Saturday, December 03, 2005

what I learned this week

Knitting is happening, there just isn't anything interesting to post pictures of...yet. This will become a knitting blog again soon, as my ob/gyn rotation is 2/3 over and I've only got another 2 weeks to go.

- women come in all sizes, shapes, heights, weights and ages, and with various previous birthing experiences, but everyone dilates to the same 10 cms.

-Epidurals don't always work. There is no way to tell, before an epidural is placed, if it's going to work. Most of them do work. If it doesn't work, there are other alternatives. The anesthesiologist can be a laboring woman's best friend.

-There are things that lamaze (and other forms of childbirth education) doesn't teach: pushing will hurt, but it might feel good to be doing something. The action of pushing uses the same muscles that are involved in episodes of consitpation. If you think about and feel like you're taking the biggest dump of your entire life, you're pushing correctly. (chin to the chest and curling around the baby might not feel great at first, but it's much more effective then arching the back and throwing the head back. I say that with absolute certainty because I've seen the difference and women "move" the baby down further when they're curled.)

-there are many ways to describe the stages of labor (aside from the well documented and classic "Three Stages of Labor") and one way is by looking at who comes into the room and what they are wearing. For instance: the nurse sees you for a labor eval. The doctor is called. The doctor arrives in nice clothes to check in with you. The nurse checks in (again and again). The doctor checks in and you're almost completely dialated. The doc appears in the room dressed in scrubs (getting close!). The doc gets dressed in a snazzy sterile blue get-up (even closer!). The room fills up with a baby nurse, a labor nurse, another doctor clad in blue and lots of "stuff" for the babe. This is a sure sign that the arrival of the little one is mere minutes away.

The birth plan = c-section observation is something I've been thinking about and I have a few additional thoughts on how it works *in the hospital system I am in.
(* this is important because I have limited experience outside of this hospital system, and do NOT believe in generalizing because there are always exceptions to the rule.)

- the women I've met who've presented the nursing staff/doctor with a birth plan have been young, and often have sisters, cousins or friends who have encouraged them to write up a plan. This could be because the women's friends/family didn't have the birth they wanted and wish that the laboring woman have a better experience OR because the friends/family did have a plan and feel that the positive experience they had was because of the plan.

- many of the women are not familar with hospital policies. The hospital that I've spent the majority of my time in has standing requirements such as each woman have a heplock or IV and that's often one of the things people wish to avoid. (most wish to hydrate themselves by drinking liquids, which is fine, but there are cases when medications need to be given quickly, and that's what the iv access is for.) Some wish to eat whatever they please during the labor and it's oftne the policy that clear liquids are all that is allowed (for many reasons). Many wish to walk, move around on the birthing ball or use the hot tub for pain relief; that's encouraged, but every 45 mins or so we ask them to stay in one place so we can monitor the baby's heartbeat and contractions for 15-20 minutes. The people who don't realize this feel restricted and it can lead to frustration that could be avoided if the policies were discussed beforehand. (I have more time to spend with patients then the doctors and nurses and try to answer as many questions and explain everything because I think an educated patient feels more comfortable with the situation they are in, and that can make for a better overall experience.)

- some women with birth plans come to the hospital for labor induction. The process starts with an overnight cervical ripening (which requires constant monitoring overnight) and the next day a medication (that is a chemical analog to the body's own natural labor starter and uterine contraction creator) is started. The medication requires an IV and IV fluids and some find that the contractions are stronger then with "natural" labor. This means that the nonmedication-based pain relief isn't as effective and then some feel like failures when they ask for pain medication. To some, this is a surprise because they didn't realize it might be "harder" with the labor induction protocols.

- no one knows how they will handle labor until they are in the middle of it. Even moms who have done labor before might find that the labor they are in is nothing like previous labor experiences. Some who are sure they'll be able to labor without any pain meds are disappointed in themselves when they feel as though they can no longer take the pain, while others who walk through the door asking for an epidural have labors that move too fast for any pain medication.

