it would be wise for ALL moms to do some deep relaxation exercises just in case. (I mean, you really never know how fast your labor will progress).
If a woman truly desires to go unmedicated, however, with proper education, training, preparation, and relaxation, childbirth does not have to feel like anguish. It doesn't have to be scary. It will always be work - very focused, challenging work - but it doesn't have to feel like pain. A majority of contractions, under deep relaxation, will feel more like pressure in your abdomen and possibly some burning back pain. It's not an easy feeling, but it doesn't have to "hurt". Of course, especially during transition, when the baby exits the uterus and/or when the contractions come so strong and fast that it's hard to relax, there will be minutes of pain, even fear possibly (and maybe even some swearing). But they pass sooner than you know, and when you feel the urge to push your baby and have all of the power and control of your muscles behind those pushes, it is AMAZING. I can't tell you how amazing.
Okay, I'm getting ethereal here. Now I'd be a liar if I said that it never hurts from that point on. Actually, when a baby is crowning, it's pretty stingy and ouchy. Gotta fess up there. But it's also short-lived when you have good control and good coaching. And then it's over, and your little guy/gal is laying there all slimy being checked out and placed on your belly. (Or, in my cases, being checked out, laid on your chest for 30 seconds, and then whisked away to the NICU for an IV or something... yeah, another post, my friend). Then, sometime in there you deliver your placenta and get stitched up (if needed), and while baby is having a bath (or an IV), your nurse starts cleaning your room, and you get up, walk into the bathroom unassisted, sit down, and pee... now that, my friends, is cooler than you can believe. Just saying...
So, if you love your epidurals but have a friend who has a genuine desire (or even remote interest) in going unmedicated, can I make a request? Don't tease them. Don't defend your decision to have an epidural. (It needs no defense.) Don't say something like "They're not handing out trophies or anything." (Please please don't.) And please don't reassure them that they should never feel bad if they decide to change their mind. There are plenty of people, their doctors included, who can give them that reassurance.
When a woman is hoping to go unmedicated, she has enough self-doubt of her own to deal with, especially if it is her first pregnancy. Instead, encourage her and wish her the very best and, if it seems appropriate, let her know that you've heard that a good Bradley class or a Hypnobirthing class can make all of the difference. It's a just a little food for thought from someone who has been where she is...
I think Bradley training is so cool, by the way. :)
Bradley births occasionally, but do not always, involve a doula (a paid childbirth coach). In fact, Dr. Bradley, who fostered the Bradley method, probably didn't think doulas were that great. (This is pure speculation, by the way). He referred to his method of birthing as "husband-coached" childbirth. He felt that the coaching experience between a husband and his laboring wife can be a powerful, emotionally intimate bonding experience for both. In his book entitled Husband-Coached Childbirth, he relates a story about when a husband was unavailable during the labor, and Dr. Bradley stepped in as the coach as well as the delivering doctor. While he was happy for how well the mother had done and how well her labor went, he expressed a feeling of almost embarrassment that he'd been playing a role that belonged to the woman's husband.
As a wife who has had two Bradley births, I can attest that having your husband coach you through such a challenging job is a great bonding experience. That's not to say that epidural births aren't great bonding experiences too. A loving husband's support and being able to share in witnessing this wonderful person's arrival can bring couples very close together. But a Bradley mom depends upon her husband's emotional and even physical support, and the husband essentially becomes the woman's "knight in shining armor." Trauma bonding, you might ask? Not really. Just equal involvement.
The biggest reason a woman needs her husband's support so much is because natural childbirth is very difficult to do, especially in this day and age. Even if a woman has done all of the research, taken a class, and goes in prepared to have an unmedicated birth, there is bound to be a point (usually when the woman goes into "transition") when she feels unsure that she can do it anymore. At this point, there is often a nurse ready to offer meds at Mom's request. If, however, the husband has also done all of the research, taken the class with Mom, and prepared and educated himself, he can offer reassurance and moral support through the difficult, and usually brief, period of discouragement. He becomes her advocate in a challenging time.
It might sound insensitive for a husband (who is not in labor) to discourage his wife from getting an epidural when she's in pain. It is very compassionate for a man to not want his wife to suffer needlessly. But epidurals bring with them risks and challenges as well, and when a woman has decided that she wants to avoid those risks and challenges, she needs that kind of positive encouragement. Again, from my own personal experience, once it starts to feel too difficult, the pushing stage is usually only minutes away. I've now had two epidural free labors, one of which was very painful at times, and I've never regretted avoiding the epidural. I am acquainted with a number of women who've also had at least 2 or 3 Bradley births, and they have been grateful each time that they avoided the epidural.
I was thinking to put off an epidural vent for another post, but it feels necessary to explain why I personally feel so strongly about avoiding an epidural. First, I'd like to include links to the American Pregnancy Association and Babycenter on epidural. Both of these articles seem to be pretty objective - neither completely for or against. A third article, which I thoroughly enjoyed as well, is from iVillage. This one is quite good, because it acknowledges the variance between studies and the hot emotions surrounding the debate. Most of all, I appreciate the conclusion it makes that epidurals are an "excellent option for some women." Notice the use of the word "some." Not "most." Not "all."
You see, I want to make it clear that I don't believe that epidurals are evil or something. They just aren't for every woman, and yet so many women who desire to avoid them are mocked by other women when the subject comes up. I am unabashed about sharing my enthusiasm for a mom-to-be who is contemplating unmedicated childbirth. But I have learned that, in a group of women who have epidurals with all of their labors, if you make the mistake of saying that you prefer unmedicated childbirth, the word "crazy" often comes up. So many women who've had epidurals in labor feel the need to defend their choice. I think that's so unfortunate, because I'm going to let you in on a little secret: You don't ever have to defend an epidural to me. I've had three babies - one with epidural and two without - and I get how painful and scary it can be at times. I've just enjoyed my unmedicated births (and recoveries) better than my epidural birth.
The problem I have with the epidural is how much they are encouraged in the medical community with very little discussion about the risks and challenges that often come with an epidural. I thought of including a link to Web MD about epidurals, but the one minute video of a MALE doctor arguing that MOST women have a more satisfactory experience with epidural just bugged me too much. :) Who is he to argue how satisfactory a woman's birth experience is? What is a woman, who has just brought a baby she already loves into the world (possibly in a very miserable way), going to do when she sees her little bundle of joy? Yell at the doctor because she tore badly or because she came down with a fever?! (Imagine incredulous look on my mysterious face) Doctors don't know exactly what is going through a woman's mind or how well a woman is going to recover after he leaves the hospital. I remind you of my labor with my daughter. When it was over, I felt euphoric - that is until the recovery stage began. Then I felt awful. So, this man's "testimonial of the epidural in labor" (which he has never actually received) means nothing to me.
Okay, I'm backing off a little now and am going to try and be objective. For the record, I'm laughing and smiling, and I hope you are too. :)
Epidurals bring risks. Not everyone reacts the same to an epidural. Not every anesthesiologist is the same. Compared to how much pain medication was once used during labor, epidurals use much less; but it's still medication in labor, and some studies indicate that babies might not latch on as well if they were born in an epidural labor. Other studies disagree. My daughter was a sleepy little slug and latched terribly from day two (because she wouldn't latch on during day one). But who knows why that was. I personally think it might have had something to do with the epidural (and the fact that I was in too poor condition to hold her during the first hour of her life).
One thing that I believe it is completely irresponsible to deny is that pushing is more difficult with an epidural. Pushing out a baby is tough work. It requires a lot of strength, and the better the pushing position, the easier and more doable it is. The best positions require you to pull your knees all the way up to your armpits - no joke. This is not easy when your legs are warm, numb blobs of flesh. It is tough.
You also cannot feel the muscles that you are pushing with very well (or maybe not at all). Don't worry, the baby still comes out with an epidural, especially if he/she is in a good position, isn't too big, and if the body is pushing some great, heavy duty contractions behind that baby. BUT, you may end up needing an episiotomy if that baby is crowning long enough to worry the doctor, and you don't want to get me started on episiotomy.
But I must get started on episiotomy, so my apologies. Episiotomies are not a bad thing. You can even find an article on website as recent as 2007 which argues that episiotomies "prevent tearing." I didn't include this link either, because I again found it annoying. When we took our Bradley class in 2004, I did extensive research on episiotomies and was amazed and impressed to find that the current consensus (and again, this was back in 2004) was that episiotomies are best saved for babies in distress. If you read the above babycenter link (on "episiotomy") you'll find the same kind of information.
