I've heard it a hundred times and I should be used to it. But I'm not.
It happened again last week.
My friend was having her third baby. She's already pushed out two babies without problems - an 8 pound and a 9 pound baby.
She's into natural birth, even considered a home birth... but then got nervous thinking about it and went on with the obstetrician. He is a nice man. I like him a lot. If I had to pick a doctor, he'd be in the top dozen that I know. But he works in the hospital and thinks the way he was trained.
Two months ago my friend came home from a prenatal with the shocking, horrifying news, "Mary, they did an ultrasound and my baby already weighs over five pounds! He's gonna be HUGE by my due date!"
I talked her through it: She'd already pushed out a 9 pound baby. This one probably wouldn't be that much bigger, if even that big. She has a great body for having babies. If she was worried about her baby getting big, she could stay away from refined carbs and sugars.
She looked skeptical. I wondered if she really was scared of doing labor again and was hoping for a c-section. I hoped not, but I had to think that perhaps that was going through her head... I loaned her some books and told her that she'd already done it twice, and I was sure she could do it again.
About two weeks ago, they did another ultrasound. This time she was told that her baby already weighed a whopping TEN pounds! Her doctor didn't like the idea of her birthing a 10+ pound baby, and she really didn't like the idea. They mutually agreed that she'd have an elective cesarean section on the following Monday. She'd be 37 weeks. Everything would be fine.
So last Monday, her belly was sliced open and this "giant baby" was extracted. He weighed 6 pounds, 7 ounces. She sighed and laid there waiting for everyone to put her insides back together while he cried and squirmed in the warmer.
The doctor smiled - another successful c-section! No respiratory problems for the baby, no issues with the mother. The ultrasound estimate of size was a little off... but no harm was done, so that really didn't matter, right?
The nurses smiled, too. All was well as the new daddy stood near his baby and held his hand and the mommy was stitched neatly closed.
This is birth... the American way.
Showing posts with label birth. Show all posts
Showing posts with label birth. Show all posts
Monday, October 26, 2009
Tuesday, October 13, 2009
People Tell You...
People tell you how tired you'll be,
but they don't tell you...
that you'll be able to survive without much sleep
because the simple act of looking at your baby
is stirring, gratifying, energizing.
- Carol Weston
Thursday, June 4, 2009
The Classic Old-School Doc Re-Appears
I am at one of the local hospitals pretty frequently, supporting doula clients in labor - often enough that I now have some favorite nurses and some of the L&D staff people remember me. That's usually a good thing.
I've also done exactly one birth each with quite a few different doctors. Fortunately, some I never see again. Other times, I wish we could trade back for the doc that attended the last birth.
As a side note, I have only ONCE in the last 4 years of attending hospital births, ended up at a birth where the attending physician was actually the laboring woman's own doctor. I used to kind of hope/assume that my client's doctor who had signed off on their birth plan and all would be there. I've stopped planning on that. It's always somebody else. Usually, somebody from that practice, but I find that doctors came come from the North and South Pole and still be in the same practice together! So, we're always in for a surprise when the doctor walks in the door (unless I've worked with him/her before... in that case, I may have an idea about what's coming!).
Not long ago, "Belinda" was due and planning a natural birth in the hospital. She had 2 little ones already, so part of our doula visits prenatally focused on who would take care of the kids and arranging transportation and all kinds of practical details. Besides her husband was in Iraq for most of the pregnancy, and arrived back just a few days before she went into labor.
As for the birth plan, her doctor had said that she was fine with everything on it.
She said that she doesn't do an episiotomy "unless it's necessary."
She said that she avoids C-sections whenever possible.
That she encourages natural birth for any of her patients who want to try it.
That she would allow her patient to move and walk and do whatever she wanted to during labor.
That she would allow her to shower during labor (since a birthing tub wasn't available).
The only thing the doc wasn't very agreeable with was delayed cord clamping. But my client decided to give on that one if she had to.
Then labor happened.
The couple had just been moved from triage into their room. Labor was progressing quickly. The nurse checked Belinda's cervix and cheerily announced, "You're a good, stretchy 7 centimeters! I better tell the doctor to come right in!" With that, she chucked her glove in the trash and hurried out. Belinda was concentrating hard on the next contraction. It looked like all she could do to keep from screwing up her face and crying out in pain.
Meanwhile, the nursing student was having trouble getting the I.V. inserted. So the phlebotomy tech came in to help. Eventually, the I.V. was in and running after the fifth try. Belinda grimaced as she gripped my hand and said, "This is the last stick, right?"
And then Mr. Old School Doctor walked in. He looked like a classic, right out of a book about an eccentric old man... And it began.
"How are you, Ms. Smith?" he asked, touching her shoulder briefly.
"I'm, uh, ok." She sighed, exhausted. "What do you need to do right now?"
"Well, we need to assess how quickly you're progressing. So, I'm going to check your cervix, and we can break your water..."
"No, I - uh, don't want my water broken. Not right now, anyway."
"Oh." he stopped and shrugged. "Well, then that's fine for now." He turned back to adjusting his glove.
Belinda spoke up quickly before the next contraction. "Then can I get up and walk around after you check me?"
"No, oh NO! No, dear. You're going to stay right in that bed. Catastrophic things can happen if you get up and move around in labor."
Belinda looked a bit shocked, but another contraction hit, and she sank back against her pillow and closed her eyes. A couple of minutes later, as she opened her eyes, and looked back at the doctor, she brought it up again. "But I've been planning to walk and be up in labor all along. My doctor said it would be just fine. We talked about it a lot. She said as long as the baby was fine, I could get into whatever position feels good while I'm having contractions."
I chimed in to try to help her. "Maybe," I appealed to the doctor, "She could stand by the side of the bed and lean over it, but not walk around...?"
He looked at me as though I was suggesting that we bring a real, live tiger into the room to help things along. I backed off and he repeated, "No, no, no.... "
Then turning to Belinda again, "Honey, I don't let people do that. The best place for you and your baby is right in that bed."
He sounded patronizing, kind of grandfatherly, and yet... I wasn't sure what to do next. The nurse had a sympathetic look on her face, but she was nodding with the doctor. I knew she knew there was no good reason f
or this. I had just done a birth with her several weeks earlier and that doctor had let the woman move anywhere she wanted during labor.
Belinda's husband looked uncomfortable. Clearly, he didn't like the conflict. "Uh, honey, maybe..." he trailed off as Belinda rode another contraction out.
Then she snapped her head around and said very calmly but firmly, "I want to be upright. I've read that it can help with labor. Can't I do something that will aid gravity to make the baby come down and out easier?"
"Ah... " he rubbed the white stubble on his chin. "We have ways to get babies out if you're worried about that. Have you ever heard of the McRoberts position?"
Another contraction hit, but he kept talking. Belinda stared, glazed over at Dr. Old School as he rattled on about the McRoberts position while she breathed and nodded and winced. I pressed on her back and wondered to myself what would come next.
He repeated, "Do you know what the McRoberts position is?"
Belinda gripped her husband's hand a little tighter. "No," she gulped, catching her breath.
"The McRoberts position opens up your pelvis as wide as possible for your baby to come through. Its when we lay you on your back and pull your knees back to your ears. So, let's do that. Okay? When it's time to push, we'll lay you on your back and your pelvis will open wider so this baby won't get stuck."
Belinda nodded and was swallowed up by the next contraction. Afterward, she tried one more time, "But can I get up now? Can I stand by the bed or something? These contractions are KILLING me! They are hurting so bad in my back here in bed."
The old doctor straightened up and adjusted his glasses. "No, dear, did you already forget what I just explained? We need you IN BED till you have this baby, okay? Terrible, terrible things can happen to babies sometimes when you get up. You wouldn't even want to know what. But they are catastrophic. Sometimes babies die. I'm just trying to keep your baby safe. And didn't you understand, the best position for this baby to come out in is when you lay back? Do you understand?"
Belinda meekly nodded her head and then looked away as she felt another contraction coming.
And so went the labor... the whole thing. I tried asking the doctor lots of questions about the how's and why's of what he was decreeing, but nothing made a difference. Every time he didn't want something done a certain way, he'd say in his most grandfatherly voice: "Catastrophic things can happen if you do ____ . Do you understand, honey?"
Belinda pushed her baby out in the McRoberts position, which the doctor insisted upon.
And really, everything went fine. Nothing catastrophic or even close to it happened. She didn't have a tear or skid mark or anything.
It wasn't that terrible of a birth. But, Belinda was frustrated at her helplessness to have any say in simple matters of labor. Frankly, I was, too. I thought the whole "not getting out of bed" thing was ridiculous.
I was honestly a little surprised to find a doctor around still practicing so "old school"... He suctioned really vigorously on the perineum for over a minute before he let the shoulders deliver... and the amniotic fluid was completely clear. And then he spent a full two minutes holding a pink, kicking, screaming baby upside down, wiping it's face again and again and again before he handed him off to his mother. I don't know what he was thinking.
I guess it was just protocol.
That's the kind of hospital births I see a lot. They're usually kind of okay, but some of the stuff you put up with is just... dumb and frustrating at times, and for some mothers, infuriating!
