Nov 18, 2010

Mistakes in Labor: Part 2

Doulas are so important!! A doula is a hired non-medical support person and they are invaluable for support of the mother *and* the father during the pregnancy, labor, and immediately postpartum. Doulas can help you find comfortable positions to labor in, advocate for the parents wishes and birth plan, offer encouragement, comfort, support, massage, hip compresses, etc.
Why this is important to know: Moms and dads play very different role in the labor and delivery room. Moms are often focused on trying to do the biggest job of her life, where some fathers often just want to do anything to make their wife comfortable, even if she has elected to have a natural delivery. A doula acts as a cheerleader for the family, as well as a lookout to make sure her care providers are following her wishes.

Anecdotal evidence: I had a doula in my last two deliveries, and I have hired one once again for my upcoming delivery. The role of a doula in a home birth or a hospital birth are both extremely important. My doula in Matthew's birth was my eyes and ears when I was being told one thing, but the nurse was doing the exact opposite. She helped me find ways to get comfortable. In the end, the Pitocin proved to be more than I could handle, and I opted for an Epidural. It was my doula who helped distract me while I tried to rip my flesh on my face and chest off because I was itching so bad while I waited for another medication to take away the itching. It was the doula who recognized that I was probably complete (by my actions and descriptions, she didn't examine me).
In my homebirth I was lucky enough to have two doulas; my own doula was helping another doula get her certification and she needed some births under her belt. Both played an amazing role, from keeping spirits high, to helping me move my baby into the correct position, to keeping me hydrated and confident. I really wish I had a doula in my first delivery (I had never even heard of them), because although I had support from my mom and husband, they didn't like seeing me hurting and didn't try to talk me out of medication when I started to have a hard time coping. The didn't know different techniques I could use to get through the contractions, they didn't know ways to help ease back pain. Remember: Each person wears one hat. You may think your midwife would make an excellent doula, but doulas they are not! Don't expect your birth team to come in with more than one role! :)

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The freedom to move, eat, and drink is invaluable! Being stuck in bed, tied to monitors is counterproductive to labor. Along the lines of my last post about declining procedures, finding an OB or Midwife that will allow you the freedom to labor as you need will help make the process a lot more comfortable.
Why this is important to know: In the normal labor process, movement is important. Nurses will typically have you "walk the halls" in early labor, but then as you get farther along will want you to stay in bed for continuous monitoring. Contractions are typically harder to handle if you are stuck on your back unable to sway your hips, bounce on a ball, or listen to your body and baby to find a comfortable position.

Anecdotal evidence: I found laboring with an empty bladder was more comfortable, but waiting for the nurses to unhook my monitors made emptying my bladder a huge hassle, especially if I had to drag around a pole with IV fluids hanging from it. And once an epidural is in place, most providers will place a catheter to keep you from leaving the bed. Once you are laying down, you remove gravity from the equation and you no longer have the option of allowing the baby to move down with the help of movement and gravity. I also have little faith in contraction monitors, I don't feel their are exactly effective as I have had very productive contractions barely show up on monitors, and even though my body was making progress, these strips were used as a reason to "move things along with the help of some Pitocin" or tell me I just wasn't making progress when I was. My babies hate the doppler and like to run away from it, so I felt a lot of the time nurses were spending more time chasing the baby or moving the strips and disrupting my concentration. Finally, some women want to eat and drink in labor, I know I loved cool sips of water or gatorade between contractions with my daughter, and ice chips just doesn't do it for my thirst.

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Don't forget about dad! Often times dad is overlooked when mom is packing her bags, touring the hospital, or making birth plans.
Why this is important to know: Your partner is your most important support person, and if they don't keep their strength up, they can't be as effective as a support person.

Anecdotal evidence: I typically have prodromal labor (early labor that starts and stops for several days or weeks) and this can be exhausting for all. In my first birth, my poor husband hadn't slept in probably 24 hours before the birth. When he had a chance, he would nap in a hard chair and we never thought to ask if there was a better option. Turns out, two of the chairs turns into beds. We also were not told this when I was in the postpartum room and he ended up leaving the hospital to stay with a friend so he could sleep. We also didn't think to have clean clothing for him, cash for food, snacks, etc.