Episiotomies involve cutting the perineum, and muscle which separates the vagina and the anus, to enlarge the vaginal opening and ease the birth of a baby. It used to be routine, especially when many moms were knocked out at birth and babies were routinely delivered by forcep extraction. In recent decades, they have still been used fairly routinely because doctors have wanted to prevent Mom from tearing. Now doctors are realizing that, unless we have a baby in distress who needs to be born NOW, it's better to give Mom some more time. For one thing, she just might not tear. For another thing, if she tears, it is not any worse, and it's usually better, than if she has an episiotomy. When a woman tears naturally, it might be a pain for a doctor to sew up (to which I respond, "I'm paying you big bucks to catch a baby. Shut up, and sew me." Too intense?). In a naturally occurring tear, however, less tissue tends to tear, and Mom usually recovers a little better than if she had an episiotomy. Believe it or not, it's true.
But here's the worst thing about elective (and when I say elective, I mean "no baby in distress") episiotomy: There is always a chance that Mom will tear beyond the episiotomy. These are ugly tears, either to the anus or the even the rectum. Ouch!! (Believe me, I know.) You do not want to have to deal with a 3rd (anal) or 4th (rectal) degree tear unless it's in the name of saving your sweet baby. So, as you can tell, it KILLS me that most of my friends have episiotomies with ALL of their labors. I've wondered at this weird phenomenon. Why would all of these doctors keep cutting their patients, thereby guaranteeing that they'll HAVE to have stitches when there is a chance that they might not tear or that their tearing would be minimal and easier to recover from? I pondered this allowed to my husband the other night. I had an epiphany.
Well, actually I had two epiphanies. First, I think doctors in my area might not be keeping up with the times on episiotomy. I live in Utah where tons of babies are born every year, and doctors out here are very busy and probably have little time to consistently spare for medical journals (or bossy moms). In some ways, it's fabulous to have such experienced doctors. In other ways, it stinks, because they're SO busy. I don't want to be conspiratorial, but I think that a lot of doctors (and some midwives) are a little impatient with how quickly a baby should be born. I guess you could argue that getting them here quicker to avoid fetal distress is better than waiting for the fetal distress, but I still think Mom should be taken into consideration on this. I also think that some busy doctors might be rationalizing cutting for their own convenience and schedule. And finally, with so many patients and having delivered hundreds of babies already, some doctors are just used to cutting their patients in labor. Unfortunately, the only ones who have to suffer for it are the patients.
The other epiphany was this: It's pretty hard to push out a baby with an epidural. Maybe that's why most of my friends get episiotomies every time. Between their busy, slightly routined doctors and the slow progress that comes with an epidural, it might just seem necessary to cut the mom most of the time. It still makes me a little sad. I have a few friends who go naturally like me, and they sometimes don't tear a bit. Imagine not tearing during childbirth!!! What a wonderful thought!
I daydream about not tearing, but I'm afraid that once you've had a 4th degree laceration in labor, you have lots of scar tissue where you once might have stretched. The chances of not tearing are pretty slim. BUT, I still have an agreement with my midwives that if the baby has some time to spare, please let me get him/her out without cutting. I'll probably tear, but it's nothing to a 3rd or 4th degree (which practically never happens without an episiotomy). In fact, in my last delivery (baby #3), the baby did start to struggle while he was crowning. My wonderful midwife, who realized that I was tired and needed a second wind, gently asserted, "If he doesn't come out on this next contraction, we'll have to do an episiotomy." I was exhausted and wanted to make it clear that I would comply if needed. Then I heard the OB in the room ask her, "Why wait?" Her answer: "She's had a 4th degree laceration." It snapped me out of fatigue and back into reality. He was struggling. We could lose him. I doubled my effort. When he didn't come out on the contraction, I kept pushing, and a few seconds later he slid out in all his glory. I tore, but only - get this - 1st degree (less than/equal to an episiotomy). Cutting me would not have changed his condition, but it would have changed mine. And, I know that sounds selfish, but a healthier recovery blesses both the mom and the baby.
So before I return to epidurals and finish my little rant there, I just want to encourage you to discuss episiotomy with your doctor and see if they'll hold off on the scissors unless it's really necessary. And do a lot of kegels.
So though I haven't discussed the obvious benefits of epidural (do I need to?), I can say with confidence that it is not without it's risks and challenges, and not every woman loves her epidural birth. (You hear me, Mr. WebMD?) So it's possible that epidurals might not be the answer for everyone.
Now do I think that moms should suffer in anguish and agony in order to bring their babies into the world? Not if it can be avoided! Sometimes I meet women (typically older than myself) who had at least one or two babies without medication because they had been made to feel guilty about considering an epidural. This makes me just as sad for them as for one who is bullied into having an epidural and then has a bad experience. It should be a woman's choice when possible. They are the ones having the babies, and they are the ones having to recover. Their choice should be respected.
Of course, there is always a slight possibility that Mom's labor will fly by so fast that she'll have a car birth or the anesthesiologist won't get to her on time. That happens, and it honestly sounds pretty scary. Considering that possibility, I think it would be wise for ALL moms to do some deep relaxation exercises just in case. (I mean, you really never know how fast your labor will progress).
If a woman truly desires to go unmedicated, however, with proper education, training, preparation, and relaxation, childbirth does not have to feel like anguish. It doesn't have to be scary. It will always be work - very focused, challenging work - but it doesn't have to feel like pain. A majority of contractions, under deep relaxation, will feel more like pressure in your abdomen and possibly some burning back pain. It's not an easy feeling, but it doesn't have to "hurt". Of course, especially during transition, when the baby exits the uterus and/or when the contractions come so strong and fast that it's hard to relax, there will be minutes of pain, even fear possibly (and maybe even some swearing). But they pass sooner than you know, and when you feel the urge to push your baby and have all of the power and control of your muscles behind those pushes, it is AMAZING. I can't tell you how amazing.
Okay, I'm getting ethereal here. Now I'd be a liar if I said that it never hurts from that point on. Actually, when a baby is crowning, it's pretty stingy and ouchy. Gotta fess up there. But it's also short-lived when you have good control and good coaching. And then it's over, and your little guy/gal is laying there all slimy being checked out and placed on your belly. (Or, in my cases, being checked out, laid on your chest for 30 seconds, and then whisked away to the NICU for an IV or something... yeah, another post, my friend). Then, sometime in there you deliver your placenta and get stitched up (if needed), and while baby is having a bath (or an IV), your nurse starts cleaning your room, and you get up, walk into the bathroom unassisted, sit down, and pee... now that, my friends, is cooler than you can believe. Just saying...
So, if you love your epidurals but have a friend who has a genuine desire (or even remote interest) in going unmedicated, can I make a request? Don't tease them. Don't defend your decision to have an epidural. (It needs no defense.) Don't say something like "They're not handing out trophies or anything." (Please please don't.) And please don't reassure them that they should never feel bad if they decide to change their mind. There are plenty of people, their doctors included, who can give them that reassurance.
When a woman is hoping to go unmedicated, she has enough self-doubt of her own to deal with, especially if it is her first pregnancy. Instead, encourage her and wish her the very best and, if it seems appropriate, let her know that you've heard that a good Bradley class or a Hypnobirthing class can make all of the difference. It's a just a little food for thought from someone who has been where she is...
Becoming a Natural Childbirth Mommy, part 2
Well many women who read the account of my first labor would notice much to criticize, and it does not all have to do with the epidural. For one thing, as I pointed out, my doctors were very controlling. Now I will admit that the hour of pushing my daughter was such a blur, and it's possible that Dr. G rushed because he feared the baby was in distress. It would definitely be understandable that having a mother run a fever for over 6 hours might not be good for the baby. But if that was the case, it was not made at all clear to me or to my husband (who was under no influence of drugs and had actually slept a little the night before). All we knew was that the doctor was not satisfied with how I was pushing, and there was no discussion of whether to cut and vacuum or to give me a few more minutes of pushing.
Another naughty OB behavior was when the other OB, Dr. J, stripped my cervical membranes without consulting with me. Stripping the cervix can present many risks, including leaking waters or even occasionally a full-on breaking of the bag of waters. It's an optional procedure that can effectively kick a woman into labor, but it should be a procedure to which informed consent is actually given rather than something snuck up onto a patient.
As far as my hospital care went, many complaints could be made about the nursing staff. Considering I was a first time mom and was receiving a great amount of IV fluids, it was unwise to decatherize me so soon, and the post-partum nurse (the young, well-intentioned one) should have been mindful of that and at least catheterized me again before going at my abdomen the way she did. She was also such a novice and should've considered that a brand new mom in terrible pain might be frightened by hearing so much detail about her loss of blood. (Don't get me wrong - this was at least more disclosure than I'd received much of the morning, but perhaps it was done in an unprofessional and insensitive manner).
