I've just found some great links on natural childbirth and epidurals, and I've just got to share them!!
First, on pregnancy.org, there is a whole section of Tips on Hypnobirthing. I've just been reading it for the last 1/2 hour, and it's fantastic. For some terrific information on medical procedures frequently used in childbirth, pay special attention to Tip #9: Your Birthing Choices.
Finally, I just read a great article on Epidurals. My reaction is - wow. :)
Happy reading!
Tuesday, January 26, 2010
Friday, January 22, 2010
Respecting Fear?
I had a meaningful exchange with a relatively new friend a few days ago that has really made me think about why I tend to become so anxious about childbirth. Because despite my enthusiasm for natural childbirth and my excitement about the event, I do tend to become anxious. It occurred to me that, though this may sound dramatic, I have a slight case of post traumatic stress disorder connected to my first birth experience. (I'm sure many women do.) Perhaps it's part of the reason I tend to cringe when I'm in a crowd of women singing the praises of epidurals. I don't just think, "No thanks, not for me." I literally feel a slight "fight or flight" impulse go through me.
I will openly acknowledge that the difficulties which I faced in my first labor and recovery were not entirely caused by the epidural. I had poor obstetric care and received very poor care from the hospital staff. I also had such little knowledge that I didn't understand enough of what was going on, and so my anxiety and fear in the situation was increased. Still, receiving my epidural was the catalyst for the many events which led to my hour of delirium and the many weeks to follow of pain, failed nursing, and increased stress (on top of the typical stress of having a newborn).
The exchange I mentioned before was with a new person in my neighborhood, a beautiful and delightful woman whom I've only known a few months. She asked how I was, and when I answered that I was "okay" (I need to stop using the word "okay", by the way), she said, "Really? Are you really okay?"
I then shared, as generically as I could that I tend to become very anxious when I'm expecting a baby, not because of the labor pain, but because I have a lot of preparation to do for labor and, being a mother of 3, I have little time to do it. She empathized that she often found insufficient time for important parts of her life (she is a mother of 2), and then she asked if I like to go unmedicated. I shared with her that I do and that I enjoy it, but also that I'd had some difficult labors and some surprising and scary deliveries. Then I gave her my reader's digest version of each labor, and she passionately empathized.
"You've had some rocky experiences, and those fears are very real and should be respected," she said when I was done.
I, sensing that she somehow understand better than many what I was talking about, asked if she knew a lot about childbirth (beyond what she would inevitably know from being a mother of two). She answered, "I'm a trained doula." (Aha!)
I gently asked, "Do you mind me asking, do you prefer unmedicated birth or do you choose an epidural?"
She responded, "I choose an epidural, but that is because I have a strong fear connected to pain in..." and then she trailed off. I could tell that she had a very real fear that affected her birth choices. And yet I could tell that she was perfectly at peace with her births and that her epidurals were not a problem for her. I respected that. As I've said, I don't think there is only one way to birth a baby, and her experience was an illustration of that.
The conversation ended well, and I had a new-found appreciation for her, not because I think epidurals are great, but because I'd met someone who I felt truly respected both sides of the issue without feelings of contention. I don't know what the root of her fear is, but I admire the fact that she, approaching childbirth with more knowledge than most women, was making a conscious, informed, self-aware decision about her labors.
I thought a lot about her use of the word "respect" in referring to my fears. I'm not 100% comfortable with it, because I don't want my personal fears to hinder or disrupt my ability to birth peacefully and comfortably. But there was something very compassionate in the use of that word. And perhaps right now, as I approach my final birth experience, I'm just very hungry for that kind of compassion. :) No I can't complain that I've had to have cesareans with all (or any) of the my births, and no, I've never lost a child in birth (thank goodness!!). But the pain and poor health associated with the epidural was real. The guilt and disappointment of having a mostly painless and very positive labor with my 2nd birth, and yet realizing that my efforts had not saved him from complications was also real. And the terrifying image of my 2nd son, pale and floppy after his rocky birth, are still real.
And yet, this fear, while I want to acknowledge it and "respect" that it has affected me, doesn't have to take away my peace. I feel my daughter's movements and feel in my heart that she is unencumbered by her cord. I see the possibility that she may arrive earlier than her siblings (which I wouldn't mind), and I know that, even if she does pass mechonium before birth, it doesn't have to be a threat to her. I know that I'm in good care, and I've doubled my confidence by discussing my birth preferences very plainly with my midwives and having our birth plan in my file. I have one of the most wonderful (and handsomest) birth coaches alive. I know that I'm going to the providers and the hospital with the best reputation in the area for natural, low intervention childbirth.
I know that it will be okay. God has blessed our previous births in one way or another, especially those of my sons, and He'll bless this one in different ways.
How do all of these musings become an advocate for natural childbirth, because I do want to openly advocate it to those who are interested in it or desire it? Well, I'd say, look at your feelings. Why are you reading this (other than that you might be a very nice person who I've invited to read it)? Perhaps you are uncomfortable with the popular attitude that there is only one obviously "sane" choice for birthing: Hospital birth with an epidural. If so, I'm glad to hear it. There are other ways to bring a baby into the world. You do not have to feel sheepish about your interest in it. It doesn't mean that you think that you're smarter or stronger than other women, and it doesn't mean that they are uninformed weaklings either. It just means that you're paying attention to your own feelings.
What I think an interest in natural childbirth says is that you might feel a slight loss or void if didn't explore other options. Perhaps you are someone who doesn't just want to "get (childbirth) over with" or who wants to really feel confident that, should you choose an epidural, it's a truly safe option for birthing and will not keep you from being able to fully participate in the birth. If you feel this way, I consider you kindred. :) I felt the same way, and I've met too many women like myself who, when face the anxiety of the unknown in their first birth, didn't prepare for natural birth and left themselves with no other option than an epidural. Many of them later felt as though they'd given away a precious experience.
So, where I'd like to go with this post is to extend the invitation to explore your options. Read about the different choices you have. Look up Hypnobirthing, Bradley birth, epidurals, OB's, CNM's, etc. Consider your health and your personality. (If you are high-risk, natural childbirth is not necessarily lost to you - you'd just need more intervention than others might). Take seriously the possible risks of epidural. (This is important, because regardless of your personality, you cannot choose your biology, the size or position of your baby, or the anesthesiologist). In other words, educate yourself and keep an open mind. And don't feel embarrassed or sheepish about your interests. No one need take offense if your choices are different from theirs.
In closing, what are my fears? Well, if you haven't read about my previous births, I'll tell you plainly that danger to my babies, having no control in a labor, and terrible postpartum pain are my deepest fears in connection to childbirth. And if I'm going to respect those fears, the best choice for me is natural childbirth.
I will openly acknowledge that the difficulties which I faced in my first labor and recovery were not entirely caused by the epidural. I had poor obstetric care and received very poor care from the hospital staff. I also had such little knowledge that I didn't understand enough of what was going on, and so my anxiety and fear in the situation was increased. Still, receiving my epidural was the catalyst for the many events which led to my hour of delirium and the many weeks to follow of pain, failed nursing, and increased stress (on top of the typical stress of having a newborn).
The exchange I mentioned before was with a new person in my neighborhood, a beautiful and delightful woman whom I've only known a few months. She asked how I was, and when I answered that I was "okay" (I need to stop using the word "okay", by the way), she said, "Really? Are you really okay?"
I then shared, as generically as I could that I tend to become very anxious when I'm expecting a baby, not because of the labor pain, but because I have a lot of preparation to do for labor and, being a mother of 3, I have little time to do it. She empathized that she often found insufficient time for important parts of her life (she is a mother of 2), and then she asked if I like to go unmedicated. I shared with her that I do and that I enjoy it, but also that I'd had some difficult labors and some surprising and scary deliveries. Then I gave her my reader's digest version of each labor, and she passionately empathized.
"You've had some rocky experiences, and those fears are very real and should be respected," she said when I was done.
I, sensing that she somehow understand better than many what I was talking about, asked if she knew a lot about childbirth (beyond what she would inevitably know from being a mother of two). She answered, "I'm a trained doula." (Aha!)
I gently asked, "Do you mind me asking, do you prefer unmedicated birth or do you choose an epidural?"
She responded, "I choose an epidural, but that is because I have a strong fear connected to pain in..." and then she trailed off. I could tell that she had a very real fear that affected her birth choices. And yet I could tell that she was perfectly at peace with her births and that her epidurals were not a problem for her. I respected that. As I've said, I don't think there is only one way to birth a baby, and her experience was an illustration of that.
The conversation ended well, and I had a new-found appreciation for her, not because I think epidurals are great, but because I'd met someone who I felt truly respected both sides of the issue without feelings of contention. I don't know what the root of her fear is, but I admire the fact that she, approaching childbirth with more knowledge than most women, was making a conscious, informed, self-aware decision about her labors.
I thought a lot about her use of the word "respect" in referring to my fears. I'm not 100% comfortable with it, because I don't want my personal fears to hinder or disrupt my ability to birth peacefully and comfortably. But there was something very compassionate in the use of that word. And perhaps right now, as I approach my final birth experience, I'm just very hungry for that kind of compassion. :) No I can't complain that I've had to have cesareans with all (or any) of the my births, and no, I've never lost a child in birth (thank goodness!!). But the pain and poor health associated with the epidural was real. The guilt and disappointment of having a mostly painless and very positive labor with my 2nd birth, and yet realizing that my efforts had not saved him from complications was also real. And the terrifying image of my 2nd son, pale and floppy after his rocky birth, are still real.
And yet, this fear, while I want to acknowledge it and "respect" that it has affected me, doesn't have to take away my peace. I feel my daughter's movements and feel in my heart that she is unencumbered by her cord. I see the possibility that she may arrive earlier than her siblings (which I wouldn't mind), and I know that, even if she does pass mechonium before birth, it doesn't have to be a threat to her. I know that I'm in good care, and I've doubled my confidence by discussing my birth preferences very plainly with my midwives and having our birth plan in my file. I have one of the most wonderful (and handsomest) birth coaches alive. I know that I'm going to the providers and the hospital with the best reputation in the area for natural, low intervention childbirth.
I know that it will be okay. God has blessed our previous births in one way or another, especially those of my sons, and He'll bless this one in different ways.
How do all of these musings become an advocate for natural childbirth, because I do want to openly advocate it to those who are interested in it or desire it? Well, I'd say, look at your feelings. Why are you reading this (other than that you might be a very nice person who I've invited to read it)? Perhaps you are uncomfortable with the popular attitude that there is only one obviously "sane" choice for birthing: Hospital birth with an epidural. If so, I'm glad to hear it. There are other ways to bring a baby into the world. You do not have to feel sheepish about your interest in it. It doesn't mean that you think that you're smarter or stronger than other women, and it doesn't mean that they are uninformed weaklings either. It just means that you're paying attention to your own feelings.
What I think an interest in natural childbirth says is that you might feel a slight loss or void if didn't explore other options. Perhaps you are someone who doesn't just want to "get (childbirth) over with" or who wants to really feel confident that, should you choose an epidural, it's a truly safe option for birthing and will not keep you from being able to fully participate in the birth. If you feel this way, I consider you kindred. :) I felt the same way, and I've met too many women like myself who, when face the anxiety of the unknown in their first birth, didn't prepare for natural birth and left themselves with no other option than an epidural. Many of them later felt as though they'd given away a precious experience.
So, where I'd like to go with this post is to extend the invitation to explore your options. Read about the different choices you have. Look up Hypnobirthing, Bradley birth, epidurals, OB's, CNM's, etc. Consider your health and your personality. (If you are high-risk, natural childbirth is not necessarily lost to you - you'd just need more intervention than others might). Take seriously the possible risks of epidural. (This is important, because regardless of your personality, you cannot choose your biology, the size or position of your baby, or the anesthesiologist). In other words, educate yourself and keep an open mind. And don't feel embarrassed or sheepish about your interests. No one need take offense if your choices are different from theirs.
