Janelle over at the Birth Sense blog is rapidly becoming one of my favorite blogs because of her very well written posts that include references to current research findings. Using one of my comments as a spring board for a post made my day today, because once again, she has provided references to current research that is of use to laboring women.
Janelle writes:
Over the 28 years I’ve been a labor nurse and then a midwife, I’ve seen Continue Reading…
Posted 7 months, 3 weeks ago at 6:02 pm. Add a comment
One of my friends is past her due date…wondering when her baby will come…so I thought I’d revive this blog post I wrote about 2.5 years ago.
So often when I talk to women in the last weeks of pregnancy, what I hear is a recollection of all the “natural” methods they have tried to induce labor. And frankly, I find this disturbing.
I have to admit, the most after my due date that I’ve gone with any of my 5 pregnancies was 2 days…and I was in denial that I was in labor when it started because Continue Reading…
Posted 1 year, 1 month ago at 7:38 pm. 6 comments
The blog-o-sphere is buzzing right now about a practice called “Pit to Distress.” Apparently Keyboard Revolutionary started it all with her post, which was quickly followed by Unnecesarean the same day. Now both of these blogs are written by “lay women”–that is, “JUST” moms, not medical professionals. So I was quite happy to see one of my favorite L&D nurse blogs jump into the fray–Nursing Birth. The Nursing Birth piece should be required reading for ANY woman who is planning a hospital birth, so that she doesn’t let this happen to her.
Pitocin seems to be almost synonomous with hospital labors anymore. I wonder how many women who labor actually manage to get through without using it at some point. One client I had switched OB practices because she had been informed that when she arrived at the hospital in active labor she would be put on Pitocin. No waiting to see how labor was progressing and if it was really needed…it was just the policy of this practice to use Pitocin on all laboring women. Medical staff will often explain away any concerns with the use of Pitocin by saying that it is just a synthetic form of the same hormone that your body produces. Which is true. But that doesn’t mean that putting it into an IV is the same as letting your body produce it!
I’ve seen some “interesting” things happen with Pitocin in my doula experience.
Over at the Independent Childbirth site, “Birth Wisdom Week” is being celebrated. I was supposed to write a post as part of this, but I’ve been a bit tied up planning some activism related to the situation with The Midwives, so I apologize profusely about how late this post is!
As a childbirth educator and doula, I have to admit, one of my greatest frustrations is that many women don’t even really seem to be bothered by the rising cesarean rate in America. If I thought that it was that the women didn’t care if they had a vaginal vs. cesarean birth, I’d be able to accept that. But I really don’t think that is the case Continue Reading…
Posted 1 year, 3 months ago at 12:47 am. 1 comment
In “honor” of Cesarean Section Awareness month, this post has been making the rounds, with a new “way” being added by each blogger. I first saw the list in “Faint Star Light” with 7 reasons. Then “Nursing Birth” joined the party, and finally “Enjoy Birth” jumped on the band wagon. And now…me. ;-) (you should note that each author has put her own spin on the text–so go read them all!)
#10 Only take the hospital sponsored childbirth classes, or no classes at all. After all, an independent viewpoint isn’t important–you’d accept a Ford dealer telling you that the Ford Windstar is the ONLY option for a family vehicle, and never consider a Honda Oddessy or Toyota Sienna, right?
#9 Choose a care provider without research – Some OB’s are cesarean happy. Some OB’s say they support vaginal birth or VBAC’s but their statistics don’t back it up. Make sure to ask your care provider about her cesarean rate–if it is over 20%, she ISN’T committed to avoiding cesarean–and that is being generous! My OB practice in my first pregnancy had a 16% cesarean rate (and they aren’t VBAC friendly, despite “talking the talk”), so I know it is possible for even an OB to have such a rate.
#8 Agree to a labor induction without medical indication. – This is a sure fire way to make a birth more of a challenge. Ask LOTS of questions. Or, the variation on this, the “back door induction“…allow yourself to be convinced that you are in labor and in need of “augmentation” when you aren’t really in labor.