I could go on and on. The biggest problem with the entire situation - the prenatal care, the labor, the delivery, and the post-partum care, etc. - was my lack of knowledge. As I previously mentioned, I had purchased and made a valiant effort at reading What to Expect While You're Expecting. The book is difficult to read, though, and is set up in a way that you won't really learn about something unless it occurs to you to look it up and study it. It is also a book that makes a great effort to avoid having an opinion on anything, and so it waters down much of the information. An excellent example of this is the entry on "episiotomy." I'm not sure if a new edition of the book has changed the view (I hope so), but it essentially states that episiotomy assists birthing, prevents tearing, and in order to avoid 3rd and 4th degree tearing, the best option is a "hockey-stick" cut. Now, at the time when my edition was published, "hockey-sticks" might have looked great on paper, but most doctors in my area still wouldn't consider doing them for one very big reason - that's a lot of cutting that might not be necessary. Midline cuts (a small cut straight toward the rectum) might carry a risk of tearing into the rectum, but they were still minimum cutting. Mediolateral (a cut toward the side at an angle) automatically create too much tissue damage, some of which is irreversible. And there is plenty more that I can say about episiotomy, when it's right and when it should be avoided, but it deserves it's own post. At any rate, I did not learn what I now know about episiotomy from What to Expect, I'll tell you that.
So having purchased a slightly useless, difficult to read book (which for some reason made me extra nauseated for my first few months) was the bulk of the my education. The other resources I had were the internet (again a "look it up when it occurs to you" resource), a one-day prenatal class offered through our doctors' office (more of an orientation than a class intended to educate couples), and a lot of intimidating conversations with friends and family. There was so much that I did not understand about pregnancy and labor. It was no wonder that I took poor care of myself during the pregnancy and was terrified of childbirth.
Here's a funny punchline though: Even after my horrible delivery with Dr. G and his practice, upon learning that I was pregnant with my second baby, I returned to the same practice. I had no idea at the time how much a part they had played in my "bad luck" labor.
It was only when my husband, daughter, and I moved into our new house that doors opened for me learning more about natural childbirth. In the years following our daughter's birth, I had many conversations with other moms about labor, and very occasionally I had an exchange with a mom who enjoyed having "Bradley" births with her babies. I knew nothing about Bradley, only that when I met a mom who had experienced a successful Bradley birth, she was extremely enthusiastic about it and would talk your ear off about how great it was (if you let her). When I met my new, very cool neighbor and learned that she had done a Bradley birth, I was very curious. She shared her first birth experience with me, which was very similar to mine with my daughter. Then she shared about her second birth experience after she and her husband had attended a Bradley class together. It wasn't without it's challenges, but the experiences were night and day, and she was so grateful to have been able to birth that way. It peaked my interest big-time. I couldn't ignore the fact that most of the women I met or knew who had planned and prepared unmedicated births were very happy about them, even when the experience wasn't complication free.
The next part of the story is history, as they say. My husband and I arranged for and attended a Bradley class (he was reluctant at first, but soon after enjoyed being so well informed and prepared). I read all of the suggested material, kept a diet log, and did prenatal exercises like crazy. Preparing for natural childbirth became one of my great goals in the coming months and weeks.
The most difficult and sobering part of the journey was the realization that many of my complications in my first labor, delivery, and post-partum were not simply a case of terrible luck. Many of them were the offspring of procedures I had been subjected to or consented to. For example, as I stated, stripping the cervix brings a risk of premature rupture of membranes and possible infection. It might still be the best choice for a woman, but even if the doctor chooses or suggests it, it is not "risk-free." The epidural, which I'd like to discuss/vent about another time, has a risk of a negative reaction (i.e. fever) for some women. The use of antibiotics during labor or afterward with baby brings a risk of yeast over-growth in the milk or thrush infection in the baby's mouth. These procedures are not necessarily bad and are sometimes necessary for a safe delivery, but they always bring risks with them. And women deserve to know about those risks in order to give truly informed consent. I mean no offense to other women when I say that I believe a large percentage of birthing moms are not well-informed on the risks as well as the benefits of medical intervention in childbirth.
After several weeks in the Bradley class, I couldn't NOT think about my labor with my daughter, and when I thought about it I was angry - at my doctors and nurses, at every mom who had ever frightened me away from pursuing natural childbirth, at my husband for shooting it down once when I expressed an interest in natural childbirth, and mostly at myself for not taking control of my pregnancy, taking a good prenatal class (ideally for me, a Bradley class), and having the courage to consider better care-providers. I'm not saying that it was healthy to become so angry at everyone. I just was, and one thing was more clear than anything - if I didn't change doctors soon, I might end up repeating my first labor experience or having one similar to it.
This might sound silly to some people, but one of the biggest things I learned in my class is that the provider is half of the experience. If you are with a provider who understands and respects your desires, communicates well with you, and wants you to be a part of the decision making, you stand a better chance at a positive, safer labor experience regardless of whether you plan to go with or without an epidural. But if your providers are unwilling to consult with you and are willing to take your entire labor into their hands, you could end up the way I did - confused, in terrible pain, and with a difficult recovery.
Okay, some might ask, "But isn't the safety of your baby the most important thing?" Of course it is, and if the safety of my baby was unimportant to me, then I wouldn't be going to a health-care provider and delivering in a hospital at all. Actually, even saying that is somewhat unfair, because I know a few mothers who always birth their babies at home, unless it's medically impossible to do so, and they are very conscientious about the safety of their babies. One of them is a registered nurse who even chooses not have a doctor or midwife at all, and it is her husband who delivers the baby. Sounds crazy? Well I wouldn't feel comfortable doing it, but she is extremely well educated about childbirth, as is he, and they have had at least 1 or 2 excellent home births just this way. The need for an ambulance, midwife, or doctor hasn't arisen and hopefully never will.
This doesn't mean that I'm advocating unassisted home births. I just won't condemn them. For some women, it's the right decision, and it honestly sounds amazing. I just haven't ever felt right about it for myself.
So, back to the issue of a baby's safety - of course it's important. I don't know a single woman who is willing to carry a baby for 9 months just to gamble their safety away like it's nothing. And yet, it is slightly debatable what could be considered a "safer" delivery method/locale. You could definitely argue that a hospital and an OB are the safest - best equipment, highest qualified, etc. During most hospital labors, however, the doctor is not present during the labor and is not visually supervising the patient in their labor. The laboring portion is left in the hands of the labor and delivery nurses on staff, and let's hope they're great! Chances are, however, they are dividing their attention between at least two or more women (especially in Utah county!).
On the other hand, with a lay or nurse midwife, either in a birthing center, hospital, or home birth, the midwife is supervising not only the delivery of the baby but mom's labor. Once it's clear that mom is in labor, the midwife comes to her side. Attending so many labors with typically undivided attention makes for incredibly expert eyes (between experience and training), and, in my opinion, you have the absolute best authority on how the labor is really progressing. The midwife is much more likely to notice if something is not right. She is also more likely to have "seen it all" so to speak, and she'll know if it's a normal part of the unpredictability of childbirth (and if there's anything consistent about childbirth, it's that it's unpredictable), or if it's something that merits medical intervention. Some people panic at the thought that a midwife is not licensed to perform cesarean sections. This might sound like a big red-flag. As one who has delivered with midwives in a fairly complicated delivery, however, I can attest that they are not insensitive to the possible need for cesarean, and they will have a qualified OB in the room during the pushing stage to ensure that a cesarean can be safely performed if necessary. (Happily, in my case, it wasn't necessary! Though that OB had magic hands and turned my posterior baby like a charm!)
Returning to my experience with the Bradley class, at 32 weeks into my 2nd pregnancy, I contacted my Bradley teacher, gave her permission to say "I told you so" (she had warned me against staying with my OB's), and asked for some suggestions. After considering a couple, I decided to try and get the wonderful family practitioner who had delivered my sweet relative's baby years before. He was very popular even as just a family practitioner, but he was only accepting obstetrics patients on certain recommendations. He accepted my reference from my Bradley instructor, and I enjoyed the remainder of my visits very hopeful that everything would go better with this delivery.
I will not go into great detail in this post on the birth of my 2nd child (my first son), but I will say upfront that I did not receive an epidural. My husband and I enjoyed this labor more and felt like active participants. That alone was a blessing and a confirmation that my personality is better suited to unmedicated childbirth. I'm not joking when I relate that my husband actually said to me at one point during the labor, "This is actually a lot more fun." Of course, he was pretty exhausted by the time our son was born, but we both felt good about how our labor went.