People like Belinda will probably have a homebirth the next time. But the hospital might get to keep her as a patient if all their doctors would just be a little more open minded to a very few things that can make a big difference in a mother's experience.
As for the catastrophic things that were likely to happen, I'm still a little confused. Beyond the possibility of a cord prolapse (which can happen at any time, in about any position), what did he think was going to happen if the mother stood beside her bed?!
Oh well. I just hope that I never run into him again at a birth. And should I ever need to have a baby of my own born at that hospital, I hope Dr. Old School won't be the one walking into my room.
But, then, again, it really wouldn't be the end of the world. If I really, really needed hospital care for me or my baby, I would put up with most of it. And I'd try to be grateful. But it would be hard to be impressed. I'm just sayin'...
I've also done exactly one birth each with quite a few different doctors. Fortunately, some I never see again. Other times, I wish we could trade back for the doc that attended the last birth.
As a side note, I have only ONCE in the last 4 years of attending hospital births, ended up at a birth where the attending physician was actually the laboring woman's own doctor. I used to kind of hope/assume that my client's doctor who had signed off on their birth plan and all would be there. I've stopped planning on that. It's always somebody else. Usually, somebody from that practice, but I find that doctors came come from the North and South Pole and still be in the same practice together! So, we're always in for a surprise when the doctor walks in the door (unless I've worked with him/her before... in that case, I may have an idea about what's coming!).
Not long ago, "Belinda" was due and planning a natural birth in the hospital. She had 2 little ones already, so part of our doula visits prenatally focused on who would take care of the kids and arranging transportation and all kinds of practical details. Besides her husband was in Iraq for most of the pregnancy, and arrived back just a few days before she went into labor.
As for the birth plan, her doctor had said that she was fine with everything on it.
She said that she doesn't do an episiotomy "unless it's necessary."
She said that she avoids C-sections whenever possible.
That she encourages natural birth for any of her patients who want to try it.
That she would allow her patient to move and walk and do whatever she wanted to during labor.
That she would allow her to shower during labor (since a birthing tub wasn't available).
The only thing the doc wasn't very agreeable with was delayed cord clamping. But my client decided to give on that one if she had to.
Then labor happened.
The couple had just been moved from triage into their room. Labor was progressing quickly. The nurse checked Belinda's cervix and cheerily announced, "You're a good, stretchy 7 centimeters! I better tell the doctor to come right in!" With that, she chucked her glove in the trash and hurried out. Belinda was concentrating hard on the next contraction. It looked like all she could do to keep from screwing up her face and crying out in pain.
Meanwhile, the nursing student was having trouble getting the I.V. inserted. So the phlebotomy tech came in to help. Eventually, the I.V. was in and running after the fifth try. Belinda grimaced as she gripped my hand and said, "This is the last stick, right?"
And then Mr. Old School Doctor walked in. He looked like a classic, right out of a book about an eccentric old man... And it began.
"How are you, Ms. Smith?" he asked, touching her shoulder briefly.
"I'm, uh, ok." She sighed, exhausted. "What do you need to do right now?"
"Well, we need to assess how quickly you're progressing. So, I'm going to check your cervix, and we can break your water..."
"No, I - uh, don't want my water broken. Not right now, anyway."
"Oh." he stopped and shrugged. "Well, then that's fine for now." He turned back to adjusting his glove.
Belinda spoke up quickly before the next contraction. "Then can I get up and walk around after you check me?"
"No, oh NO! No, dear. You're going to stay right in that bed. Catastrophic things can happen if you get up and move around in labor."
Belinda looked a bit shocked, but another contraction hit, and she sank back against her pillow and closed her eyes. A couple of minutes later, as she opened her eyes, and looked back at the doctor, she brought it up again. "But I've been planning to walk and be up in labor all along. My doctor said it would be just fine. We talked about it a lot. She said as long as the baby was fine, I could get into whatever position feels good while I'm having contractions."
I chimed in to try to help her. "Maybe," I appealed to the doctor, "She could stand by the side of the bed and lean over it, but not walk around...?"
He looked at me as though I was suggesting that we bring a real, live tiger into the room to help things along. I backed off and he repeated, "No, no, no.... "
Then turning to Belinda again, "Honey, I don't let people do that. The best place for you and your baby is right in that bed."
He sounded patronizing, kind of grandfatherly, and yet... I wasn't sure what to do next. The nurse had a sympathetic look on her face, but she was nodding with the doctor. I knew she knew there was no good reason f
or this. I had just done a birth with her several weeks earlier and that doctor had let the woman move anywhere she wanted during labor.Belinda's husband looked uncomfortable. Clearly, he didn't like the conflict. "Uh, honey, maybe..." he trailed off as Belinda rode another contraction out.
Then she snapped her head around and said very calmly but firmly, "I want to be upright. I've read that it can help with labor. Can't I do something that will aid gravity to make the baby come down and out easier?"
"Ah... " he rubbed the white stubble on his chin. "We have ways to get babies out if you're worried about that. Have you ever heard of the McRoberts position?"
Another contraction hit, but he kept talking. Belinda stared, glazed over at Dr. Old School as he rattled on about the McRoberts position while she breathed and nodded and winced. I pressed on her back and wondered to myself what would come next.
He repeated, "Do you know what the McRoberts position is?"
Belinda gripped her husband's hand a little tighter. "No," she gulped, catching her breath.
"The McRoberts position opens up your pelvis as wide as possible for your baby to come through. Its when we lay you on your back and pull your knees back to your ears. So, let's do that. Okay? When it's time to push, we'll lay you on your back and your pelvis will open wider so this baby won't get stuck."
Belinda nodded and was swallowed up by the next contraction. Afterward, she tried one more time, "But can I get up now? Can I stand by the bed or something? These contractions are KILLING me! They are hurting so bad in my back here in bed."
The old doctor straightened up and adjusted his glasses. "No, dear, did you already forget what I just explained? We need you IN BED till you have this baby, okay? Terrible, terrible things can happen to babies sometimes when you get up. You wouldn't even want to know what. But they are catastrophic. Sometimes babies die. I'm just trying to keep your baby safe. And didn't you understand, the best position for this baby to come out in is when you lay back? Do you understand?"
Belinda meekly nodded her head and then looked away as she felt another contraction coming.
And so went the labor... the whole thing. I tried asking the doctor lots of questions about the how's and why's of what he was decreeing, but nothing made a difference. Every time he didn't want something done a certain way, he'd say in his most grandfatherly voice: "Catastrophic things can happen if you do ____ . Do you understand, honey?"
Belinda pushed her baby out in the McRoberts position, which the doctor insisted upon.
And really, everything went fine. Nothing catastrophic or even close to it happened. She didn't have a tear or skid mark or anything.
It wasn't that terrible of a birth. But, Belinda was frustrated at her helplessness to have any say in simple matters of labor. Frankly, I was, too. I thought the whole "not getting out of bed" thing was ridiculous.
I was honestly a little surprised to find a doctor around still practicing so "old school"... He suctioned really vigorously on the perineum for over a minute before he let the shoulders deliver... and the amniotic fluid was completely clear. And then he spent a full two minutes holding a pink, kicking, screaming baby upside down, wiping it's face again and again and again before he handed him off to his mother. I don't know what he was thinking.
I guess it was just protocol.
That's the kind of hospital births I see a lot. They're usually kind of okay, but some of the stuff you put up with is just... dumb and frustrating at times, and for some mothers, infuriating!
People like Belinda will probably have a homebirth the next time. But the hospital might get to keep her as a patient if all their doctors would just be a little more open minded to a very few things that can make a big difference in a mother's experience.
As for the catastrophic things that were likely to happen, I'm still a little confused. Beyond the possibility of a cord prolapse (which can happen at any time, in about any position), what did he think was going to happen if the mother stood beside her bed?!
Oh well. I just hope that I never run into him again at a birth. And should I ever need to have a baby of my own born at that hospital, I hope Dr. Old School won't be the one walking into my room.
But, then, again, it really wouldn't be the end of the world. If I really, really needed hospital care for me or my baby, I would put up with most of it. And I'd try to be grateful. But it would be hard to be impressed. I'm just sayin'...
Tuesday, November 18, 2008
Are We Causing Our Incredibly High Preterm Rate?
The San Francisco Chronicle on the national trend towards C-section:
The Centers for Disease Control and Prevention have tracked an increase in preterm births for decades, with the percentage of births delivered before 37 weeks of gestation rising 21 percent between 1990 and 2006. That increase is the main reason the nation's infant mortality rate has stubbornly refused to decline, remaining higher than most other developed nations.
The Centers for Disease Control and Prevention have tracked an increase in preterm births for decades, with the percentage of births delivered before 37 weeks of gestation rising 21 percent between 1990 and 2006. That increase is the main reason the nation's infant mortality rate has stubbornly refused to decline, remaining higher than most other developed nations.
Some preterm births were linked to mothers' smoking, and others to the mothers' lacking insurance. But more than 90 percent of the increase in preterm, nonmultiple births is attributable to an increase in babies being delivered by C-section at 34 to 36 weeks gestation, according to the March of Dimes.
"It comes from a general change in obstetric practice in our society," said Dr. Alan Fleischman, medical director of the March of Dimes Foundation. "The doctors and the women are intervening in a much more aggressive style toward the end of pregnancy."