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Do your research. This is the most important part of pregnancy, delivery, and parenthood! Don't have regrets, you don't get a do-over.
Why this is important to know: Just like you cannot un-ring a bell. Choices you make the first time around can affect the rest of your life. Something as simple as consenting to an induction because you are tired of being pregnant at 3 days overdue can cause a domino effect you cannot predict or stop. One intervention often leads to another and you may be left with an experience that you still regret decades later.

Anecdotal evidence: I have tons of regrets that are so personal to me I won't go into them, some that didn't just cause regrets with my first child, but every child after that. However you live and learn, you do your research, and you try to get past regrets knowing you did the very best you knew how.

Nov 13, 2010

Mistakes in Labor: Part 1

Since these will be long, I am going to break them into sections. This part will cover: Irregular Contractions, Pitocin, and Pain Relief.

I have always felt birth should be natural, but it seems like no matter how good my intentions were in the past it seemed that my desire for a hands off birth were out of reach. I hope by sharing some of my mistakes with you, I can help others who may be misguided or unaware.

Not everyone has regular contractions! It seems the books all tell you that the hallmark between real labor vs. false labor is regularity of contractions, but I am here to tell you, that is NOT the rule and there ARE exceptions.
Why this is important to know: Often times caregivers may suggest a drug called Pitocin (more about that later) to regulate contractions, but do your research, sometimes irregular contractions ARE making a difference and moving labor along.

Anecdotal evidence: I have had three deliveries, two in the hospital augmented by Pitocin, one at home without any intervention. In all three labors my contractions were irregular, even after Pitocin was maxed out in the first two pregnancies, despite being told it would regulate them and was necessary to "pick things up", it only did the later, they still stayed irregular. And guess what, I still managed to give birth all three times!

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If you are told Pitocin won't make your contractions any more intense, or more difficult to get through... they lie! Pitocin is a synthetic form of oxytocin, the hormone your body naturally creates to stimulate contractions. The decision to use Pitocin is not one to take lightly. I am not saying it is evil, or does not have a place in obstetrics, but it can have some serious consequences.
Why this is important to know: Some of the risks of Pitocin are:
* fetal distress
* more likely to request pain medication like an epidural
* cesarean section
* uterine rupture
Not only does Pitocin cause contractions to be harder to manage, they can also start a domino effect of interventions leading to a cesarean section, or cause unnecessary stress on the mom and baby.

Anecdotal evidence: Watch any birth show on TV and you will see story after story where Pitocin is introduced. Baby's heart rate starts dropping and mom is rushed off to the O.R., or, the mom is given Pitocin, the pain is too much for mom to handle and she gets an Epidural and then has complications from the Epidural.

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Myth: An Epidural is the only way to make labor comfortable. Epidural anesthesia is the most common method of pain relief in labor. However, sometimes there are serious (and some not so serious) side effects. The most serious being maternal or fetal death, but the more common complaints by women are the inability to move freely, being tied to the monitors, not being allowed to get up to use the restroom, itching, a drop in blood pressure, headaches, nausea and vomiting, shivering or shaking, backache, uneven/incomplete/nonexistent pain relief, feelings of regret. Epidurals can also cause the baby to have changes to their heart tones, cause a poor sucking reflux and lethargy, and leads to a higher rate of cesarean sections.
Why this is important to know: Epidurals have become so routine in hospitals now days, that some women do not know there are alternatives for pain relief, or that they may have regrets later. Several childbirth classes, such as Hypnobabies, Hypnobirthing, Bradley, etc, have very high success rates in helping a mom cope with normal, un-augmented labor. Other methods may be walking, changing position, rocking in a rocking chair, bouncing on a birthing ball, massage, hip compresses, laboring in a hot bath tub or shower, visualization, reassurance, etc.

Anecdotal evidence: I mentioned I had two Epidural deliveries, and one without an Epidural. Between Hypnobabies, a birth pool, my Doula and support, my natural labor was FAR more enjoyable than my medicated deliveries, without any side effects.
Also, did you know that Epidurals can interfere with bonding? In labor, our body produces beta-endorphins to help us cope with the sensations of birth and make the changes easier on our bodies. These beta endorphins cause an amazing surge of euphoria unlike anything I can explain. The feeling is amazing and creates a bonding experience like no other. Not only was my daughter more alert after my natural birth, but afterward *I* was more alert and my husband and I bonded so well with our newest family member.

Stay tuned for Part Two.