I will also be plain and point out that it was not an uncomplicated delivery. I had hoped that a labor free of unnecessary intervention would minimize the complications in the delivery, but there are some things which you cannot prevent - like passing of and aspiration of mechonium. (More on this next time). I will say that, in light of the challenges my handsome boy faced during his first trying hours and days in the real world, I believe that it served him well that he came into the world drug free.
By the way, that same boy is still ridiculously handsome and has a passion for Legos and Wii, which I swear we only let him play on the weekends...
Another naughty OB behavior was when the other OB, Dr. J, stripped my cervical membranes without consulting with me. Stripping the cervix can present many risks, including leaking waters or even occasionally a full-on breaking of the bag of waters. It's an optional procedure that can effectively kick a woman into labor, but it should be a procedure to which informed consent is actually given rather than something snuck up onto a patient.
As far as my hospital care went, many complaints could be made about the nursing staff. Considering I was a first time mom and was receiving a great amount of IV fluids, it was unwise to decatherize me so soon, and the post-partum nurse (the young, well-intentioned one) should have been mindful of that and at least catheterized me again before going at my abdomen the way she did. She was also such a novice and should've considered that a brand new mom in terrible pain might be frightened by hearing so much detail about her loss of blood. (Don't get me wrong - this was at least more disclosure than I'd received much of the morning, but perhaps it was done in an unprofessional and insensitive manner).
I could go on and on. The biggest problem with the entire situation - the prenatal care, the labor, the delivery, and the post-partum care, etc. - was my lack of knowledge. As I previously mentioned, I had purchased and made a valiant effort at reading What to Expect While You're Expecting. The book is difficult to read, though, and is set up in a way that you won't really learn about something unless it occurs to you to look it up and study it. It is also a book that makes a great effort to avoid having an opinion on anything, and so it waters down much of the information. An excellent example of this is the entry on "episiotomy." I'm not sure if a new edition of the book has changed the view (I hope so), but it essentially states that episiotomy assists birthing, prevents tearing, and in order to avoid 3rd and 4th degree tearing, the best option is a "hockey-stick" cut. Now, at the time when my edition was published, "hockey-sticks" might have looked great on paper, but most doctors in my area still wouldn't consider doing them for one very big reason - that's a lot of cutting that might not be necessary. Midline cuts (a small cut straight toward the rectum) might carry a risk of tearing into the rectum, but they were still minimum cutting. Mediolateral (a cut toward the side at an angle) automatically create too much tissue damage, some of which is irreversible. And there is plenty more that I can say about episiotomy, when it's right and when it should be avoided, but it deserves it's own post. At any rate, I did not learn what I now know about episiotomy from What to Expect, I'll tell you that.
So having purchased a slightly useless, difficult to read book (which for some reason made me extra nauseated for my first few months) was the bulk of the my education. The other resources I had were the internet (again a "look it up when it occurs to you" resource), a one-day prenatal class offered through our doctors' office (more of an orientation than a class intended to educate couples), and a lot of intimidating conversations with friends and family. There was so much that I did not understand about pregnancy and labor. It was no wonder that I took poor care of myself during the pregnancy and was terrified of childbirth.
Here's a funny punchline though: Even after my horrible delivery with Dr. G and his practice, upon learning that I was pregnant with my second baby, I returned to the same practice. I had no idea at the time how much a part they had played in my "bad luck" labor.
It was only when my husband, daughter, and I moved into our new house that doors opened for me learning more about natural childbirth. In the years following our daughter's birth, I had many conversations with other moms about labor, and very occasionally I had an exchange with a mom who enjoyed having "Bradley" births with her babies. I knew nothing about Bradley, only that when I met a mom who had experienced a successful Bradley birth, she was extremely enthusiastic about it and would talk your ear off about how great it was (if you let her). When I met my new, very cool neighbor and learned that she had done a Bradley birth, I was very curious. She shared her first birth experience with me, which was very similar to mine with my daughter. Then she shared about her second birth experience after she and her husband had attended a Bradley class together. It wasn't without it's challenges, but the experiences were night and day, and she was so grateful to have been able to birth that way. It peaked my interest big-time. I couldn't ignore the fact that most of the women I met or knew who had planned and prepared unmedicated births were very happy about them, even when the experience wasn't complication free.
The next part of the story is history, as they say. My husband and I arranged for and attended a Bradley class (he was reluctant at first, but soon after enjoyed being so well informed and prepared). I read all of the suggested material, kept a diet log, and did prenatal exercises like crazy. Preparing for natural childbirth became one of my great goals in the coming months and weeks.
The most difficult and sobering part of the journey was the realization that many of my complications in my first labor, delivery, and post-partum were not simply a case of terrible luck. Many of them were the offspring of procedures I had been subjected to or consented to. For example, as I stated, stripping the cervix brings a risk of premature rupture of membranes and possible infection. It might still be the best choice for a woman, but even if the doctor chooses or suggests it, it is not "risk-free." The epidural, which I'd like to discuss/vent about another time, has a risk of a negative reaction (i.e. fever) for some women. The use of antibiotics during labor or afterward with baby brings a risk of yeast over-growth in the milk or thrush infection in the baby's mouth. These procedures are not necessarily bad and are sometimes necessary for a safe delivery, but they always bring risks with them. And women deserve to know about those risks in order to give truly informed consent. I mean no offense to other women when I say that I believe a large percentage of birthing moms are not well-informed on the risks as well as the benefits of medical intervention in childbirth.
After several weeks in the Bradley class, I couldn't NOT think about my labor with my daughter, and when I thought about it I was angry - at my doctors and nurses, at every mom who had ever frightened me away from pursuing natural childbirth, at my husband for shooting it down once when I expressed an interest in natural childbirth, and mostly at myself for not taking control of my pregnancy, taking a good prenatal class (ideally for me, a Bradley class), and having the courage to consider better care-providers. I'm not saying that it was healthy to become so angry at everyone. I just was, and one thing was more clear than anything - if I didn't change doctors soon, I might end up repeating my first labor experience or having one similar to it.
This might sound silly to some people, but one of the biggest things I learned in my class is that the provider is half of the experience. If you are with a provider who understands and respects your desires, communicates well with you, and wants you to be a part of the decision making, you stand a better chance at a positive, safer labor experience regardless of whether you plan to go with or without an epidural. But if your providers are unwilling to consult with you and are willing to take your entire labor into their hands, you could end up the way I did - confused, in terrible pain, and with a difficult recovery.
Okay, some might ask, "But isn't the safety of your baby the most important thing?" Of course it is, and if the safety of my baby was unimportant to me, then I wouldn't be going to a health-care provider and delivering in a hospital at all. Actually, even saying that is somewhat unfair, because I know a few mothers who always birth their babies at home, unless it's medically impossible to do so, and they are very conscientious about the safety of their babies. One of them is a registered nurse who even chooses not have a doctor or midwife at all, and it is her husband who delivers the baby. Sounds crazy? Well I wouldn't feel comfortable doing it, but she is extremely well educated about childbirth, as is he, and they have had at least 1 or 2 excellent home births just this way. The need for an ambulance, midwife, or doctor hasn't arisen and hopefully never will.
This doesn't mean that I'm advocating unassisted home births. I just won't condemn them. For some women, it's the right decision, and it honestly sounds amazing. I just haven't ever felt right about it for myself.
So, back to the issue of a baby's safety - of course it's important. I don't know a single woman who is willing to carry a baby for 9 months just to gamble their safety away like it's nothing. And yet, it is slightly debatable what could be considered a "safer" delivery method/locale. You could definitely argue that a hospital and an OB are the safest - best equipment, highest qualified, etc. During most hospital labors, however, the doctor is not present during the labor and is not visually supervising the patient in their labor. The laboring portion is left in the hands of the labor and delivery nurses on staff, and let's hope they're great! Chances are, however, they are dividing their attention between at least two or more women (especially in Utah county!).
On the other hand, with a lay or nurse midwife, either in a birthing center, hospital, or home birth, the midwife is supervising not only the delivery of the baby but mom's labor. Once it's clear that mom is in labor, the midwife comes to her side. Attending so many labors with typically undivided attention makes for incredibly expert eyes (between experience and training), and, in my opinion, you have the absolute best authority on how the labor is really progressing. The midwife is much more likely to notice if something is not right. She is also more likely to have "seen it all" so to speak, and she'll know if it's a normal part of the unpredictability of childbirth (and if there's anything consistent about childbirth, it's that it's unpredictable), or if it's something that merits medical intervention. Some people panic at the thought that a midwife is not licensed to perform cesarean sections. This might sound like a big red-flag. As one who has delivered with midwives in a fairly complicated delivery, however, I can attest that they are not insensitive to the possible need for cesarean, and they will have a qualified OB in the room during the pushing stage to ensure that a cesarean can be safely performed if necessary. (Happily, in my case, it wasn't necessary! Though that OB had magic hands and turned my posterior baby like a charm!)