In closing, what are my fears? Well, if you haven't read about my previous births, I'll tell you plainly that danger to my babies, having no control in a labor, and terrible postpartum pain are my deepest fears in connection to childbirth. And if I'm going to respect those fears, the best choice for me is natural childbirth.
Wednesday, January 6, 2010
On Dads in Labor...
This is a delicate issue, and I've composed and revised at least 5 versions of this post - no exaggeration. First of all, not all birth dads are actually husbands yet. So I kept feeling unsure about the title "On Husbands in Labor." That said, if I have to use the words "husband or lover" every time I refer to a birthing dad, you're going to become really sick of me really fast. So from here on out I want to simplify and use "husband" as my blanket term for all men who participate in a wife's/lover's labor.
The most delicate thing about this issue, however, is that I could very easily offend a lot of men (if any indulged me enough to read this). I could also offend a lot of women on behalf of their husbands. I could sound very accusatory and make men sound like they are unhelpful or are inadvertently sabotaging their wives' birth experiences. That's the last thing I want to do.
I do want to make one thing clear, however, and I'm just going to be blunt. A husband's support and involvement is crucial and will have a profound impact on his wife's labor. If you are interested in going unmedicated but your husband disagrees with your desires, you will be facing a very uphill battle once you are in labor. There I've said it, and it's T.R.U.E. True.
Pregnancy is a very challenging time for a woman. She is going through so many physical and emotional changes. She is likely to experience a fair amount of self-doubt, and her perception of how her husband feels about her will greatly impact how well she deals with stress and other challenges.
If pregnancy is a challenge, labor is a Herculean task. It can not only be painful and exhausting, but it can be frightening. Even if a woman is feeling pretty good during much of her labor, there is almost always a point where self-doubt begins to set in. A husband's reaction to that self-doubt will make all of the difference in the world.
I want to back up though, and I hope you don't mind me doing it. I want to share a little about my husband and the changes in his attitude about childbirth through the years. He and I have discussed this, and he has given me permission to use him as an example. I really appreciate his openness, and I hope that I can do justice to what a great person he is.
When I was about 6 or 7 months pregnant with our oldest child, I finally found some time after work to sit down and read some of the magazines that came in our "Welcome" packet at the doctor's office. For many months I had been debating in my head and was inconclusive about whether or not I wanted to labor with or without an epidural. At this point I was still loaded with fear over labor and had no confidence that I'd "be able to take the pain." Just the same, the question still hovered over my head about whether or not an epidural was a safe, wise option in childbirth and a good option for me with my personality.
In one of the magazines I was reading, I found an article that gave suggestions for coping with labor pain unmedicated. It discussed some of the risks of an epidural, most of which I had not heard about before. It also discussed some of the benefits of unmedicated childbirth. Interestingly enough, in the 5-6 months that I had known I was pregnant, I had not heard even one very positive story about an unmedicated birth. In fact, any time I mentioned to friends or coworkers that I was interested in unmedicated childbirth, I usually heard horror stories or was mildly teased about my interest. One friend sent me a cartoon of a hospital room that had been torn apart. Everything was damaged, the doctor had a black eye, and the mother sat happily cuddling her newborn baby. In the caption, the doctor was saying to the husband, "Sir, next time you may want to convince your wife to consider pain medication in labor." It was a very cute cartoon, and I took little offense to it; but I'll admit that it didn't help me very much. :)
Back to my evening of magazine reading: After I had read and considered the article on natural childbirth for awhile, my husband came home. Instead of asking him to read the article and tell me what he thought of it, I just sheepishly mentioned that I was interested in learning more about unmedicated birth. Thinking that my interest was only mild, he shared that he wanted the labor to be a happy experience, and he was concerned that if I was in terrible pain then it would be a miserable one. He also gently mentioned that I don't have a very high pain tolerance. (And he's right, by the way).
I must admit that I was a little disappointed that he wasn't more open to the idea, but I had my own fears and insecurities on top of his skepticism. I had so little confidence and conviction that I didn't pursue it any further with him. From that point on I hoped to not need the epidural while expecting that I probably would.
Now I want to repeat again that I don't mean to disrespect my husband. He is and has always been a wonderful man, and he's very far from being a male chauvinist. He just didn't know much about the benefits of unmedicated labor or even the risks of epidurals. He had also heard a story from a fairly close relative about how she had attended a class at a church activity given by a doula, and she left feeling very guilted about her personal plans to have an epidural. He had little knowledge and no positive experience with natural childbirth, and he made a judgment based on what he knew.
Then I had our daughter. It was a disastrous birth. Yes, there have been worse labors and deliveries. Yes, we're both alive and well, and we didn't even need a c-section. It was still a disaster, though. It was both physically and emotionally traumatizing, and recovery and nursing were both horribly impacted by the whole experience. With my little knowledge at the time about labor and delivery, I actually returned to the same OB group with our next pregnancy. I was certain about one thing, though - I did not want an epidural with my next delivery. I did not want to risk a fever or difficulty pushing out the baby again.
Once I'd had the fateful conversation with a neighbor that convinced me that I wanted a Bradley birth, I approached my husband about taking a Bradley class. He didn't argue, but he was uncertain. The class was expensive and a large time commitment - $120 and 10 weeks, one night a week. For us that meant babysitting and extra stress when we didn't have much excess income or time. We had already taken a short class in our previous pregnancy and had experienced labor, and he saw little need for another class. He also admitted that he was unsure how comfortable he'd be with the kinds of people who were very gung-ho about unmedicated labor. From his experience, they seemed a bit extreme; and my husband has a strong aversion to extremes. :)
Despite his concerns, he knew that this was important to me. He also knew that I looked back on our first daughter's birth with pain and disappointment. She was such a joy and worth any difficulty I experienced, but she suffered along with me when I was struggling with intense pain and low milk supply for several weeks after birth. If it could help me feel better prepared for this next labor, my husband was willing to make the time and investment for a Bradley class.
Throughout the 10 weeks of the class, my husband's attitude slowly changed. He never became passionate about me not having an epidural. He did, however, gain a great appreciation for not only the medical benefits of unmedicated birth but also what a positive bonding experience it could be for a couple. He made time to read some of the extra material assigned in the class. He encouraged me to do my exercises, and he excitedly prepared for the labor experience by picking out music and making a birth "wish list" with me. It was very touching to watch how much respect he gained for couples who are willing to put in the preparation and effort for an unmedicated birth.
During our second labor, when our son "Mr. Handsome" was born, my husband was a great support. For one thing, he had learned so much about labor that he sensed I was in labor before I did. I had begun vomiting throughout the day and was in bed most of the time, and he had learned that it was a possible symptom of the onset of labor. He also knew that dehydration wasn't great for a woman who is 40 weeks pregnant. :) Once we were in the hospital, he was very attentive in offering to get me things and checking my comfort level. He consistently massaged my back during each strong contraction, and he encouraged me to switch positions and use the bathroom frequently as I needed to. He was quick to respond to any discomfort I had and seemed to read my cues better than I often did. At one point, when I had gotten in the shower for comfort, he smiled at me and said, "This is a lot more fun than the last time." (The previous time, he could do little more than get me ice chips and blankets and, when I had a bout of vomiting, hold the container for me).
Now it wasn't easy for him. When we had been in the hospital for almost 10 hours and I had been dilated to 8 centimeters for over 5 hours and was getting pretty exhausted and grumpy, he had been rubbing my back all night and was ready to pass out. Once the doctor and I agreed to break my water, however, my husband got a second wind. When my water was broken, my dilation went from 8 to 10 centimeters in one contraction, and I was lying flat on my back. (This was VERY painful.) I derailed for a minute or two. Gratefully, my husband was very comforting and encouraging. He had learned about the signs of transition, and he knew that the end was near. (In fact, I was pushing 5 minutes later.) So as I yelled out, "Please put something in my IV!" he worked to soothe me by telling me that it was okay and that I was doing great. (He was VERY sweet considering I'd just sworn in front of everyone and ripped my hospital gown off.)
When I began to push, he just stood by me and told me that I was doing a great job. And when our son came out all muddy and slimy, my husband burst in tears, hugged and kissed me, and told me that he was so proud of me and the baby was so beautiful. (Incidentally, my son is a miniature of my husband, so you can guess where he got his looks).
In our 3rd pregnancy, I chose to go with Certified Nurse Midwives instead of an OB or family doctor. Though my husband wasn't fully comfortable with the idea of midwives, he had also learned that since I was the one having the baby, my feelings should come first in the matter. During our somewhat complicated labor, his tremendous support enabled me to labor unmedicated despite having a full blast of Pitocin almost the entire time. I personally believe that, had I received an epidural with that labor, I would have needed a cesarean. Even a year later when I expressed insecurity and guilt that maybe I shouldn't have been so resistant to a cesarean with that birth, my husband reassured me that we were in the best hands and had done the right thing each step of the way. When I claim that I was a bad patient, he says that I did a great job with our son and I shouldn't ever doubt the choices we made.
Now my husband has always cared for the baby's and my safety. He has always had my comfort and best interest at heart. When I requested my epidural with our first baby, my husband quickly got the nurse to call the anesthesiologist. He was encouraging and attentive during that labor as well, doing whatever he could to assist me. He felt a little helpless, though. He was limited in what he could do, and he was forced to sit by and watch much of the time. He also understood so little about what was happening. When people announced to us that I would receive this drug or IV or this procedure would be performed, he knew no reason to not consent to things. And I was so gone during that labor that I had no ability to stay really involved.
Can you see why I feel so passionately about couples taking a good class together? :) My husband went from being a compassionate but slightly helpless observer of my trauma to being an active participant in and advocate for my empowerment. Instead of wanting to rescue me from "unnecessary pain," he joined me on my journey and was crucial in making it more positive and safer. I have always adored him, but my love for him has grown so much through these experiences among others.
I want to be clear again that I don't think that unmedicated childbirth is the choice all women need to make. Many women, knowing all of the risks and benefits of the two options, would still opt for the pain relief of the epidural. I do feel, however, that couples should work hard to become educated together - well educated. Whenever possible, expectant couples should make the time and investment for a good class - one offered independent of an OB practice and requiring multiple evenings. They should come in with as equal knowledge and understanding as possible about nutrition, pregnancy exercises, medical procedures, alternatives for pain relief or pain minimizing, the stages of labor, pushing positions, postpartum care, and lactation.
Most importantly, the husband should have a good understanding of his wife's desires about childbirth, and they should both come in prepared to work together to support those desires. If the woman is low risk and would like to deliver with midwives - CNM's deliver in hospitals and they're great! - the husband should give this serious consideration. If she feels strongly about natural childbirth, he should encourage her in her desires and be prepared to give encouragement during labor.
To be more specific about labor, it is very important for couples to take things one step at a time and let the laboring woman give the cues. If a woman wants to labor unmedicated, the husband should be very careful in reading his wife's reaction during contractions. A woman may appear to be in greater pain than she really is, or she may even discover that she doesn't mind difficult contractions because they always come to an end and she gets breaks between them. A well meaning husband might be tempted, at the sight of his wife's grimaces or the sound of her moans, to say, "Honey, if you want an epidural, I totally support you." As kind as the intentions are, this could sound like a vote of no confidence to a woman who is already emotionally vulnerable. So, to be plain, it is a good idea for couples to make a plan that no medication be offered unless the wife first requests it.
Husbands deserve to know that their love and support means the world to their wives, especially during an experience like labor. A loving, knowledgeable, and involved husband who works with and follows his wife's lead during labor is invaluable, and I believe that he receives a great reward in having played such an active part during her labor.
Such a husband can become a "birth partner" in the truest sense of the word.
The most delicate thing about this issue, however, is that I could very easily offend a lot of men (if any indulged me enough to read this). I could also offend a lot of women on behalf of their husbands. I could sound very accusatory and make men sound like they are unhelpful or are inadvertently sabotaging their wives' birth experiences. That's the last thing I want to do.
I do want to make one thing clear, however, and I'm just going to be blunt. A husband's support and involvement is crucial and will have a profound impact on his wife's labor. If you are interested in going unmedicated but your husband disagrees with your desires, you will be facing a very uphill battle once you are in labor. There I've said it, and it's T.R.U.E. True.