#7 Go the hospital in the early phases of labor. Because hey, what helps you to relax and allow your body to “do its thing” more than entering a bright, noisy environment where people you’ve never met before want to touch your most private parts. Remember…(assuming you conceived naturally)…the environment that was necessary to get the baby *in* is the best one to get the baby *out.* Including some smooching if you are so moved.
#6 Don’t eat or drink during a long labor. Because you really don’t want to do what I did. I mean really, eating a breakfast befitting a lumberjack while having contractions 3 minutes apart was just CRAZY. I didn’t have a crystal ball that told me I wouldn’t eat again for nearly 24 hrs.
#5 Get an amniotomy too soon. Because hey, after having 2 or more vaginal births, it’s fun to have an emergency cesarean for cord prolapse (yes, despite what one of my cousins is being told to scare her into a primary cesarean with her second baby, it is QUITE common for babies to still be “high and floating” until a multipara is in active labor–even my 5th baby, who was a petite 6 lbs 3 oz didn’t “engage” until well into labor). Scaring all your family half to death is fun! (Yes, I do know someone who had this happen–and frustratingly enough, the family was singing the praises of the Dr. who broke the water because he knew just what to do to save the baby!)
#4 Accept pitocin to induce or stimulate contractions.
#3 Request an epidural. Despite having 5 babies with nary a pain medication on board (okay, I did take one dose of Tylenol with Sophie after my midwife confirmed that I wasn’t making progress), I don’t begrudge women epidurals. I just think women ought to be aware that being restricted to bed increases your risk of having a posterior baby, which increases your chance of cesarean. Having an epidural (or Pitocin) also means constant fetal monitoring, which has also been shown to increase the risk of cesarean–without improving fetal outcomes. And finally, I’ve had clients who needed to change positions in order to birth–two in particular needed to use hands & knees. If they hadn’t been able to get into that position, they would have either needed a cesarean, or had a very poor fetal outcome (9 lb 11 oz baby with shoulder dystocia–mom flipped to hands & knees and the baby slid right out with no tearing. Had she been stuck on her back she would have needed a big episiotomy and possibly forceps).
#2 Accept hospital staff’s comments on lack of progress without challenge. Don’t concern yourself with stats that shown that “failure to progress” cesearans are much more likely to be performed at 4 p.m. than 4 a.m.–its not that your care provider is just wanting to get home for dinner.
#1 Just ask – or Failure to Ask Questions! – Sure, some moms ask for cesareans, though despite media reports that make you think it is common, survey research indicates that it is very rare. It is more likely that moms are told they need a cesarean because of xyz (breech baby, twins, big baby) and they don’t ask questions, get second opinions, etc.
Posted 1 year, 4 months ago at 12:51 am. 2 comments
Before the birth…
This being our second child, we approached the birth much differently than we had our first. I was not scared of labor, I knew I could handle it. I had switched care providers from a practice with 4 OB/GYN’s to a single OB/GYN in practice with a midwife. I joked repeatedly with Dr. R. that after a 33 hr first labor, I would be happy with anything under 20 hrs this time around. I did not want a repeat of Jessica’s posterior positioning, so I did a lot of research on how to avoid posterior position.
At my 38 week pre-natal visit I learned that I had tested positive for Group B Strep. This is a normal bacteria that occurs in approximately 1/3 of adults at any given time causing them no harm. However it can be very serious to a newborn-even fatal. It is easily treated with IV antibiotics administered during labor, but that meant I would have to have a Hep-lock, something I had been quite happy to skip in my first labor. I also learned at this visit that my blood pressure was starting to creep up.
At my 39 week visit my blood pressure was still up (148/90), so I was told I could not continue working and should start mild bedrest. I had planned to work up until my due date as I had in my first pregnancy. This was on a Thursday. I got reluctant permission from Dr. R. to finish out the week at work because I had things I needed to get completed. My labor story picks up at this point.
Wet Clean Up on Aisle 9!
(this part of the story was written during the evening of Saturday, June 17)
I was out shopping this afternoon (bedrest? LOL!), and about 2 hrs into my little excursion I started thinking that the wetness I was feeling didn’t really seem like the “stress incontinence” I’ve had for the past few months–mainly that I didn’t take coughing to produce wetness.