Returning to my experience with the Bradley class, at 32 weeks into my 2nd pregnancy, I contacted my Bradley teacher, gave her permission to say "I told you so" (she had warned me against staying with my OB's), and asked for some suggestions. After considering a couple, I decided to try and get the wonderful family practitioner who had delivered my sweet relative's baby years before. He was very popular even as just a family practitioner, but he was only accepting obstetrics patients on certain recommendations. He accepted my reference from my Bradley instructor, and I enjoyed the remainder of my visits very hopeful that everything would go better with this delivery.
I will not go into great detail in this post on the birth of my 2nd child (my first son), but I will say upfront that I did not receive an epidural. My husband and I enjoyed this labor more and felt like active participants. That alone was a blessing and a confirmation that my personality is better suited to unmedicated childbirth. I'm not joking when I relate that my husband actually said to me at one point during the labor, "This is actually a lot more fun." Of course, he was pretty exhausted by the time our son was born, but we both felt good about how our labor went.
I will also be plain and point out that it was not an uncomplicated delivery. I had hoped that a labor free of unnecessary intervention would minimize the complications in the delivery, but there are some things which you cannot prevent - like passing of and aspiration of mechonium. (More on this next time). I will say that, in light of the challenges my handsome boy faced during his first trying hours and days in the real world, I believe that it served him well that he came into the world drug free.
By the way, that same boy is still ridiculously handsome and has a passion for Legos and Wii, which I swear we only let him play on the weekends...
How I Became a Natural Childbirth Mommy
Childbirth is an extremely emotional topic. I would wager it is at least as emotional as politics and religion. For one thing, it is one of pinnacle events in a woman's life. For another, there are so many contradicting philosophies surrounding childbirth. Births come in about a million flavors. You have your hospital births, some induced, some cesarean, many naturally occurring, and most with many medical procedures and mechanisms utilized to ensure the safety of baby and Mom. Then you have your birthing centers, some of which are equipped with sanitized tubs for water laboring/birthing, etc. Then you have your home births, which occasionally occur in tubs, and which involve either certified nurse midwives, lay midwives, or no midwife. If these aren't enough flavors to throw into the mix, you have the occasional, but extremely exciting sounding car birth (where only a select few are assisted by someone trained in the medical profession).
Then there are the varieties of caregivers, and they too are impossible to categorize very simply. You see, there are obstetricians who favor a great deal of intervention (in their minds - insurance), OB's who feel strongly about only very specified intervention, certified nurse midwives (CNMs) who will only deliver in hospitals - some of them very intervention minded and others more "supervision/intervention when needed" minded, and then there are CNMs who advocate home births. They too are prepared to intervene, but tend to put off interventions until it is clearly necessary. And somewhere in that mix are other care practitioners who may wear one of the above titles, but who may function in more moderate territory.
Finally, there are different approaches to childbirth. There are women who expect childbirth to be difficult work and are happy to have any assistance, intervention, or pain-relief that can ease the experience. There are others who don't look forward to labor at all and want it to be as easy and painless a procedure as possible. Then there are women who are anxious to have a bit of control over the situation, but are happy to have strong guidance of and intervention into their labor and delivery. THEN (have we had enough "then"s?) there are the women who are determined to be very active in all of the decision making connected to their labor. And FINALLY, there are the "die-hards" who are determined to make all of the decisions. These poor ladies are often not well thought of. Many people imagine them having unassisted home-births and expect that they will make headlines such as "Mommy and Baby Lost in Home Delivery" (or something else completely awful).
Does not all this exhaust you? It does me. At 26, when I first learned that I was pregnant with my oldest child, I had no idea what I wanted. I had seen plenty of movies with women heaving and moaning and screaming in what seemed liked a perpetual contraction, and when I thought of childbirth, I had two emotions - confusion and fear. I had heard from plenty of moms that it was indescribably painful. Pain medication in childbirth sounded like one of those angelic pharmaceuticals that rescued women from the anguish of hell. I heard about big babies - 8 pounds or more! Wow! I heard about tearing, episiotomies, birthing pools, more tearing, babies in distress, etc. The issue was huge, and I did the first thing that made sense at the moment. I bought a book - What to Expect When You're Expecting. I mean, here should lie all of the information I would need to make the best decisions regarding prenatal care and childbirth, right?
The next thing I did was call a relative for suggestions on who my care provider should be. My sweet relative mentioned the family practitioner who delivered her baby (oh that I had known to take that reference, because that terrific man actually delivered my second baby!). I gently asserted that I felt strongly about having an obstetrician. (I actually didn't feel strongly about it. An obstetrician just sounded good at the moment).
Well, with very little research or consideration, I took the first OB name she threw out and scheduled with him right away. After two visits, however, I tearfully realized that I wanted a more "first-time mom friendly" environment. This first OB seemed rushed and to the point and didn't take the time to explain things as I wanted. I was also moderately-ill up until 20 weeks, and I wanted more sympathy than he was offering. So I took the next suggestion that was thrown at me, and this time I ended up with three very highly qualified OB's in a beautiful new office. Their bedside manner seemed great as far as I could tell. Joke nicknames like "baby-meister" were tossed around. One doctor suggested that if I needed to take a couple of Flinstone vitamins as prenatals during the sick stage, I should beware of saying "Yabba-Dabba Doo!" Oh, they were darling. And their credentials looked great. Well trained, highly qualified, very skilled in the cesarean, forceps, vacuum extraction. They were sensitive to the pains and discomforts of pregnancy with in-office B6 shots and kind, friendly nurses to take phone-calls whenever. They even enjoyed starting you out at your first visit with a short, free ultrasound. And after every visit, you got a delicious chocolate. I loved my check-ups, and it seemed clear that whichever of the three I ended up delivering with, I'd be in good hands.
There were only two problems with these obstetricians, and I didn't really understand the problems until I was pregnant with my second child three years later. First, they had a sign in their office that said something a little like this: "We are very concerned about the safety of our patients and their babies. For this reason, if you would like a birth-contract, doula assisted, or Bradley birth, please let us know so that we can transfer your care elsewhere." My husband noticed this sign at our first visit to the office, and he thought it was great. He had heard some negative things about intense, naturally-geared women and about doulas, and he had already formed a strong opinion against them. He liked the doctors for asserting themselves so. I can honestly say that I think that sign is great. I don't like the attitude connected to it, but being upfront can save time and grief for a woman who really pays attention to it.
I'd like to re-translate the sign, however, to explain what these doctors were really saying. It should have gone a little something like this: "We each attended medical school for many years and have all delivered lots of babies. So let's make one thing really clear - We're the experts. Please don't bring someone into the room who might interfere with our doctoring, like a doula. Please don't ask us to sign a contract trying to respect your birth wish lists. And please don't try to disagree with us on when and how your baby should be born. We're the experts. That's why you're here, right?" In other words, these doctors were pretty determined to call all of the shots on your delivery.
The second problem with these doctors (which was really a tenet of the first problem) was that they do not feel the need to discuss things with you. They tell you what will happen instead of discussing options with you. You do not have the option of declining a test, a shot, or a procedure. This wasn't very clear during the prenatal visits. It only became clear after the birth of my baby, and even then it was years later before I really understood how controlling they had been.
The only way to illustrate this is to just describe the labor, so here goes. At 39 1/2 weeks, I went in for my routine check-up. In the previous week, one OB had declared that my cervix was dilated to at least two centimeters. "Hurray," I had thought. That's hopeful! But when the next OB checked my cervix, he said that I was dilated to no more than 1 or 1 1/2. By this time, I was huge and exhausted. Having started pregnancy at 160 pounds (ish), I now weighed 225 pounds. I had educated myself so poorly on appropriate nutrition and had already been such a big eater that, once my pregnancy sickness ended at 20 weeks (when I had already gained a good 20 pounds), I went nuts and did not exercise much at all. I felt terrible. It was obvious that I was carrying a good sized baby (who turned out to be 9'3"), and big babies are not a happy thing in obstetrics. Of course, I happen to be 5'9" tall and have a large bone structure. So, a big baby, while not a thrilling idea, shouldn't have made anyone panic. But with this practice, over 9 pounds is not okay. After the OB at this 39 week check-up gave me a quick ultrasound to make sure the baby wasn't breach, he said, "Well, let's have another look." Then came a cervical check that was much more painful than the first. He said, "No, you're still the same, but let's send you in for a non-stress test. If you fail, then we'll just induce you." Not to my surprise, I had started bleeding after that 2nd cervical check. I learned/realized later that what the doctor had done was strip my cervical membranes. Usually, when doctors do something like this, they discuss it with the patient first.
