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Monday, 05 May 2014 09:13

Do We Have Control in Birth?

I recently came across an article about “control” that I think is really relevant to the way that we approach birth in the present highly-medicalized system. We are accustomed to handing over control to our doctors and to the hospital with the (often misguided) notion that they will make the best decision for us. 

Anyone who has met me knows that my mantra is: “Women need to take responsibility for their birth.” What does that actually mean, and what does it have to do with control? If you are pregnant and reading this then I suggest that you take some time to think about a few questions related to the way that you view your pregnancy, your choice of care provider, and the way you are preparing for your birth. 

Who (if anyone) is in control throughout the birth process?  

Birth is personal. You are the only one who can give birth to your baby. Sure, you will be in the hospital, under the care of your chosen provider(doctor or midwife) and nurses, but you will be the one who is experiencing labor and you have ultimate control over what is happening. 

Any decisions that need to be made at any time should be done as a team. Have a discussion between yourself, your husband and your doctor – with the best outcome for all as the best possible solution. 

How much control can we maintain? 

You control your mind. Your mind controls your body. You control your fear (or your ability to confront or move beyond fear). You control how you experience the intensity of the birth experience. 

Is letting go a necessary part of the process?  

Yes, absolutely. There are certain things that are out of our control. Things like the position of the baby, how long labor may take and certain situations that may arise necessitating a change of plan. Let go of what you cannot control. Hold on to what you can. You can control your attitude, your ability to be flexible in the face of unexpected circumstances. You control how you stay connected to your baby, your body and the process of giving birth. You can control your mind, your thoughts, your beliefs and your expectations. 

How is the birth experience affected by our attitudes toward authority and autonomy?

Do you blindly agree to everything your care provider suggests? Do you question decisions and routine procedures and how (or if) they relate to you and your pregnancy? Do you feel comfortable discussing your fears and expectations with your care provider?  Would you consider changing providers or even hospitals if you felt that after having several discussions, your wishes are not being respected? 

Here is a little acronym that I use in my birth preparation classes to help parents form a framework for opening discussions with their care providers. Think BRAT - Benefits, Risks, Alternatives, Timing

Benefits: What is the problem we are trying to prevent or to fix? Will this procedure fix the problem? If not, what would we do next? 

Risks: What are possible risks or side effects? 

Alternatives: What are the possible alternatives? What would happen if we did nothing? 

Timing: Is the situation urgent, or is it possible to wait? 

This is a great way to discuss things with your provider so that you can prepare for and have a no fault, no blame birth. If you confidently participate in all the decisions made during your labor and delivery–even those that were not in your birth plan--you are likely to look upon your birth with no blame and no regrets.

 

 

 

Pregnant women: print this out and hand it right to your partner, you will thank me later.

By now you’ve already gone through the excitement of a positive pregnancy test, received the hugs and high fives from friends and family, and made the decision whether to find out if you’re expecting a he or a she. Now, though, it’s starting to sink in: you have to have this baby! This cheat sheet is by no means everything that your partner will need to know on the big day, rather it is something to fall back on if it’s go time and all the information from childbirth classes fly out the window.  

By now you’ve learned more about the uterus and cervix than you ever thought you would; even heard about something called a mucus plug. Now it’s time to connect the dots, to understand just what’s going on down there, in there, and out here. The uterus and cervix, believe it or not, are actually one in the same. The cervix is the gateway to the uterus, which contains your baby, the placenta, amniotic sac and nearly a gallon of fluid!

Early Labor: How to Know & What to Do!

When the early stage of labor begins, the cervix begins to thin out and become softer, allowing it open easily.  She may feel what is described as a shooting or pricking sensation along with mild cramping, similar to PMS cramps for some. She will probably be able to maintain a nice conversation with small pauses while going about her business. The best thing to do is to go about what you had planned and focus on your last few hours or days as just a couple (or more!) It’s also important to note here that if she has had a cervix check done at the midwife or doctor’s office, it may not mean much. Some women are 4 centimeters for weeks before going into labor. My mother went from 0 centimeters to nearly having me in the hospital parking lot!!

Active Labor: What now!?

