Showing posts with label Epidurals. Show all posts
Showing posts with label Epidurals. Show all posts

Wednesday, June 23, 2010

The positive impact of prenatal exercise

The following is a re-post of my August 2008 post Wanna Improve Your Odds?:

I mentioned back in April that I had been skimming the book Exercising Through Your Pregnancy, by James F. Clapp M.D. I was really impressed at that time with the amazing benefits of exercising through pregnancy. But I didn't read the book in-depth. I decided earlier this week that I wanted to take a closer look. Now that I've read several of the chapters and examined the data thoroughly, I am telling you... it absolutely blows me away.

There are risks inherent in pregnancy and childbirth, but we can do things to minimize those risks. We all know that good nutrition is essential for pregnant women. Poor nutrition often leads to pre-term and low-birthweight infants as well as pre-eclampsia in mothers. Eating well is one of the absolute best things you can do for your unborn child's physical and neurological growth. But now I'm convinced that exercise may be just as important.

I won't go into all the benefits of prenatal exercise here. I'd just like to focus on one set of benefits in particular--the effects of exercise on the course of labor. You might remember my very early post about the benefits of doulas. Having a doula assist your labor and delivery reduces many chidbirth risks significantly. Prenatal exercise has even more pronounced benefits.

Women who continue exercising regularly through the end of their pregnancies (three times a week for at least 20 minutes at a moderately hard to hard level of exertion) demonstrated the following reduced risks during the birth process...
* 35% decrease in the need for pain relief
* 75% decrease in the incidence of maternal exhaustion
* 50% decrease in the need to artificially rupture membranes
* 50% decrease in the need to induce or augment labor with pitocin
* 50% decrease in the need to intervene because of abnormalities in the fetal heart rate
* 55% decrease in the need for episiotomy
* 75% decrease in the need for operative intervention (forceps or cesarean section)
In addition, check these out...
* More than 65% of the exercising women delivered in less than four hours.
* 72% delivered before their due date (but fewer of them delivered before 37 weeks--preterm--than the control group). The exercising women delivered, on average, 5-7 days earlier than active women who did not exercise regularly.
* Significant reduction in the incidence of umbilical cord entanglement.
* Much lower incidence of fetus passing meconium from distress.
* Umbilical cord blood samples indicated that babies of exercising moms remained relatively stress-free with plenty of oxygen. They seemed to tolerate the stresses of labor and delivery better than the control group.
* The exercising mothers' infants were, on average, 14 oz lighter but overall growth was not compromised.
* Placentas of exercising mothers are larger, more efficient, and healthier-looking.
* Infants born to exercising mothers were more alert postpartum and needed less consolation from others.
(All of these results are taken from Dr. Clapp's studies as reported in Exercising Through Your Pregnancy. See this fabulous book for even more amazing benefits.)

It blows my mind.

Imagine how huge the risk reductions would be if you exercised through pregnancy AND had a doula. Whoah. We can do so much to avoid the pitfalls of pregnancy and birth. It gives me so much joy and hope to know that I am not at the mercy of chance. I have a great deal of power over my circumstances when it comes to pregnancy and birth. It is a wonderful thing to be able to choose to pro-actively reduce risks and bring so much benefit to myself and my babies. I love it!

Tuesday, April 6, 2010

Hear me roar

After a few weeks of caring for her precious first-born baby, my friend Fig declared, "Motherhood is blood, sweat, and tears. Rinse and repeat." Are you nodding and chuckling at the same time? Fig's good at inducing the chuckle-nod. She's so witty. And right on.

So I've been thinking, of late, about how I focus so much on the intense physical challenge of labor (some, including me, call it "pain") that I have sort of neglected to give attention to other physical "pains" associated with bearing and nurturing children. For example...

* The cramping associated with ovulation and/or menstruation is painful for some women.
* PMS can cause painful bloating, headaches, etc.
* Love-making is painful for some women.
* Some women experience round-ligament twinges and/or cramping in early pregnancy.
* Morning sickness can range from mildly bothersome to excruciatingly miserable.
* Some pregnant women suffer with back pain, sciatic nerve pain, joint pain, etc.
* Preterm labor pains keep some women on bed rest for weeks or months.
* Then there are the after-pains (I think they get worse with each birth... wowza!).
* Some women endure general perineal tenderness, pain from perineal tears/episiotomies, or cesarean section wounds.
* Breastfeeding hurts like the (toe-curling) dickens in the beginning, being compounded initially by painful breast engorgement, painful milk let-down, and more intense after-pains due to the uterine contractions produced by suckling.
* The muscle strain from carrying around a 5 to 10 lb newborn can lead to sore arms and/or sore backs, especially with a first child.
* Once an infant has teeth that introduces a whole new kind of potential pain during breastfeeding.
* Back pain can continue and intensify from carrying increasingly hefty babies and toddlers.
* Rinse and repeat.

(And that's not even getting into the emotional pains we endure.)

The other day a first-time pregnant woman I love told me she's pretty sure she'll get an epidural 'cause she's (and these were her exact words) "such a pansy." I couldn't help myself... I rushed toward her, grasped her face in my hands, and said, "No! You're not!" This woman has endured excruciating menstrual cramps every month for over a decade followed by miserable morning sickness for the last couple of months... and she thinks she's a "pansy!"

Look at the list above, ladies. Take a good, long look at it. Do you really think God would entrust those challenges to a bunch of pansies?



Nope.

We are women. We are strong. We can push ourselves to our absolute limit and somehow find the strength to push some more. And then rinse and repeat.

Don't you dare call yourself a pansy. 

 (Photo by Fife Photography, Fall 2005)

Saturday, February 6, 2010

Curvy

About two years ago I went to a chiropractor, hoping he could help me figure out why I had chronic pain in my right shoulder blade region. (It still plagues me to this day.)

Wow. That's what I thought when I saw the x-rays of my spine. Wow. Holy cow. Good grief!

Back when I was a teenager I was diagnosed with scoliosis, but they watched it for a while and it never became more than "mild" scoliosis, so they sent us on our way and I sort of stopped thinking about it. Until the pain started several years later. When I was lying "flat" on my back, things just didn't seem to be where they were supposed to be. I was definitely right! As we stood there looking at the x-rays, I thought to myself, hmmm... that doesn't look like "mild" scoliosis to me! The chiropractor concurred. Mommyhood had taken its toll and made my curvy spine even curvier.

What does this have to do with birth, you're asking?

A recent post by Rixa alerted me to something fascinating. It's totally logical... one of those things you learn and wonder how you never thought of it before. Scoliosis and epidurals aren't always compatible. Makes sense, huh? I really don't know how it never occurred to me before.

So I just googled "epidural scoliosis," and found quite a few stories from women with scoliosis on forums and Q&A sites. It seems to be hit or miss. Some women with scoliosis had no trouble, but they seem to be in the minority. Most of the women with scoliosis fell into one (or more) of these categories:
1) They forgot about their scoliosis until the anesthesiologist pointed it out. It took some time to place the epidural, but it worked fine.