- sometimes expectations (such as those found in a birth plan) seem to hinder progress. Most of the birth plans I've seen are for "all natural" labors** and they are frustrated with how slow things can move. Women who are tired and in constant pain (sometimes) do not progress as fast as those who are more comfortable and able to "open up" to let their body do what it needs to do. There are a few reasons for a c-section and two of them include "failure to progress" (not dialating or the baby isn't moving down) or a babies inability to handle the labor. In the failure to progress cases (when the baby is doing fine) an epidural can be all it takes for everything to relax and rest and dialate.

(** I now believe that a "natural" labor is one that results in a baby.)


Anonymous Anonymous said...

I agree with your definition of "natural". I got all hung up on not wanting meds with my first. But darn, the induction hurts! And the epidural, for me, was all it took to relax!


11:05 PM  
Anonymous Carole said...

I was able to endure labor and delivery sans drugs but had no expectations going in. I think that made a big difference. And your definition of natural? Right on.

11:39 PM  
Blogger Cari said...

Eeek! I'm starting to get nervous. I think I'll put my head in the sand for another month or so and THEN start thinking about labor. It's hard enough getting used to the idea of being pregnant and the fact that I wake up to a slightly changed body every morning.

12:24 PM  
Blogger Kathy said...

It's true that epidurals don't always work. With my induction I asked for one after the pictocin started (those contractions are horribly painful - worse than transition with no meds in my second birth) but it only took on one side. Only sort of helpful, and the anesthesiologist couldn't do much of anything more. Made me very glad that I had learned ways to relax through contractions and deal with them on my own.

I did want to add that there are legitimate reasons to avoid interventions such as an epidural, episoitomy, pitocin, etc. if they aren't medically needed during birth (and that last phrase can be heavily debated, to be sure!). There are a lot of things to be said for a natural (no medication, no interventions other than support present and monitoring) birth, benefits to both mother and baby provided both are healthy throughout. Not to say that every mother needs to choose this route or even that medical interventions aren't absolutely necessary at times, but by the same token they aren't always needed or wanted.

1:10 PM  
Blogger Carina said...

I had two all natural labors, but I think I was helped by the fact that I live with serious pain as a part of life anyway. I had already developed ways to deal with that pain, and when transition almost overwhelmed me, I remembered that it would end if I just kept going and was as bad as my worst endo pain, which I can only manage with ibuprofen, visualization, heat, and moaning (that really helps, btw).

My worst endo pain is the same as my transition pain was both times, but it can on for days and doesn't have a happy ending like a baby. I felt more confident in my body because of it, though, which I suppose is pretty weird.

You're right, though: our lives are hard enough without beating ourselves up about whether or not we had the "perfect" labor and birth or beating anyone else up, for that matter. Whatever got the job done is good.

5:52 PM  
Blogger Melissa said...

I had 2 unmedicated births in a hospital (with a birth plan). I was/am educated about the childbirthing process (for example I knew my 22 hour labor was typical and expected for a first time mom). I made sure all the Drs. in my group knew my wishes and signed my plan, I also made sure (through the help of my doula and Bradley childbirth instructor) I knew my hospital's policies regarding different procedures.

I guess my point is having a birth plan doesn't make me more likely to have a c-section. I think unmedicated births take planning and education on the mom's part.


8:55 PM  
Anonymous Linda said...

I wish you had been with me during my first child's birth. I had 54 hours of "dysfunctional" labor, an epidural that only took on one side, and ultimately a c-section. Luckily I was on demerol and the whole experience was very drug induced happy. After the birth I was rolled into my room and I was extolling the virtues of Dr. Foley, the guy who invented the thing they stick in your bladder so you pee into a bag. During my second birth, also a c section, the anesthesiologist almost killed me by almost injecting a drug I am allergic to into my iv. Luckily the labor nurse intervened and I'm alive to tell the tale.

8:32 AM  
Blogger Dympna said...

I see you have learned alot in your 4 weeks. I was an L & D nurse for 10 years. I do miss the births.
I now work on a mom/baby unit and enjoy the experience. Wish I could get the mothers to not feel bad when they didn't get the birth they wanted.
I agree any birth that results in a baby is a natural birth.

11:10 PM  

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