Pregnancy is a very challenging time for a woman. She is going through so many physical and emotional changes. She is likely to experience a fair amount of self-doubt, and her perception of how her husband feels about her will greatly impact how well she deals with stress and other challenges.
If pregnancy is a challenge, labor is a Herculean task. It can not only be painful and exhausting, but it can be frightening. Even if a woman is feeling pretty good during much of her labor, there is almost always a point where self-doubt begins to set in. A husband's reaction to that self-doubt will make all of the difference in the world.
I want to back up though, and I hope you don't mind me doing it. I want to share a little about my husband and the changes in his attitude about childbirth through the years. He and I have discussed this, and he has given me permission to use him as an example. I really appreciate his openness, and I hope that I can do justice to what a great person he is.
When I was about 6 or 7 months pregnant with our oldest child, I finally found some time after work to sit down and read some of the magazines that came in our "Welcome" packet at the doctor's office. For many months I had been debating in my head and was inconclusive about whether or not I wanted to labor with or without an epidural. At this point I was still loaded with fear over labor and had no confidence that I'd "be able to take the pain." Just the same, the question still hovered over my head about whether or not an epidural was a safe, wise option in childbirth and a good option for me with my personality.
In one of the magazines I was reading, I found an article that gave suggestions for coping with labor pain unmedicated. It discussed some of the risks of an epidural, most of which I had not heard about before. It also discussed some of the benefits of unmedicated childbirth. Interestingly enough, in the 5-6 months that I had known I was pregnant, I had not heard even one very positive story about an unmedicated birth. In fact, any time I mentioned to friends or coworkers that I was interested in unmedicated childbirth, I usually heard horror stories or was mildly teased about my interest. One friend sent me a cartoon of a hospital room that had been torn apart. Everything was damaged, the doctor had a black eye, and the mother sat happily cuddling her newborn baby. In the caption, the doctor was saying to the husband, "Sir, next time you may want to convince your wife to consider pain medication in labor." It was a very cute cartoon, and I took little offense to it; but I'll admit that it didn't help me very much. :)
Back to my evening of magazine reading: After I had read and considered the article on natural childbirth for awhile, my husband came home. Instead of asking him to read the article and tell me what he thought of it, I just sheepishly mentioned that I was interested in learning more about unmedicated birth. Thinking that my interest was only mild, he shared that he wanted the labor to be a happy experience, and he was concerned that if I was in terrible pain then it would be a miserable one. He also gently mentioned that I don't have a very high pain tolerance. (And he's right, by the way).
I must admit that I was a little disappointed that he wasn't more open to the idea, but I had my own fears and insecurities on top of his skepticism. I had so little confidence and conviction that I didn't pursue it any further with him. From that point on I hoped to not need the epidural while expecting that I probably would.
Now I want to repeat again that I don't mean to disrespect my husband. He is and has always been a wonderful man, and he's very far from being a male chauvinist. He just didn't know much about the benefits of unmedicated labor or even the risks of epidurals. He had also heard a story from a fairly close relative about how she had attended a class at a church activity given by a doula, and she left feeling very guilted about her personal plans to have an epidural. He had little knowledge and no positive experience with natural childbirth, and he made a judgment based on what he knew.
Then I had our daughter. It was a disastrous birth. Yes, there have been worse labors and deliveries. Yes, we're both alive and well, and we didn't even need a c-section. It was still a disaster, though. It was both physically and emotionally traumatizing, and recovery and nursing were both horribly impacted by the whole experience. With my little knowledge at the time about labor and delivery, I actually returned to the same OB group with our next pregnancy. I was certain about one thing, though - I did not want an epidural with my next delivery. I did not want to risk a fever or difficulty pushing out the baby again.
Once I'd had the fateful conversation with a neighbor that convinced me that I wanted a Bradley birth, I approached my husband about taking a Bradley class. He didn't argue, but he was uncertain. The class was expensive and a large time commitment - $120 and 10 weeks, one night a week. For us that meant babysitting and extra stress when we didn't have much excess income or time. We had already taken a short class in our previous pregnancy and had experienced labor, and he saw little need for another class. He also admitted that he was unsure how comfortable he'd be with the kinds of people who were very gung-ho about unmedicated labor. From his experience, they seemed a bit extreme; and my husband has a strong aversion to extremes. :)
Despite his concerns, he knew that this was important to me. He also knew that I looked back on our first daughter's birth with pain and disappointment. She was such a joy and worth any difficulty I experienced, but she suffered along with me when I was struggling with intense pain and low milk supply for several weeks after birth. If it could help me feel better prepared for this next labor, my husband was willing to make the time and investment for a Bradley class.
Throughout the 10 weeks of the class, my husband's attitude slowly changed. He never became passionate about me not having an epidural. He did, however, gain a great appreciation for not only the medical benefits of unmedicated birth but also what a positive bonding experience it could be for a couple. He made time to read some of the extra material assigned in the class. He encouraged me to do my exercises, and he excitedly prepared for the labor experience by picking out music and making a birth "wish list" with me. It was very touching to watch how much respect he gained for couples who are willing to put in the preparation and effort for an unmedicated birth.
During our second labor, when our son "Mr. Handsome" was born, my husband was a great support. For one thing, he had learned so much about labor that he sensed I was in labor before I did. I had begun vomiting throughout the day and was in bed most of the time, and he had learned that it was a possible symptom of the onset of labor. He also knew that dehydration wasn't great for a woman who is 40 weeks pregnant. :) Once we were in the hospital, he was very attentive in offering to get me things and checking my comfort level. He consistently massaged my back during each strong contraction, and he encouraged me to switch positions and use the bathroom frequently as I needed to. He was quick to respond to any discomfort I had and seemed to read my cues better than I often did. At one point, when I had gotten in the shower for comfort, he smiled at me and said, "This is a lot more fun than the last time." (The previous time, he could do little more than get me ice chips and blankets and, when I had a bout of vomiting, hold the container for me).
Now it wasn't easy for him. When we had been in the hospital for almost 10 hours and I had been dilated to 8 centimeters for over 5 hours and was getting pretty exhausted and grumpy, he had been rubbing my back all night and was ready to pass out. Once the doctor and I agreed to break my water, however, my husband got a second wind. When my water was broken, my dilation went from 8 to 10 centimeters in one contraction, and I was lying flat on my back. (This was VERY painful.) I derailed for a minute or two. Gratefully, my husband was very comforting and encouraging. He had learned about the signs of transition, and he knew that the end was near. (In fact, I was pushing 5 minutes later.) So as I yelled out, "Please put something in my IV!" he worked to soothe me by telling me that it was okay and that I was doing great. (He was VERY sweet considering I'd just sworn in front of everyone and ripped my hospital gown off.)
When I began to push, he just stood by me and told me that I was doing a great job. And when our son came out all muddy and slimy, my husband burst in tears, hugged and kissed me, and told me that he was so proud of me and the baby was so beautiful. (Incidentally, my son is a miniature of my husband, so you can guess where he got his looks).
In our 3rd pregnancy, I chose to go with Certified Nurse Midwives instead of an OB or family doctor. Though my husband wasn't fully comfortable with the idea of midwives, he had also learned that since I was the one having the baby, my feelings should come first in the matter. During our somewhat complicated labor, his tremendous support enabled me to labor unmedicated despite having a full blast of Pitocin almost the entire time. I personally believe that, had I received an epidural with that labor, I would have needed a cesarean. Even a year later when I expressed insecurity and guilt that maybe I shouldn't have been so resistant to a cesarean with that birth, my husband reassured me that we were in the best hands and had done the right thing each step of the way. When I claim that I was a bad patient, he says that I did a great job with our son and I shouldn't ever doubt the choices we made.
Now my husband has always cared for the baby's and my safety. He has always had my comfort and best interest at heart. When I requested my epidural with our first baby, my husband quickly got the nurse to call the anesthesiologist. He was encouraging and attentive during that labor as well, doing whatever he could to assist me. He felt a little helpless, though. He was limited in what he could do, and he was forced to sit by and watch much of the time. He also understood so little about what was happening. When people announced to us that I would receive this drug or IV or this procedure would be performed, he knew no reason to not consent to things. And I was so gone during that labor that I had no ability to stay really involved.
Can you see why I feel so passionately about couples taking a good class together? :) My husband went from being a compassionate but slightly helpless observer of my trauma to being an active participant in and advocate for my empowerment. Instead of wanting to rescue me from "unnecessary pain," he joined me on my journey and was crucial in making it more positive and safer. I have always adored him, but my love for him has grown so much through these experiences among others.
I want to be clear again that I don't think that unmedicated childbirth is the choice all women need to make. Many women, knowing all of the risks and benefits of the two options, would still opt for the pain relief of the epidural. I do feel, however, that couples should work hard to become educated together - well educated. Whenever possible, expectant couples should make the time and investment for a good class - one offered independent of an OB practice and requiring multiple evenings. They should come in with as equal knowledge and understanding as possible about nutrition, pregnancy exercises, medical procedures, alternatives for pain relief or pain minimizing, the stages of labor, pushing positions, postpartum care, and lactation.
Most importantly, the husband should have a good understanding of his wife's desires about childbirth, and they should both come in prepared to work together to support those desires. If the woman is low risk and would like to deliver with midwives - CNM's deliver in hospitals and they're great! - the husband should give this serious consideration. If she feels strongly about natural childbirth, he should encourage her in her desires and be prepared to give encouragement during labor.
To be more specific about labor, it is very important for couples to take things one step at a time and let the laboring woman give the cues. If a woman wants to labor unmedicated, the husband should be very careful in reading his wife's reaction during contractions. A woman may appear to be in greater pain than she really is, or she may even discover that she doesn't mind difficult contractions because they always come to an end and she gets breaks between them. A well meaning husband might be tempted, at the sight of his wife's grimaces or the sound of her moans, to say, "Honey, if you want an epidural, I totally support you." As kind as the intentions are, this could sound like a vote of no confidence to a woman who is already emotionally vulnerable. So, to be plain, it is a good idea for couples to make a plan that no medication be offered unless the wife first requests it.
Husbands deserve to know that their love and support means the world to their wives, especially during an experience like labor. A loving, knowledgeable, and involved husband who works with and follows his wife's lead during labor is invaluable, and I believe that he receives a great reward in having played such an active part during her labor.
Such a husband can become a "birth partner" in the truest sense of the word.
Friday, December 4, 2009
Lamaze vs. Bradley or Hypnobirthing
I just thought I’d take a moment to pretend that I’m an expert on Lamaze and take a few hits at it. But seriously, though I don’t know very much about the Lamaze method of unmedicated childbirth, I still have negative feelings about it. First of all, I have known a few women who attempted to go unmedicated using the Lamaze method, but none were drug free. The success rate for unmedicated birth with the Lamaze method is extremely low. Secondly, it’s easy for a Lamaze mother to hyperventilate during labor, especially when she uses higher paced breathing. This is dangerous to both mother and baby as well as painful. The more oxygen a mom gets, the less pain she feels. The inverse of this is true. And since Mom is the means for Baby to get oxygen, when she has a shortage, Baby suffers.
Despite this, when most people think of unmedicated childbirth, they think of Lamaze with the rhythmic huffing and puffing. Bill Cosby made the rhythmic breathing legendary in his amazing skit on the birth of his first baby. Most movies where a woman is attempting to go natural feature Lamaze breathing. This is probably owing to the fact that Lamaze is an older method than the other methods. Still, I’d love to see a movie where the actress is having a Bradley or Hypno birth. Seeing a woman in the calm, resting state that comes with these methods might open some doors for curious man and women everywhere, and it might make unmedicated childbirth more popular and attainable to more women.
So what’s the difference? Well, here’s Babycenter’s description of the Lamaze method. Here’s the Lamaze website. I don’t know how much the breathing has or has not changed, but one thing seems to remain the same – Lamaze education is less gung-ho about the need to go un-medicated. (This might have something to do with the method not being very effective for avoiding medication).