Fleischman and other medical experts say there are a number of reasons doctors and mothers are choosing C-section delivery - and not all of them stem from medical necessity, the health of the mother or infant.
Read the rest of the article here.
Sunday, November 2, 2008
Unassisted Birth... A Good Thing?
Unassisted Childbirth (sometimes called UC for short) seems to be growing by leaps and bounds in popularity. Is it a trend that we want to encourage and "sell" people on?
Did any of you watch the Discovery Health Feature about it a couple of weeks ago?
I've been thinking about commenting on the trend, but have 'til this point, decided to leave that controversial topic alone. I know that both sides of the debate have equally strong feelings... and to even venture to state my opinion on the whole matter is risky.
What shapes my opinion on the matter?
A lot of things.
~I was born unassisted, with only my dad and grandma there, in the early '80's.
~The first birth I ever witnessed was my little sister's unassisted birth.
~I'm now a hospital doula and a homebirth midwifery student.
~I'm friends with mothers who choose completely unassisted birth, non-professional (i.e. a crowd of friends and family) attended births, midwife attended home birth, midwife attended birth center births, midwife attended hospital birth, physician attended homebirth, physician attended birth center births, and physician attended hospital birth.
~I've spent more than my share of time dealing with birth-related policy issues through my work on midwifery and birth-related legislation.
Yes, I have a lot to say about unassisted birthing. Maybe I'm right, maybe I'm not.
I'll tell you what I think in a future post, as soon as I get my thoughts formatted.
In the mean time, though, why don't you tell me what YOU think about unassisted childbirth?
Check out the poll I just put up!
Did any of you watch the Discovery Health Feature about it a couple of weeks ago?
I've been thinking about commenting on the trend, but have 'til this point, decided to leave that controversial topic alone. I know that both sides of the debate have equally strong feelings... and to even venture to state my opinion on the whole matter is risky.
What shapes my opinion on the matter?
A lot of things.
~I was born unassisted, with only my dad and grandma there, in the early '80's.
~The first birth I ever witnessed was my little sister's unassisted birth.
~I'm now a hospital doula and a homebirth midwifery student.
~I'm friends with mothers who choose completely unassisted birth, non-professional (i.e. a crowd of friends and family) attended births, midwife attended home birth, midwife attended birth center births, midwife attended hospital birth, physician attended homebirth, physician attended birth center births, and physician attended hospital birth.
~I've spent more than my share of time dealing with birth-related policy issues through my work on midwifery and birth-related legislation.
Yes, I have a lot to say about unassisted birthing. Maybe I'm right, maybe I'm not.
I'll tell you what I think in a future post, as soon as I get my thoughts formatted.
In the mean time, though, why don't you tell me what YOU think about unassisted childbirth?
Check out the poll I just put up!
Saturday, August 23, 2008
"Just don't think about it, Honey, and you'll be okay!"
I recently attended one of my doula client's prenatal visits with her obstetrician.
She had been telling me about her obstetrician for several months. "I like her," she would say. "She seems open-minded and willing to work with me and respect my wishes... but I'm just not sure if she's just stringing me along or not...."
Over all, most of the reports about her doctor sounded pretty good. She did say a couple things about her that concerned me. For one, the doctor couldn't really remember exactly what her c-section rate was, but she assured the patient that it was "pretty low" and definitely not higher than the other obstetricians in the practice because she only does them "when necessary."
I agreed to come along to a routine prenatal visit and meet her doctor. My client wanted me to tell her what my impression of her doc was afterwards.
I was liking her doctor a lot.
She was saying lots of good things, answering questions openly and took plenty of time to discuss anything my client brought up.
And then my client again brought up c-sections. "You know, Dr. Smith," she said earnestly. "I just don't want a c-section with this baby. I'm counting on you to do everything you can to make sure that doesn't happen to me. Surgery just freaks me out and I don't want end up there... I'm trying to get myself educated so that I know about the risks and benefits of various things and can know what is most likely to make a c-section happen. Is there anything I can do to help prevent myself from becoming a c-section statistic?"
Dr. Smith smiled. "Oh, honey! Don't worry yourself about having a c-section! There's only one good way to deal with that fear of becoming a c-section statistic -- Just don't think about it!
You probably won't have one, and if you end up with a c-section, you can just know that it was necessary and you can be happy that you and your baby are healthy!"
Dr. Smith turned back to charting, but my mind was spinning.
Her best advice on avoiding a cesarean section? Just don't think about it!
I wonder how many other docs give this advice to nervous couples expecting their first baby?
She had been telling me about her obstetrician for several months. "I like her," she would say. "She seems open-minded and willing to work with me and respect my wishes... but I'm just not sure if she's just stringing me along or not...."
Over all, most of the reports about her doctor sounded pretty good. She did say a couple things about her that concerned me. For one, the doctor couldn't really remember exactly what her c-section rate was, but she assured the patient that it was "pretty low" and definitely not higher than the other obstetricians in the practice because she only does them "when necessary."
I agreed to come along to a routine prenatal visit and meet her doctor. My client wanted me to tell her what my impression of her doc was afterwards.
I was liking her doctor a lot.
She was saying lots of good things, answering questions openly and took plenty of time to discuss anything my client brought up.
And then my client again brought up c-sections. "You know, Dr. Smith," she said earnestly. "I just don't want a c-section with this baby. I'm counting on you to do everything you can to make sure that doesn't happen to me. Surgery just freaks me out and I don't want end up there... I'm trying to get myself educated so that I know about the risks and benefits of various things and can know what is most likely to make a c-section happen. Is there anything I can do to help prevent myself from becoming a c-section statistic?"
Dr. Smith smiled. "Oh, honey! Don't worry yourself about having a c-section! There's only one good way to deal with that fear of becoming a c-section statistic -- Just don't think about it!
You probably won't have one, and if you end up with a c-section, you can just know that it was necessary and you can be happy that you and your baby are healthy!"
Dr. Smith turned back to charting, but my mind was spinning.
Her best advice on avoiding a cesarean section? Just don't think about it!
I wonder how many other docs give this advice to nervous couples expecting their first baby?
Monday, April 14, 2008
Dear "Sarah": There IS Hope for a Better Birth!
Sarah,
When I read your email, my heart went out to you. I know of so many women who dread to think of having another baby... because of the trauma of labor and birth. Some of my friends, even though they've wanted another baby, have told me that they've cried to see the little pink line appear on their pregnancy test, as reality hit them and they knew that once again they would be subject to a overwhelmingly painful labor in a few short months.
I can't promise that this birth will be different for you, even if you do everything suggested. Some women have relatively easy births. And some women have agonizing births. I've learned over the years, it's not all about whether the woman is a wimp or not or whether she thinks positive thoughts, or whether she just hasn't yet discovered the pain coping technique that "works for her."
You are absolutely right. Some of the most painful and overwhelming labors are those that happen so fast. Women talk about 12 or 20 hours of painful labor, and then say, "What?! You got away with 2 hours of labor?!" In reality, what most of them don't realize is that many times a 2 hour labor is just like compressing the 12 or 20 hours that they experienced into a fraction of the time. So, yes, it is often even more overwhelming, relentless, and excruciatingly painful. There is not magic solution to slow your labor down and let it hit you with the normal intensity that most women experience, but there are certainly some things that you can do to make it a better memory.
Some women try everything and still, they have miserable labors and/or births.
You are absolutely right. Some of the most painful and overwhelming labors are those that happen so fast. Women talk about 12 or 20 hours of painful labor, and then say, "What?! You got away with 2 hours of labor?!" In reality, what most of them don't realize is that many times a 2 hour labor is just like compressing the 12 or 20 hours that they experienced into a fraction of the time. So, yes, it is often even more overwhelming, relentless, and excruciatingly painful. There is not magic solution to slow your labor down and let it hit you with the normal intensity that most women experience, but there are certainly some things that you can do to make it a better memory.
Some women try everything and still, they have miserable labors and/or births.
Getting prepared is good, but it doesn't fix everything.
Being well-supported is good, but it doesn't fix everything.
Being in the right environment is good, but it doesn't fix everything.
Neither does trusting your care team,
or being in water
or being upright
or being in bed
or planning to "just ask for pain meds"
or listening to music
or being at home
or being in the hospital
or being at home
or being in the hospital
or eating handfuls of Vitamin C tablets
or overdosing on Calcium and Magnesium in labor
or eating more beans during pregnancy
or the hundred other things that friends, magazines,
websites and other helpful people will recommend!
or the hundred other things that friends, magazines,
websites and other helpful people will recommend!
Sometimes you do everything right (I'm not implying that all of the above are "right" or a good idea) and STILL your birth is a miserable experience.
But I can offer you hope. Rarely does a women come to birth well prepared, well supported, choosing the right environment and the right care provider for her situation and still hate the way it turned out.
A friend of mine who I'll call Susan has had 8 children. They've all been hospital births, mostly with epidurals. One was a forceps delivery that damaged her son's spinal column for life. One of the middle kids was a c-section for an emergency that arose in labor. She has polyhydramnios (too much amniotic fluid in pregnancy) and she has borderline gestational diabetes. Sometimes her doctors control her diabetes with insulin, sometimes she controls it with diet. She's been induced for part of her labors. Other times she's labored naturally for about 24 hours before making little progress and succumbing to an epidural.