I had one more store I needed to go to–Steve wanted some shoes that were on sale, and I was determined to find them (silly man…he picked out *women’s* walking shoes from the ad! No wonder I couldn’t find them despite thoroughly examining the men’s shoe section!). As I was packing up Jessica’s stroller after putting her into the car I had a stronger discharge, so I grabbed one of her diapers, and got into the car. Paged Steve. This was at 3:30.
I was about 10 minutes into my drive home when I decided to page Steve again because he still hadn’t returned my call. Turns out that he was napping, so I made it the whole way home without him responding. I got home, still not sure that it was really my water leaking. So I called Dotty (our Bradley instructor and doula) to get her input. We called Steve’s parents to see if Jessica could spend the night with them “just in case.” Started scurrying around to pack a hospital bag-I hadn’t even started one yet-and an overnight bag for Jessica, fix carseats in the car (only a person truly obsessed with safety would install a tether anchor with her water broken!). After about 1 hr of being home (around 5pm) I was convinced I had a slow leak in my water. I was also starting to notice a few very mild contractions.
By 8 pm we were just waiting for the contractions to get stronger/more regular. We planned a trip to the grocery store because I hadn’t shopped yet for food to take to the hospital. We also considered Friendly’s for dinner–we went there for breakfast when I was in labor with Jessica. I was a bit perturbed that once again the labor process was beginning the day after I quit working. I really had things that I wanted to get done–mostly just some relaxing!
Waiting for labor to start
(this portion of the birth story was written on Tuesday, June 20) We didn’t really know exactly how Dr. R. would handle things with my water broken before labor–we hadn’t really thought we needed to discuss it with him since I was 8-9 cm dilated with Jessica before my water broke. So we were hesitant to call him-we didn’t want to get put on a clock to c-section since most OB’s will only “allow” a mom to have ruptured membranes for 12-24 hours. By 10 pm Saturday my contractions had been about 5 min apart all through dinner at Friendly’s (one hour), and were coming 2-3 min apart in the grocery store–although they were still very mild. We decided to call Dr. Rittenhouse on my cell phone. I chatted with him, and he never asked if my water was broken. As we ended the conversation he told me to come into the hospital when my contractions got more intense or if my water broke. Crossing my fingers and going on the technicality that he phrased his directive in the future tense and my water breakage was a past tense event, I said “okay!” and hung up
When we got home, my contractions slowed down considerably when I stopped moving. We went to bed for the night. My water quit leaking all night–I actually hadn’t noticed it since around 7 or 8 pm, so I was hoping it had resealed, something Dotty said could happen. I got up at 3 am because I couldn’t sleep. I painted my toenails & read a magazine, then went back to bed around 4:30. I was having occasional (every 1/2 hour) contractions that were mildly painful, but nothing that seemed serious.
We got up around 6:30 Sunday morning (Father’s Day!) and took a walk. Then we went out to breakfast. As we were leaving the diner at around 8 am I had a significant gush of water, so we decided to head into the hospital–a bit disheartened because I still didn’t have a good contraction pattern.
We arrived at the hospital around 9 a.m. I was set up in the same room I had been in for Jessica’s birth. By 9:30 I was on IV antibiotics. Dr. R. couldn’t get in right away, so the nurses asked if I wanted the on duty resident to check my progress, or if I wanted to wait for the midwife who works with Dr. R. I opted for the midwife. When I got done with the antibiotics & got the IV disconnected she wasn’t there yet, so Steve and I set off walking. She arrived shortly after that, and we chatted. She asked why I thought my water had broken, so I told her about the gush of fluid as I left the restaraunt at 8 am (I know this let her believe that is when my water broke, but it was a choice my DH and I had discussed. We decided that the risks of our baby actually catching GBS vs. the risks of c-section made this the correct thing to do). She stressed that she and Dr. R. are very proud of their low c-section rate, and that she was totally confident that since I was a second time mom I didn’t need to worry about that–of course I would go into labor within 12 hours of my water breaking. It was nice to deal with her non-interventionalist attitude, but of course I knew that my water had already been broken for at least 19 hours at that point. She expected that around 8 pm if I wasn’t in labor that Dr. R. would start discussing Pitocin. She did an internal at around 11 am and I was 3 cm, 50% effaced, at -1 to -2 station.