Bradley and Hypno birthing (which are mainly the same, though Hypnobirth training is more technique focused and Bradley training is more about overall childbirth and pregnancy education) is focused on deep, deep relaxation to minimize pain. So where Lamaze is geared toward distraction from the pain, the others are geared toward minimizing or eliminating the pain by minimizing tension. Also, Bradley and Hypnobirthing take the no-medication thing pretty seriously, which I appreciate. If I’m determined to gain the medical benefits for my baby and myself of unmedicated and low-intervention childbirth, I want a method that is serious about helping me not want medication. It may sound more extreme, but a program that makes light of medication in labor has little right to claim that it’s a true advocate for unmedicated labor.
So let’s keep our fingers crossed that someday a big Hollywood film will feature a woman having a good Hypnobirth. Somehow I think that might make an impression on America. In the meantime, if you’re considering natural childbirth, think Mongan or Bradley, not Lamaze (no offense, Dr. L).
Despite this, when most people think of unmedicated childbirth, they think of Lamaze with the rhythmic huffing and puffing. Bill Cosby made the rhythmic breathing legendary in his amazing skit on the birth of his first baby. Most movies where a woman is attempting to go natural feature Lamaze breathing. This is probably owing to the fact that Lamaze is an older method than the other methods. Still, I’d love to see a movie where the actress is having a Bradley or Hypno birth. Seeing a woman in the calm, resting state that comes with these methods might open some doors for curious man and women everywhere, and it might make unmedicated childbirth more popular and attainable to more women.
So what’s the difference? Well, here’s Babycenter’s description of the Lamaze method. Here’s the Lamaze website. I don’t know how much the breathing has or has not changed, but one thing seems to remain the same – Lamaze education is less gung-ho about the need to go un-medicated. (This might have something to do with the method not being very effective for avoiding medication).
Bradley and Hypno birthing (which are mainly the same, though Hypnobirth training is more technique focused and Bradley training is more about overall childbirth and pregnancy education) is focused on deep, deep relaxation to minimize pain. So where Lamaze is geared toward distraction from the pain, the others are geared toward minimizing or eliminating the pain by minimizing tension. Also, Bradley and Hypnobirthing take the no-medication thing pretty seriously, which I appreciate. If I’m determined to gain the medical benefits for my baby and myself of unmedicated and low-intervention childbirth, I want a method that is serious about helping me not want medication. It may sound more extreme, but a program that makes light of medication in labor has little right to claim that it’s a true advocate for unmedicated labor.
So let’s keep our fingers crossed that someday a big Hollywood film will feature a woman having a good Hypnobirth. Somehow I think that might make an impression on America. In the meantime, if you’re considering natural childbirth, think Mongan or Bradley, not Lamaze (no offense, Dr. L).
Wednesday, November 4, 2009
A Response to Hypnobirthing by Marie Mongan
I just finished reading Hypnobirthing by Marie Mongan last night, and I thought it was a great, very helpful book. It is a very positive, encouraging approach to childbirth with some wonderful specifics on achieving relaxation during labor. It was a good refresher to get me started on preparation for my next birth. There were, however, a couple of things that I was either concerned about or found myself questioning a bit. I'll share those in a second.
The best part about the book is it's positive message - that childbirth can be a comfortable and enjoyable experience without pain medication. (Hurray!) It also emphasized the need to avoid unnecessary medical intervention (which is so prevalent in this country). Mongan points out the importance of choosing your care provider very carefully. She expresses the importance of communicating respectfully with your doctors/midwives/nurses on your birth wishes in order to create a positive atmosphere in prenatal visits and in the birthing location. She even puts forth alternative language for birthing couples to use in order to keep the mindset of childbirth family, rather than medically, oriented. I found these all impressive and very encouraging.
There were a few concerns for me, though. First of all, Mongan is SO positive about her descriptions of the right birth that I fear it can raise unreasonable expectations about childbirth. For example, when she refers to the birthing stage known in the medical community as "transition," she avoids pointing out that the uterine surges or contractions reach a new level of intensity and that it requires the deepest focus and relaxation of all. She works so hard to avoid any reference to pain that I could imagine it might be an alarming stage for a hypnobirthing mom to reach if she starts to feel like she has some pain. For some women, the transition stage isn't a big deal. But for many more, it really is the point when the contractions totally peak, and it can start to feel painful - not unbearable and not even extremely painful - but they're strong enough that you have to focus intensely through each one and you might even vocalize a bit. She does acknowledge that it is a point when moms might start to doubt themselves, and she turns it around very positively by saying that this is an exciting sign - a sign that the birthing stage is near. This is great, but moms deserve to know that if you start to feel like the contractions are painful, it's okay. It is short-lived, and this is when your partner/coach should offer reassurance and praise to the birthing mom. Indeed, the end is near, and it's so awesome.
Mongan doesn't like the word "coach." It makes it sound like birth is an athletic event to her. I get that. But "coaches" aren't necessary yelling at their wives. They are encouraging, comforting, soothing - and I don't think there is anything wrong with the word. (Besides, I'm a Bradley mom, and you're kind of picking on my lingo, Lady.) :)
There was an overall sense in the book that childbirth shouldn't seem exhausting. I wholeheartedly agree with this in that it shouldn't involve intense huffing and puffing (which can lead to hyperventilation anyway), and pushing should not be some Herculean task that breaks blood vessels. But labor does require some stamina, especially if any stage of it is prolonged or if it begins at the end of a long day and goes into the night (which often happens). This is okay, and it provides good reasoning for consistent exercise during pregnancy. Mongan touched on exercise, but more lightly than the Bradley method does (to which I'm so obviously biased).
I was intrigued by her thoughts on stage 2 of labor, typically referred to as the pushing stage. She strongly criticizes the idea of pushing a baby out and points out that it can not only make the baby's experience more violent, but that it can increase damage to the pelvic floor as it can cause the perineal muscles to constrict. She encourages instead "gentle birthing" and "breathing" the baby down. This is a terrific concept, don't get me wrong. I love the idea of gentle birthing, and I've noticed that in my own experience with my second baby and in many birthing experiences, the final "pushes" in crowning are best if they're not really pushes. A nurse or midwife might say with that last contraction, "Okay, don't push on this one. Just breath deeply." This can be great, because a baby on the threshold of birth who is "breathed out" can have a more gentle birth, the body will be more relaxed, and it can/will minimize or eliminate tearing.
Here are my concerns with the "breathing them out is best" principle: First of all, if your baby is in an awkward position or is particularly large, breathing down your baby might not be possible or could take much longer than everyone expects it to. It might require you putting some pushing behind it. In Bradley training, we're not taught to push with all of our might. We're taught to push as much as we comfortably can, but we're a very active part of it. We're also taught the signs of appropriate pushing - that is, the best sign is that the perineum (the muscle between the vagina and the anus) is bulging. This is not constriction of the perineum - it encourages the perineum to unfold.
Also, Mongan's description of "breathing your baby down" makes it sound like crowning shouldn't involve any pain. Again, we're back to my unreasonable expectations issue. What if it does hurt at that point? I've noticed in my births (with my reasonably large babies - 9'4" and 8'1" with knots and tangles) that once the dilation stage is over, pushing is really comfortable (and cool), but crowning stings a bit - it even hurts at some point. Does this mean I've done it all wrong? I don't think so. First of all, you can't really practice this stage much during pregnancy except when you're having a bowel movement, and even then you need to take it easy. So I'd honestly be curious to poll hypnobirthing moms about crowning and how it felt to them. Did it hurt? Sting? Burn? Did they push? How was their pushing?
Of course, these concerns and speculations might be answered if I took a hypnobirthing class. Perhaps in the class the teachers give a more realistic view of the experience. Also, the "breathing down" might make more sense to me if I saw a woman do it. But I think it would be advisable for any woman to prepare for the possibility that if her baby is not progressing much with the "breathing down" method, more active pushing might be needed and shouldn't be feared.
Another thing that concerned me was Mongan's use of the words "needing an episiotomy" (in case baby isn't being born quickly or easily enough). Mongan clearly wrote this in the age when the medical community still saw tears as something to seriously avoid. I'm not saying tears are swell, but as I've already pointed out, tearing is not a big deal. It's so much better to let mom tear than to cut her unless there is an urgent need to get the baby out now. If a mom is afraid to really push her baby out and she has this fear of tearing, then a practitioner might feel the need to perform an episiotomy - and you know how I feel about episiotomies (and the tears they sometimes bring along with them). So, basically, I'm just allergic to the word "episiotomy" and it makes me sad when I hear those words...
As a word of advice to hypnobirthing moms, really work on your breathing down. But if baby isn't coming out with that, don't be afraid to push. Get those knees back, and try to pee on someone! :)
Another thing that frustrated me a little when reading the book was, again, her extreme optimism - only this time about the medical community. She repeated here and there that there were "many" practitioners who would support birthing requests, etc. I don't know how obstetrics is in New Hampshire, but here it's another story. If you want a practitioner who is supportive of natural birth and routinely avoids unnecessary intervention, it is like looking for a needle in a haystack. They are hard to come by. For one thing, there are laws which make it difficult for them. For example, Utah law basically states that doctors and midwives have to induce you by a certain time past the due date. They are required to do so. These laws must be based on some of the challenges that can come with overdue babies (especially in epidural births), and they are pretty apprehensive of big babies. (Believe me, I know.) Another thing is that birthing in a tub (which she mentions lightly but advocates) is illegal in Utah (I believe). It happens in certain home-births but never in hospitals out here. You may labor in a tub, but not birth in one. (You are welcome to contradict me on this, by the way. This is based on my understanding of the laws and has no legal references to back it up).
It's a big challenge out here to find a doctor or midwife who routinely holds back unnecessary intervention. It's also difficult to know how a doctor will handle your labor. They don't fess up easily on their routines. I didn't know until I was in the hospital with my oldest that continuous fetal monitoring and IV's were non-negotiable with my doctors, but no one would say this upfront. You have to know exactly what to ask about when seeking a practitioner, know what signs to look for, and you have to tread very lightly while asking your questions. Also, their answers to a less experienced mom might be deceiving. For example:
Me: So do you encourage your patients to have epidurals, or can they choose not have one?
Evil Dr. J (aka - Cervix Assaulter): No, if you don't want one, you don't have to have one. My wife didn't want one, because she didn't think the contractions were that big a deal. Her dad was a drill sergeant, you see. She actually broke her arm once, and no one realized it because she didn't mention it to anyone for a whole day.
On the surface it sounds like he's saying that epidurals aren't forced on you and they totally respect your wishes. But he's also saying that you'd have to have a ridiculously high pain tolerance to endure unmedicated childbirth. Well, I don't have a high pain tolerance. If I stub my toe unexpectedly I curse, and I try to not curse. So if you express a desire to go natural and your practitioner tells a story like this, switch doctors NOW.
Here's another dialogue, because that last one was so fun:
Me: So do you routinely perform episiotomies? (I worded this badly. The word "routinely" is a red-flag to doctors...)
Evil Dr. J: Hey, if your bottom's big enough, then I won't cut you.
This was a favorite exchange of mine. Since I'm rather gifted with languages, I'll translate: "I don't believe in the perineum's ability to stretch, and I don't like tears. It takes too long to sew them up. If your baby isn't coming out as easily and as fast as I like, then I'll cut you." I know, can you believe that much was said in just those few words???!!!! Some languages are just weird!
What you want to know is not whether or not they like epidurals. It's whether they are happy to hold back intervention in your low-risk labor. Unnecessary intervention could make your labor less manageable, and hence you might end up choosing an epidural. When you're looking for a provider, you want to know some of the following: When do they use IV's? Are they comfortable with intermittent fetal monitoring when mom and baby are doing well? Are they comfortable allowing a mom to tear (or not tear) instead of performing an episiotomy as long as the baby is well? Do they mind sharing their cesarean rates with you? Do they use vacuum or forceps frequently in births? Do they get uncomfortable with moms having large babies if the mom is no petite lady (not necessarily a problem, by the way)? Would they allow eating or drinking in labor? Are they comfortable with a "birth contract" or a "labor wish list?" Would they mind if you hired a doula? Will they always consult with you to discuss interventions and allow you veto power unless it's an emergency? Do they attend a lot of unmedicated births?