Susan has talked about how horrible birth is for as long as I can remember. As a teenager, my mental picture of birth was partly painted by the things Susan would tell me about her births. I shuddered to think that birth had to be that hard and that for her, the only saving grace was an epidural.
When she became pregnant with her eighth and last child, I had recently taken some doula training, and offered to be at her birth. With very little experience and only a stack of books to loan her, she began unloading on me the full horrors of her past birth experiences. She explained how she never goes into a normal contraction pattern once she gets past about 5 centimeters dilation. She said, "The doctors always come in and look at my fetal monitor strip and say, 'Wow. You don't do contractions like most women. You just have one long contraction till you start to push.' "
She explained how her contractions all melt into one, and she only gets a short break of a minute or less every half hour or so. "So, you see why I can't do it without the epidural," she explained. I totally understood. If I had one long contraction for 48 hours, I'd be begging to get signed up for the epidural as well! I felt very powerless to change what her body does to her. After all, this had happened seven times now, right?
But I encouraged her to work towards what she wished her birth experience could be, even if it wasn't likely to happen that way. She began reading books on Natural Childbirth and for the first time in her life she was saying, "Oh, I wish my labors were normal so I could do them without the epidural...." She really did want a natural birth, but she felt that would be absolutely impossible in her situation. Nevertheless, she prayed desperately that somehow this baby would be born differently. My dear friend had endured 30-40 hours of torture with other earlier births before getting the epidural, and saw no point in doing that to herself again with this one. I didn't disagree with her decision, just tried to be supportive.
The day came when she wondered if she was in labor. We headed to the hospital to see. Contractions were regular, but not very painful or strong. Things were most likely just putsing around. The doctor gloved up and reached for the cervix, when his eyebrows shot up.
"Oh, my!" he exclaimed. "Have you been doing this labor for awhile?"
"Well," she said, "Kind of all day, but I pretty much ignored it and went on with my work because I had a lot going on."
"Well, you're going to be happy. You're a stretchy 7 centimeters!"
Now we looked shocked. She the most shocked as she stammered, "I've never experienced 7 centimeters without an epidural! Never! I've never been able to handle it by the time I get to 5 centimeters. Usually by then I'm climbing the walls with pain, and there is no break between contractions! And usually by the time I get to 5, I've been in labor for at least 24 hours!"
An hour later, Susan was sitting on the birth ball, still smiling and talking between contractions.
An hour later, after the doctor broke her water, she was declared completely dilated and ready to push with her next contraction. Things were getting intense at that point as she was in transition and crying, "I can't do this. It hurts so bad!"
Then for ten whole minutes, her husband, the doctor, the nurse, and I just stood and waited for a contraction that didn't happen. Susan kept looking around the room and saying, "This is so weird. It's surreal. Is something wrong? Why am I not contracting anymore?"
The doctor wisely smiled. "Oh," he said, "Sometimes this happens. It's usually just your body giving you a little break for what's ahead..."
Soon the contractions resumed and she set to work pushing, which she had never experienced without an epidural. Even though she could feel what she was doing, and was being more effective that her usual pushing, she hated the feeling. Fifteen minutes of pushing, a few screams, yelps, blowing and breathing, a few more,"I can't do it's" and "Yes, you can! You're moving your baby down" later, she had a chubby pink baby girl in her hands.
Sobbing, and panting she looked over at me and said, "I don't know how that happened like that! I can't believe I just had a baby like that! I wanted a natural birth. I never thought I'd get one, but I did! God is so good!"
Years later, she still talks about her birth to almost every woman she meets, telling them that birth isn't always bad, and there is always hope that you can have a "good" birth, no matter how many miserable experiences you've had.
She's asked me over and over again what it was that I did for her to miraculously change her birth experience. I have told her over and over that I honestly didn't do anything except answer her questions, breathe with her, get her extra pillows, and show her husband where counter-pressure felt good on her back during labor. I didn't do anything special, but her body obviously did a totally new labor pattern that she had never experienced with her seven previous babies.
I don't know what happened or why that birth was different. All I know is that her last birth radically changed her life. Instead of feeling helpless and at the mercy of a "dysfunctional body," she's never forgot how empowered she felt to push out her own baby and to see her body work perfectly fine.
I wish for you the same miracle.
In the meantime, though, I suggest that you do everything you can to prepare for the birth you've always wished to have.
I recommend an experienced doula as #1 on your list.
When you are experiencing overwhelming contractions, it makes all the difference in the world to have someone there to walk through each one with you, and keep you centered, helping you to stay on top of the pain. Of course, husbands are great and it sounds like your husband does a great job helping you through labor, but they can also be so emotionally pulled into your pain that they can't focus on your need in the same calm, reassuring way that a motherly doula can. It is optimal to have one person there to focus on whatever you want physically (back pressure, massage, cool washcloth for your forehead, etc) and one person there who is going to stay right at your face constantly during every contraction, watching your every facial expression, and listening to everything you do so that they can totally focus on where you are at "in your head" and walk you through the contraction one at a time. Find a doula who is experienced and has attended at least a few dozen births in that role. Someone who you feel comfortable with and can trust. Many doulas are certified through ALACE (http://alace.org/) or DONA (http://dona.org/), but other very good and qualified doulas have attended hundreds of hospital births, but have never been certified. Interview them thoroughly. Who do you like? Who seems to understand how you feel about birth and what you wish could be different? Who do you feel completely comfortable with?
My #2 recommendation would be to evaluate whether your birthing location and caregiver are appropriate and best for your situation.
You may have always went to the hospital and used an obstetrician for your births, but perhaps your situation would be more appropriately handled at home with an experienced, well-trained midwife. That is a decision that you will have to make, based on lots of research and reading. Of course, you may be a person with certain risk factors that makes a hospital birth a necessity. If so, or if you just aren't comfortable with a homebirth, then make sure that you have the best doctor (or hospital based CNM) and hospital for your particular situation. Is your doctor committed to helping you have the best birth possible? Is s/he sensitive to your wishes and needs during labor and birth? Do they adhere rigidly to protocols and procedures that are typical, but not evidence-based? Will your doctor allow you to labor in whatever position/use whatever comfort techniques are helpful to you?
Many people think of homebirth as more "risky" than typical hospital birth. It can be when not done right or not properly attended. But when properly attended, it can actually be safer for healthy, low-risk women. I encourage you to do your research carefully. All of the quality homebirth studies show that planned homebirth (when attended by a well-trained midwife) is equal or safer in outcomes for mothers and babies, with far less interventions like c-sections and forceps/vacuum delivery. Of course, there are things that can occur at home that would be better handled in the hospital, because they have the technology/machines to deal with that particular situation. But, on the other hand, there are many situations that occur in the hospital (think: under staffing, more medical errors, infection rates) that would be more safely handled at home. The risk factors for home and hospital birth are different. But that does not mean that there are more risks at home for healthy low risk women attended by experienced, knowledgeable midwives. If, after much research, you decide that homebirth is for you, do some more research and talk with your midwife about the possibility of water birth. Obviously, it's not for everyone and benefits and risks should be carefully considered. But, for many women who have really intense, painful births, having a water birth makes all the difference in the world to them. Waterbirth International (Barbara Harper, author of Gentle Birth Choices) offers lots of resources in this area.
There are many, many ideas out there for reducing the pain of labor. Some of them have been suggested in the comments section of the previous post. Many of them have not been mentioned on this blog. As I find time, I will post more ideas for you.
Regardless of who you decide to have deliver your baby, and where you decide to give birth, I hope that you will think it through carefully and research your options. Birth is never something to be taken lightly. On one hand, it carries with it a life and death responsibility, and on the other hand, it can be the most joyous, beautiful day of your life!
Plan for your birth to be better this time, know that it can be, and then take steps towards making that happen!
And whatever happens, I applaud you for your bravery to experience natural, unmedicated childbirth to give your baby the best start possible. You are among the bravest 10% of American women who experience labor with no pain medication!
I recommend an experienced doula as #1 on your list.
When you are experiencing overwhelming contractions, it makes all the difference in the world to have someone there to walk through each one with you, and keep you centered, helping you to stay on top of the pain. Of course, husbands are great and it sounds like your husband does a great job helping you through labor, but they can also be so emotionally pulled into your pain that they can't focus on your need in the same calm, reassuring way that a motherly doula can. It is optimal to have one person there to focus on whatever you want physically (back pressure, massage, cool washcloth for your forehead, etc) and one person there who is going to stay right at your face constantly during every contraction, watching your every facial expression, and listening to everything you do so that they can totally focus on where you are at "in your head" and walk you through the contraction one at a time. Find a doula who is experienced and has attended at least a few dozen births in that role. Someone who you feel comfortable with and can trust. Many doulas are certified through ALACE (http://alace.org/) or DONA (http://dona.org/), but other very good and qualified doulas have attended hundreds of hospital births, but have never been certified. Interview them thoroughly. Who do you like? Who seems to understand how you feel about birth and what you wish could be different? Who do you feel completely comfortable with?
My #2 recommendation would be to evaluate whether your birthing location and caregiver are appropriate and best for your situation.