2) Placing the epidural was extremely difficult. The anesthesiologist had to poke them multiple times, sometimes excessively, and they suffered back pain for days, weeks, or months after the birth.

3) The epidural only worked on one half of their body or only worked when they positioned their body a certain way. Most of these women went on to choose natural deliveries for subsequent children and raved about how much better they were compared to their complicated epidural experiences.

4) Their OB recommended meeting with the anesthesiologist in advance and bringing along x-rays to ensure everything would be smooth.

5) They were told an epidural would not be possible because of the severity of their scoliosis. They opted instead for a spinal, a c-section under general anesthesia (Seriously... one lady's doctor let her have an elective scheduled cesarean because her scoliosis was incompatible with an epidural. Seriously.), or a natural delivery.
I feel so fortunate that I didn't have to learn these things the hard way. What if I had gone into my first birth expecting the epidural to save me from the agony? I think an unmedicated birth is so much more painful and difficult when it is unwanted and the mother is completely unprepared for it. It never occurred to me to mention my scoliosis to my OB or hospital nurse. I wonder how many women with scoliosis have miserable births because, like me, they didn't realize it could impact their experiences.

I also discovered through my internet digging that scoliosis can affect fundal height measurements. One women was told she would give birth to a 10+ pound baby because she was measuring so "big." Her child came out a 7 pounder. If you have scoliosis and your doc starts pressing for an induction or cesarean for a suspected "big baby," keep this in mind. Spinal curvature just might be misrepresenting the size of your baby. When I imagine hours of bone-crunching pit-contractions followed by an epidural that only works on half of my body followed by months of back pain from the multiple insertion attempts... all for an unnecessary induction... Ugh. NO thanks.

Fascinating stuff.

Sunday, October 25, 2009

No medals here

Wow. Huge thanks to Jill (The Unnecesarean) for sharing this fabulous post by Arwyn: "Just like athletics: exploring a childbirth analogy." Jill described it as her "favorite breakdown of the childbirth-athletics analogy," and I have to agree that it is definitely my new favorite as well.

Arwyn eloquently discusses how our culture is quick and eager to praise, admire, and encourage those engaged in athletic feats--marathons, sporting events, and even local 5Ks, but when a woman attempts natural childbirth (a likewise challenging physical feat), she is lucky if she finds one or two supporters to cheer her on. Instead, far too often, it is those on the sidelines who should be her loudest cheerleaders who tell her she "can't do it."

I am personally saddened and disheartened when I (frequently) hear women tell me that it is their husbands who say, "You're definitely not tough enough for a natural birth," or who "can't bear to see her in pain," and thus push her toward an epidural. Would they also suggest that she's not tough enough for a marathon, if that was her goal, or stop her in the last grueling miles of the race and say, "You need to stop... I can't stand seeing you in so much pain"? I certainly hope they wouldn't. All this stuff has brought to mind this post from last June--"Nobody thinks you're a hero."

Here are a couple of teasers from Arwyn's post:
Everyone has heard of and no one doubts the existence of “runner’s high”, so why do we start plugging our ears and rolling our eyes and flapping our tongues when we speak of “birthing high”? Just as in athletics, in the absence of intolerable pain and unnecessary interferences (the latter of which is all too often responsible for the former), birthing has the potential to produce the most delicious chemical cocktail which feels good. (Divine even: I certainly felt like a birthing goddess afterward.) Even discounting that, or in its absence, there is potential for pride and a sense of accomplishment: something we value so much in athletics, yet scoff at in childbirth, where our effort benefits both us and another. We deny women that pride in accomplishment (for which support of athletics is so vital to girls’ sense of self and women’s equality), that boost in self-esteem and feeling of competency, right when we need it most: at the start of parenting, one of the most demanding journeys a person can undertake. . . .

But the current cultural construction of birth must change: not by moving backward to a time when women had no options in childbirth, and were expected — even encouraged — to suffer, and in which there were no medical interventions for when they were truly needed; but forward, to a time when our bodies are valued, our spirits are supported, and the work of birth is seen as hard, yes, and even sometimes painful, but within reach of most of us, and oh so worth it: just like athletics.
And some pics, for fun...

My dad (in the blue hat) finishing the Boston Marathon as a 50th birthday gift to himself, with his friend, and my (now deceased) brother, Steven, running the last 5 miles with him (behind my dad)...Me and my husband with his Boston Marathon finisher's medal (April '08)...My husband helping me run my first 10K, the longest race I've ever run...And then again, helping me through one of the most difficult (and best) experiences of my life (with my doula as another cheerleader)...So much better than a medal...

Saturday, August 22, 2009

What do you THINK?

I was sitting at the table eating dinner the other day, and my baby boy started acting like he was ready to nurse. I started thinking about taking him over to the couch to meet his request, and BOOM my milk let-down. I'd wager most nursing moms have experienced this chain of events hundreds of times.

That experience got me thinking. All I have to do is think about nursing my baby and my body responds within seconds. The salivation reflex is similar. You start thinking about something delicious and BAM... your mouth is ready for it with a gush of saliva.

And that got me thinking about how interconnected our thoughts and our biological processes are. Our thoughts can create almost instantaneous physical reactions! How amazing is that?! And how frightening too. It all depends on what you are thinking about.

So let's take this concept into the realm of birth. How can our thoughts affect the birth process? Michel Odent was the first to apply the phrase "fetal ejection reflex" to human birth. Odent has observed that when childbirth is undisturbed, delivery is an involuntary, reflexive process occurring extremely quickly and effortlessly. In order for this reflexive process to occur, a woman must be in a certain type of environment. A California College of Midwives bulletin explains:
For many mothers her need to be undisturbed is balanced by an equally powerful need to be in the “right” place and have family members of great psychological importance, as well as the doctor or midwife present, before she can “permit", at least at a subconscious level, that dynamic labor process to unfold. For those who prefer hospital care, these mothers must have arrived at the hospital before the Maternal-FER [Maternal-fetal ejection reflex] can complete itself (source).
Being at a hospital (or an interventive home birth) can also produce the opposite effect--essentially shutting-down this reflexive process:
One theory explaining M-FER is the role of primitive brain in facilitating the spontaneous processes of labor and birth. This theory also identifies as negative the influence of the neo-cortex . . . and a host of institutionally-originating disruptions such as bright lights, loud noises, coming and going or milling about of unfamiliar people, unnatural, anti-gravitational positions and frequent disruptions provided by invasive procedures such as vaginal exams, catherizations, fussing with EFM belts, etc. The “intensive care” nature of intrapartum nursing in hospitals means most women experiencing the exact opposite of “secure and unobserved” – all these nursing and medical ministrations and application of technology signal the potential for problems. They worry about themselves and their baby and feel very much like a bug under a microscope (source).
Where we are, who is with us, what they are doing, what we are thinking (or not thinking) about... all of these things have an impact on the birth process.