I can't tell you exactly how to ask these questions. It's important to be respectful, but you don't have to be sheepish either. It's your birth. If you start asking these questions and the doctor or midwife is enthusiastic or plainly states something like, "Labor, when issues don't arise, should be a natural as possible," you've found yourself a winner. You can reassure them that you are prepared for the possibility that some things might go wrong, and you're glad you're in good hands. (Of course, that doesn't mean to skip the "wish list.") If, however, you start asking these questions and the practitioner gets uncomfortable or makes a joke about having to catch a baby on the ground or something (happened to a family member), then you have a red flag. Switch practitioners NOW. And if you're 32 weeks along when it hits you that it's time to change, don't beat yourself up. Take control of your birth.
Mongan isn't wrong to be optimistic and positive about the medical community, but when she uses the word "many" in referring to supportive doctors/midwives/hospitals, it feels overly optimistic. Hypnobirthing moms would do well to take extra care in choosing their providers and should not feel abashed about asking a lot questions. Most of us don't have a ton of babies, and you have a right to have say in how your care is handled. It's your baby and your body.
How about nutrition and medical interventions and their risks and benefits? What if things go wrong? Well, that's my final concern with the hypnobirthing book. Well, it's not really a concern with the book itself. The book is great for preparing you for an uncomplicated delivery with a good low-risk pregnancy, but I felt that it touched only very lightly on the more comprehensive parts of childbirth education - the medical and nutritional side of childbirth. It's good to keep the language positive and gentle, but when you're birthing in a hospital, they use terms like "transition," "contractions," "water rupturing," instead of gentler hypnobirthing terms. Hearing the more common medical terms shouldn't frustrate couples. Knowing what they mean should be comforting.
Again, I haven't taken a class, and it's very possible that the class fills in some of these gaps. The book is definitely not meant to stand alone, though, as Mongan repeatedly refers the reader to their Hypnobirthing teacher and specific handouts. Couples considering a class might want to ask if these extra topics are covered and, if not, what books or websites might be a good supplement to the class.
For someone only reading the book, I'd definitely encourage hypnobirthing couples to supplement their education with other materials, like a friend's Bradley class workbook (and a few hours doing research on the internet) or Childbirth the Bradley Way by Susan McCutcheon. It's a little dated, and there are tons of nudy shots (so sorry for that!! I suggest post-it notes to cover the photos), but the book not only gives some great detail on childbirth, but it helps you educate yourself comprehensively on nutrition, medical interventions, and what is best when some things can go wrong. This might sound a little negative (which Mongan is anxious to avoid), but if a complication arises and you understand what it is and what care is best, then you can still feel good about the good parts of your labor. And you can feel great about being a couple that understands what is going on and what care is best for the situation.
Much of this might sound negative about the book, but I really do think it's a great book, especially as part of preparation for the deep relaxation necessary for comfortable childbirth. In Marie Mongan fashion, I want to end on a positive note and point out two of my favorite parts in the book.
First of all, I love Ms. Mongan's descriptions of her own birth experiences and the genesis of hypnobirthing based on them. In her first two experiences, she labored comfortably, completely unassisted and unmedicated, despite the derision of the nurses, and was crowning before she was forcibly put-under and her baby was birthed with her unconscious. By her third labor, she stood up for herself and made firm requests about birthing her baby consciously and about having her husband in the room. This was so unorthodox and extremely brave. She is such an amazing woman to have been able, at such a time, to stand her ground and have relatively positive birth experiences. And all of it started with her reading Childbirth Without Fear by Grantly Dick-Read. Her own experiences and her courage are very inspiring. She also takes some time to outline the history of viewpoints on childbirth, and you can see how the emotional atmosphere in our society has really fostered pain in childbirth. Women are scared to pieces and dread labor, and then they have traumatic experiences that pave the way for other women. And these are great, amazing women who are being terrified into fearing a very important event in their lives. Mongan is an amazing pioneer in natural childbirth, as was Dr. Dick-Read and Dr. Bradley (and even Dr. Lamaze, I'm sure).
The other part I loved - my favorite part - was a chapter that I really needed on releasing fear. I am so grateful to the friend who suggested this section to me. I realized that I had been getting very caught up in the negative aspects of my previous labors and was stressing myself out everyday replaying the experiences in my head. It was very distracting. Mongan warns that fear from any source - abuse, previous birth experiences, others' birth experiences, the opinions of others, etc - can become self-fulfilling prophecy in a bad way. Every woman, every pregnancy, and every labor is different. There is no need to assume that because something went wrong once, it will happen with every labor. There is no need to fear complications in a healthy labor. Things can happen, but they usually don't - and moms don't need to stress themselves, their partners, or their babies out with anxiety. What a blessing to be reminded of this and to be advised that I have to let go of the disappointments of the past and have faith that it'll be okay!
Hypnobirthing is a great book and an excellent resource for any mom preparing to birth naturally. I wouldn't use it as my only resource for preparation and education, but it would be a valuable staple in the natural birthing mom's library. Borrow, buy, or steal it (no, don't do that, I'm just joking). Just get it and read it often!!
The best part about the book is it's positive message - that childbirth can be a comfortable and enjoyable experience without pain medication. (Hurray!) It also emphasized the need to avoid unnecessary medical intervention (which is so prevalent in this country). Mongan points out the importance of choosing your care provider very carefully. She expresses the importance of communicating respectfully with your doctors/midwives/nurses on your birth wishes in order to create a positive atmosphere in prenatal visits and in the birthing location. She even puts forth alternative language for birthing couples to use in order to keep the mindset of childbirth family, rather than medically, oriented. I found these all impressive and very encouraging.
There were a few concerns for me, though. First of all, Mongan is SO positive about her descriptions of the right birth that I fear it can raise unreasonable expectations about childbirth. For example, when she refers to the birthing stage known in the medical community as "transition," she avoids pointing out that the uterine surges or contractions reach a new level of intensity and that it requires the deepest focus and relaxation of all. She works so hard to avoid any reference to pain that I could imagine it might be an alarming stage for a hypnobirthing mom to reach if she starts to feel like she has some pain. For some women, the transition stage isn't a big deal. But for many more, it really is the point when the contractions totally peak, and it can start to feel painful - not unbearable and not even extremely painful - but they're strong enough that you have to focus intensely through each one and you might even vocalize a bit. She does acknowledge that it is a point when moms might start to doubt themselves, and she turns it around very positively by saying that this is an exciting sign - a sign that the birthing stage is near. This is great, but moms deserve to know that if you start to feel like the contractions are painful, it's okay. It is short-lived, and this is when your partner/coach should offer reassurance and praise to the birthing mom. Indeed, the end is near, and it's so awesome.
Mongan doesn't like the word "coach." It makes it sound like birth is an athletic event to her. I get that. But "coaches" aren't necessary yelling at their wives. They are encouraging, comforting, soothing - and I don't think there is anything wrong with the word. (Besides, I'm a Bradley mom, and you're kind of picking on my lingo, Lady.) :)
There was an overall sense in the book that childbirth shouldn't seem exhausting. I wholeheartedly agree with this in that it shouldn't involve intense huffing and puffing (which can lead to hyperventilation anyway), and pushing should not be some Herculean task that breaks blood vessels. But labor does require some stamina, especially if any stage of it is prolonged or if it begins at the end of a long day and goes into the night (which often happens). This is okay, and it provides good reasoning for consistent exercise during pregnancy. Mongan touched on exercise, but more lightly than the Bradley method does (to which I'm so obviously biased).
I was intrigued by her thoughts on stage 2 of labor, typically referred to as the pushing stage. She strongly criticizes the idea of pushing a baby out and points out that it can not only make the baby's experience more violent, but that it can increase damage to the pelvic floor as it can cause the perineal muscles to constrict. She encourages instead "gentle birthing" and "breathing" the baby down. This is a terrific concept, don't get me wrong. I love the idea of gentle birthing, and I've noticed that in my own experience with my second baby and in many birthing experiences, the final "pushes" in crowning are best if they're not really pushes. A nurse or midwife might say with that last contraction, "Okay, don't push on this one. Just breath deeply." This can be great, because a baby on the threshold of birth who is "breathed out" can have a more gentle birth, the body will be more relaxed, and it can/will minimize or eliminate tearing.
Here are my concerns with the "breathing them out is best" principle: First of all, if your baby is in an awkward position or is particularly large, breathing down your baby might not be possible or could take much longer than everyone expects it to. It might require you putting some pushing behind it. In Bradley training, we're not taught to push with all of our might. We're taught to push as much as we comfortably can, but we're a very active part of it. We're also taught the signs of appropriate pushing - that is, the best sign is that the perineum (the muscle between the vagina and the anus) is bulging. This is not constriction of the perineum - it encourages the perineum to unfold.
Also, Mongan's description of "breathing your baby down" makes it sound like crowning shouldn't involve any pain. Again, we're back to my unreasonable expectations issue. What if it does hurt at that point? I've noticed in my births (with my reasonably large babies - 9'4" and 8'1" with knots and tangles) that once the dilation stage is over, pushing is really comfortable (and cool), but crowning stings a bit - it even hurts at some point. Does this mean I've done it all wrong? I don't think so. First of all, you can't really practice this stage much during pregnancy except when you're having a bowel movement, and even then you need to take it easy. So I'd honestly be curious to poll hypnobirthing moms about crowning and how it felt to them. Did it hurt? Sting? Burn? Did they push? How was their pushing?
Of course, these concerns and speculations might be answered if I took a hypnobirthing class. Perhaps in the class the teachers give a more realistic view of the experience. Also, the "breathing down" might make more sense to me if I saw a woman do it. But I think it would be advisable for any woman to prepare for the possibility that if her baby is not progressing much with the "breathing down" method, more active pushing might be needed and shouldn't be feared.
Another thing that concerned me was Mongan's use of the words "needing an episiotomy" (in case baby isn't being born quickly or easily enough). Mongan clearly wrote this in the age when the medical community still saw tears as something to seriously avoid. I'm not saying tears are swell, but as I've already pointed out, tearing is not a big deal. It's so much better to let mom tear than to cut her unless there is an urgent need to get the baby out now. If a mom is afraid to really push her baby out and she has this fear of tearing, then a practitioner might feel the need to perform an episiotomy - and you know how I feel about episiotomies (and the tears they sometimes bring along with them). So, basically, I'm just allergic to the word "episiotomy" and it makes me sad when I hear those words...
As a word of advice to hypnobirthing moms, really work on your breathing down. But if baby isn't coming out with that, don't be afraid to push. Get those knees back, and try to pee on someone! :)
Another thing that frustrated me a little when reading the book was, again, her extreme optimism - only this time about the medical community. She repeated here and there that there were "many" practitioners who would support birthing requests, etc. I don't know how obstetrics is in New Hampshire, but here it's another story. If you want a practitioner who is supportive of natural birth and routinely avoids unnecessary intervention, it is like looking for a needle in a haystack. They are hard to come by. For one thing, there are laws which make it difficult for them. For example, Utah law basically states that doctors and midwives have to induce you by a certain time past the due date. They are required to do so. These laws must be based on some of the challenges that can come with overdue babies (especially in epidural births), and they are pretty apprehensive of big babies. (Believe me, I know.) Another thing is that birthing in a tub (which she mentions lightly but advocates) is illegal in Utah (I believe). It happens in certain home-births but never in hospitals out here. You may labor in a tub, but not birth in one. (You are welcome to contradict me on this, by the way. This is based on my understanding of the laws and has no legal references to back it up).