You may have always went to the hospital and used an obstetrician for your births, but perhaps your situation would be more appropriately handled at home with an experienced, well-trained midwife. That is a decision that you will have to make, based on lots of research and reading. Of course, you may be a person with certain risk factors that makes a hospital birth a necessity. If so, or if you just aren't comfortable with a homebirth, then make sure that you have the best doctor (or hospital based CNM) and hospital for your particular situation. Is your doctor committed to helping you have the best birth possible? Is s/he sensitive to your wishes and needs during labor and birth? Do they adhere rigidly to protocols and procedures that are typical, but not evidence-based? Will your doctor allow you to labor in whatever position/use whatever comfort techniques are helpful to you?
Many people think of homebirth as more "risky" than typical hospital birth. It can be when not done right or not properly attended. But when properly attended, it can actually be safer for healthy, low-risk women. I encourage you to do your research carefully. All of the quality homebirth studies show that planned homebirth (when attended by a well-trained midwife) is equal or safer in outcomes for mothers and babies, with far less interventions like c-sections and forceps/vacuum delivery. Of course, there are things that can occur at home that would be better handled in the hospital, because they have the technology/machines to deal with that particular situation. But, on the other hand, there are many situations that occur in the hospital (think: under staffing, more medical errors, infection rates) that would be more safely handled at home. The risk factors for home and hospital birth are different. But that does not mean that there are more risks at home for healthy low risk women attended by experienced, knowledgeable midwives. If, after much research, you decide that homebirth is for you, do some more research and talk with your midwife about the possibility of water birth. Obviously, it's not for everyone and benefits and risks should be carefully considered. But, for many women who have really intense, painful births, having a water birth makes all the difference in the world to them. Waterbirth International (Barbara Harper, author of Gentle Birth Choices) offers lots of resources in this area.
There are many, many ideas out there for reducing the pain of labor. Some of them have been suggested in the comments section of the previous post. Many of them have not been mentioned on this blog. As I find time, I will post more ideas for you.
Regardless of who you decide to have deliver your baby, and where you decide to give birth, I hope that you will think it through carefully and research your options. Birth is never something to be taken lightly. On one hand, it carries with it a life and death responsibility, and on the other hand, it can be the most joyous, beautiful day of your life!
Plan for your birth to be better this time, know that it can be, and then take steps towards making that happen!
And whatever happens, I applaud you for your bravery to experience natural, unmedicated childbirth to give your baby the best start possible. You are among the bravest 10% of American women who experience labor with no pain medication!
Saturday, April 5, 2008
Sarah's Births - "Will I always Scream and Find the Pain Unbearable?"
Since the last post, I have received a number of emails from women asking all sorts of questions... telling sad birth stories, asking if things could have been different for them.
I decided that rather than try to respond to each person individually, I would try to respond to some of these emails on my blog as I have been given permission.
So, here is the first email I will respond to.
First, though, while I am composing a reply, I thought I'd put it out there for the rest of you to comment on. Please do suggest anything that you think might be helpful for this mother. I look forward to hearing your ideas and even just your stories, validating what she has experienced. It is the worst feeling to feel like you are the only person in the world with a particular problem or experience.
I know from my years of experience as a doula that "Sarah" is not alone and there are many women who are like her.
If you would like to reply to her off-list, feel free to email me at: betterbirth4you {at} gmail {dot} com and I will gladly forward your messages to her as well.
Thank you!
Hi Mary,
I am wondering if there is a way I could have a less painful birth experience. I am pretty certain that we are pregnant right now with our fourth baby. Our three previous births have all been with midwives (but not at home)who never encouraged "purple pushing", but my births are horribly painful toward the end.
I have a very high tolerance for pain, but I still end up screaming every time. Our first birth was by far the worst. It was so traumatic for me that I literally cried for almost a year any time I actually thought about what I had been through. Just remembering the pain brought back tears. I screamed with every contraction for five or six hours before our little girl was born.
Then I had trouble with bleeding afterward, as I have with every one of our births. My uterus does not want to contract back into shape after the baby is out, so I lie there in a happy state of shock, bleeding away. It is always scary to everyone but me. I turn pale, and hardly feel a thing. I am totally happy to have a little baby in my arms and to be out of pain, but everyone else sees the blood and my paling face and gets worried. That's after the birth...
Before the baby is born, this is what it is like. My early contractions are usually tolerable until I get to about four centimeters. I wince and ache, but I can pace and breathe through them. Then at that point, my body usually kicks in high gear and I dilate the rest of the way very quickly. Once my body decides to get serious I can go from four to ten centimeters in half an hour. This period is so intensely painful that I choose to start pushing as soon as I am fully dilated because I can't stand the pain. The pain is especially intense in my lower back, so I usually birth in a hands and knees position while my husband pushes HARD on my lower back with his fist/knuckles, which helps a little, and which I really appreciate. I push the baby out as fast as I can because I am screaming and exhausted and I can't stand the thought of slowing down and allowing the pain to linger a moment longer than it has to.
I always wondered if I was wierd. I know that nurses don't seem to be used to the screaming. I never hear screaming when I know the woman down the hall is giving birth, too. It's a little embarassing for me. I am definitely not a dramatic type of person who would choose to put on a show like this. And I am definitely not just screaming because I think it's therapeutic or something. It just really is THAT bad. I can't stop it or help it.
When I have spoken about this, other women tend to doubt that it could have been this way for me. It seems like outright screaming is unusual. I never knew that it was until I started reading other people's birth stories. No screaming. I have even heard people say that they experienced almost no pain at the very end, that all their pain came during dilation, whereas my pain just kept going until the baby was born.
My births are done without pain medication. They never give me pitocin until after the baby is born, to deal with the bleeding problem.
Am I doing something wrong? Is there a way I could do this differently? Have you ever worked with someone like me? Do you have any thoughts on this?
Any ideas or words of wisdom you could share with me would be greatly appreciated! Thanks for taking the time to read this.
Sincerely,
"Sarah"
I decided that rather than try to respond to each person individually, I would try to respond to some of these emails on my blog as I have been given permission.
So, here is the first email I will respond to.
First, though, while I am composing a reply, I thought I'd put it out there for the rest of you to comment on. Please do suggest anything that you think might be helpful for this mother. I look forward to hearing your ideas and even just your stories, validating what she has experienced. It is the worst feeling to feel like you are the only person in the world with a particular problem or experience.
I know from my years of experience as a doula that "Sarah" is not alone and there are many women who are like her.
If you would like to reply to her off-list, feel free to email me at: betterbirth4you {at} gmail {dot} com and I will gladly forward your messages to her as well.
Thank you!
Hi Mary,
I am wondering if there is a way I could have a less painful birth experience. I am pretty certain that we are pregnant right now with our fourth baby. Our three previous births have all been with midwives (but not at home)who never encouraged "purple pushing", but my births are horribly painful toward the end.
I have a very high tolerance for pain, but I still end up screaming every time. Our first birth was by far the worst. It was so traumatic for me that I literally cried for almost a year any time I actually thought about what I had been through. Just remembering the pain brought back tears. I screamed with every contraction for five or six hours before our little girl was born.
Then I had trouble with bleeding afterward, as I have with every one of our births. My uterus does not want to contract back into shape after the baby is out, so I lie there in a happy state of shock, bleeding away. It is always scary to everyone but me. I turn pale, and hardly feel a thing. I am totally happy to have a little baby in my arms and to be out of pain, but everyone else sees the blood and my paling face and gets worried. That's after the birth...
Before the baby is born, this is what it is like. My early contractions are usually tolerable until I get to about four centimeters. I wince and ache, but I can pace and breathe through them. Then at that point, my body usually kicks in high gear and I dilate the rest of the way very quickly. Once my body decides to get serious I can go from four to ten centimeters in half an hour. This period is so intensely painful that I choose to start pushing as soon as I am fully dilated because I can't stand the pain. The pain is especially intense in my lower back, so I usually birth in a hands and knees position while my husband pushes HARD on my lower back with his fist/knuckles, which helps a little, and which I really appreciate. I push the baby out as fast as I can because I am screaming and exhausted and I can't stand the thought of slowing down and allowing the pain to linger a moment longer than it has to.
I always wondered if I was wierd. I know that nurses don't seem to be used to the screaming. I never hear screaming when I know the woman down the hall is giving birth, too. It's a little embarassing for me. I am definitely not a dramatic type of person who would choose to put on a show like this. And I am definitely not just screaming because I think it's therapeutic or something. It just really is THAT bad. I can't stop it or help it.
When I have spoken about this, other women tend to doubt that it could have been this way for me. It seems like outright screaming is unusual. I never knew that it was until I started reading other people's birth stories. No screaming. I have even heard people say that they experienced almost no pain at the very end, that all their pain came during dilation, whereas my pain just kept going until the baby was born.
My births are done without pain medication. They never give me pitocin until after the baby is born, to deal with the bleeding problem.
Am I doing something wrong? Is there a way I could do this differently? Have you ever worked with someone like me? Do you have any thoughts on this?
Any ideas or words of wisdom you could share with me would be greatly appreciated! Thanks for taking the time to read this.
Sincerely,
"Sarah"
Friday, March 14, 2008
Ten Centimeters. Push!