The next few hours were basically walking with mild contractions 2-3 minutes apart interspersed with monitoring where my contractions would drop to every 10-15 minutes and even milder. Oh–and antibiotics every 4 hours. At around 3 pm Dr. R. arrived at the hospital. He did another internal, and I hadn’t progressed at all. He was very sympathetic about it–he really does treat the emotional side of the patient, he doesn’t adopt just an “all business” attitude. He explained then that since it was Father’s Day he really did want to go visit his father, so he was going to be gone. If I hadn’t gone into labor by 9 pm he would have the resident discuss with me putting in a chip of prostaglandin to see if that would get things going. He was willing to let me try 3 doses of this–administered one chip every 4 hours–prior to then moving on to Pitocin. This was a much less interventionalist approach than I had expected even waiting so long to suggest any sort of drugs, let alone waiting on the Pit.
Let’s get this show on the road!
At 9 pm when the resident walked into the room I had a significant gush of fluid–I think that the small tear in my membranes may have totally ripped open at that point. But I hadn’t progressed, so the resident put the chip in–it was a very tiny thing, less than 1/4 inch across. I had to lay on my back for 1 hour while it dissolved, but since I wasn’t really having contractions, this wasn’t too hard to do. At the very end of the hour I had 3 contractions that were starting to build in intensity and were hard to take laying down, so I didn’t wait a minute beyond my 1 hour mark to get out of bed. We started walking the halls. Labor really got serious at that point. It was pretty painful, although not as painful as it had been with Jessica. We were pretty confident that I wasn’t having back labor this time–although I did have pain in my back. The difference was though that I had pain in my front as well, and I don’t really recall having pain in my front with Jessica–if I did it was totally overpowered by the back! I was pretty upbeat that things were going well, although I kept reminding Steve and Dotty that they weren’t allowed to call the contractions “nice” — as in “that was a nice strong contraction!”
At 1 am the resident wanted to check me again to see if we should do another prostaglandin chip. I already knew that my answer was NO! because I knew I couldn’t handle laying on my back for an hour. She did the check though because Steve, Dotty, and I were sure I had progressed and we wanted to see how far. She was totally all business, seemed to make no attempts to be gentle at all. Announced that I was 5 cm dilated, 90% effaced, and -2 to -3 station. No smile or positive reinforcement or focusing on how I had progressed. Now the 90% effaced was nice, but since I could literally feel my baby pushing into my cervix toward the end of each contraction then pulling back up, I had expected more than 2 cm of change in dilation. And what was with the baby moving UP when I could see with my own eyes that the butt had dropped about 2 inches? So I asked her if she was sure, and she got real bristly. “That is what you are, I’m not the one in labor so I can’t do anything about it.” Turned around and walked out of the room.
We discussed this amongst ourselves and decided that no way did I want to have any more interactions with that woman. We asked the nurse to call Dr. R. and have him come in to the hospital. After that point I was pretty discouraged. I’m sure some of it was just natural transition stuff, and some of it was from the resident’s attitude, but I really was thinking that I couldn’t do this anymore, that I just wasn’t going to progress. I was thinking “here I am, a co-leader for the Bradley childbirth board, and I am sure I am going to have a c-section!” Just like how I took my diagnosis with GBS, it is MUCH easier for me to encourage others that this does not mean failure than it was for me to accept it for myself. I kept a lot of this to myself. I started to turn around though as we walked past the room of an woman who had been admitted just a few hours after me and heard the resident telling her husband that the MORPHINE would kick in soon. Wow. Just knowing that I would never consider giving my baby Morphine for the level of pain I was in–this helped me to know that I could do it.
Water play
We decided to try the shower for pain relief. I really wanted the Jacuzzi, but was kind of scared that not being vertical would slow my progress. The shower was nice, but it was really hard on Steve’s & my already very tired feet. So we decided to try the Jacuzzi. Dr. Rittenhouse had been called to the hospital sometime around 1:30, 1:45, and arrived around 2:15 while I was getting out of the shower. I was just tired & in pain, so I barely mumbled at him that I was doing okay and was glad he was there as I slowly walked past him on my way to the Jacuzzi. I think it was around 2:30 when I got into the Jacuzzi.