It's a big challenge out here to find a doctor or midwife who routinely holds back unnecessary intervention. It's also difficult to know how a doctor will handle your labor. They don't fess up easily on their routines. I didn't know until I was in the hospital with my oldest that continuous fetal monitoring and IV's were non-negotiable with my doctors, but no one would say this upfront. You have to know exactly what to ask about when seeking a practitioner, know what signs to look for, and you have to tread very lightly while asking your questions. Also, their answers to a less experienced mom might be deceiving. For example:
Me: So do you encourage your patients to have epidurals, or can they choose not have one?
Evil Dr. J (aka - Cervix Assaulter): No, if you don't want one, you don't have to have one. My wife didn't want one, because she didn't think the contractions were that big a deal. Her dad was a drill sergeant, you see. She actually broke her arm once, and no one realized it because she didn't mention it to anyone for a whole day.
On the surface it sounds like he's saying that epidurals aren't forced on you and they totally respect your wishes. But he's also saying that you'd have to have a ridiculously high pain tolerance to endure unmedicated childbirth. Well, I don't have a high pain tolerance. If I stub my toe unexpectedly I curse, and I try to not curse. So if you express a desire to go natural and your practitioner tells a story like this, switch doctors NOW.
Here's another dialogue, because that last one was so fun:
Me: So do you routinely perform episiotomies? (I worded this badly. The word "routinely" is a red-flag to doctors...)
Evil Dr. J: Hey, if your bottom's big enough, then I won't cut you.
This was a favorite exchange of mine. Since I'm rather gifted with languages, I'll translate: "I don't believe in the perineum's ability to stretch, and I don't like tears. It takes too long to sew them up. If your baby isn't coming out as easily and as fast as I like, then I'll cut you." I know, can you believe that much was said in just those few words???!!!! Some languages are just weird!
What you want to know is not whether or not they like epidurals. It's whether they are happy to hold back intervention in your low-risk labor. Unnecessary intervention could make your labor less manageable, and hence you might end up choosing an epidural. When you're looking for a provider, you want to know some of the following: When do they use IV's? Are they comfortable with intermittent fetal monitoring when mom and baby are doing well? Are they comfortable allowing a mom to tear (or not tear) instead of performing an episiotomy as long as the baby is well? Do they mind sharing their cesarean rates with you? Do they use vacuum or forceps frequently in births? Do they get uncomfortable with moms having large babies if the mom is no petite lady (not necessarily a problem, by the way)? Would they allow eating or drinking in labor? Are they comfortable with a "birth contract" or a "labor wish list?" Would they mind if you hired a doula? Will they always consult with you to discuss interventions and allow you veto power unless it's an emergency? Do they attend a lot of unmedicated births?
I can't tell you exactly how to ask these questions. It's important to be respectful, but you don't have to be sheepish either. It's your birth. If you start asking these questions and the doctor or midwife is enthusiastic or plainly states something like, "Labor, when issues don't arise, should be a natural as possible," you've found yourself a winner. You can reassure them that you are prepared for the possibility that some things might go wrong, and you're glad you're in good hands. (Of course, that doesn't mean to skip the "wish list.") If, however, you start asking these questions and the practitioner gets uncomfortable or makes a joke about having to catch a baby on the ground or something (happened to a family member), then you have a red flag. Switch practitioners NOW. And if you're 32 weeks along when it hits you that it's time to change, don't beat yourself up. Take control of your birth.
Mongan isn't wrong to be optimistic and positive about the medical community, but when she uses the word "many" in referring to supportive doctors/midwives/hospitals, it feels overly optimistic. Hypnobirthing moms would do well to take extra care in choosing their providers and should not feel abashed about asking a lot questions. Most of us don't have a ton of babies, and you have a right to have say in how your care is handled. It's your baby and your body.
How about nutrition and medical interventions and their risks and benefits? What if things go wrong? Well, that's my final concern with the hypnobirthing book. Well, it's not really a concern with the book itself. The book is great for preparing you for an uncomplicated delivery with a good low-risk pregnancy, but I felt that it touched only very lightly on the more comprehensive parts of childbirth education - the medical and nutritional side of childbirth. It's good to keep the language positive and gentle, but when you're birthing in a hospital, they use terms like "transition," "contractions," "water rupturing," instead of gentler hypnobirthing terms. Hearing the more common medical terms shouldn't frustrate couples. Knowing what they mean should be comforting.
Again, I haven't taken a class, and it's very possible that the class fills in some of these gaps. The book is definitely not meant to stand alone, though, as Mongan repeatedly refers the reader to their Hypnobirthing teacher and specific handouts. Couples considering a class might want to ask if these extra topics are covered and, if not, what books or websites might be a good supplement to the class.
For someone only reading the book, I'd definitely encourage hypnobirthing couples to supplement their education with other materials, like a friend's Bradley class workbook (and a few hours doing research on the internet) or Childbirth the Bradley Way by Susan McCutcheon. It's a little dated, and there are tons of nudy shots (so sorry for that!! I suggest post-it notes to cover the photos), but the book not only gives some great detail on childbirth, but it helps you educate yourself comprehensively on nutrition, medical interventions, and what is best when some things can go wrong. This might sound a little negative (which Mongan is anxious to avoid), but if a complication arises and you understand what it is and what care is best, then you can still feel good about the good parts of your labor. And you can feel great about being a couple that understands what is going on and what care is best for the situation.
Much of this might sound negative about the book, but I really do think it's a great book, especially as part of preparation for the deep relaxation necessary for comfortable childbirth. In Marie Mongan fashion, I want to end on a positive note and point out two of my favorite parts in the book.
First of all, I love Ms. Mongan's descriptions of her own birth experiences and the genesis of hypnobirthing based on them. In her first two experiences, she labored comfortably, completely unassisted and unmedicated, despite the derision of the nurses, and was crowning before she was forcibly put-under and her baby was birthed with her unconscious. By her third labor, she stood up for herself and made firm requests about birthing her baby consciously and about having her husband in the room. This was so unorthodox and extremely brave. She is such an amazing woman to have been able, at such a time, to stand her ground and have relatively positive birth experiences. And all of it started with her reading Childbirth Without Fear by Grantly Dick-Read. Her own experiences and her courage are very inspiring. She also takes some time to outline the history of viewpoints on childbirth, and you can see how the emotional atmosphere in our society has really fostered pain in childbirth. Women are scared to pieces and dread labor, and then they have traumatic experiences that pave the way for other women. And these are great, amazing women who are being terrified into fearing a very important event in their lives. Mongan is an amazing pioneer in natural childbirth, as was Dr. Dick-Read and Dr. Bradley (and even Dr. Lamaze, I'm sure).
The other part I loved - my favorite part - was a chapter that I really needed on releasing fear. I am so grateful to the friend who suggested this section to me. I realized that I had been getting very caught up in the negative aspects of my previous labors and was stressing myself out everyday replaying the experiences in my head. It was very distracting. Mongan warns that fear from any source - abuse, previous birth experiences, others' birth experiences, the opinions of others, etc - can become self-fulfilling prophecy in a bad way. Every woman, every pregnancy, and every labor is different. There is no need to assume that because something went wrong once, it will happen with every labor. There is no need to fear complications in a healthy labor. Things can happen, but they usually don't - and moms don't need to stress themselves, their partners, or their babies out with anxiety. What a blessing to be reminded of this and to be advised that I have to let go of the disappointments of the past and have faith that it'll be okay!
Hypnobirthing is a great book and an excellent resource for any mom preparing to birth naturally. I wouldn't use it as my only resource for preparation and education, but it would be a valuable staple in the natural birthing mom's library. Borrow, buy, or steal it (no, don't do that, I'm just joking). Just get it and read it often!!
Tuesday, October 27, 2009
My Second Bradley Birth, well sort of...
I say "well sort of" because, in my mind, a Bradley birth is more than just unmedicated birth. It is relaxed, more comfortable birth. It's a really wonderful experience, and I fully admit that I wish I could share the Bradley gospel with all women, because it is such a blessing to not have to fear labor and be in terrible pain. I said "sort of" because baby #3's labor wasn't as comfortable and relaxed as baby #2's labor was. His birth, however, was at least as surprising.
By the way, I'm reading the Hypnobirthing book right now, and it's pretty amazing too. I've noticed so far that the main difference between Bradley and Hypnobirthing is that Bradley tends to be a little more comprehensive and inclusive of diet, exercise, education on medical interventions and their risks and benefits, etc. It's a little more medical minded, and hypnobirthing tries to be a little more natural minded. So far hypnobirthing seems to be mainly about the birthing event, but that's not to bag on the book. It's extremely positive and has already helped me start to feel better and have more faith in my next labor, and I'm only halfway through it!
The biggest reason I am about to share this experience, even though it's not a very relaxing one, is that if an induction becomes necessary for your baby's safety, it is still possible to have a good, healthy labor without an epidural. I say this because when I was pregnant with Mr. Handsome and had not yet experienced childbirth without medication, I was uncertain if I'd be able to ever endure a Pitocin induced labor. From my third labor I now know that, while there is a difference in the pace of contractions and the environment in the labor room (more anxiety than is ideal), the contractions don't actually get any stronger than your strongest natural contractions. A woman can still relax through those powerful contractions and give birth to her baby without feeling the need for an epidural. Isn't that good news?
Here's my story:
After a normal, low-risk, healthy pregnancy, I went to my 39 week check-up with my two rowdy kids in tow. There was a male midwife in training joining the regular midwife, but that didn't bother me. He just happened to have been there when I had my strep-B swab a few weeks before (how nice), so I didn't care that he was there to hear a heartbeat. To our surprise, the heartbeat was low - around 90ish (when it should be around 120). I had noticed some slowing in the baby's movements, but he had still consistently moved pretty frequently throughout the day. It had also become difficult to take the time to count movements since I was chasing after my other kids, and summer vacation had just begun. Anyway, the midwife suggested that I have a non-stress test (aka NST) in their office for an hour or two. It was disappointing, but I will admit that I had been very anxious for several weeks now. Mr. Handsome's birth was often running through my mind, and I was practically convinced that something would not be quite right again. I still wonder if this was self-fulfilling prophecy.
During the NST, the heartrate was not steadily low, but there were variables in the heartrate. It would look great for a few minutes, and then there would be a small drop, and then it would be great again for a few more minutes, and then drop again, and so on. It went back and forth like this. After a rather stressful, uncomfortable hour of watching the varying heartrate (as well as watching my children ransack the room I was in and calling my husband for help), the midwife on call asked me to go to the hospital for an extended NST.
My husband met up with me, we got our kids to his parents, and he and I grabbed dinner before getting to the hospital for my NST. I found a good comfortable position, and this time our baby looked great. No variables for two whole hours. The midwife on call came in, said that everything looked good and he was obviously a healthy guy, but advised that we should check again in a day or two and pray that our baby would come sooner. She speculated that there might be something going on with his cord.
Two days later, we packed our bag in case we had to be induced, got our kids to my husband's parents, bought a birthday cake and OJ for after the delivery, and went to the hospital with mixed feelings. I wanted the baby here and safe and was anxious to birth him, but I wanted him to be healthy and fine and not need an induction. Again I didn't want to have an unmanagable labor, and I feared that if I was induced with Pitocin then the contractions would become more than I could relax through, and I might give in. As a reminder, I didn't want to risk another fever or slowing down a labor or having difficulties pushing the baby out - especially if he was struggling.
I picked the best position I could find and settled in with my husband for the NST. There were variables the whole time. After about 45 minutes or an hour, the little guy did a pretty interesting stretch, and his heart-rate dropped down to 90 again. David and I looked at each other - was that him or me that the monitor picked up? I still don't know, but it was enough to get me checked in for the night. I was not happy. I was as concerned as everyone, but I wanted my body to just get to work. I had a feeling that once my body got going that it would progress fast. And I was afraid of the Pitocin.
I had the blessing of two midwives that evening - midwives J and M. I was grateful, because though M was more experienced and confident, J was a little nicer and more helpful to me. She also had longer fingers. (This is a good thing for cervical checks). I got changed, got my monitor and IV (IV always come with Pitocin induction - that's how they give it to you), and got my cervix checked. I was at 5 centimeters. (Good body. Now why hadn't you started yet, silly?) It was at least a good start. With it being my 3rd baby, no epidural planned, having gone unmedicated before, a great coach/birth partner, and two supportive midwives, things looked good.