Last week I found myself in one of my favorite positions -- Leaning over a hospital bed, rubbing the back of a laboring mother.
Over all, the labor wasn't bad.
I went in with a positive attitude, hopeful of seeing a good birth. I liked the obstetrician - she was an extremely nice woman with a great personality, and seemed to genuinely be enjoying her job. She was very supportive of the mother's desire to have no epidural if possible. Although medical reasons made the obstetrician decide that induction of labor was appropriate, she respected the mother's wishes to keep the Pitocin drip at a minimum and not turn it up once she started contractions.
The mother had given birth in the same hospital twice previously and was well prepared for labor. Her husband was supportive and as helpful as possible.
As labor progressed and the Pitocin induced contractions became more and more unbearable and on top of each other, the nurses were awesome. They provided one-on-one care, basically having someone in the room with us constantly. They, along with the father and I, encouraged the mother to try all sorts of positions - standing, hands and knees, sitting on the birth ball, rocking, etc.
I was even more impressed when the nurses got into whatever positions they had to to continue to monitor the baby's heart rate. It seemed that whenever the mother was in an upright position, the electronic fetal monitor (EFM) just wasn't tracing the heartbeat very well. So, the nurse had to stand there for several hours continuously holding the doppler in place to maintain a tracing. There was absolutely no "I'm really busy. You'll just have to lay in bed so we can get a decent tracing" or any, "I'm sorry this isn't working. We're going to have to put in a fetal scalp electrode." (The obstetrician wanted constant monitoring because of an increased risk of fetal distress with the Pitocin induction.) Care was all focused around what the mother wanted and needed and what made her most comfortable.
I was also impressed with the information that they provided the parents with before taking any action. The mother got vaginal exams when she wanted them, not every two hours or according to any set protocol. The father and mother both didn't want her water broken early in labor. The hospital staff respected their decision and didn't do it till near the end, when the mother requested it.
As I massaged the mother's shoulders and gave the father suggestions for new ways he could support her and asked the nurses to better explain the progress to the couple, I found myself thinking, "This birth isn't bad. It's about as good as hospital birth gets."
Of course, the Pitocin made things miserable for the mother, and more than once she just burst into tears and cried, "I just can't do this anymore!" But every time she got to that point, we managed to re-focus her on dealing with this contraction and just getting through right now. Her obstetrician poked her head into the room at just such a moment, and very quietly, almost reverently watched her experiencing an intense contraction. "Wow," she whispered. "You just never see women willing to do this any more. I'm so impressed."
Ten centimeters came as the sun came up. The shift would be changing soon, but these nurses were excited that they would get to see the fruit of this labor before they left. The doctor was summoned. Mother got back into bed and was positioned in a semi-sitting position. The bed was broke down, and her legs were spread apart while the overhead lights were turned onto the site of action. The doctor gowned and gloved. Two nurses held one leg (since the stirrups were uncomfortable) and I held the other. Sterile drapes were placed everywhere, leaving only the vaginal opening exposed. The father, nervous and excited at the same time, held her hand, and reassured his exhausted, tearful wife that she was almost done. She was so tired, and kept saying, "I don't think I have the energy to push. I can't."
We all assured her over and over that she could and would get her baby out. The doctor leaned in close to her face and looked her in the eyes, "Just listen to me and do what I tell you. Just follow my instructions closely and you'll be just fine."
The mother nodded through her tears, and the father whispered, "Honey, you can do it. Just listen to the doctor."
"Okay, on the next contraction...." The doctor began to explain the process of letting the contraction build, then taking a deep breath and holding it while pushing as hard as possible while the nurses count to ten.
I sighed to myself. Purple pushing. Why do all doctors think that this is the only way to get a baby out? I knew they'd do this. Why do I even hope that this time will be different?
("Purple pushing" is the above described technique, termed such by many doulas and midwives because the mother has so little time to breathe and exerts herself so intensely that she often starts to turn purple and even burst the blood vessels in her eyes. It has been employed at nearly every hospital birth I've ever attended. It barrels a baby a baby out faster than any other method of pushing. A first time mother who might take an hour to push a baby out when allowed to do it at her own pace, will usually push a baby out in less the 20 minutes with this incredibly intense way of pushing. I personally think that purple pushing can be necessary and effective if a baby is in fetal distress and there is a good reason to get the baby out as quickly as possible. If there is not medically indicated reason, I think it just traumatizes the mother's body [tissues don't have much time to stretch and she's more likely to tear, etc.] more than necessary, not to mention that she thinks of pushing as one of the hardest, most exhausting things she's ever done.)
So, the pushing began. "Take a deep breath. Hold it! PUSH!! One.... two..... three..... four.... no, no, don't take a breath yet! Keep pushing down and out as hard as you can!... five.... six... that's a girl!... seven.... eight... nine... TEN! Good push! Now, quick, quick, another deep breath, and down and out! One.... two.... three.... "
(Mother falls back exhausted. "I can't! I have to catch my breath! I can't breathe! Just let me catch my breath!")
"No, honey. Not till this contraction is done." (Pulling her forward) "Take a deep breath right now, and hold it. Hold it while I count to ten... (more insistently) ONE! TWO! THREE! FOUR...."
Ten minutes have passed. We're seeing a baby's head. The doctor comments on all the hair. Mother is gasping for air between pushes and saying she needs to slow down. The Pitocin drip is still going, and the contractions are coming right on top of another.
"No, not till your baby's here. Keep going!"
The nurses get in her face to help her stay with the pushing a little longer. I want to tell her she can take a 10 second break, but that is obviously not the opinion of the doctor.
I tell myself that this is ridiculous, but determine to keep my mouth shut. I'm the doula, not the obstetrician. The doc keeps taking sideways glances at the monitor. The baby's heart rate shows no sign of compromise. It's plugging away with nice short and long term variability around 140, even during contractions with head compression. Wow! The doctor smiles, "Your baby is doing great! Let's hurry up and get him out!"
The contraction ends. Mom falls back on her pillow and sobs and gasps for air. "Just... just let me rest for a minute..." I'm happy to see that the contraction is over and baby is wonderful. Surely they will let her rest till the next contraction hits. The father looks slightly concerned, torn between wanting to help his wife get what she says she needs, and wanting to follow the doctor's orders for the safety of the baby.
But, no, rest is not an option. The doctor wants to get this kid OUT! "You're almost crowning! You can't stop pushing now till your baby's head is out," she says firmly. The mother wearily sits forward, clutches her thighs again and pushes.
"No, harder, longer. Take a deep breath. Hold it while we count...." And again.... and again.
Finally a head emerges.
I breathe a sigh of relief. Finally the mother will get to inhale once without holding her breath for the count to ten.
I wait for the doctor to feel for cord around the neck. Instead she graps the baby's head firmly, locking her fingers under it's jaw line on both sides, braces her feet against the base of the hospital bed, and leans back, pulling for all she's worth. "PUSH!" she shouts at the dazed mother.
I watch with horror. The baby hasn't even rotated! How does she expect to pull the little guy out without allowing his shoulders to properly spiral through the pelvis?
The baby doesn't pop loose. Her eyes register panic. I see "lawsuit!" flashing through her mind. She yanks a little harder on the head. Still no baby. "Stuck baby!" the doctor half whispers severely to the nurses. The father has realized that the doctor is frightened and something is dead wrong. Tears squeeze out of his eyes.
"Supra-pubic pressure!" the doctor shouts in the direction of the nurse at her right shoulder. There are four nurses and a respiratory therapist standing by. Three of the nurses dive for the mother's stomach. (Supra-pubic pressure is usually applied with the palm of the hand, pressing down hard on the top of the pubic bone, trying to help the baby's shoulder "pop" out from underneath. It's a maneuver used for shoulder dystocia.)
One nurse lays the bed back flat with one swift maneuver. The other three pile onto the mother, leaning all of their weight into her stomach. She screams. "PUSH!" everyone yells together. "HARDER! HARDER! You've got to get this kid out!" The mother again grips her thighs, now having her knees almost to her ears and pushes with every ounce of strength she has left.
The doctor leans back and with all of her 200 pounds, pulls on the baby as if her life depended on it.
The baby pops out. It's been less then 15 seconds since the head emerged. The doctor quickly grabs a hold of the pink, squirming body of a crying baby and suctions and cuts the cord while uttering a sigh of relief. All that scare and an APGAR of 10. The nurses straighten up, slightly shaky. The parents can't stop crying and shaking. Their little boy is here, but his arrival was the worst minute of their life.
I stand there, still holding the mother's trembling leg and rubbing it and thinking...
About how this birth happened. About how it could have happened differently, if only some common sense had been used and everybody hadn't been in such a rush.
I replay every move over and over. It wasn't a shoulder dystocia. It was a little 6 lb. baby, being pushed out by a woman with a more than ample pelvis. If the baby would have been given another 30 seconds to rotate and line up the rest of his body, he would have slid out with the next push.
I shake my head, feeling sorry for the obstetrician who created her own emergency and is still shaking about the "close call" she had.
I feel most sorry for the mother and father who just went through some of the scariest moments of their life as they welcomed their baby.