The next stage is active labor, this is when the cervix begins to open at a more rapid pace and your baby begins to make the journey into the pelvis. This is strong, amazing work, and she should be treated as it is by everyone in the room. Contractions become stronger, longer, and take on a regular pattern, happening every few minutes.

This is the time to encourage and support every single minute. Suggest that she relax her mouth and muscles while contracting, letting out deep sounds from her belly along with deep breaths to give oxygen to your baby (fun fact: the mouth, anus and vaginal muscles are all related! Relaxing and opening them helps labor progress effectively.

Physical support is critical during this time frame. You don’t have to be a licensed massage therapist to give her fantastic pain relief, just rub wherever you see her tensing up, especially the shoulder area. Alternate hot and cold cloths on her face and the back of her neck, this will help with her constant temperature changes.

Encourage changes in position, being on all fours, sitting and bouncing on a Pilates ball, and side lying on the bed are all great choices.  Avoid laying on the back as much as possible, contrary to popular belief, this can actually close the pelvis and make baby journey uphill.  Make sure you always have a water bottle handy, offering it to her constantly, even putting the straw right in her mouth. Snacks on hand will keep her energy up, but remember too that labor can be a time for puking. So choose foods that are high in protein, healthy fats and natural sugar while keeping in mind that it needs to be able to come back up as easy as it goes down.

When to make the call

By now, you may be wondering if it’s time to head into the hospital or call the midwife (for home birthing families.) While there is no right or wrong answer, short of actually seeing the baby coming out (CALL 911!) it’s a personal decision.

The general rule is 4-1-1: contractions that are 4 minute apart, lasting at least 1 minute, for 1 hour, but we all know that not everyone plays by those rules, babies included.  Some better signs to look for are emotional markers.  She may begin to enter a phase of self-doubt, you may hear the tell tale “I can’t do this!” mantra.  It’s common shortly before the quickest and most intense part of labor, transition; by the way, the appropriate response to this is always “You are doing it!”

She may be short on conversation and might be short with you, period. Don’t take this personally, it means that she is in the labor zone and conserving energy whenever she can. Physically, you may notice that she is starting to get closer to the ground and, sorry to say, but she may start farting. A lot. Your partner may also poop a bit. If you need to take a moment to giggle, let it all out now; we can almost guarantee that she is self-conscious about this. If she does do either, put down the air freshener. Most birthing women will poop on the table.  Pretend it didn’t happen, instead tell her how she’s getting so close to having her baby! She will thank you later. Isn’t it funny that in labor, rudeness and flatulence are encouraged? These are all great signs that point towards going in.

You will need to speak to you practitioner about the procedure for calling and arriving at labor and delivery before hand.

At the Hospital!

Once at the hospital, your support is a top priority! Quite a few first timers believe that their doctor, midwife or labor nurse will be there 24/7, but this is rarely the case. Nurses are the unsung heroes of the maternity ward (bring them cookies, seriously) and often take on a huge patient load to help many mamas birth. Your care provider usually comes in to “catch” your baby and maybe to discuss options with you once in awhile. There are exceptions, of course, but this is why it pays to be prepared (and hire a doula their expertise will help greatly…just saying!)

As she enters the transition phase, contractions will come very close together and she may look like she is in a totally different place. She may not be able to respond, so consider suggesting position changes, keep giving her water and food (depending on hospital policy) and through each contraction, remind her of how close she is. This is the most common time to ask for pain relief, usually while she is in the middle of a walloping contraction. Remind her that she is going to be holding her baby very, very soon and maybe suggest: “Let’s talk about an epidural in three more contractions,” so she can make a real, informed choice at a better time. Generally though, transition only lasts thirty minutes to an hour before pushing begins, it is both the hardest work and the most relieving as it means you are almost there!

All About Pushing

First timers always ask, “when will I know to push,” trust me you will know. She may start feeling as though she needs to use the toilet really badly. She may start making grunting or growling noises. If you haven’t already, this is the time to hit the “call nurse” button.

