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Wednesday, 23 July 2014 16:57

Code Word

During transition in my last labor, I remember being on my hands and knees on the floor of the hospital and moaning, “I can’t do this...I need an epidural...I want an epidural.”

But I wasn’t serious, and even in those moments of intense discomfort I knew I wasn’t serious. I didn’t really want medicine.

 

Fortunately, my husband and nurse were completely on board with my all-natural birth preferences and didn’t rush to get me drugs when they heard me asking. However, after reflecting on that birth and looking ahead to my next one, I think there’s a lesson to be learned.

 

I need to be able to complain. I want my pain and strength to be validated when I am in labor. I realize now that when I asked for an epidural, I was really asking for my pain to be validated and for more support through the process of labor. It was a cry for both praise and help, not for pharmacological pain relief.

 

So this time, going forward, I’ve decided to designate a “code word” to be used if I need pharmacological pain relief. This will enable me to whine and complain, to ask for drugs or an epidural all I want, but without tempting my husband to call for them. Instead, I will use the “code word” if I begin to suffer and an epidural becomes necessary. Something like “code red!” or “bananas!” so that my labor team will know when I’m not kidding around anymore.

 

If my labor team hadn’t patiently urged me to keep going without drugs, I may well have ended up with an epidural when I asked for one. I don’t want to risk that again. I want easy access if I need medicinal pain relief, but I don’t want to get it unless I really need it. I think a code word will enable me to do just that.

 

Did you use a code word for your labor? Would you consider doing so? Share your thoughts with me!

Published in Labour

At 41 weeks pregnant, I woke up late Wednesday evening feeling pains stronger than the "menstrual-like cramps" of Braxton Hicks.  I let my husband sleep as I started to get excited and braced myself for the journey ahead.  Thursday morning, I told him that he could finally stay home today, because it was time to start laboring!  He was so awesome through the whole pregnancy and I knew he was going to shine now, too.  So we started hanging out around the house, doing our pre-labor stuff.   I was feeling strong contractions that were starting to locate in my back, and we thought we would call our midwife to let her know what was up.  She came by a few hours later, and after checking my cervix for dilation, saw that I was 2 cm dilated (where I had been at for a few days now). Bummer.  No progress really then.  She said we should get out of the house and try to lose the labor focus.  So we went to the Lowes down the street to pick up a plant; we wanted to have a living reminder of this labor and something that our baby could see "grow up with her."  We came home; planted the bonsai juniper tree we bought, baked cupcakes, watched a movie, and then settled into bed.

I was still having contractions, but I was able to get some sleep, until around 4:00 am when my water broke!  I heard a pop and felt a surge of warm fluid while sleeping, and woke up to run to the bathroom, yelling, "Erich, wake up! My water broke!"  Thankfully, we had layered the bed with a plastic sheet the previous day in preparation of our home birth. As I sat on the toilet, leaking, my contractions were already getting stronger and closer together, so we called our midwife again to let her know what was going on. About 4 hours later, I was starting to enter labor land, so we timed the rushes again.  They were coming about 5 minutes apart and lasting about a minute each, so our midwife headed over to the house.  Once she was here (around 9:30 am Friday morning) I was really contracting, and the back labor was becoming very intense. With every contraction I would need my husband to push as hard as he could on my lower back until the rush was over.  My midwife seemed to think everyone was doing well, so we pushed on through the day.  We were laboring in and out of the house, walking around the neighborhood, still in good spirits. I was really looking forward to getting into the birthing tub!  However, knowing that it would be best to wait until just the right moment, I did not enter the tub that night. 

So now it is Friday evening, and I had been laboring through the day. The back labor was exhausting, and the rushes were coming close together, but they did not have a strong pattern to them.  We decided to try to get some sleep that night and start again in the morning.  By “we” I suppose I mean my husband and midwife, as they got some sleep; I was still laboring. I was attempting to rest in bed, with a heating pad underneath my back, but every contraction was powerful and I needed the counter pressure to be able to bear it.

In the morning, as tired as we were, we put on our labor hats and plunged deep into the canyon again. My husband and I went for a long walk, and I lunged on the walk. We went up and down the stairs, lunging. We tried every position known and unknown. We bounced on the birth ball, sat on the toilet backwards (I spent a lot of time there, with a pillow to lean into), got on my hands and knees, tried to dance the baby out.  All the while, I was experiencing the worst back pain I could possibly imagine. My husband's hands are probably still sore from the counter pressure. I moaned low and loud, I grunted, I sang, I focused my breath, my energy, I asked the baby to prepare herself. I clung to this process and hoped that the Goddess would deliver us from it. 