I saw this truth first-hand with my 2nd and 3rd births. My second daughter's posterior on-again-off-again labor didn't kick into gear until I finally said, "This has to be the real thing. We're going to the hospital!" And she was born (still posterior) within 3 hours of that thought. As I labored with my son, I am certain that my thoughts and psychological state slowed the process until my midwives had arrived and my husband was finished putting my daughters to bed. Once all the essential players were present, I surrendered to my body. My son was born less than 2 hours later. Though I wouldn't describe either of these births as fetal-ejection-reflex experiences, they did demonstrate the profound power of our thoughts and emotions as we give birth. (I hope to experience the true fetal-ejection reflex someday!)

It makes me all the more wishful that we could guard all women from negative influences or comments in their labors. A friend told me this week that she had planned and hoped for a drug-free birth with her first daughter, but her nurse told her, "Honey, you can't do it." Imagine what kind of thoughts that negative statement produced in her! Of course she got an epidural. (And chronic back pain at the epidural site to go with it... still bothering her over two years later. Fortunately she was able to have her son without drugs and had a vastly better experience.) Women in labor internalize what they hear. What might be a simple statement can have a huge impact on her thoughts and thus her body.

I'm looking forward to exploring this topic further. What do you think about when you're in labor and giving birth? Do you think it affects the process? I'd love to hear your experiences.

Friday, April 24, 2009

Pitocin on the brain

I've got Pitocin and induction on the brain. In large part because I'm about halfway through Pushed, by Jennifer Block, and just finished reading about the consequences of Pitocin and labor induction. Here are some sobering excerpts...
"A British midwife told a researcher that the sounds women make when they're on artificial oxytocin [Pitocin] are hauntingly different: 'It's a panic, it's a scream and it's different from the noise they make when they're working with their bodies. . . . It sounds like someone's being murdered'" (p. 135).

"And with an epidural deadening the body's natural pain threshold, staff can keep upping the dose, which can lead to contractions that fire like a machine gun or that last for minutes, during which time the fetus is oxygen-deprived. This is called hyperstimulation. It is not uncommon and would be considered a trauma--beyond what is normal" (p. 137).

"A recent ACOG survey found that in 43% of malpractice suits involving neurologically impaired babies, Pitocin was to blame" (p. 137).

"Even Williams Obstetrics offers a sobering history: 'Oxytocin is a powerful drug, and it has killed or maimed mothers through rupture of the uterus and even more babies through hypoxia from markedly hypertonic uterine contractions'" (p. 138).

"A 2004 study out of Australia found that autistic children were twice as likely to have been born without natural labor, either by elective cesarean or induction" (p. 139).
Pitocin use in U.S. hospitals has increased alarmingly in the past couple of decades. In 1990, only 9.5% of labors were induced. In 2006, in a study of 5500 low-risk, first-time mothers, 40% were induced and 70% received Pitocin at some point during labor (see Pushed, p. 5-6).

I can see these stats reflected all around me. I know very few women who have given birth without Pitocin dripping through their veins. If it's true that 70% of low-risk first-time mothers are given Pitocin, then it's no wonder birth horror stories and epidural use are the norm. How strange that so few women know what normal birth actually feels like. Instead they have a warped and painfully skewed misrepresentation. We are human beings, but yet so far removed from the most basic human experience.

The truth is that we really don't know how these highly-medicalized births may be influencing and possibly damaging our society. Oxytocin is the hormone of bonding and love, so some suspect that these births (virtually devoid of natural oxytocin) may be partly to blame for the increased violence, autism, and other mental and psychological disorders running rampant in our modern world. Pitocin (and cesarean sections) may also influence how we bond and how we respond to our children as parents.

I've never had Pitocin in labor, but I was given Pitocin through my IV following my first daughter's birth to help slow my bleeding. It wasn't until a couple of weeks ago that I had an epiphany about that Pitocin drip. It's almost certain that once Pitocin was introduced into my system, my body stopped or slowed its own oxytocin production. Artificial oxytocin doesn't produce the same bonding effects as the hormone produced by our own bodies. It wasn't until roughly a week after her birth that I "fell in love" with my daughter. I thought there was something wrong with me... why didn't I love her right away? I'm now quite certain that Pitocin interfered.

There are certainly plenty of women who fell in love with their babies at first sight even with Pitocin or cesareans. But not all women do. Everyone's individual body chemistry is unique. If I could struggle even having had an unmedicated, wonderful birth experience, I have to wonder what it would have been like for me if I'd had drugs or a cesarean... I shudder to think where those paths might have taken me...

Then I contrast those struggles with my most recent birth, and I'm in awe. As my births have gotten progressively more "natural," bonding has gotten progressively easier. And my parenting style has gotten progressively more responsive. I spent the first couple of weeks after my son's birth feeling blissed-out and totally and madly in love with him. In fact, I could hardly bear to be separated from him. What a change from my Pitocin-jolted postpartum experience!

Pitocin has its time and place. But there's no question that it--and the droves of women and babies receiving it needlessly--are being abused. Will we stand by and let this abuse continue?

Thursday, March 19, 2009

The Doula Difference

I wrote this post last month for my personal/family blog, but I wanted to re-post it here for those of you who haven't seen it. :-)

I think every laboring women needs a doula. And here's why...

1) Doulas are nothing new.
A lot of people, when they first hear about doulas, think... oh, that's new. But it's not at all. For thousands and thousands of years women have been supported by other women during childbirth. We watched an awesome film at our training called "The Timeless Way" which showed the history of childbirth starting with ancient artifacts and moving to more modern depictions. I was struck how the very same image was represented through sculpture, wall carvings, pottery, and art over and over and over again. It is the "classic birth triad"--an upright laboring woman supported from behind by another woman, with a midwife in front ready to catch the baby. It has only been in the last century that this "classic birth triad" has all but disappeared. Doulas are not new. Modern obstetric practice is what has strayed (very far, I might add) from the time-tested norm.

2) Women need a "buffer" (i.e. Hospitals and drugs mess with birth).
Don't get me wrong. I am so grateful we have hospitals and drugs to handle birth complications (which do happen!). But, really, when used excessively (as they are) they mess with birth big time. The hospital with its policies (no food or drink, IVs, restriction to bed, bright artificial lighting, time constraints, flat on back or semi-recumbent positions for pushing, etc.) is really the least ideal place to facilitate the birth process. And pretty much any and all of the drugs hospitals introduce into the process screw up birth's carefully orchestrated hormonal responses, often leading to the need for further interventions to counter-act the drugs' side effects. So... here's my point... because 99% of American women give birth in hospitals (80-90% of those with drugs), there is a dire need for a buffer of sorts--something or someone to help women and babies come out of the modern birth machine as unscathed as possible. Doulas can be (and are being) just that buffer. And, I should add, sometimes epidurals just don't work (or only work on one half of a woman's body). Plus you still have to get through early labor (0-4 cm) before most doctors/hospitals will allow you to get an epidural. For some women, even early labor is killer. So it's a good idea to have someone present who is trained to help you cope with labor pain (even if you plan to get an epidural)!