While each practice or hospital may have different policies on pushing, evidence shows that any position other than the back is best to let gravity do the work.  Yes, babies do come out! The pushing you see on TV, with the people shouting “ONE! TWO! THREE!” are only usually used in labors where mama has had a strong epidural and is no longer able to feel the need to push.  When she knows she has to, she rarely needs someone else to guide her.  The best encouragement is to remind her to follow her body, to push when it feels best for her.  

It’s Baby Time!

When your baby is crowning, you could ask for a mirror to hand to her if she’d like to see the action or encourage her to reach down and touch her baby. This may be too much for her, so say something like “wow, he/she has a lot of beautiful hair!” this will remind her of her ultimate payoff. Then, it’s baby time! Out comes a new, amazing little creature, covered in waxy vernix; encourage having the baby placed skin to skin on your partner’s chest. Now would be a great time to remind your care provider if your partner would like to keep the cord pumping precious blood to your baby while still attached and uncut, as well as a reminder if she has chosen not to receive Pitocin to deliver the placenta unless medically necessary. The placenta, thankfully, does not have bones and usually detaches and comes out by itself within a few minutes to half an hour, usually with just one push.

After this there’s not much else to say. Bask in your love for your partner as well as your new daughter or son. Go ahead and enjoy that oxytocin high; both of you have earned it. You only get one birth experience for each child, why not do everything you can and hire the best fitting doctor/midwife and doula support for your family? Do your research, find your voice and give your partner your all, for your baby—for your whole family.

Published in Birthing Assistance

Women go through labor in a similar manner to the way they live, and because childbirth can be a hyped-up and emotional time behaviors are often magnified. Coping skills are vital to have during this process, as certain personality characteristics are potential risk factors for a high or low risk birth. Inner conflicts and anxieties that are not dealt with before labor can make a woman feel out of control, victimized, and in crisis. Northrup described some of these issues as physical abuse, sexual abuse, self-image issues, dependence, passivity, resistance to change, and lack of support (473). What is necessary is that women become aware of their weaknesses and strengths so that they are capable of physically and psychologically enduring the labor process and becoming a mother. 

Fear of Pain

When the average woman enters the delivery room they have no idea of the extent of pain or discomfort they will feel. Pain is a strange experience and perceptions vary. Their reactions to the pain also vary and are often influenced by the way they deal with stress or fear.  First time moms often feel that the experience will never end. Some women enter the labor and delivery room and the first words they express is, “I don’t want to feel a thing.”  These women convince themselves that they are not capable of giving birth naturally. Some are scared, many feel unprepared, and others believe that labor is a complete inconvenience.  Other women react to labor pain as if they are being wounded or physically hurt - instead of relaxing into the contractions they resist. 

 Surrender or Resistance

It is common for some mothers to come into the hospital with a list of items that they refuse during pregnancy- no IV, no monitors, no students, particular room requests, and no interventions. I want every mother to feel safe and in control.  I agree with most of these requests under the right circumstances, trust me! Sadly control is often a survival mechanism and an attempt to remain safe when scared. The longer list of items a woman attempts to control the higher tendency there is for intervention.  

If you desire to - write a birth plan - be prepared and know your options. Also know that you are entering a hospital – many of these facilities are focused on business and protocol. If you feel that the medical team is moving too fast ask them to slow down and explain what is going on and offer options. 

Know Yourself

Events do not always go as planned and it is necessary to have adequate coping skills.  A woman should know herself. Her attitude towards life and the way she deals with problems will come up during labor.  Northrup described potential risk factors in childbirth (473).  Here are some questions based off this research that all women should ask themselves as they prepare for labor and delivery.  If you answer yes to most of these questions statistically you have a better chance at a low-risk childbirth. If you have issues in these areas, start to address them so you will be prepared during birth and into motherhood.

Do you consider yourself an active and independent woman? 

Are you able to take support from others? 

Are you able to deal with changes in an appropriate manner or do you tend to resist?

Are you honest in your communication?

Do your spiritual beliefs match your birth plan?

Have you been abused or sexually abused? If so have you dealt with these issues? (women who have experienced sexual abuse are more likely to have dysfunctional or high risk labors)

Do you ever consider yourself powerless?  If so what types of situations does this happen in, and how do you deal?

Do you and your partner have a loving relationship? Do you trust one another?