The obstetrician tugs on the still pulsing cord, pulling out the placenta and throws it into a basin for pathology to inspect. She asks the nurse to turn the Pitocin up (to keep the mother from bleeding), and then inspects for tearing.
Seeing none, she looks pleased. It's been almost 5 minutes since the baby was born. He is wailing in his little warmer next to the bed. The mother is too exhausted to want to hold him right now, so the nurses are playing with him. The doctor pats her patient on the leg and says, "You look great! You'll be a little sore. Just use ice packs for a couple days. Congratulations! You have a beautiful baby!" She breezes out the door, to deliver the next patient.
I like her. She's a nice, caring woman. She's sweet and friendly. The nurses were great.
But now I know why I don't want a hospital birth. Sometimes I forget.
I'll remember this one for awhile.
Over all, the labor wasn't bad.
I went in with a positive attitude, hopeful of seeing a good birth. I liked the obstetrician - she was an extremely nice woman with a great personality, and seemed to genuinely be enjoying her job. She was very supportive of the mother's desire to have no epidural if possible. Although medical reasons made the obstetrician decide that induction of labor was appropriate, she respected the mother's wishes to keep the Pitocin drip at a minimum and not turn it up once she started contractions.
The mother had given birth in the same hospital twice previously and was well prepared for labor. Her husband was supportive and as helpful as possible.
As labor progressed and the Pitocin induced contractions became more and more unbearable and on top of each other, the nurses were awesome. They provided one-on-one care, basically having someone in the room with us constantly. They, along with the father and I, encouraged the mother to try all sorts of positions - standing, hands and knees, sitting on the birth ball, rocking, etc.
I was even more impressed when the nurses got into whatever positions they had to to continue to monitor the baby's heart rate. It seemed that whenever the mother was in an upright position, the electronic fetal monitor (EFM) just wasn't tracing the heartbeat very well. So, the nurse had to stand there for several hours continuously holding the doppler in place to maintain a tracing. There was absolutely no "I'm really busy. You'll just have to lay in bed so we can get a decent tracing" or any, "I'm sorry this isn't working. We're going to have to put in a fetal scalp electrode." (The obstetrician wanted constant monitoring because of an increased risk of fetal distress with the Pitocin induction.) Care was all focused around what the mother wanted and needed and what made her most comfortable.
I was also impressed with the information that they provided the parents with before taking any action. The mother got vaginal exams when she wanted them, not every two hours or according to any set protocol. The father and mother both didn't want her water broken early in labor. The hospital staff respected their decision and didn't do it till near the end, when the mother requested it.
As I massaged the mother's shoulders and gave the father suggestions for new ways he could support her and asked the nurses to better explain the progress to the couple, I found myself thinking, "This birth isn't bad. It's about as good as hospital birth gets."
Of course, the Pitocin made things miserable for the mother, and more than once she just burst into tears and cried, "I just can't do this anymore!" But every time she got to that point, we managed to re-focus her on dealing with this contraction and just getting through right now. Her obstetrician poked her head into the room at just such a moment, and very quietly, almost reverently watched her experiencing an intense contraction. "Wow," she whispered. "You just never see women willing to do this any more. I'm so impressed."
Ten centimeters came as the sun came up. The shift would be changing soon, but these nurses were excited that they would get to see the fruit of this labor before they left. The doctor was summoned. Mother got back into bed and was positioned in a semi-sitting position. The bed was broke down, and her legs were spread apart while the overhead lights were turned onto the site of action. The doctor gowned and gloved. Two nurses held one leg (since the stirrups were uncomfortable) and I held the other. Sterile drapes were placed everywhere, leaving only the vaginal opening exposed. The father, nervous and excited at the same time, held her hand, and reassured his exhausted, tearful wife that she was almost done. She was so tired, and kept saying, "I don't think I have the energy to push. I can't."
We all assured her over and over that she could and would get her baby out. The doctor leaned in close to her face and looked her in the eyes, "Just listen to me and do what I tell you. Just follow my instructions closely and you'll be just fine."
The mother nodded through her tears, and the father whispered, "Honey, you can do it. Just listen to the doctor."
"Okay, on the next contraction...." The doctor began to explain the process of letting the contraction build, then taking a deep breath and holding it while pushing as hard as possible while the nurses count to ten.
I sighed to myself. Purple pushing. Why do all doctors think that this is the only way to get a baby out? I knew they'd do this. Why do I even hope that this time will be different?
("Purple pushing" is the above described technique, termed such by many doulas and midwives because the mother has so little time to breathe and exerts herself so intensely that she often starts to turn purple and even burst the blood vessels in her eyes. It has been employed at nearly every hospital birth I've ever attended. It barrels a baby a baby out faster than any other method of pushing. A first time mother who might take an hour to push a baby out when allowed to do it at her own pace, will usually push a baby out in less the 20 minutes with this incredibly intense way of pushing. I personally think that purple pushing can be necessary and effective if a baby is in fetal distress and there is a good reason to get the baby out as quickly as possible. If there is not medically indicated reason, I think it just traumatizes the mother's body [tissues don't have much time to stretch and she's more likely to tear, etc.] more than necessary, not to mention that she thinks of pushing as one of the hardest, most exhausting things she's ever done.)
So, the pushing began. "Take a deep breath. Hold it! PUSH!! One.... two..... three..... four.... no, no, don't take a breath yet! Keep pushing down and out as hard as you can!... five.... six... that's a girl!... seven.... eight... nine... TEN! Good push! Now, quick, quick, another deep breath, and down and out! One.... two.... three.... "
(Mother falls back exhausted. "I can't! I have to catch my breath! I can't breathe! Just let me catch my breath!")
"No, honey. Not till this contraction is done." (Pulling her forward) "Take a deep breath right now, and hold it. Hold it while I count to ten... (more insistently) ONE! TWO! THREE! FOUR...."
Ten minutes have passed. We're seeing a baby's head. The doctor comments on all the hair. Mother is gasping for air between pushes and saying she needs to slow down. The Pitocin drip is still going, and the contractions are coming right on top of another.
"No, not till your baby's here. Keep going!"
The nurses get in her face to help her stay with the pushing a little longer. I want to tell her she can take a 10 second break, but that is obviously not the opinion of the doctor.
I tell myself that this is ridiculous, but determine to keep my mouth shut. I'm the doula, not the obstetrician. The doc keeps taking sideways glances at the monitor. The baby's heart rate shows no sign of compromise. It's plugging away with nice short and long term variability around 140, even during contractions with head compression. Wow! The doctor smiles, "Your baby is doing great! Let's hurry up and get him out!"
The contraction ends. Mom falls back on her pillow and sobs and gasps for air. "Just... just let me rest for a minute..." I'm happy to see that the contraction is over and baby is wonderful. Surely they will let her rest till the next contraction hits. The father looks slightly concerned, torn between wanting to help his wife get what she says she needs, and wanting to follow the doctor's orders for the safety of the baby.
But, no, rest is not an option. The doctor wants to get this kid OUT! "You're almost crowning! You can't stop pushing now till your baby's head is out," she says firmly. The mother wearily sits forward, clutches her thighs again and pushes.
"No, harder, longer. Take a deep breath. Hold it while we count...." And again.... and again.
Finally a head emerges.
I breathe a sigh of relief. Finally the mother will get to inhale once without holding her breath for the count to ten.
I wait for the doctor to feel for cord around the neck. Instead she graps the baby's head firmly, locking her fingers under it's jaw line on both sides, braces her feet against the base of the hospital bed, and leans back, pulling for all she's worth. "PUSH!" she shouts at the dazed mother.
I watch with horror. The baby hasn't even rotated! How does she expect to pull the little guy out without allowing his shoulders to properly spiral through the pelvis?
The baby doesn't pop loose. Her eyes register panic. I see "lawsuit!" flashing through her mind. She yanks a little harder on the head. Still no baby. "Stuck baby!" the doctor half whispers severely to the nurses. The father has realized that the doctor is frightened and something is dead wrong. Tears squeeze out of his eyes.
"Supra-pubic pressure!" the doctor shouts in the direction of the nurse at her right shoulder. There are four nurses and a respiratory therapist standing by. Three of the nurses dive for the mother's stomach. (Supra-pubic pressure is usually applied with the palm of the hand, pressing down hard on the top of the pubic bone, trying to help the baby's shoulder "pop" out from underneath. It's a maneuver used for shoulder dystocia.)
One nurse lays the bed back flat with one swift maneuver. The other three pile onto the mother, leaning all of their weight into her stomach. She screams. "PUSH!" everyone yells together. "HARDER! HARDER! You've got to get this kid out!" The mother again grips her thighs, now having her knees almost to her ears and pushes with every ounce of strength she has left.
The doctor leans back and with all of her 200 pounds, pulls on the baby as if her life depended on it.
The baby pops out. It's been less then 15 seconds since the head emerged. The doctor quickly grabs a hold of the pink, squirming body of a crying baby and suctions and cuts the cord while uttering a sigh of relief. All that scare and an APGAR of 10. The nurses straighten up, slightly shaky. The parents can't stop crying and shaking. Their little boy is here, but his arrival was the worst minute of their life.
I stand there, still holding the mother's trembling leg and rubbing it and thinking...
About how this birth happened. About how it could have happened differently, if only some common sense had been used and everybody hadn't been in such a rush.