3) Birth is women's work.
We put a lot of pressure on dads (particularly first-time dads) to be the sole support for their wives in labor. The fact of the matter is that it's overwhelming to many of them. They are often at a loss when faced with their own difficulty in seeing their wife's pain while simultaneously trying to help support her through that pain. A study comparing first-time fathers' and experienced doulas' participation in birth showed that males touched their laboring partner only 20% of the time while doulas touched them 95% of the time. They also spent less time with the women and were close to them less than the doulas (Bertsch et al. 1990). I absolutely believe that a husbands' presence can be vital. I would never want to give birth without Ax by my side. But I also believe that the assistance of wise, experienced women is also vital for laboring women. As much as a husband's support is wanted and needed, he is a man and can't ever understand what his wife is experiencing. Experienced women offer a different and much-needed emotional support. Doulas are also trained to assist fathers, giving them suggestions for ways to help their wives when they are unsure how (or are reluctant) to step in and help. My first "doula" did this beautifully.

4) Doulas are proven to improve outcomes for mothers and babies.
Study after study has shown that doulas have a profoundly positive impact on birth outcomes. Check out these numbers (from one of my doula training handouts):
When all the studies are calculated together, the presence of a doula reduces:

* Cesarean sections by 50% (!)
* Length of labor by 25%
* Oxytocin [Pitocin] use by 40%
* Pain medication [opiates] use by 30%
* Forceps deliveries by 40%
* Requests for epidurals by 60%

Other findings:

* Decreased maternal fever
* Decreased newborn admissions to NICU
* Decreased sepsis workups on newborns
* Decreased infant health problems

Long term benefits:

* Increased mother/infant bonding
* Decreased postpartum depression
* Increased success in breastfeeding
Who wouldn't welcome those amazing benefits?! As my doula trainer so aptly pointed out, if a doula were a machine, every hospital would have three of them.

I'm not telling you all this to drum-up business for myself. Even if I was looking for clients, I wouldn't be charging anyone. I'm telling you this because I am (excessively) passionate about helping women have wonderful, satisfying birth experiences. Doulas can work wonders, but I don't think most women are aware of just how much difference a skilled doula can make. I just had to spread the word!

As for me... I've got two fabulous births under my belt, and I'm a trained doula myself, but I am still going to have TWO doulas (and two midwives) at my next birth. I am thrilled that we will be surrounded by supportive, experienced women as we bring our first son into this world. I feel confident that their loving presence will make this our best birth yet.

P.S. If you'd like to hire a doula but can't afford one, have no fear! There are always doulas willing to volunteer their services. It's a generally universal doula belief that all women should have access to doulas regardless of ability to pay.

Tuesday, March 10, 2009

My First Birth

As my baby boy's birth draws closer, I find myself reminiscing about my first two birth experiences. I thought my readers might enjoy reading the accounts of those births. So... here's my first daughter's birth, written five and a half years ago. I'll also add present commentary about things I would have done differently knowing what I know now in italics. Enjoy!Ax (my husband) and I were lying in bed on Monday night, September 22, 2003. We had been talking about the baby and wondering when she would be born. A few weeks before, Ax had guessed that she would be born on September 23. He was getting impatient and kept telling the baby, “Come out and play!” Even though I was nervous, I was also starting to get impatient. I just wanted to get on with things.

It was a few hours later (about 12:40 a.m. on September 23) when I felt and heard a “pop-pop.” My first reaction was, “What was that?” And then I was suddenly afraid because I figured that maybe my water had broken. I didn’t want to move because I was sure that fluid would start to come out. Eventually I did move and, sure enough, I felt a warm trickle of fluid. I made my way to the bathroom, and by that point it was certain. I was sort of in denial. A part of me was excited and happy, but another part of me was terrified because I knew there was no turning back. I knew that I would have a baby in the next 24 hours and I knew that a great deal of pain was coming. It didn’t seem real.

I had been having frequent Braxton-Hicks contractions for a couple of weeks, and they had intensified, but I hadn’t had any contractions that were really painful. As soon as my water broke, though, the contractions started to feel like cramps. Since I hadn’t had any real labor contractions until that point, I was worried that it was going to be a long labor. And the contractions didn’t seem to come at any regular interval--nothing like I had expected. I figured they would have started out 20 minutes apart or so and then gradually they would have come closer together. Instead they started coming suddenly and they were between three and eleven minutes apart. Anyway, we gathered our stuff, got into regular clothes, and took one last pregnancy picture before we got in the car.

When we arrived at the hospital, the security guard by the elevators saw us and automatically said we could head up to the fifth floor--I guess he could tell why we were there. We checked in at Labor and Delivery and they put me in a room. It was strange to be there. There was a warming table with a blanket all set up on one side of the room. I remember thinking... that’s going to be for my baby... holy cow, I’m having a baby. After I had changed into my hospital gown, we met the nurse who would end up helping me through my entire labor and delivery--Eve. She hooked me up to the fetal heart monitor, the contraction monitor, and the blood pressure cuff. She checked my cervix and I was 3 centimeters dilated and 90% effaced.

The contractions were still pretty mild at this point. I breathed through them--the “slow-paced breathing” we had learned in our Lamaze class. Next she gave me my I.V. She said I had “good veins,” but, even so, she had difficulty getting a good spot for the needle. She had to try twice before it worked, and my hand was bleeding and swelling up. I still have bruises and sore spots from it all.

[If I could go back now, I think I would have taken a different prenatal class--Hypnobirthing or Bradley. Though they probably would have been too expensive for us to afford. The Lamaze "focal points" and funky "hee-hee" breathing techniques were totally useless, though I've heard the classes don't teach those breathing techniques anymore. In retrospect, I would also have hired a doula. And I would have requested a heplock instead of IV fluids.]

Eve asked me a bunch of questions and had me sign several forms. One of them was a release form for epidurals. It talked about the risks involved and explained that 80% of the patients at that hospital received epidurals. They had me sign it just in case I decided I wanted one. I had already thought a lot about the decision and done a lot of research, and I wanted to try to go natural. But I was also open to pain relief if it became necessary. Eve was really friendly and let us know that she was more than willing to help us if we needed anything and that if I wanted to go natural she could give us ideas of different positions to try and other coping strategies--that was wonderful to hear and such a relief. I knew I would need a supportive nurse, and I definitely got one! She said she would be back in an hour or so to check on me and left.

The contractions were slowly becoming more intense, but I was still cheerful and excited. I just breathed through them and sometimes utilized a focal point--something on the wall, the clock, or Ax’s face. I noticed that if he was talking to me, it distracted me from the pain, so I had him talk me through several contractions. He massaged my feet also. So far, things weren’t too tough, and I was feeling good.