Do you have an internal control of your life rather than a supposed external control?

Is there anything you are scared of, if so are these fears being worked through?

 

For more information on this topic, pregnancy, or to read birth stories visit: http://birthwithbalance.com

 

Northrup, Christiane. Women’s Bodies, Women’s Wisdom Creating Physical and Emotional Health and Healing. New York City. Batman Books. 2010. Print.

Friday, 31 January 2014 10:06

Fetal Monitoring - Is it Really Safer?

Beep. Beep. Beep. You are in labor, lying in bed attached to an electronic fetal heart monitor (EFM).  A medical professional enters the room and immediately walks over to this machine, and with no eye contact he or she unfolds the long strands of paper to read a foreign language that no one explained to you.  Nervously you peer down at your fingers as if you are getting graded. Beep. Beep. With that he or she responds,  “Okay, looking good. I will be back to check on you in a couple hours.”  Beep. Wait a minute. Did the professional check on you or the machine? That is where lines blur. Babies all over the world are being continuously monitored without clear evidence of the benefit.

EFM was enthusiastically introduced into the medical system during the 1960s and took off in the 1980s with hopes that continuously detecting a baby’s heart rate would ensure safety and lower the risk of perinatal death.  Ina May Gaskin explains that this, in turn, increased the rate of cesarean section because doctors had not expected that “the lowered fetal heart rates during uterine contractions that could be picked up for the first time with the continuous monitor...were absolutely normal” (116).  Many heart rate tracings are identified as abnormal when the baby is in no distress. Continuous EFM is highly sensitive and has the ability to identify fetuses that are distressed, but also has low specificity, or the ability to identify those that are not in distress. The EFM “therefore has a high false positive rate” (Walsh 60). 

Walsh conducted a systematic review involving 12 studies and 37,000 women comparing continuous EFM to intermittent auscultation (listening by hand with a fetoscope periodically after a contraction). This review found (58):

  • No differences between the two in perinatal death, Apgar scores, NICU admissions, or cerebral hypoxia (or lack of oxygen to the brain).
  • EFM halved neonatal seizures, but also resulted in a significant increase in cesarean sections and assisted vaginal births.

Evidence shows that intermittent listening with a fetoscope is just as reliable as EFM, and in most cases takes away much of the fear involved in birth resulting in fewer cesareans.  So why is this method still in practice? Continuously monitoring a woman in labor requires less human contact. One nurse is able to “monitor” several patients at a time from a local station. Doctors are able to monitor an entire unit. This in turn lowers costs and shows evidence, via the long strands of paper, that the baby was watched throughout labor if a courtroom was ever involved.

Beep. Beep. Beep. Imagine that you are back in that hospital room. Let’s say that your female nurse walks in and begins to document your baby’s heart rate. This time instead of looking down, look into her eyes and ask her to turn down that noise. Maybe even ask if she will turn the machine away from your line of vision so that it is no longer your concern, just hers.  Then ask her the best ways to move around. Most likely she will respond with compassion and understanding.

As a labor and delivery nurse I do this for all of my patients. I always offer to educate them regarding what we are monitoring, why we are monitoring and the policies that go along with that. Then I ask permission to tilt the machine away so that it is no longer a concern. Sometimes the mother and I even cover the machine with a blanket! I then show her how to move around the room while still being monitored, and encourage her to get out of bed if she does not have an epidural. 

Technology has a way of creating the illusion that we are progressing. This is not always true and there are data to prove it.  Hospital staff and even parents tend to depend on these machines, creating a mind-body split. Sometimes the monitor becomes more important than the internal experience. Don’t let that happen to you – keep yourself empowered and ask questions. The ancient ways of birthing through continuous human contact are still relevant and vital to health and safety for mothers and newborns.

For more information on this topic, pregnancy, or to read birth stories visit: http://birthwithbalance.com

Gaskin, Ina May. Birth Matters a Midwife’s Manifesta. New York City. Seven Stories Press. 2011. Print. 

Walsh, Denis. Evidence and Skills for Normal Labour and Birth a Guide for Midwives. New York City. Routledge. 2012. Print

 

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