For the first hour my contractions felt only like Braxton Hicks, nothing more. But they were steady, and they were a start. During the second hour they increased the Pitocin. The contractions became more powerful, but I could still move around easily. I got up and down to use the bathroom a few times, and the rest of the time I spent on my side breathing deeply. During the third hour, the deep back-pain started and the contractions increased in strength. Midwife J functioned almost as a free doula by pushing on my back during those contractions and being a second support person with my husband. I felt very grateful for both of them.
The progress between the hours was very fast, and there was tension in the room as the baby's heartrate continued to have his variables. Though if I understand correctly, they were more frequent than at the start. During the final 30 minutes of dilation, the contractions had peaked in strength, and it was hard not to vocalize during each contraction. My husband was my hero, holding my leg up for me during each contraction (it helped - I couldn't have a pillow propping it up, because the monitor was right where a pillow would've been). I can't say full out that the surges in my abdomen were painful, but the back-pain was very strong. I was so grateful to still have midwife J pushing on and massaging my back during these contractions.
Suddenly I felt something like a water-balloon popping inside me, and I knew that my bag of waters had broken. We checked and the midwife confirmed it. There was a little mechonium in the fluid, but "not much" reassured midwife M. I asked if I could have a bath. I guess our baby's variables had become consistent enough that they didn't feel good about a bath. Instead they checked my cervix, and midwife J thought at first that I was at a full 10. "Do you feel an urge to push?" No, was my answer, but I wanted to push. They decided to let me try pushing. Then midwife M checked my cervix. It turned out that there was a lip on the cervix.
Okay, only a woman who has had a lip on the cervix knows this one. The contractions are no worse. It's just that, if you are anxious to start pushing instead of waiting a little longer for it to just go away, then what the midwife needs to do is push on the lip while Mom pushes with the contraction. It hurts.
It took two tries to get the lip out of the way, and the second time I literally grabbed midwife M's wrist as she pushed on the lip because it hurt so much (she backed up and suggested that we recollect ourselves). But the lip was gone. I declared that I wanted a mirror, and they propped one right up where I could see it. This was it. Time to push him out. Here he comes.
Except he didn't come as I pushed. This made me more tense. I pushed and did my best, but I was frustrated that he wasn't there. At this point, the room was filling up with people, including Dr. P, one of the nice OB's connected to the midwife practice. At the time, I wasn't thrilled to see him, but it was good that he was there just in case he was needed.
They realized that the baby was posterior and that was why he wasn't emerging. Midwife M was about to turn the baby, but then she said, "No, let's have Dr. P do it instead." I didn't know what to expect in having the baby turned. More pain? How much more? Dr. P walked up with his gloved hand, and midwife M said, "Don't push on this next one." I took a deep breath, didn't push, Dr. P barely reached inside with two fingers, turned his hand, and the baby was turned. I hardly felt a thing. Wow. That guy had magic hands.
For the next 10 minutes the pushes were more successful, and I could see the baby's head emerging. Now here's a challenge in labor that is really unavoidable, but can hurt more in unmedicated labor. Crowning and birth requires stretching. The slower and more gentle the birthing, the easier the stretching and the better it is for both mom and baby. Unfortunately, I had two problems. One, having so much scar tissue from my first labor tear, my body can only stretch so far. Two, once our baby was crowning, his heart-rate dropped and didn't come back up. It didn't stop, but it had dropped. At this point, an oxygen mask was placed on my face.
I was tired. It was after 1:00 AM, and this labor had been more stressful and hurt more than my last labor. I had been humbled by the pain. I was also staring at a mirror where, as I had pushed during the less productive phase, large amounts of brown fluid were coming out. Mechonium fluid meant serious distress to me. And there my body was during the crowning, looking as if it might tear apart as I tried to get this baby out. I was not fully present, to be honest. I was tired, confused, afraid of tearing, and feeling the tugging, stinging pain of crowning.
As I previously mentioned, midwife M approached me and said, "If he's not out on the next push, we'll have to perform an episiotomy." I had been such a bad patient, I felt. I had resisted everyone's advice, and I wanted it clear that I would comply of course. Then I heard the exchange that midwife M had with the doctor where she explained that I'd had a 4th degree laceration before. I realized that I was wearing an oxygen mask and I heard the heart-beat, steady but slow. I felt the next contraction, and this time I really pushed. He still didn't come out, so I kept pushing after the contraction and suddenly he slipped out.
What happened next was almost comical if it hadn't been so scary. Midwife J, who was waiting to receive the baby, reached out and caught him, and her eyes unconsciously widened as she started to unwrap the baby. His cord was tied in 4 different directions - around one arm, two or three times around the neck, around the opposite arm, and around his waist. What had he been doing???? It was amazing that he had only variables in his heartrate. He was completely white, long and slender, and very still. The cord was quickly cut and he was transferred to the incubator and table for examination.
My husband and I were so sure that, if the baby was still with us, he must've breathed the fluid. How could he not have? As the cord continued to come out of my body, we all stared in shock at a tight knot - technically referred to as a true knot. Our little Rambo had not only wrapped himself every which way, but somewhere along the line, he had swam a knot into his cord. What on earth?! Everyone was amazed and grateful that he was out and safer. Knots, if baby gets too big and isn't born soon enough, can mean the very worst, which I won't even say. You know what I mean, though.
People asked me how I was, and I could only stare over at the table. The baby was moving slowly. "Is he okay?" I kept asking. "Did he breath it?" There was very little relief at this point. My husband approached the doctor examining the baby and asked if the baby had aspirated the mechonium. He answered that he was unsure. The baby sounded a little funny, but not very bad. "Let's get him some IV's" and they could tell then.
I told my husband that he could go with the baby, but he was kind and stayed with me. I don't know if it's because he knew that I needed him or because he didn't want to be without me. I delivered the placenta shortly after the baby was born, and then the midwives stitched me up. I completely stopped liking midwife M at this point. She was giving midwife J pointers on a cool way to stitch me, and it felt like I laid there for at least 30-45 minutes shivering to death. I did need a couple of shots of local anesthetic since I'd had none until then. The stitching ended, and I was transferred to the recovery room. Just before or after I was transferred, we were informed that the baby hadn't aspirated the fluid. It was such a miracle to us! He just needed one more IV, and then he'd be good to stay with us.
Hope had returned, but I was humbled. Though Mr. Handsome had aspirated the mechonium in labor #2, the labor itself had mostly gone so well that I had left the hospital almost cocky. It wasn't really an "I'm so cool for going natural" thing. Actually, it was more of a "It's too bad more women don't give this a chance" thing. This time, however, with all of the fear and anxiety, the power, speed, and discomfort of this 3rd labor, the pain with the lip on the cervix, and the whole hour of pushing, I was humbled. Grateful, but humbled. Incidentally, I could walk, but I couldn't pee just yet. :) Too much local anesthetic, I guess.
Two and a half hours after our labor, the final miracle of Mr. Rambo's birth came - he was with us and doing just fine - at 2 1/2 hours! With my daughter, I wasn't ready to hold her until at least 4 hours after birth. With Mr. Handsome, I didn't even hold him until the next day. I nursed Mr. Rambo, and we both held him lots. He was so cute, and we were so happy and humbled to have him. It was a truly blessed event. He had a little jaundice during his second week, but I nursed him a ton, it passed, and there was no hospitalization necessary. His birth weight was 8'1" - a skinny dude in our family, but by the time he was 3 or 4 days old, he was 9'1". That was more like it.
He is such a cutie! He is also completely busy and completely exhausting when he's awake. He is just about 17 months old now, and I cannot leave him in a room for more than a minute unattended, or disaster occurs. He certainly keeps me on my toes (or humbled if I'm not). Of course, I'm 24 weeks pregnant, 35 years old, and have never been pregnant with such a young toddler. But it's all good. We are truly blessed.
Am I glad I skipped the epidural on this one? Well, to be honest, with how he was doing when I was on the Pitocin, I don't know if they would have even let me have one had I asked. I wonder if that's saying something. But I am glad that I didn't have one. Again, my recovery was better, I eluded the episiotomy again and my tearing was less (this time only 1st degree), and I was able to push him out unassisted once he was positioned right. I have a feeling that, had I opted for the epidural, our scary vaginal birth would have turned into a c-section. And I'm grateful it didn't have to. Again, he probably would have been in similar condition, but I wouldn't have been in such good shape.
Needless to say, I'm grateful and humbled that we were in such good hands and that all ended well. Now it's time to be grateful, let go of the fear, and send our little girl positive messages to come safely and peacefully into the world. :) And I'll encourage her to put off passing stools, knitting, or Chinese jump-rope experiments for later. Much later.
By the way, I'm reading the Hypnobirthing book right now, and it's pretty amazing too. I've noticed so far that the main difference between Bradley and Hypnobirthing is that Bradley tends to be a little more comprehensive and inclusive of diet, exercise, education on medical interventions and their risks and benefits, etc. It's a little more medical minded, and hypnobirthing tries to be a little more natural minded. So far hypnobirthing seems to be mainly about the birthing event, but that's not to bag on the book. It's extremely positive and has already helped me start to feel better and have more faith in my next labor, and I'm only halfway through it!
The biggest reason I am about to share this experience, even though it's not a very relaxing one, is that if an induction becomes necessary for your baby's safety, it is still possible to have a good, healthy labor without an epidural. I say this because when I was pregnant with Mr. Handsome and had not yet experienced childbirth without medication, I was uncertain if I'd be able to ever endure a Pitocin induced labor. From my third labor I now know that, while there is a difference in the pace of contractions and the environment in the labor room (more anxiety than is ideal), the contractions don't actually get any stronger than your strongest natural contractions. A woman can still relax through those powerful contractions and give birth to her baby without feeling the need for an epidural. Isn't that good news?
Here's my story:
After a normal, low-risk, healthy pregnancy, I went to my 39 week check-up with my two rowdy kids in tow. There was a male midwife in training joining the regular midwife, but that didn't bother me. He just happened to have been there when I had my strep-B swab a few weeks before (how nice), so I didn't care that he was there to hear a heartbeat. To our surprise, the heartbeat was low - around 90ish (when it should be around 120). I had noticed some slowing in the baby's movements, but he had still consistently moved pretty frequently throughout the day. It had also become difficult to take the time to count movements since I was chasing after my other kids, and summer vacation had just begun. Anyway, the midwife suggested that I have a non-stress test (aka NST) in their office for an hour or two. It was disappointing, but I will admit that I had been very anxious for several weeks now. Mr. Handsome's birth was often running through my mind, and I was practically convinced that something would not be quite right again. I still wonder if this was self-fulfilling prophecy.
During the NST, the heartrate was not steadily low, but there were variables in the heartrate. It would look great for a few minutes, and then there would be a small drop, and then it would be great again for a few more minutes, and then drop again, and so on. It went back and forth like this. After a rather stressful, uncomfortable hour of watching the varying heartrate (as well as watching my children ransack the room I was in and calling my husband for help), the midwife on call asked me to go to the hospital for an extended NST.
My husband met up with me, we got our kids to his parents, and he and I grabbed dinner before getting to the hospital for my NST. I found a good comfortable position, and this time our baby looked great. No variables for two whole hours. The midwife on call came in, said that everything looked good and he was obviously a healthy guy, but advised that we should check again in a day or two and pray that our baby would come sooner. She speculated that there might be something going on with his cord.
Two days later, we packed our bag in case we had to be induced, got our kids to my husband's parents, bought a birthday cake and OJ for after the delivery, and went to the hospital with mixed feelings. I wanted the baby here and safe and was anxious to birth him, but I wanted him to be healthy and fine and not need an induction. Again I didn't want to have an unmanagable labor, and I feared that if I was induced with Pitocin then the contractions would become more than I could relax through, and I might give in. As a reminder, I didn't want to risk another fever or slowing down a labor or having difficulties pushing the baby out - especially if he was struggling.