Around 5 pm Saturday our midwife checks my dilation again, and sees that I am at 5 cm now, and that our baby is OP, or "sunny side up" meaning her face was pointing towards my pubic bone. This is causing the hard part of her skull to rest on the bony part of my spine. Thus causing my back labor, and making it not ideal for her to come down into the birth canal. On top of that, her head was resting off centered on my cervix.  This was giving her a "top hat" and swelling my cervix without dilating (because she was not putting the right pressure, in the right place).  With this new information, we know I still have a ways to go, and our baby and I need to do some work to get her positioned correctly for the vaginal birth I so craved. When night came, we thought it best to try the "resting" thing again. I took some herbs to help strengthen the contractions, and my midwife and husband tried to lay their heads down.  I paced the house and eventually got in the bath. With each contraction I screamed to my husband to get out of bed and turn on the jets on our garden tub, and then turn them off again. Because my water was broken, we didn't want to chance an infection by leaving them on the whole time, so for three hours I sat in the tub, and my husband tried to sleep in bed, between helping me.  Looking back on it, we both think “Why the heck didn’t Erich try to sleep on the bathroom floor so he was close to the switch for the jets?”  The lack of thought process going on here shows how tired we all were at this point.

Come Sunday morning, I was suffering for lack of nutrition from not eating or drinking, so we started an IV of fluids (still at home.)  We also decided that getting some antibiotics into my system would be best for our baby and lower the infection risk, so we started that too.  Three bags of fluids later I was feeling better and a bit more energized so we started trying EVERYTHING again.  Because, damn it, I was going to have this baby at home!  I cannot express how much I wanted to sit in the birthing tub and push my baby out.  All I wanted was to feel an intense sensation to push, to feel my baby's head in my birth canal, to connect with every woman out there who has done this and will do this; I wanted to feel the energy of the world soaring through my vagina.  So we tried.  We walked again, we bounced, we sang and I moaned. I felt like my back was being split open, like an alien was about to rip its way through my spine!  I was still taking herbs, and homeopathic remedies.  I was visualizing, I was opening to my baby.  I was doing everything they said to do and anything I thought I should do.  

Sunday afternoon, after four days of active labor, our midwife checked my dilation again, (still at 5 cm! What!) and we decided to try to turn the baby to a more favorable position. Our midwife reached in through my cervix, and gently put pressure on our baby’s head to encourage her to move into the birth canal.  She succeeded in turning her a bit, and then the little butter bean moved right back into the same spot she had been in.  We tried again, but alas, she did not want to be in the "right" position.  So as I leaned on the bed, bracing myself through yet another mind bending, back searing, contraction, I saw what I knew to be a bad sign, fall out and onto the chux pad underneath me. 

There was meconium.  My poor baby was stressed (gee...I wonder why?).  I called for our midwife and we assessed the situation.  She listened to her heart tones, and felt they were dropping.  My husband and I were scared, tired, and starting to feel like we needed some help outside the house.  So tearfully, we decided to transport to the hospital.   

When we got to the hospital Sunday evening, I already knew I wanted an epidural.  I was in so much pain, I couldn't stand, couldn't  think, couldn't  see straight. After what felt like hours of questions, I finally got some relief as I slept for the first time in days, numb from the epidural.  We also started pitocin, as my contractions were still not consistent enough to position the baby.  At this point I still had hope for a vaginal birth.  I thought the epidural will relax me, the pitocin will work and I can push this baby out.  Looking back, I feel that my midwife and the doctor were probably thinking differently, and we started the pitocin just to be able to say we tried it.  Which I am thankful for; I know at this point I really did do anything and everything to try to have a natural, then vaginal, birth.  But two hours later, I am still at 5 cm, my cervix is extremely swollen, and there are no signs of things changing.  It's been almost 5 days of labor, and our baby needs to come Earthside.  So with a heavy, scared, and very emotional heart, we know that a Cesarean birth is our only option. I looked to my husband, and he said "this is the right thing," as we prepped for surgery.

I told my husband later how I am sad that I don't fully remember the next few days, and he said "Well, even if you don't remember, you knew how to do it!  As soon as she was out, you were telling me what to do!  Say her name, touch her, stay with her!"  Having the knowledge that she was never out of our sight, at any time, while we were at the hospital, helped to relieve some of the emotions from being there in the first place.  Also, the staff at the hospital understood our wishes, and never fought back on them.  The nurse even asked if I wanted to take my placenta home!

The hardest part of the whole experience came after the procedure, while I was in the recovery room.  Alone, but for the nurse, I had all these emotions and no baby to hold.  I will never forget lying there, feeling as though time had stopped and the agony of having to wait.  Finally she was brought to me, and I put her right to my breast. There she stayed for the next three days as we recovered in the hospital together, as a family. 