[If I could go back, I wouldn't have spent this time reclined in a hospital bed. Sheesh. I would have asked for a birth ball right away to sit and rock on and would have remained upright and mobile during these easy early labor contractions.]

When Eve came back and checked me, I was dilated to “4 plus” centimeters. My first thought was... that’s all?? But she and Ax both seemed to think that was an accomplishment. I thought... boy this is going to be a long night. Six centimeters to go. The contractions were becoming even more intense. I started closing my eyes and pulling more inward. I was feeling a lot of the pain in my back, and I had heard horror stories about “back labor,” so it worried me. Eve showed us a position that was supposed to help with back labor. She raised the back of the bed to almost a 90 degree angle and had me sit with my back against it and my legs over the end of the bed. She showed Ax how to push on my knees during the contractions so that the bed put counter pressure on my back. I’m not sure whether it really helped, but just the sheer fact that we were doing something was better than just sitting there through the pain.

I had lost track of time by this point. Time had dissolved into short intervals--contracting, not contracting, contracting, not contracting. All I could think about was getting through each contraction and trying to utilize the breaks between them. I tried to focus on keeping my body relaxed. I knew that if I created tension elsewhere in my body, the pain would only intensify. And I also knew that the more relaxed I was, the more of my body’s energy could be focused on my uterus, and the more effective the contractions would be--which would mean the labor would be shorter.

After a while, the position Eve showed us was no longer as effective. But she surprised and thrilled me when she asked if I wanted to get in the shower. I had read and heard a lot about how water and heat can help to ease the pain. Getting from the bed to the shower was difficult though. I had expected that standing would ease the pain because I had seen so many pictures of laboring women standing--supposedly as a means of handling the pain. For me, though, it seemed like standing up made the contractions even worse. A couple of them hit as I headed to the bathroom. All I could do was lean on Ax and rock backward and forward. Then, once I got to the bathroom, I sat on the toilet for a while and leaned forward onto Ax some more. I think it was then that I started moaning.

Finally, I made it into the shower and Ax took the hand sprayer and sprayed hot water on my back. First, I kneeled in the tub and leaned over a stool, rocking back and forth. Then I stood up for a while and rocked some more. And again I kneeled and again I stood up. I was completely oblivious to everything but what I was feeling. I’m not sure how long I was in the shower, but I knew by the intensity of the pain that my labor was certainly moving forward--which was both good and bad. Eventually, I decided to get out, and promptly sat back on the toilet for several more contractions--still moaning. We managed to get my robe back on between contractions and we headed back into the room.

As soon as I got out of the bathroom, Eve offered the birth ball for me to sit on. I sat and rocked through a few contractions, but it wasn’t really working for me. At this point it seemed that nothing eased the pain. Really, all I wanted to do was lie in the bed and curl up in a ball. So I did. Eve checked my cervix and I was at six centimeters. I was relieved to know that I only had four more to go and that all that pain had brought results. She asked if I wanted anything for the pain, and I toyed with the idea but decided I could wait a little longer. So I just lay there on my side, moaning and breathing through each contraction.

I had been told that, if I could get to seven centimeters, I could make it all the way without medication/epidural. I could tell by the pain and by my own responses to my situation that I was likely nearing “transition”--the seven to ten centimeter span. With each contraction, it seemed I could feel the baby descending and opening my cervix--pushing and stretching, lots of pressure. As I lay there, I focused on only a few things--Eve’s and Ax’s reassuring voices and touches and my own breathing. I was essentially oblivious to everything else.

It didn’t seem like much time had passed before Eve asked me again if I wanted some pain relief. I wasn’t in much of a state for making a decision. I remember moaning, “I don’t know.” I also remember asking if it was too late. Eve said it wasn’t, but said, “Let me check you first.” She checked my cervix and said I was nine centimeters dilated. I was shocked and relieved that I was so close. She said I could still get an epidural but other drugs wouldn’t be possible. I decided that I could make it the rest of the way--only one more centimeter. She said that she had delivered naturally before and that it felt good once you could push. I was grateful for her experience and her encouragement. At some point, she asked me if I would mind if a resident came into the room to observe/help. I really could not have cared less if the entire hospital staff was in the room. I said, between moans, that I did not care. So, Dr. Ron Hansen came in.

All of the sudden, during a contraction, I felt an involuntary convulsive pushing motion in my lower abdomen. It was happening on its own. I told them, “I need to push.” Dr. Hansen checked my cervix again and said that I was fully dilated--finally ten centimeters! All I remember after that was being given the go-ahead to push. And I couldn’t have been more ready. I started pushing with the contractions, and Eve was right. It did feel better to push--at least the contractions didn’t seem as painful. It felt good to be doing something proactive. It took me a few pushes to get the hang of how to really be productive. Unfortunately, to my embarrassment, I pushed out more than I had bargained for even before the baby was born. Dr. Hansen and Eve had to clean up a few messes, but they said it was normal and expected since the same muscles control the vaginal opening as well as the rest of that region.

[Umm... yeah... make sure you use the bathroom a few times before you get to pushing.] :-)

I remember looking at the clock when I started pushing. I think it was five or ten minutes after 6:00, but I can’t remember exactly. I had heard and read that some women push for hours. That prospect sounded horrible. I wanted to be as effective as I could be so I could get the pushing over with as soon as possible. I didn’t even care about the pain anymore--in fact, I don’t even remember feeling painful contractions. What I remember is the burning sensation when I would bear down.

At this point it was time for the nurses’ shift change. But Eve said she didn’t want to leave, so she ended up staying until the birth. So, I had two nurses. The other nurse (I wish I could remember her name) was also wonderful. She gave me a perfect piece of advice as I was pushing. She said not to stop pushing when it started to burn--to push into the burn. That bit of advice made a huge difference. A couple of pushes like that and the head was crowning. That’s when I knew what they meant by “ring of fire.” I remember Dr. Hansen saying she had lots of hair, and I remember looking down and seeing part of her head as it was coming out. They told me to stop pushing just as her head was coming out so they could ease it out. I had to kind of pant/blow to keep from pushing. Dr. Hansen said I was “stretching well.” I was glad to hear it because I really didn’t want an episiotomy.

It was a strange feeling having her head there between my legs. Not very comfortable, actually, but it was exhilarating at the same time because I knew how close the birth actually was. It seemed unreal that this could be happening to me. And I couldn’t believe how quickly the past few hours had flown by and how crazy it was that I was about to have a baby. The shoulders were the widest part, so it burned as they eased out, but then the rest of her body just slid right out, slippery and wiggly. It was 6:24 a.m. I remember breathing in and out quickly and heavily, full of unbelief and wonder at what had just happened. They held her up for a brief moment--she looked so small and red. It was unbelievable. I couldn’t believe I had done it! And I couldn’t believe I had a baby.