I picked the best position I could find and settled in with my husband for the NST. There were variables the whole time. After about 45 minutes or an hour, the little guy did a pretty interesting stretch, and his heart-rate dropped down to 90 again. David and I looked at each other - was that him or me that the monitor picked up? I still don't know, but it was enough to get me checked in for the night. I was not happy. I was as concerned as everyone, but I wanted my body to just get to work. I had a feeling that once my body got going that it would progress fast. And I was afraid of the Pitocin.
I had the blessing of two midwives that evening - midwives J and M. I was grateful, because though M was more experienced and confident, J was a little nicer and more helpful to me. She also had longer fingers. (This is a good thing for cervical checks). I got changed, got my monitor and IV (IV always come with Pitocin induction - that's how they give it to you), and got my cervix checked. I was at 5 centimeters. (Good body. Now why hadn't you started yet, silly?) It was at least a good start. With it being my 3rd baby, no epidural planned, having gone unmedicated before, a great coach/birth partner, and two supportive midwives, things looked good.
For the first hour my contractions felt only like Braxton Hicks, nothing more. But they were steady, and they were a start. During the second hour they increased the Pitocin. The contractions became more powerful, but I could still move around easily. I got up and down to use the bathroom a few times, and the rest of the time I spent on my side breathing deeply. During the third hour, the deep back-pain started and the contractions increased in strength. Midwife J functioned almost as a free doula by pushing on my back during those contractions and being a second support person with my husband. I felt very grateful for both of them.
The progress between the hours was very fast, and there was tension in the room as the baby's heartrate continued to have his variables. Though if I understand correctly, they were more frequent than at the start. During the final 30 minutes of dilation, the contractions had peaked in strength, and it was hard not to vocalize during each contraction. My husband was my hero, holding my leg up for me during each contraction (it helped - I couldn't have a pillow propping it up, because the monitor was right where a pillow would've been). I can't say full out that the surges in my abdomen were painful, but the back-pain was very strong. I was so grateful to still have midwife J pushing on and massaging my back during these contractions.
Suddenly I felt something like a water-balloon popping inside me, and I knew that my bag of waters had broken. We checked and the midwife confirmed it. There was a little mechonium in the fluid, but "not much" reassured midwife M. I asked if I could have a bath. I guess our baby's variables had become consistent enough that they didn't feel good about a bath. Instead they checked my cervix, and midwife J thought at first that I was at a full 10. "Do you feel an urge to push?" No, was my answer, but I wanted to push. They decided to let me try pushing. Then midwife M checked my cervix. It turned out that there was a lip on the cervix.
Okay, only a woman who has had a lip on the cervix knows this one. The contractions are no worse. It's just that, if you are anxious to start pushing instead of waiting a little longer for it to just go away, then what the midwife needs to do is push on the lip while Mom pushes with the contraction. It hurts.
It took two tries to get the lip out of the way, and the second time I literally grabbed midwife M's wrist as she pushed on the lip because it hurt so much (she backed up and suggested that we recollect ourselves). But the lip was gone. I declared that I wanted a mirror, and they propped one right up where I could see it. This was it. Time to push him out. Here he comes.
Except he didn't come as I pushed. This made me more tense. I pushed and did my best, but I was frustrated that he wasn't there. At this point, the room was filling up with people, including Dr. P, one of the nice OB's connected to the midwife practice. At the time, I wasn't thrilled to see him, but it was good that he was there just in case he was needed.
They realized that the baby was posterior and that was why he wasn't emerging. Midwife M was about to turn the baby, but then she said, "No, let's have Dr. P do it instead." I didn't know what to expect in having the baby turned. More pain? How much more? Dr. P walked up with his gloved hand, and midwife M said, "Don't push on this next one." I took a deep breath, didn't push, Dr. P barely reached inside with two fingers, turned his hand, and the baby was turned. I hardly felt a thing. Wow. That guy had magic hands.
For the next 10 minutes the pushes were more successful, and I could see the baby's head emerging. Now here's a challenge in labor that is really unavoidable, but can hurt more in unmedicated labor. Crowning and birth requires stretching. The slower and more gentle the birthing, the easier the stretching and the better it is for both mom and baby. Unfortunately, I had two problems. One, having so much scar tissue from my first labor tear, my body can only stretch so far. Two, once our baby was crowning, his heart-rate dropped and didn't come back up. It didn't stop, but it had dropped. At this point, an oxygen mask was placed on my face.
I was tired. It was after 1:00 AM, and this labor had been more stressful and hurt more than my last labor. I had been humbled by the pain. I was also staring at a mirror where, as I had pushed during the less productive phase, large amounts of brown fluid were coming out. Mechonium fluid meant serious distress to me. And there my body was during the crowning, looking as if it might tear apart as I tried to get this baby out. I was not fully present, to be honest. I was tired, confused, afraid of tearing, and feeling the tugging, stinging pain of crowning.
As I previously mentioned, midwife M approached me and said, "If he's not out on the next push, we'll have to perform an episiotomy." I had been such a bad patient, I felt. I had resisted everyone's advice, and I wanted it clear that I would comply of course. Then I heard the exchange that midwife M had with the doctor where she explained that I'd had a 4th degree laceration before. I realized that I was wearing an oxygen mask and I heard the heart-beat, steady but slow. I felt the next contraction, and this time I really pushed. He still didn't come out, so I kept pushing after the contraction and suddenly he slipped out.
What happened next was almost comical if it hadn't been so scary. Midwife J, who was waiting to receive the baby, reached out and caught him, and her eyes unconsciously widened as she started to unwrap the baby. His cord was tied in 4 different directions - around one arm, two or three times around the neck, around the opposite arm, and around his waist. What had he been doing???? It was amazing that he had only variables in his heartrate. He was completely white, long and slender, and very still. The cord was quickly cut and he was transferred to the incubator and table for examination.
My husband and I were so sure that, if the baby was still with us, he must've breathed the fluid. How could he not have? As the cord continued to come out of my body, we all stared in shock at a tight knot - technically referred to as a true knot. Our little Rambo had not only wrapped himself every which way, but somewhere along the line, he had swam a knot into his cord. What on earth?! Everyone was amazed and grateful that he was out and safer. Knots, if baby gets too big and isn't born soon enough, can mean the very worst, which I won't even say. You know what I mean, though.
People asked me how I was, and I could only stare over at the table. The baby was moving slowly. "Is he okay?" I kept asking. "Did he breath it?" There was very little relief at this point. My husband approached the doctor examining the baby and asked if the baby had aspirated the mechonium. He answered that he was unsure. The baby sounded a little funny, but not very bad. "Let's get him some IV's" and they could tell then.
I told my husband that he could go with the baby, but he was kind and stayed with me. I don't know if it's because he knew that I needed him or because he didn't want to be without me. I delivered the placenta shortly after the baby was born, and then the midwives stitched me up. I completely stopped liking midwife M at this point. She was giving midwife J pointers on a cool way to stitch me, and it felt like I laid there for at least 30-45 minutes shivering to death. I did need a couple of shots of local anesthetic since I'd had none until then. The stitching ended, and I was transferred to the recovery room. Just before or after I was transferred, we were informed that the baby hadn't aspirated the fluid. It was such a miracle to us! He just needed one more IV, and then he'd be good to stay with us.
Hope had returned, but I was humbled. Though Mr. Handsome had aspirated the mechonium in labor #2, the labor itself had mostly gone so well that I had left the hospital almost cocky. It wasn't really an "I'm so cool for going natural" thing. Actually, it was more of a "It's too bad more women don't give this a chance" thing. This time, however, with all of the fear and anxiety, the power, speed, and discomfort of this 3rd labor, the pain with the lip on the cervix, and the whole hour of pushing, I was humbled. Grateful, but humbled. Incidentally, I could walk, but I couldn't pee just yet. :) Too much local anesthetic, I guess.
Two and a half hours after our labor, the final miracle of Mr. Rambo's birth came - he was with us and doing just fine - at 2 1/2 hours! With my daughter, I wasn't ready to hold her until at least 4 hours after birth. With Mr. Handsome, I didn't even hold him until the next day. I nursed Mr. Rambo, and we both held him lots. He was so cute, and we were so happy and humbled to have him. It was a truly blessed event. He had a little jaundice during his second week, but I nursed him a ton, it passed, and there was no hospitalization necessary. His birth weight was 8'1" - a skinny dude in our family, but by the time he was 3 or 4 days old, he was 9'1". That was more like it.
He is such a cutie! He is also completely busy and completely exhausting when he's awake. He is just about 17 months old now, and I cannot leave him in a room for more than a minute unattended, or disaster occurs. He certainly keeps me on my toes (or humbled if I'm not). Of course, I'm 24 weeks pregnant, 35 years old, and have never been pregnant with such a young toddler. But it's all good. We are truly blessed.
Am I glad I skipped the epidural on this one? Well, to be honest, with how he was doing when I was on the Pitocin, I don't know if they would have even let me have one had I asked. I wonder if that's saying something. But I am glad that I didn't have one. Again, my recovery was better, I eluded the episiotomy again and my tearing was less (this time only 1st degree), and I was able to push him out unassisted once he was positioned right. I have a feeling that, had I opted for the epidural, our scary vaginal birth would have turned into a c-section. And I'm grateful it didn't have to. Again, he probably would have been in similar condition, but I wouldn't have been in such good shape.
Needless to say, I'm grateful and humbled that we were in such good hands and that all ended well. Now it's time to be grateful, let go of the fear, and send our little girl positive messages to come safely and peacefully into the world. :) And I'll encourage her to put off passing stools, knitting, or Chinese jump-rope experiments for later. Much later.
Taking a Moment....
I feel the need to share my labor with my third child, but I want to take a moment to say that I'm not trying to dwell on the negative. I have been dwelling on the negative, I admit it. That's part of the reason I've been pretty emotional lately. I felt so good about my preparation and caregivers on my last two deliveries, and yet there were unavoidable problems that arose anyway, and it's been a little hard to come to peace with that. The fact was, the babies and I were in good hands each time, and they did very well despite their challenges. So that's a positive thing to focus on.
Another important thing to remember is that, unless you have a major medical condition that always recurs with pregnancy, each pregnancy, baby, and delivery is different. And that's SO important to remember. What happened with baby #2 wasn't quite the same as baby #3, and the complications just happened and were not a result of neglect, abuse, or poor care. They just happened. There is no reason for me to fear that this next baby will face the same issues. My current "project" is to focus on the positive, have some faith, and let go of the issues of the past. They were resolved and don't need to haunt me anymore.
That goes for anyone who reads this too. Don't let my labors haunt you. The biggest reason I feel to share my experiences is 1) to be honest and open about my labors and not romanticize them, and 2) to show examples of labors when I didn't need an epidural and was happy about it. But my labors are my labors, and they are not going to be your labors. If you're expecting and are having a normal, healthy, low-risk pregnancy, you have every reason to believe that your labor will go FINE. :) See yourself having a good, healthy, comfortable birth everyday, and you will. I'll do the same, okay?
Just reminding you of that before I share this next story...
Another important thing to remember is that, unless you have a major medical condition that always recurs with pregnancy, each pregnancy, baby, and delivery is different. And that's SO important to remember. What happened with baby #2 wasn't quite the same as baby #3, and the complications just happened and were not a result of neglect, abuse, or poor care. They just happened. There is no reason for me to fear that this next baby will face the same issues. My current "project" is to focus on the positive, have some faith, and let go of the issues of the past. They were resolved and don't need to haunt me anymore.
That goes for anyone who reads this too. Don't let my labors haunt you. The biggest reason I feel to share my experiences is 1) to be honest and open about my labors and not romanticize them, and 2) to show examples of labors when I didn't need an epidural and was happy about it. But my labors are my labors, and they are not going to be your labors. If you're expecting and are having a normal, healthy, low-risk pregnancy, you have every reason to believe that your labor will go FINE. :) See yourself having a good, healthy, comfortable birth everyday, and you will. I'll do the same, okay?
Just reminding you of that before I share this next story...
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