The last place I ever wanted to give birth was in a hospital, but if not for one, my baby and I might not be alive today. I learned a lot through this process. It taught me to trust my baby and my body.  Even though I was not able to birth vaginally, my body WAS working in harmony with my baby. If I had been contracting stronger, her little body might have been damaged, her neck might have been broken!  I know I did everything I could to birth my baby... and in the end I DID bring a beautiful, strong, magical being into this world.  Her path here was not mine to decide.  Her path around the Earth will not be either.  I am merely the platform from which she can jump from.  All I can do is accept her, love her, and foster joy every day, from now on.  And whenever I see her sweet face and smile, I know I would do it all over again. 

Published in Birthing Stories

My favorite semester of nursing school was my maternal-child class. I spent a couple of days on a post-partum unit, a couple in the NICU, and was scheduled to do two days in Labor & Delivery. In both days there, I saw zero vaginal deliveries. None. Zip. Nada. My instructor scheduled me for a third day on the unit so I could observe vaginal deliveries. I saw two: one with an epidural, one natural. The woman with the epidural had a quick delivery, but I just remember watching the epidural placement and thinking how painful it looked and how awful it would be to have that tube just sticking out your back.

The second delivery was much longer. She had been laboring for so long, she was completely exhausted. She was wearing an oxygen mask, and was in bed on the monitors. She looked miserable. The nurse and midwife were coaching pushing, counting to 10 three times during each contraction. The father wept when his baby was born, and we took the baby straight to the warmer. I remember thinking how cool it was that my classmate and I got to do the newborn exam all by ourselves, since the nurse was busy helping the midwife control bleeding. As far as I could tell the mother was starting to hemorrhage.

Personally, this is one of my biggest regrets. I stood between that woman and her child. If I could go back now, I would take that baby and put him right back on his mama’s chest. I can’t imagine after such a difficult delivery not being able to hold my child. I wish I could apologize to her. I wish I could go back and encourage her to breast feed, which would also help with the bleeding. In fact, if I could go back there would be a lot of things I would different.

When I found out we were pregnant with our first child, I embarked on a journey of enlightenment. As a nurse, I thought I was pretty educated about pregnancy and childbirth. I had no idea what I didn’t know. I knew nothing of birth hormones, of how our bodies are MADE to birth babies, how empowering birth can be when the mother is educated, informed, and in control. I had to ask myself, “Why didn’t I know any of this?”.  After much thought, I’ve realized a few things about my education.

First, nursing education is based upon and centered on the medical ideology of birth. Nurses work closely with doctors, and therefore must know what to expect and how to treat clients under medical care. Our school only had so much time to teach us the massive amounts of information necessary for hospital births, including what to do in basically any medical emergency, as well as pre and post-natal care. Education on natural birth processes could easily be deemed not as important because most women don’t birth that way in a hospital setting, where a nurse would be working. What nurses are taught, what I was taught, is consistent with what nurses “need” to know.

Additionally, even if nurses were trained in natural childbirth, they would spend their shifts caring for women birthing in a medical manner. Any natural childbirth education would be forgotten among the days and nights of epidurals, Pitocin, IV fluids, monitors, coached pushing, bedridden deliveries, and unfortunately, failed birth plans. Seeing all this, it's no wonder nurses don’t have faith in a woman’s ability to birth naturally! And, because of our “sue happy” society, nurses may often feel that to encourage a woman to birth the natural way she desires could place them in the way of a lawsuit. Or a nurse may feel that if later on the woman changes her mind, she (the nurse) will be held responsible if the new wishes of the woman cannot be fulfilled; such as an epidural not being available due to the anesthesiologist being gone, or the woman being to advanced in labor to give pain medication.

Basically, it goes back to the mindset of birth in America. Birth is treated as a medical problem with medical treatments. And in some cases, it is. Nurses should continue to be trained in how to handle medical emergencies related to pregnancy and birth. However, as we continue to educate the public and change the general opinion of how birth “has to be,” being a voice to local hospitals, and lovingly educating the nurses caring for us, I hope that nurses will become more familiar with and be able to support and assist women who chose a natural birth.

 

*This article is simply the experience and opinion of one woman with a nursing education, and should not be taken as medical advice or recommendation. 

Published in Birthing Assistance
Friday, 27 April 2012 11:08

Purple Pushing - What is It?

"Purple Pushing" (or directed pushing), is commonly used for women who have had pain medication and are not able to fully feel their body’s natural urge to push through the contractions.  Purple pushing is directed by the nurses and the OB who will tell you to begin pushing as a contraction begins and count slowly to ten while telling you to keep pushing for the duration of the contraction.  While this type of directed pushing can serve a purpose for a mother who is unable to feel anything below her waist, it often leads to an increased need for an oxygen mask, quicker exhaustion, increased chances of assisted delivery, and increased risk of tearing because the mother isn’t able to “listen” to her body by way of backing out of a push when it feels appropriate and stop when her body needs time to stretch and rest.

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