[I really wish I could go back and re-do this delivery. Oy. First of all, I would have pushed with my urges rather than doing the stupid hold-your-breath-and-count-to-ten maneuver. Second of all, I would have requested an upright delivery position, or at the very least a side-lying position. Third, I would have taken my sweet time. Pushing "into the pain" was a horrible piece of advice, actually. Sure, the baby came out fast, but she also tore me up inside. If I had taken it easy and listened to my body, I really don't think I would have torn as badly as I did. Lastly, I would have requested to hold her immediately. Instead, it was a considerable amount of time before I was able to hold her, and it certainly wasn't skin-to-skin like it should have been. I really think our initial separation messed with our bonding.]

I was in a state of bewilderment and shock and wonder. I tried to take in everything that was happening as everyone bustled around, but it was hard to focus. I was still so overwhelmed by the intense experience my body had just gone through. I watched Ax cut the umbilical cord. They took her over to the warming table and I remember hearing her start to cry. I remember turning as Dr. Lohner walked in the door with a shocked look on his face. He was supposed to be the delivering doctor, but he arrived too late. He went straight to work on me though--delivering the placenta. I remember turning to Dr. Hansen and Eve and thanking them over and over. And I asked them if the baby was okay--they said she was fine. Dr. Hansen seemed impressed with me. He said some people push for several hours, and “You don’t see many natural births around here.” Dr. Lohner said, “You’re a brave girl.” I was so grateful I was able to obtain my goal. I know everyone’s experience is different, and I was grateful mine had gone so smoothly.

I also asked Eve if I had been given an episiotomy. She said I hadn’t, but that I had torn. It turned out that I had torn quite severely in several places. Dr. Hansen looked so apologetic--he seemed to feel really bad. Dr. Lohner looked agitated and told Dr. Hansen he ought to have cut me. Personally, I’m glad he didn’t. Dr. Lohner gave me a local anesthetic and stitched up my tears, not very gently I might add. It was quite unpleasant, and he kept telling me to put my bottom down (I was tensing and lifting up). They never told me exactly how severe the tearing was, but before the local anesthetic had even worn off, the nurses were giving me a cocktail of pain killers--Tylenol with Codeine, Perkacet, and Motrin. I was in a bit of a drugged daze after that to say the least.

Back to the stitches... Dr. Hansen continued to look sympathetic and compassionate throughout the ordeal. I was grateful for his gentle kindness. I was so relieved when Dr. Lohner finished. Then Dr. Hansen took over to “clean me up.” He was so much more gentle, as though he felt really bad about the tearing and the way Dr. Lohner had stitched me so roughly. When he came back later to say good-bye, I thanked him again and again and was so grateful he had been the one to deliver my baby.

After they got my baby cleaned up, they brought her to me to hold--all bundled up. I couldn’t believe I was holding my baby. She was so beautiful. The nurse said we had a “good recipe.” I spoke to her softly and she seemed calmed by my voice--she seemed to know me. That was a wonderful feeling, knowing that my voice could calm her cries. I could see the tears in Ax’s eyes. He was so full of love and joy. We just looked at each other in amazement. I had never felt so much closeness and intimacy--the three of us together.

Thursday, March 5, 2009

Thank you, girl whose name I can't remember

Last night I went to my first West Valley Birth Advocates meeting. We watched "The Business of Being Born" and then discussed it. I brought along three friends who hadn't seen the film. I'm so glad we went. But that's not really what this post is about...

Our discussion reminded me, once again, how incredibly lucky I am. Many of the women at the meeting talked about how sad it is that they had to learn so much the "hard way." So many women have negative experiences with their first births and are then prompted to do research and seek a better experience with their subsequent births.

I was reminded, again, of a brief moment in my past. I was a newlywed and childless. I had an acquaintance who was pregnant with her first child. We crossed paths one day as she carried a stack of birth-related books. We chatted briefly about her pregnancy, and she happened to mention that she was planning to give birth without drugs. My response was something like, "Are you serious?! I didn't know people still did that!" Really... that's what I said. She responded, "Yeah! My mom had all her babies that way. There are tons of benefits!" Those two sentences changed my life forever.

I'm fairly convinced that I wouldn't be the person I am today if this brave woman hadn't been open about her birth plans. If no one had ever informed me that YES, in fact, people DO still give birth without drugs (and for good reason), I don't think I ever would have considered it.

So I'm feeling grateful for her today. Extremely grateful. Thanks to her, I got my own stack of books from our library (a very small library, but gratefully well stocked with natural birth literature!), determined to explore the benefits she had mentioned. Thanks to her, I was informed and able to avoid so many of the pitfalls of hospital birthing.

I can't remember her name. But I will never forget her.

Wednesday, December 3, 2008

More good news about exercise

The studies keep rolling in... prenatal exercise is so worth it! The New York Times reported Monday about a small Brazilian study showing that regular prenatal exercise significantly reduced the need for pain medication during labor--"only 27 percent of the exercisers, compared with 65 percent of the controls, requested pain medication during labor"(click here for the full article). Here's the study's abstract.

Speaking of exercise... I'm supposed to be running a 5K this Saturday morning. And my Thanksgiving holiday vacation really threw off my exercise routine... yikes. Gotta get back on the ball!

Tuesday, November 4, 2008

Painless Childbirth?

Off and on over the last six years I've heard people claim to have painless childbirths. Some attain it through hypnosis or other methods, some simply don't register their contractions as painful. I have to admit that I have a hard time believing people when they claim "painless childbirth." And even further than that, I don't know if I'd even want it myself.

The other night I was talking with my husband. We were on the subject of how this birth could go very quickly, and I told him I really hoped it wouldn't because I'd feel short-changed. I said, "I don't want it to be over quickly. At least give me a few hours." He looked at me sort of like I was insane. Why prolong the agony? no doubt he was thinking. But after a moment, his facial expression relaxed, and he said, "I guess I can see that." He's a hard-core running fanatic and marathon addict, so putting it through that lens, he acknowledged: "It's like why I would prefer to run a marathon than a 5K." Exactly. Some people see it as prolonging the agony, but for the one who chooses it willingly, it is simply magnifying and intensifying the satisfaction and euphoria.

Now, don't get me wrong. I'm not asking for an intense 24-hour labor. And I don't want to make it any more painful than it has to be. But "quick and painless" wouldn't be my ideal birth. Ecstatic and euphoric and beautiful... bring it on! But painless?

I just can't even comprehend it. I love giving birth! But I'm not going to lie to you. It hurt A LOT. But there's nothing like the relief and release that washes over you when that slippery little person emerges. I think that's how God and nature intended it--that it is your beautiful baby who brings you the gift of relief. Most women experience that glorious relief prematurely--as a gift from the anesthesiologist so many admit to wanting to kiss.