I replay every move over and over. It wasn't a shoulder dystocia. It was a little 6 lb. baby, being pushed out by a woman with a more than ample pelvis. If the baby would have been given another 30 seconds to rotate and line up the rest of his body, he would have slid out with the next push.
I shake my head, feeling sorry for the obstetrician who created her own emergency and is still shaking about the "close call" she had.
I feel most sorry for the mother and father who just went through some of the scariest moments of their life as they welcomed their baby.
The obstetrician tugs on the still pulsing cord, pulling out the placenta and throws it into a basin for pathology to inspect. She asks the nurse to turn the Pitocin up (to keep the mother from bleeding), and then inspects for tearing.
Seeing none, she looks pleased. It's been almost 5 minutes since the baby was born. He is wailing in his little warmer next to the bed. The mother is too exhausted to want to hold him right now, so the nurses are playing with him. The doctor pats her patient on the leg and says, "You look great! You'll be a little sore. Just use ice packs for a couple days. Congratulations! You have a beautiful baby!" She breezes out the door, to deliver the next patient.
I like her. She's a nice, caring woman. She's sweet and friendly. The nurses were great.
But now I know why I don't want a hospital birth. Sometimes I forget.
I'll remember this one for awhile.
Monday, February 25, 2008
Be Happy! It's a 7lb, 3oz. Baby Girl!
I received this email from a new baby's grandma about week ago. It's the story of millions of American women who don't know whether they should grieve over their surgical birth, or just move on and "be happy" that they have a healthy baby.
After all, what more could they ask for? Their doctor all but promised them a healthy baby.
S/he didn't promise how that baby would arrive, except that it would be in the safest way possible, the best that 21rst century medicine can deliver.
After all, what more could they ask for? Their doctor all but promised them a healthy baby.
S/he didn't promise how that baby would arrive, except that it would be in the safest way possible, the best that 21rst century medicine can deliver.
"Noelle" was surgically delivered before noon today
7 lb 3oz.
They say she has a full head of long dark hair and that she is pink and alert when awake, nursing at least every 3 hours.
They sent a picture of her to my cell phone. The picture of Noelle is now my cell wallpaper.
The interventions and subsequent "fetal distress" were horrific. I cried all day long from anxiety over what they did to "Sarah" [daughter in law] and my granddaughter. They tied her, they trussed her, they starved her, they drugged her, they exhausted her and they terrified her.
After that torture, "fetal distress" was inevitable. (Eeek! fetal heart tones dropped to 127!!)
.... It was all conveniently resolved with major abdominal surgery.
After that torture, "fetal distress" was inevitable. (Eeek! fetal heart tones dropped to 127!!)
.... It was all conveniently resolved with major abdominal surgery.
In spite of the interventions, Noelle was vigorous upon extraction. Oops, no cord wraps or fetal depression after all, hmmm.... But they got the kid conveniently "delivered" during daylight hours and within the 24 hour deadline from spontaneous rupture of membranes (SROM). Another "good outcome" for their stats.
A good outcome on paper. But was it good for mother and baby?
Did the treatment they received increase their chances of safety, of life, of successful breastfeeding,
of bonding, of happy mothering?
A good outcome on paper. But was it good for mother and baby?
Did the treatment they received increase their chances of safety, of life, of successful breastfeeding,
of bonding, of happy mothering?
They had a one in three chance of C-section just by choosing hospital birth in the United States.
But 1 to 3 is 100% if you happen to be the ones sectioned.
It's not like my daughter-in-law was only 33% sectioned.
But 1 to 3 is 100% if you happen to be the ones sectioned.
It's not like my daughter-in-law was only 33% sectioned.
I am grateful that Noelle seems to have weathered the storms of intervention fairly well. But who knows the long term effects? Mommy, on the other hand, is now not only a new mother, but a post operative patient.
There is a place for emergency C-sections. But in this case, the emergency was created by the very system my loved ones blindly trusted to provide "safety".
I was painfully aware of the peril they were entering with their choice of care and helpless to avert the impending tragedy.
I did what I could to provide accurate information and techniques for dealing with a system that is more about avoiding medical liability than supporting the normal process of birth. (And I had prayed that they would "luck out" and end up being blissfully ignorant of the dangers they had avoided.)
I did what I could to provide accurate information and techniques for dealing with a system that is more about avoiding medical liability than supporting the normal process of birth. (And I had prayed that they would "luck out" and end up being blissfully ignorant of the dangers they had avoided.)
I am so angry at the successful "sale" of "services" with which my loved ones got a total "bait and switch".
The reality of grandmotherhood has not really set in. I SO want to be happy.
And I am grateful for the precious child.
But I am heartbroken by the inhumane way she and her mother were treated at such a crucial time in their lives.
And I am grateful for the precious child.
But I am heartbroken by the inhumane way she and her mother were treated at such a crucial time in their lives.
Thankfully, Sarah planned to breastfeed which seems to be going fine.
It's tomorrow now. Maybe I have cried myself out and I can get some sleep now.
Saturday, January 5, 2008
What Are the Risks of Cesarean Section?
What are the risks of having a Cesarean section? …The risk of having two, even three C-sections? …For the mother, for the baby? 
What are the risks of vaginal birth? …For the mother, for the baby?
Hearing women talk about cesareans has often made me wonder exactly what the average pregnant woman does and doesn’t know about having a c-section when she walks into the hospital to give birth. I’m on a mission to find out…
Is she adequately informed of the risks? Does she have a clear idea of the risks and benefits? Does she know as much about this procedure on her and her baby’s body as she does about purchasing her new car and comparing models?
I checked out What to Expect When You’re Expecting, and no where in its 437 pages could I find even one paragraph informing mothers of the potential risks for themselves when undergoing Cesarean delivery. The most I found for mothers was information on what a C-section would be like and how to be calm as you were wheeled back to the operating room for an emergency c-section, and then what recovery would entail – pain around the incision, possibly nausea and vomiting, possibly referred shoulder pain for a few hours and possible constipation, then it should be 4-6 weeks before you feel completely back to normal.
And this quote to put everyone’s fears to rest –
Question: “My doctor told me I will have to have a cesarean. But I’m afraid the surgery will be dangerous.”
Answer: “Today…cesareans are nearly as safe as vaginal deliveries for the mother, and in difficult deliveries or when there’s fetal distress, they are often the safest mode of delivery for the baby. Even though its technically called major surgery, a cesarean carries relatively minor risks – much closer to those of a tonsillectomy than of a gall bladder operation, for instance.”
Hmmmm…I’ve heard a few other things about cesareans recently. I’ll post them here as I get a chance…
Saturday, December 29, 2007
The Making of Mothers
"It's not just the making of babies, but the making of mothers that midwives see as the miracle of birth."
-- Barbara Katz Rothman,
Sociologist, Author of The Tentative Pregnancy,
Genetic Maps and Human Imaginations and other books.
Ina May Gaskin has this quote up on her site: http://www.inamay.com
as the "quote of the week," and I just couldn't resist posting it here.
It's so true. People ask me how midwifery care is different from seeing an OB for a monthly prenatal check-up. Sometimes it's hard to articulate exactly what it is about the Midwives Model of Care that compels mothers who have experienced it to do almost anything to find a midwife for their next pregnancy. People in the medical field are baffled as they almost never come back to the obstetrical model of care. Why?
This quote sums it up, I believe.
Monday, December 24, 2007
A Christmas Wish for Birthing Women
As everyone rushes around, gathering with family and friends for Christmas, baking cookies, piling their cars high with gifts, and eating more than ample portions of Christmas candy and sweets, I’ve thought about what I really want this Christmas.
What I want isn’t tangible, and I won’t get it tomorrow morning as a Christmas gift.
But I still wish for it, for my future, and that of every young woman who will someday face the prospect of pregnancy, birth, and motherhood.
I dream of the day….
~ When pregnant women are honored and treasured by society as life-givers and very special people.
~ When all women will be informed and educated about their bodies, birth, and babies.
~ When maternity care providers will believe that parents are good decision makers when presented with accurate information.
~ When every woman will have access to a midwife, a doula, a physician, a circle of supportive friends and anyone else she needs or wants to give her the best pregnancy possible.
~ When pregnant women walking through the grocery story will hear, “You can do it!” instead of, “I hope you signed up for an epidural! You have no idea how bad it hurts!”
~ When women aren’t expected to have perfect bodies that show no signs of having carried and birthed a baby.
~ When birth and babies again belong to mothers and fathers…. Not the state, not the American Medical Association, not the insurance companies, or the hospitals or obstetricians.
It won’t happen overnight, but it can happen when committed people work to change their own little corner of the world.
You may not be able to transform your local hospital’s policies, but you can educate your daughters, the girls in your neighborhood, your classmates and colleagues about birth.
You may not be able to stem the rising C-section rate, but you can help this mother avoid an unnecessary one.
You may not write a book that improves birth for other women, but you can write a letter to the newspaper about women’s birth options in your area.
You may never get everyone to breastfeed, but you can convince some people of the huge difference it can make in the future health of any baby.
You may never appear on a talk show about birth, but you can talk to your friends about improving birth.
You may never change the world, but you can change your world!
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