Nov 12, 2010

Mistakes in Pregnancy

I had a nice sobering wake-up call this week that has really rocked my world and shaken me to the core. I am not ready to post the entire story yet, because it is still playing out, but I would like to talk about things I have learned in my pregnancies

You are the boss! Did you know that your caregiver is your employee? They work for you, and if you feel mistreated, unappreciated, or not taken seriously, YOU have the right to fire them and find someone new!
Why this is important to know: Sometimes we forget that we have the power to be treated the way we want to be treated, and will take the abuse of someone in power because we tell ourselves they know best.

Anecdotal evidence: I fired a midwife in Sophie's pregnancy because she was down right fear-mongering. She told me because I was not at my ideal body weight at the start of pregnancy I WOULD (not could) have gestational diabetes, high blood pressure, and likely end up with a cesarean section. The other midwife in the practice told me several times she thought I was going to miscarry because I had some minor bleeding in pregnancy and she thought my hCG (the hormone in pregnancy that increases as the baby grows and is what pregnancy tests test for) was too low (it wasn't). After my 12 week visit, I followed my gut and I fired the practice and found a new group. With just a few weeks left, when my new midwife wanted to transfer my care to her partner (and OB I did not like), I left their practice too and found a home birth midwife. It is never too late!

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You don't have to take any test you don't agree with! Did you know that you have the power to waive any procedure or test? You may have to sign a waiver, but if you don't agree with the test, decline!
Why this is important to know: There are some tests that can cause unnecessary worry or inaccurate results in pregnancy. I personally will not get a pap smear in pregnancy, even if I am due for one, because I have never had an abnormal pap and there is a higher chance of bleeding, infection, and inaccurate results in pregnancy. I will wait until I am six weeks and have no problem declining the test. I also do not do the 15 week tests that check for birth defects (triple screen, AFP, nuchal fold, etc) because I decided it would not change the outcome of the pregnancy as I would not abort over elevated/irregular results.

Anecdotal evidence: I have known more than one woman who had irregular results and the stress that it created for the woman over a test that ended up being normal in the end was harder on the woman than need be. We have all stressed over test results unnecessarily, but so the research and ask yourself "Do I believe this test has a high accuracy rate?", "Do I agree with how this test is taken?" (ie Gestational Diabetes, not every lab has the same rules for fasting vs. non fasting, cutoffs, etc), "Would these results change my pregnancy?" (genetic tests are taken early so you can chose to abort or not, if they showed an anomaly, would you abort?) "If this test is positive, would I agree to more invasive tests for higher accuracy?"

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You don't just have to suck it up and take it when it comes to the symptoms of pregnancy! Almost every symptom of pregnancy can be eased or relieved with supplementation, medical, or alternative therapy.
Why this is important to know: Sometimes we just deal with it because we think we have to. There are remedies for leg cramps, swelling, morning sickness, aches, headaches, etc.

Anecdotal evidence: For morning sickness things to try include eating small, frequent, high protein snacks, wearing sea bands, avoiding fried fatty foods, and wearing Sea-Bands can help ease nausea and vomiting. Heartburn can be helped with papaya enzymes, and liquid calcium/magnesium. Swelling can be eased by swimming in a pool and making sure you are getting a good balance of electrolytes. Back pain can be aided with the help of a chiropractor. Calcium/magnesium before bed can prevent charlie horses. If you talk to your caregiver, friends, family, search the internet, talk to a naturopath, you may find all sort of ways to make your pregnancy more comfortable. Some symptoms can only be eased, but some can be avoided all together!

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You are not alone! Pregnancy is tough, seek out support and friends. There are so many Due Date Clubs, forums, local playgroups, groups, etc.
Why this is important to know: Pregnancy and postpartum can feel socially isolating. When you are too tired with a newborn to shower, or too weak to take your other kids to the park because of an all day marathon of hugging the toilet, there is a lot of guilt that comes with it. Knowing you are not alone can make a world of difference!

Anecdotal evidence: When I had my first son I felt so isolated and alone. I had problems with breastfeeding and I never knew the problems I was experiencing were NOT normal because I didn't have anyone to compare notes with. By the time I had my 6 week checkup I found we had a case of thrush that lasted FIVE MONTHS and eventually caused us to switch from breastfeeding to bottle feeding.

Stay tuned for my next post where I will discuss Mistakes in Labor.