I've never given birth without pain, so I have no concept of what it would be like. Most of the women I know have given birth with epidurals. I wouldn't presume to claim that their births were any less miraculous and wonderful, but I just have no concept of what it would be like. As strange as it may sound, I don't really want to know what it would be like.

Am I totally insane? Thoughts?

Wednesday, October 29, 2008

Irksome and Infuriating

I've been reading a fabulous new document today--Evidence-Based Maternity Care: What It Is and What It Can Achieve--available through Childbirth Connection. I wish every female would read this info-packed document, especially those who are pregnant or ever plan to be in the future. Women need to know the real facts about the slew of medical interventions they could potentially encounter in childbirth. But that's not what irks me.

As I was reading along in the document, I got to the section about epidurals and found a statistic that felt like salt in an already festering wound. The estimated increase in cost from epidural use for low-risk experienced mothers is 36%. Why should that bother me? I'm not getting an epidural anyway, right? Ha! That's where the already festering wound comes in.

Back when I was investigating my birth options a few months ago, I contacted the hospital where my midwives deliver to find out how much they charge for normal vaginal deliveries without epidurals. The woman on the line gave me a number. Then I clarified, just to be sure, that it was the cost without drugs or epidurals. She said it's the same amount whether you have an epidural or not. Umm... what? Yeah, you heard that right. I have to pay for an epidural whether I want one or not. And I tell you what... it infuriates me.

I really thought we were going to save ourselves some big bucks with my natural birth choices. But now they tell me I have to pay for a bunch of crap I don't even want? If the 36% increase stat is correct, that's a huge increase in cost for someone who will be paying out-of-pocket. &$^%#%^@^! I also asked the lady on the phone if we'd save money leaving the hospital early... say if we didn't stay overnight. Nope. You pay for a two-day stay regardless of when you check out (unless, of course, you stay longer... then they'll of course take some more of your money). Awesome. This hospital and I have gotten off to a really great start.

Have I told you I really, really hate stupid, ridiculous, retarded hospital policies? I am thinking I may try to fight this one. It makes me want to vomit.

Saturday, April 12, 2008

Giving Birth, so far

I'm about a third of the way through Giving Birth: A Journey into the World of Mothers and Midwives, by Catherine Taylor. So far, I find it fascinating! It is exactly what it says it is--a journey into the world of mothers and midwives. It has opened my eyes to just how unique each mother and each midwife/doctor is. Though we can say that most midwives have common philosophies, they are by no means a uniform group. Midwives' practices vary widely depending upon where they deliver, who their back-up physicians are, what insurance companies they're affiliated with (if any), and where they received their midwifery training. Even within ONE midwifery practice each midwife will have her own style and leanings. Catherine Taylor also masterfully weaves-in statistics and research about birth and various medical interventions. Here are some excerpts I found informative, eloquent, right on, or though-provoking...
I don't understand the hospital's need to separate mother and child; I don't understand their need to immediately quantify everything about the baby. Can't that wait an hour? And couldn't any observations that need to be done to assess the newborn's health be done with the baby lying with or on the mother if she wants it there? (p. 38)
"Most clients ask about ultrasound," Sarah comments. "A decade ago we did them routinely. But the cost to the system is high, and routine use has not been shown to improve birth outcomes," she explains. In situations where the doctor bills for every service and the patient's insurance pays for these kinds of tests, some doctors still order them automatically. In fact, I have one friend whose doctor ordered an ultrasound for every visit. When she asked why this was necessary, he brushed her off, saying, "Oh, it gives us important information," without explaining what that information might be or what they might be expected to do with it. In fact, the American College of Radiology recommends that ultrasound screening be done only when there is a "valid medical reason," and the World Health Organization finds that "routine ultrasound assessment has not been shown to decrease morbidity and mortality" (p. 42-43).
On this final item [epidural-induced fevers], Nancy's statements are backed up by research done by Dr. Ellice Lieberman of Harvard University and published in the journal Pediatrics that shows epidurals are indeed associated with a hugely increased frequency (fourteen-fold) of fevers in birthing mothers and finds that the resulting "neonatal sepsis workups and administration of antibiotics are not necessarily benign." . . . She concludes, "Given the cost, risk, and pain to the newborn, the higher proportion of sepsis workups that may be attributable to epidural use is cause for concern" (p. 58).
[Liz] explained, "If you have a midwife manage the same population as a physician, the midwife is going to order fewer tests, she's going to have fewer expensive interventions and procedures, and she's going to have better outcomes, despite the fact that she didn't throw all this technology at the patients" (p. 73).
More good stuff to come!

Saturday, February 16, 2008

Posterior Ponderings

My second baby came into this world upside down, or "sunny side up" as some people say. She was posterior (facing my front side) rather than the normal anterior position (facing my back). Her posteriority (I think I just invented a word!) brought with it some surprises. I had fully expected my second birth to happen very quickly. My sister's labors were each roughly half as long as the previous. My first daughter's birth lasted less than six hours, so I was expecting my second to come in less than three! I suspected she might be posterior, however, when that supposed-to-be-fast labor turned into an on-again-off-again roughly 28-hour labor.

Fortunately, for me and my baby, the planets aligned to make our birth experience smooth and uncomplicated. My labor started and stopped every few hours, eventually kicking into full gear after about 26 hours. I arrived at the hospital nearly 6 centimeters dilated and delivered my baby about two hours later. There was no need for forceps or vacuum to get her out, I pushed for less than 20 minutes (it wasn't until then that my midwife said the p-word and confirmed my suspicions about my baby's position), and I suffered only a minor tear. My recovery was terrific compared to my previous birth. My first baby was not born posterior, but I suffered extensive tearing followed by a very painful recovery. Ultimately, I succeeded in having a very satisfying unmedicated labor and delivery despite having a posterior baby.

I feel fortunate, because, for many women, a posterior position is a recipe for disaster. A 2005 article, "Digital/manual rotation reduces need for C-section," in OB/GYN News explains: "Previous epidemiologic studies have estimated the prevalence of the occipitoposterior position to be about 5%. Among such pregnancies, there is a high incidence of cesarean section, instrumental delivery, third- and fourth-degree perineal tear, postpartum hemorrhage, and puerperal infection" (source).

I shudder to think what my experience could have been like. If I had gone to the hospital earlier when my labor was periodically stalling, it is likely I would have been given Pitocin. The contractions produced by the Pitocin would likely have been too painful for me to handle without medication, so I would have likely asked for an epidural. Epidurals make the pushing stage more challenging for many mothers, particularly those with posterior babies, so it's highly likely I would have ended up with an instrumental or cesarean delivery. I feel so fortunate to have evaded those outcomes!

I will be forever grateful that I trusted my baby and my body enough to wait things out and let labor kick into full gear on its own. I spent most of my labor upright, moving, walking, rocking my pelvis, getting on my hands and knees--outdoors and in my own and family members' homes until the last couple of hours. Sometimes these measures will help a baby to turn. Sometimes babies just stay put. And that's okay. Don't let the "p-word" scare you. Having a posterior baby doesn't have to mean a horrible birth experience. For me it was smooth and satisfying. I believe it can be smooth and satisfying for most women when labor is allowed to progress without interference.