I passed my non-stress test with flying colors and moped home with my husband feeling very forlorn that I wasn't going to be induced or something. I felt so huge and terrible, and I just wanted my ginormous baby out of my body. Then the strangest thing started happening - I kept wetting myself. Except, I wasn't peeing. After at least 3 0r 4 hours of noticing liquid every time I leaned forward or backward, I became confident that my waters had started leaking. I spoke to the OB on call (a different one from that day's check-up), and he declared that if my water had broken, then it would be gushing down my leg. My husband and I had taken a one day class (offered through their practice) where the nurse mentioned that occasionally the waters only leak, and then it is as if the baby acts as a stopper. So instead of gushing, you just having some dripping of fluid as you move around. He advised me to go to the triage at the hospital to be checked and confirm the fluid. My husband and I headed over to the hospital, and I was checked for leaking. Unfortunately, the paper which nurses use to identify amniotic fluid (which turns blue at the presence of fluid) shows the same reaction to blood, and I was still bleeding slightly. So it was near impossible for the nurse to confidently identify the fluid and confirm that my waters were leaking. I was certain however about the fluid as I continued to leak and leak in the hospital, and the doctor decided to have me admitted and wait to see if I began laboring. So I was placed in a bed, given an IV, hooked up to fetal monitoring, had my temperature taken and dilation checked (just 2 centimeters), and then I sat and watched Dave Letterman with my husband.
Now I had read in a magazine that epidurals can slow down labor and hinder pushing somewhat, so I hoped that with my background in theatre and my previous training with relaxation and yoga, etc., I'd just instinctively be able to relax my way through contractions. The thing was, I had not yet been able to identify contractions. I had been told during the non-stress test that I was having contractions (1 every 5-7 minutes), but I had been sure that it was just my baby stretching or something. I didn't realize that those "Braxton Hicks" were actually beginning contractions. I had been having them on and off for weeks.
At about 11:00 PM, Dr. G (my on-call OB) called and said that if my body didn't kick in with the real contractions by midnight, the nurse would start administering Pitocin to induce labor. I said okay and thought, "Please, body, get to work." I had heard horror stories about Pitocin making labor more painful than it naturally would be. At about 11:30, I felt my first natural, strong contraction. It was something like a deep, burning menstrual cramp, and I had no idea how to react to it. I was suddenly afraid and declared to my husband that I wanted my epidural. While the anesthesiologist was placing the needle and tube for my epidural, I felt two or three more contractions like the first, and I was grateful for the upcoming pain relief. Then I laid back and felt my legs slowly start to numb and become very warm. My first thought was that the relief was sweet. My second was,"How long will I have to lay here like this?"
The nurse added the Pitocin to my IV at midnight, and my husband and I started the long wait. The room started to feel pretty chilly, so I asked my husband to turn the heat up. This continued for the next hour until the room was 80 degrees, I was covered in blankets, and the nurse came in wondering why it suddenly felt like furnace. She decided to check my temperature again, and I was running a 102 degree fever. After a phone call, the nurse added anti-fever meds and anti-biotics to my IV. I had some ice chips, my husband video recorded me (speaking in slurring, drunken tongues), and he and I continued to play the waiting game. I was catheterized, so I didn't need a potty break, but I wanted to move onto my side. I couldn't move my warm legs, though. I didn't enjoy it. I felt nauseated. The nurse continued to check my dilation, adjusted my Pitocin up and down as was necessary ("You've had a couple of big ones there. Let's make sure that uterus doesn't overdo it...") I threw up a couple of times, and then I just laid there, waiting to get to 10 centimeters. There was nothing good on TV, and I wasn't interested in a movie or anything. I slept a little and laid there a lot. My husband got me ice-chips as I requested, caught my vomit in a little container, and slept the rest of the time. I must've dozed off after a few hours, because when I woke up it was about 7:00 AM and I was at 10 centimeters.
I was also extremely nauseated and started throwing up large quantities of bile. When I was done vomiting, the nurse placed my legs in stirrups and pointed out to my husband that our daughter had a lot of hair on her head. This was cool for them. I had stopped administering the epidural medicine sometime in the early morning and hadn't administered in a while. I wanted to feel my contractions so that I could push better. I could feel pressure, and I hoped it would help me push. The nurse removed my catheter and coached me on some practice pushes. I had no idea what I was doing. I was supposed to pull my legs back, but I couldn't feel my legs to control them. I couldn't feel my other lower muscles. I could only feel pressure from my uterus.
For the first 20-30 minutes I kept thinking, "Where's Dr. G? Isn't he supposed to be here?" I didn't understand that the doctor wouldn't be there during the whole pushing stage. They knew better than I did that I was not going to have my baby within that first 30 minutes.
The next part is really just a blur. My husband and I had made the mistake of giving our phone number out to family members and announcing the induction. During the next hour, my mother repeatedly called and the nurses told her to call back later. Dr. G arrived, and suddenly the room was full of people telling me to push. I pushed as best as I could imagine, though I still couldn't feel my legs and my arms were exhausted as they tried to pull the legs back. I could only feel the pressure of the contractions and then I'd scrunch up my whole body. I'm sure I did a terrible job. I had no idea if the baby was crowning or what until my husband started to say, "She's almost here." I pushed when told, and after my pushing had hit an hour, the doctor told my husband that he was going to vacuum extract the baby. During this time, I was still running a slight fever and my IV was flowing so fast that it was leaking down my arm. The doctor performed an episiotomy, hooked up the vacuum, and pulled my baby out on the next push. I tore all the way to the rectum, but it was over. She was here, and that was all I thought of.
She was beautiful and big and red. She also had a little mechonium (Baby's first bowel movement) on her body, and they wanted to make sure she was okay, so after they held her up to show her to me (sorry, Mom, no holding her yet), they took her to the nursery for some oxygen and a bath. My husband asked if he could go too, and I laid there satisfied to be done. Then the phone rang, and this time I took the call from my mom. While I chattered away on the phone, my doctor pulled on the cord and removed the placenta (mostly intact) and started to stitch up my 4th degree laceration. By the time I got off the phone with my mother, Dr. G was gone. Then it hit me that I was in a lot of pain. The epidural tube was removed, the IV was removed, and I was alone with a very young, well-intentioned nurse who started to push hard onto my belly. Then the worst pain began. I was so shocked that I cried out with each push. I was apparently bleeding quite a bit, and the nurse kept responding with exclamations like, "Wow, that clot was bigger than my fist!" (This didn't help.) The room was bright, but the lines in my vision started getting really fuzzy, and I KNEW that I needed to use the bathroom. I tried to ask her to help me to the toilet. I kept repeating myself, but she kept saying, "What? I don't understand you." My speech was very slurred, I guess. This time, however, it wasn't the drugs. It was the pain.
Hesitantly, the nurse helped to lift my huge body while I hobbled to the toilet, and I sat down and tried to release the urine from the bladder. I couldn't feel my muscles to release anything. I just watched the blood drip, and I could feel the stitches tug as I sat on the toilet. I could tell that the nurse was terrified with me sitting there. When I stood up, she moved me to an inflatable-ring in a wheel-chair, brought me down to the recovery level, and delivered me to my new nurse. I had no idea what was happening or where I was going.
The recovery nurse helped me into my new bed and gently touched my abdomen, and I cried out again in pain. I started pleading with her, "Please don't bring me the baby. I'm so afraid I'll drop her. I can't hold her yet." She leaned forward and kindly explained to me that my bladder was full, and she was going to catheterize me and get me some better pain medication. When she catheterized me, the bag filled up with a quart of urine (which is apparently a lot). The nurse called the doctor and got me some Percocet. After receiving my new wonder drug (which I continued taking for more than a week), I closed my eyes in the dim room and drifted off to sleep for at least 3 or 4 hours. When I awoke, I felt like a different person. David and I then happily requested that our baby be brought to us, and I got to hold her for the first time. She was very beautiful and big. And pretty sleepy.