Just like with Jessica, it was SUCH relief. It did space my contractions out I think…I don’t really know because Steve and I both were sleeping between contractions, and we were alone in the room. About the 4th or 5th contraction that I had I thought I felt a tiny urge to push, so I told Steve that I thought it might be time to get out, lets wait for the next contraction to see. We both promptly fell back to sleep. Woke up not even a minute or two later for a DEFINITE pushing contraction. Steve pulled the panic cord–he says it was 3:15 then–and the nurse was there before my contraction was even over. Dotty & Dr. R. were close behind her. It was kind of funny with everyone struggling to get me out of the Jacuzzi (it is set up very poorly as far as “grab bars” go for getting a pregnant woman out of it), then deciding what state of attire I would be in for the trip back to my room. I shoo-ed most everyone out of the room so that I could take my bathing suit top off (a two piece maternity suit with as much coverage as a fairly modest one piece–very handy for labor!) and put the hospital gown back on. It was kind of funny since I had told a nurse earlier who tried to cover my legs with a sheet prior to Dr. R. checking my progress that it was kind of pointless since he was standing right there and was just going to push it up so that it offered less coverage than the hospital gown I had on-I must be one of the only women to experience an increase in modesty as labor progesses. I slowly worked my way back to my room, doing my best not to push. It had taken us about 30 seconds to walk the entire U-shaped hallway of the unit earlier, now I only had to walk about 1/3 of it to get from the Jacuzzi to my room and it took about 5-10 minutes between the slowness of my walking and stopping for contractions.
Dr. R. checked me when I got to my room and he said I was basically complete (9.5 dialated), a slight anterior lip that was very stretchy so I could push through it if I wanted to. I’m not quite sure why, but he started back out of the room to go sit down at the nurses’ station rather than getting his scrubs on. Perhaps with the slowness of my going from 9 to complete with Jessica–7 hours-he thought he still had a wait. He made it half way across the hallway before Dotty and I started arguing over whether or not I should push — I didn’t want to tear and she said I needed to push because the baby was crowning! Dr. R. was instantly at my side, encouraging me that it was okay to push. My body was pushing whether I wanted to join in or not. 3 contractions & 10 minutes later and Katie was born. I was too busy to notice, but Dotty and Steve said it was funny to watch Dr. R. struggling to get into his scrubs & booties (never got his face mask on) in time to catch. I was very surprised with this speed that I didn’t tear at all–just a little bit of “rug burn.”
The umbilical cord was wrapped around Katie’s body, so she was pretty blue when she was born–but she was breathing & crying okay. Her apgars were 6 & 8. A few hours after she was born the nurse said I needed some Pitocin by IV & a shot because I was bleeding more than they wanted me to. Since Katie was already born I wasn’t too concerned about having Pitocin at that point, so I readily agreed to it. However, as odd as it may sound considering I had just given birth without pain medication, I really did NOT want to feel the injection! LOL!
Thoughts after the birth…
I got my wish-a labor less than 20 hours. I actually only had less than 6 hours of true labor. Unfortunately I was totally exhausted for all of it because of the premature rupture of membranes. If I had it to do all over again I would still wait to go into the hospital until the morning-to at least get some sleep. But I would have asked to be induced first thing in the morning while I was still fresh rather than waiting in hopes that labor would start.
The “prostaglandin chip” used to induce my labor was 1/4 of a dose of Prepidil–a suppository used to induce labor. I’ve learned that the hospital I was birthing at prefers to dose it this way rather than giving the whole suppository every 12 hours, as this seems to reduce the risk of hyperstimulation.. I found it very effective in inducing my labor, and allowed me to avoid the use of Pitocin, which would have come with a constant IV and constant fetal monitoring that would have kept me tethered close to my bed and out of the Jacuzzi. Given the slow progress I had made, I could have had a second dose if I wanted it. But being unmedicated I knew that my contractions were effective enough without it. Sure enough, I gave birth shortly after refusing the second dose. If I had taken it I could have possibly experienced uterine hyperstimulation.
Posted 1 year, 6 months ago at 6:05 pm. Add a comment