Tuesday, January 22, 2008

"The Birth of a Breastfeeding Baby and Mother"

Check out this column by Judith A. Lothian (PhD, RN, LCCE, FACCE) in the Journal of Perinatal Education. Here's the abstract:

"In this column, the author describes the way in which the normal, natural process of labor and birth prepares both mother and baby for breastfeeding. Birth practices including induced labor, routine interventions, epidural analgesia, and separation of mother and baby disrupt the process of early breastfeeding for mother and baby. Normal, natural birth sets the stage for uncomplicated breastfeeding."

Monday, November 26, 2007

Down with the I.V. league

“You’re thirsty? Do you want some more ice chips?” Most women laboring in U.S. hospitals, no matter how thirsty or hungry they may be, must resign themselves to sucking and munching on ice. I munched my way through that rite of passage with my first baby. Enduring labor and birth has been compared to enduring and completing a marathon. Both feats are extremely physically taxing, but you would never expect a marathon participant to run without drinking or consuming any kind of fuel. Hospitals across the country expect laboring women to do just that, but is this deprivation really necessary?

When a patient must undergo general anesthesia for emergency surgery, there is a risk of stomach contents being inhaled into the lungs (also known as “aspiration”). Hospitals ask women to refrain from eating or drinking in order to reduce the risk of death from pulmonary aspiration. Even with these precautions in place, however, there is no guarantee that a woman’s stomach will be empty in the event that she needs general anesthesia. The risks of death from pulmonary aspiration are miniscule—1 in 1,250,000. Furthermore, deaths from pulmonary aspiration in these situations have more to do with anesthesiologists’ errors than whether a woman has had food or fluids recently. It is very uncommon for a laboring woman to require general anesthesia. Most of the problems arising in childbirth can be recognized and addressed without such extreme measures being taken.

What do hospitals offer as a “substitute” for food and drink? Intravenous fluids (IVs). Yes, IVs provide fluids, but quite often they provide too much, particularly when mother is given a “bolus” (large amount of fluid) before receiving an epidural (an attempt to prevent the blood pressure drop often resulting from epidural anesthesia). Fluid overload resulting from IV fluids can lead to other complications, among them:

* Fluid in mother’s and baby’s lungs.
* Diluted blood, leading to anemia and decreased oxygen supply to the uterus and fetus.
* Newborn jaundice, as excess fluid causes baby’s red blood cells to burst and release bilirubin (yellow product of red blood cell breakdown).

Aside from these issues, an IV will also hinder a laboring woman’s ability to move while in labor. Movement, particularly in early labor, is an effective way to cope with the pain of contractions. Lying strapped to a pole and a monitor in a bed will increase a laboring woman’s discomfort greatly. Additionally, when a laboring woman remains lying in a bed for an extended period of time, labor will not progress as effectively as when aided by movement and gravity.

I remember how strange it was to me when I came home from the hospital after my first baby was born and found that my legs and feet were swollen with fluid for a few days. I had heard plenty of pregnant women complain of swollen ankles and feet, but I had not experienced any swelling while pregnant. It surprised me to see swelling afterward. I also noticed swelling in my face and hands in the pictures taken of me just after my daughter’s birth. I can’t prove that it was the result of I.V. fluids, but I feel fairly confident they were to blame. Here's a picture of me in my swollen post-partum state...Lovely, eh?

When I gave birth to my second child, I chose to see a group of nurse-midwives who delivered at a small community hospital where they had, finally, convinced administrators to allow laboring women to drink. Instead of being given an I.V., I received a “hep-lock” which is simply an I.V. needle inserted in a vein but without the fluids. They like to have an “open vein” in case of an emergency. I spent less than three hours of my labor in the hospital because I had already progressed to about 6 centimeters upon arrival, and my labor progressed quickly afterward. I think I took a few sips of water when I felt thirsty, but not a lot. It was wonderful, however, to not be tied to the I.V. pole. I was also pleased to notice that I experienced no swelling afterward. Here's a much less frightening post-partum picture...
Not every laboring woman will be given the option to bypass IV fluids. Some hospitals have strict policies, and women who are induced, given narcotics or epidurals, or a c-section will have no choice but to submit to an I.V. Every intervention alters the birth process, however, and the more interventions, the more complicated the birth process becomes. I encourage women to avoid unnecessary interventions and trust the process of birth. Seek out care providers who honor and respect the birth process and will advocate for your right to experience birth as you wish, including eating and drinking if you choose. You and your baby are worth the effort.

For more info, see the "Evidence Basis for the Ten Steps of Mother Friendly Care."

Wednesday, May 2, 2007

Think you're better off with an epidural? Think again...

• Epidurals cause women’s bodies to stop or slow the release of oxytocin—slowing labor and removing the feel-good effects of the hormone. The first stage of labor tends to be about 26 minutes longer and the pushing stage 15 minutes longer in women with epidurals. Epidurals also eliminate the natural peak of oxytocin intended to occur at the time of birth to facilitate the delivery and bonding processes.

• Women with epidurals are nearly three times more likely to have Pitocin—to speed up labor—than those without epidurals.

• When the pelvic floor muscles have been numbed by an epidural, a woman’s body cannot guide the baby’s head to the ideal birth position as effectively. Babies are four times more likely to be posterior (facing up—a more difficult position for birth) in the final moments of labor when their mothers have epidurals. As a result of these complications, some women with epidurals experience difficulty pushing their babies out—doubling their risk of forceps or vacuum extractor deliveries.

• Other epidural side effects for mothers include: drop in blood pressure, difficulty passing urine, itchiness, shivering, sedation, nausea and vomiting, fever, breathing difficulty, inadequate pain relief, slurred speech, drowsiness, convulsions, postpartum weakness and/or numbness, postpartum back pain, mild to severe postpartum headache (sometimes lasting six weeks), temporary or permanent paralysis, cardiac arrest, respiratory arrest, and death. A woman’s risk of dying from childbirth complications triples when she has an epidural. (For a recent news story on the rise in epidural-related maternal deaths, see here.)

• When mother develops an epidural-induced fever, her infant tends to have poorer condition at birth, has an increased risk of having signs of brain damage, and will likely undergo an invasive sepsis evaluation to check for infection.

• Epidurals can lead to worrisome fetal heart rate changes also. This is in part because women with epidurals tend to lie down in one position for extended periods of time which can restrict blood flow to the fetus. Change of position will often improve the fetal heart rate abnormalities. When an epidural is coupled with Pitocin, the signs of fetal distress can be more prolonged and severe.

• Some data also indicate that babies born to women who had epidurals show increased risk of poor brain function at one month of age.

• As many as 85% of women in some U.S. hospitals receive epidurals.