Labour

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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
Friday, 08 February 2013 18:00

The Cascade of Interventions

The Cascade of Interventions aka the Snowball Effect

In a hospital setting where your care providers are actively managing your labour, once you have one intervention it makes more interventions more likely to be needed in order to remedy the effects of the previous ones.

In our Western society culture, there has been a tendency to turn pregnancy and childbirth into a medical experience. One intervention can lead to another in a cascading sequence of questionable procedures, many made necessary only because of a previous intervention.

We are lucky to live in the time of modern medicine, however medical interventions such as labour induction, pain relief, and cesareans—measures that have saved many lives—have been overused.

When you intervene uneccessarily with nature's role, generally there is a waterfall of effects that occur because one things leads to another.

Doctors need to inform their patients of all the risks instead of assuming we don't need to know. It is our bodies, after all...

Facts - did you know that:

  • The World Health Organization (WHO) states that no region in the world is justified in having a cesarean rate greater than 10 to 15 percent.
  • In the past twenty years, the cesarean section rates have nearly quintupled in the US to 23.8% in 1989 and nearly quadrupled in Canada to 18.3% in 1987-8.
  • Of 11,814 women admitted for labor and delivery and attended by midwives to 84 freestanding birth centers in the US, 15.8% were transferred to the hospital and 4.4% had a cesarean section. Although the women were lower than average risk of a poor pregnancy outcome, their cesarean rate is one-fifth of the national average.

This is a wonderful representation of how one intervention can snowball into the next from "Thinking Woman's Guide" by Henci Goer.

1. Changing into the hospital gown

Putting on the hospital gown shifts the balance of power from woman to hospital.  Her perception of herself shifts, and she sees herself as a patient, in the care of “experts,” rather than as a woman confident in her ability to birth on her own terms. This simple act may also make the woman feel less comfortable, feel cold or she may be concerned about modesty as well, which increases stress and makes relaxation harder.

2. Continuous Electronic Fetal Monitoring (EFM)

The major effect  of continuous EFM is that it keeps the mother immobile in bed. The use of EFM is not evidence-based, and even ACOG (American Congress of Obstetricians and Gynecologists) admits it has had no effect in improving outcomes for babies .  Evidence shows that Intermittent EFM with a handheld Doppler is just as effective as continuous EFM at identifying babies in distress.  The only effect continuous EFM has had is that it has increased the cesarean section rate.

3. Getting the IV

IV’s restrict a woman’s mobility and make it easier to administer fluids and medications that can interfere with natural birth.  Sometimes, IVs can be helpful, especially if a woman is unable to tolerate oral hydration, or in an emergency situation.  In normal labor, women need to be free to move their bodies throughout labor, and should be encouraged to change positions frequently.  Having an IV can hinder that. The IV is also simply uncomfortable, annoying and may interfere with her focus on relaxing with contractions as well and make holding hands with her support person more uncomfortable or impossible. Even a hep lock can be bothersome in the same ways. The perception that having an IV readily available is helpful in an emergency is not evidence based. Many times this IV port is not working well enough to handle an emergency and must be restarted.

4. Labour Augmentation with Pitocin

The use of synthetic oxytocin (Pitocin®) makes labor more painful for the mother, and more difficult for the baby to tolerate. There are studies that show Pitocin may interfere with the body's natural ocytocin hormone production which may hinder the mother's natural efforts in the pushing stage, may contribute to postpartum hemorrhage and may interrupt her bonding with her baby, contributing to postpartum depression. http://www.birthresourcenetwork.org/resources/54-pitocin-the-whole-story

5. Pain Relief

Because the contractions are so intense with Pitocin, the mother frequently will choose to receive an epidural for pain relief.

6. Restriction of Movement

An epidural keeps a woman confined to bed for the duration of the labor and birth.  Being unable to move restricts the woman’s ability to help her baby get into a good position for birth. It may also hinder the baby's ability to move, too.

7. Contractions Slow Down

Epidurals can slow labor progress, which results in increasing dosages of Pitocin® to increase contraction intensity and frequency, which can lead to an even greater need for pain relief and greater risk of fetal distress.

8. Progress Slows or Stops

Assuming the woman reaches full dilation, the epidural can interfere with the woman’s ability to push effectively.

9. Fetal Distress

Hard contractions, combined with reduced blood pressure and the lack of blood flow to the baby, can cause the baby to go into distress.

10. Cesarean Section

After having exhausted all of the tools at the obstetrician’s disposal, this one option remains.

 

 

Published in Labour

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