Over the next several weeks, I had a difficult recovery. Recovery is always hard for first time moms, but I learned that a 4th degree laceration (when the patient tears all the from the vagina to the rectum) is a serious issue and is difficult to recover from. I had no idea what I was doing with nursing, and our daughter was very tired and didn't latch for the first day. When she finally did latch on the second day, I didn't care that it was a painful, poor latch. I was just relieved that she was nursing. We encountered many difficulties over the next several weeks, including yeast in my milk ducts, and by 6 weeks, she had finished being hungry after feedings. I had begun to offer supplemental bottles when I learned that she was only gaining about 1-2 ounces per week in the first month (it should be at least 3-7 ounces per week). When she learned that she didn't have to be hungry, she refused the breast entirely in favor of the bottle (smarty-pants!!). At 8 weeks post-partum, I was still bleeding, and the doctor discovered that, upon delivering my placenta for me, he had left some placental remains in my uterus. He plucked it out and got me an ultrasound to make sure there was nothing else remaining. (Incidentally, placental remains in the uterus can hinder milk supply, as the body is a little confused and still thinks it might be pregnant).
So, that was my first labor. I think it was terrible, but the true is that a lot of what I experienced is somewhat common. For the next three years, I shared my labor experiences like a great sports story. I was irritated when friends or family criticized my doctors or the hospital where I delivered. I felt like someone was telling me that I couldn't make a good choice for myself. What did they know? I considered myself terribly unlucky. It was only when I started taking a Bradley class almost 3 years later that I realized how little my labor complications had to do with luck.
Well, mommy duties are calling, but in the next post, I will share about my realizations about this labor and the care-givers. I will also share my transition to being an enthusiastic "natural" mommy.
Then there are the varieties of caregivers, and they too are impossible to categorize very simply. You see, there are obstetricians who favor a great deal of intervention (in their minds - insurance), OB's who feel strongly about only very specified intervention, certified nurse midwives (CNMs) who will only deliver in hospitals - some of them very intervention minded and others more "supervision/intervention when needed" minded, and then there are CNMs who advocate home births. They too are prepared to intervene, but tend to put off interventions until it is clearly necessary. And somewhere in that mix are other care practitioners who may wear one of the above titles, but who may function in more moderate territory.
Finally, there are different approaches to childbirth. There are women who expect childbirth to be difficult work and are happy to have any assistance, intervention, or pain-relief that can ease the experience. There are others who don't look forward to labor at all and want it to be as easy and painless a procedure as possible. Then there are women who are anxious to have a bit of control over the situation, but are happy to have strong guidance of and intervention into their labor and delivery. THEN (have we had enough "then"s?) there are the women who are determined to be very active in all of the decision making connected to their labor. And FINALLY, there are the "die-hards" who are determined to make all of the decisions. These poor ladies are often not well thought of. Many people imagine them having unassisted home-births and expect that they will make headlines such as "Mommy and Baby Lost in Home Delivery" (or something else completely awful).
Does not all this exhaust you? It does me. At 26, when I first learned that I was pregnant with my oldest child, I had no idea what I wanted. I had seen plenty of movies with women heaving and moaning and screaming in what seemed liked a perpetual contraction, and when I thought of childbirth, I had two emotions - confusion and fear. I had heard from plenty of moms that it was indescribably painful. Pain medication in childbirth sounded like one of those angelic pharmaceuticals that rescued women from the anguish of hell. I heard about big babies - 8 pounds or more! Wow! I heard about tearing, episiotomies, birthing pools, more tearing, babies in distress, etc. The issue was huge, and I did the first thing that made sense at the moment. I bought a book - What to Expect When You're Expecting. I mean, here should lie all of the information I would need to make the best decisions regarding prenatal care and childbirth, right?
The next thing I did was call a relative for suggestions on who my care provider should be. My sweet relative mentioned the family practitioner who delivered her baby (oh that I had known to take that reference, because that terrific man actually delivered my second baby!). I gently asserted that I felt strongly about having an obstetrician. (I actually didn't feel strongly about it. An obstetrician just sounded good at the moment).
Well, with very little research or consideration, I took the first OB name she threw out and scheduled with him right away. After two visits, however, I tearfully realized that I wanted a more "first-time mom friendly" environment. This first OB seemed rushed and to the point and didn't take the time to explain things as I wanted. I was also moderately-ill up until 20 weeks, and I wanted more sympathy than he was offering. So I took the next suggestion that was thrown at me, and this time I ended up with three very highly qualified OB's in a beautiful new office. Their bedside manner seemed great as far as I could tell. Joke nicknames like "baby-meister" were tossed around. One doctor suggested that if I needed to take a couple of Flinstone vitamins as prenatals during the sick stage, I should beware of saying "Yabba-Dabba Doo!" Oh, they were darling. And their credentials looked great. Well trained, highly qualified, very skilled in the cesarean, forceps, vacuum extraction. They were sensitive to the pains and discomforts of pregnancy with in-office B6 shots and kind, friendly nurses to take phone-calls whenever. They even enjoyed starting you out at your first visit with a short, free ultrasound. And after every visit, you got a delicious chocolate. I loved my check-ups, and it seemed clear that whichever of the three I ended up delivering with, I'd be in good hands.
There were only two problems with these obstetricians, and I didn't really understand the problems until I was pregnant with my second child three years later. First, they had a sign in their office that said something a little like this: "We are very concerned about the safety of our patients and their babies. For this reason, if you would like a birth-contract, doula assisted, or Bradley birth, please let us know so that we can transfer your care elsewhere." My husband noticed this sign at our first visit to the office, and he thought it was great. He had heard some negative things about intense, naturally-geared women and about doulas, and he had already formed a strong opinion against them. He liked the doctors for asserting themselves so. I can honestly say that I think that sign is great. I don't like the attitude connected to it, but being upfront can save time and grief for a woman who really pays attention to it.
I'd like to re-translate the sign, however, to explain what these doctors were really saying. It should have gone a little something like this: "We each attended medical school for many years and have all delivered lots of babies. So let's make one thing really clear - We're the experts. Please don't bring someone into the room who might interfere with our doctoring, like a doula. Please don't ask us to sign a contract trying to respect your birth wish lists. And please don't try to disagree with us on when and how your baby should be born. We're the experts. That's why you're here, right?" In other words, these doctors were pretty determined to call all of the shots on your delivery.
The second problem with these doctors (which was really a tenet of the first problem) was that they do not feel the need to discuss things with you. They tell you what will happen instead of discussing options with you. You do not have the option of declining a test, a shot, or a procedure. This wasn't very clear during the prenatal visits. It only became clear after the birth of my baby, and even then it was years later before I really understood how controlling they had been.
The only way to illustrate this is to just describe the labor, so here goes. At 39 1/2 weeks, I went in for my routine check-up. In the previous week, one OB had declared that my cervix was dilated to at least two centimeters. "Hurray," I had thought. That's hopeful! But when the next OB checked my cervix, he said that I was dilated to no more than 1 or 1 1/2. By this time, I was huge and exhausted. Having started pregnancy at 160 pounds (ish), I now weighed 225 pounds. I had educated myself so poorly on appropriate nutrition and had already been such a big eater that, once my pregnancy sickness ended at 20 weeks (when I had already gained a good 20 pounds), I went nuts and did not exercise much at all. I felt terrible. It was obvious that I was carrying a good sized baby (who turned out to be 9'3"), and big babies are not a happy thing in obstetrics. Of course, I happen to be 5'9" tall and have a large bone structure. So, a big baby, while not a thrilling idea, shouldn't have made anyone panic. But with this practice, over 9 pounds is not okay. After the OB at this 39 week check-up gave me a quick ultrasound to make sure the baby wasn't breach, he said, "Well, let's have another look." Then came a cervical check that was much more painful than the first. He said, "No, you're still the same, but let's send you in for a non-stress test. If you fail, then we'll just induce you." Not to my surprise, I had started bleeding after that 2nd cervical check. I learned/realized later that what the doctor had done was strip my cervical membranes. Usually, when doctors do something like this, they discuss it with the patient first.
I passed my non-stress test with flying colors and moped home with my husband feeling very forlorn that I wasn't going to be induced or something. I felt so huge and terrible, and I just wanted my ginormous baby out of my body. Then the strangest thing started happening - I kept wetting myself. Except, I wasn't peeing. After at least 3 0r 4 hours of noticing liquid every time I leaned forward or backward, I became confident that my waters had started leaking. I spoke to the OB on call (a different one from that day's check-up), and he declared that if my water had broken, then it would be gushing down my leg. My husband and I had taken a one day class (offered through their practice) where the nurse mentioned that occasionally the waters only leak, and then it is as if the baby acts as a stopper. So instead of gushing, you just having some dripping of fluid as you move around. He advised me to go to the triage at the hospital to be checked and confirm the fluid. My husband and I headed over to the hospital, and I was checked for leaking. Unfortunately, the paper which nurses use to identify amniotic fluid (which turns blue at the presence of fluid) shows the same reaction to blood, and I was still bleeding slightly. So it was near impossible for the nurse to confidently identify the fluid and confirm that my waters were leaking. I was certain however about the fluid as I continued to leak and leak in the hospital, and the doctor decided to have me admitted and wait to see if I began laboring. So I was placed in a bed, given an IV, hooked up to fetal monitoring, had my temperature taken and dilation checked (just 2 centimeters), and then I sat and watched Dave Letterman with my husband.
Now I had read in a magazine that epidurals can slow down labor and hinder pushing somewhat, so I hoped that with my background in theatre and my previous training with relaxation and yoga, etc., I'd just instinctively be able to relax my way through contractions. The thing was, I had not yet been able to identify contractions. I had been told during the non-stress test that I was having contractions (1 every 5-7 minutes), but I had been sure that it was just my baby stretching or something. I didn't realize that those "Braxton Hicks" were actually beginning contractions. I had been having them on and off for weeks.
At about 11:00 PM, Dr. G (my on-call OB) called and said that if my body didn't kick in with the real contractions by midnight, the nurse would start administering Pitocin to induce labor. I said okay and thought, "Please, body, get to work." I had heard horror stories about Pitocin making labor more painful than it naturally would be. At about 11:30, I felt my first natural, strong contraction. It was something like a deep, burning menstrual cramp, and I had no idea how to react to it. I was suddenly afraid and declared to my husband that I wanted my epidural. While the anesthesiologist was placing the needle and tube for my epidural, I felt two or three more contractions like the first, and I was grateful for the upcoming pain relief. Then I laid back and felt my legs slowly start to numb and become very warm. My first thought was that the relief was sweet. My second was,"How long will I have to lay here like this?"
The nurse added the Pitocin to my IV at midnight, and my husband and I started the long wait. The room started to feel pretty chilly, so I asked my husband to turn the heat up. This continued for the next hour until the room was 80 degrees, I was covered in blankets, and the nurse came in wondering why it suddenly felt like furnace. She decided to check my temperature again, and I was running a 102 degree fever. After a phone call, the nurse added anti-fever meds and anti-biotics to my IV. I had some ice chips, my husband video recorded me (speaking in slurring, drunken tongues), and he and I continued to play the waiting game. I was catheterized, so I didn't need a potty break, but I wanted to move onto my side. I couldn't move my warm legs, though. I didn't enjoy it. I felt nauseated. The nurse continued to check my dilation, adjusted my Pitocin up and down as was necessary ("You've had a couple of big ones there. Let's make sure that uterus doesn't overdo it...") I threw up a couple of times, and then I just laid there, waiting to get to 10 centimeters. There was nothing good on TV, and I wasn't interested in a movie or anything. I slept a little and laid there a lot. My husband got me ice-chips as I requested, caught my vomit in a little container, and slept the rest of the time. I must've dozed off after a few hours, because when I woke up it was about 7:00 AM and I was at 10 centimeters.
I was also extremely nauseated and started throwing up large quantities of bile. When I was done vomiting, the nurse placed my legs in stirrups and pointed out to my husband that our daughter had a lot of hair on her head. This was cool for them. I had stopped administering the epidural medicine sometime in the early morning and hadn't administered in a while. I wanted to feel my contractions so that I could push better. I could feel pressure, and I hoped it would help me push. The nurse removed my catheter and coached me on some practice pushes. I had no idea what I was doing. I was supposed to pull my legs back, but I couldn't feel my legs to control them. I couldn't feel my other lower muscles. I could only feel pressure from my uterus.
For the first 20-30 minutes I kept thinking, "Where's Dr. G? Isn't he supposed to be here?" I didn't understand that the doctor wouldn't be there during the whole pushing stage. They knew better than I did that I was not going to have my baby within that first 30 minutes.
The next part is really just a blur. My husband and I had made the mistake of giving our phone number out to family members and announcing the induction. During the next hour, my mother repeatedly called and the nurses told her to call back later. Dr. G arrived, and suddenly the room was full of people telling me to push. I pushed as best as I could imagine, though I still couldn't feel my legs and my arms were exhausted as they tried to pull the legs back. I could only feel the pressure of the contractions and then I'd scrunch up my whole body. I'm sure I did a terrible job. I had no idea if the baby was crowning or what until my husband started to say, "She's almost here." I pushed when told, and after my pushing had hit an hour, the doctor told my husband that he was going to vacuum extract the baby. During this time, I was still running a slight fever and my IV was flowing so fast that it was leaking down my arm. The doctor performed an episiotomy, hooked up the vacuum, and pulled my baby out on the next push. I tore all the way to the rectum, but it was over. She was here, and that was all I thought of.
She was beautiful and big and red. She also had a little mechonium (Baby's first bowel movement) on her body, and they wanted to make sure she was okay, so after they held her up to show her to me (sorry, Mom, no holding her yet), they took her to the nursery for some oxygen and a bath. My husband asked if he could go too, and I laid there satisfied to be done. Then the phone rang, and this time I took the call from my mom. While I chattered away on the phone, my doctor pulled on the cord and removed the placenta (mostly intact) and started to stitch up my 4th degree laceration. By the time I got off the phone with my mother, Dr. G was gone. Then it hit me that I was in a lot of pain. The epidural tube was removed, the IV was removed, and I was alone with a very young, well-intentioned nurse who started to push hard onto my belly. Then the worst pain began. I was so shocked that I cried out with each push. I was apparently bleeding quite a bit, and the nurse kept responding with exclamations like, "Wow, that clot was bigger than my fist!" (This didn't help.) The room was bright, but the lines in my vision started getting really fuzzy, and I KNEW that I needed to use the bathroom. I tried to ask her to help me to the toilet. I kept repeating myself, but she kept saying, "What? I don't understand you." My speech was very slurred, I guess. This time, however, it wasn't the drugs. It was the pain.
Hesitantly, the nurse helped to lift my huge body while I hobbled to the toilet, and I sat down and tried to release the urine from the bladder. I couldn't feel my muscles to release anything. I just watched the blood drip, and I could feel the stitches tug as I sat on the toilet. I could tell that the nurse was terrified with me sitting there. When I stood up, she moved me to an inflatable-ring in a wheel-chair, brought me down to the recovery level, and delivered me to my new nurse. I had no idea what was happening or where I was going.
The recovery nurse helped me into my new bed and gently touched my abdomen, and I cried out again in pain. I started pleading with her, "Please don't bring me the baby. I'm so afraid I'll drop her. I can't hold her yet." She leaned forward and kindly explained to me that my bladder was full, and she was going to catheterize me and get me some better pain medication. When she catheterized me, the bag filled up with a quart of urine (which is apparently a lot). The nurse called the doctor and got me some Percocet. After receiving my new wonder drug (which I continued taking for more than a week), I closed my eyes in the dim room and drifted off to sleep for at least 3 or 4 hours. When I awoke, I felt like a different person. David and I then happily requested that our baby be brought to us, and I got to hold her for the first time. She was very beautiful and big. And pretty sleepy.
Over the next several weeks, I had a difficult recovery. Recovery is always hard for first time moms, but I learned that a 4th degree laceration (when the patient tears all the from the vagina to the rectum) is a serious issue and is difficult to recover from. I had no idea what I was doing with nursing, and our daughter was very tired and didn't latch for the first day. When she finally did latch on the second day, I didn't care that it was a painful, poor latch. I was just relieved that she was nursing. We encountered many difficulties over the next several weeks, including yeast in my milk ducts, and by 6 weeks, she had finished being hungry after feedings. I had begun to offer supplemental bottles when I learned that she was only gaining about 1-2 ounces per week in the first month (it should be at least 3-7 ounces per week). When she learned that she didn't have to be hungry, she refused the breast entirely in favor of the bottle (smarty-pants!!). At 8 weeks post-partum, I was still bleeding, and the doctor discovered that, upon delivering my placenta for me, he had left some placental remains in my uterus. He plucked it out and got me an ultrasound to make sure there was nothing else remaining. (Incidentally, placental remains in the uterus can hinder milk supply, as the body is a little confused and still thinks it might be pregnant).
So, that was my first labor. I think it was terrible, but the true is that a lot of what I experienced is somewhat common. For the next three years, I shared my labor experiences like a great sports story. I was irritated when friends or family criticized my doctors or the hospital where I delivered. I felt like someone was telling me that I couldn't make a good choice for myself. What did they know? I considered myself terribly unlucky. It was only when I started taking a Bradley class almost 3 years later that I realized how little my labor complications had to do with luck.
Well, mommy duties are calling, but in the next post, I will share about my realizations about this labor and the care-givers. I will also share my transition to being an enthusiastic "natural" mommy.
Subscribe to:
Posts (Atom)
