There are many studies for and against immunizations. My own pediatrician suggested that there has been such extensive research concluding that vaccinations does not cause autism that the government will not likely fund any further study on the matter.
Here are two recent yet opposing views on the matter. Read and draw your own conclusions
http://www.cnn.com/2011/HEALTH/01/05/autism.vaccines/index.html
http://canaryparty.net/index.php/the-news/123#.ULlTzchfCBM.facebook
It's your birth and your choice.
Tuesday, December 18, 2012
Thursday, June 30, 2011
Exercise in Pregnancy
Exercise in pregnancy is almost as important as a healthy diet. Yet prenatal exercise is often over looked as a necessary component to a healthy pregnancy. It is a popular misconception that pregnancy is a time to take it easy, kick back, relax, and be sedintary.
Unfortunately, this approach may lead to a number of serious consequences including, toxemia, eclampsia, heart failure, depression, and thyroid disease.
Pregnant women should exercise a minimum of 30 minutes daily. Two fifteen minute walks daily may provide the following benefits:
Elevated Mood
Improved Circulation
Enhanced Digestive Funtion
Greater Endurance
Increased Muscle Tone
Stable Metabolism
Deeper States of REM Sleep
Higher levels of Energy
Women who did not exercise prior to pregnancy should begin exercising as soon as they possibly can. Start with a short and easy workout gradually building your musle and cardiovascular capacity. Some basic rules to follow about exercise in pregnancy are as follows:
Be Consistent
Begin exercise with a warm-up
Never do anything that hurts
Keep core body temperature under 100.4 degrees
Keep intensity level in the moderate range
Stop exercising before reaching point of fatique or exhaustion
Stop immediately if you experience, bleeding, cramping, or faintness
Reduce intensity with presence of high blood pressure
Practice abdominal breathing to oxygenate the body properly
Avoid activities that stress joints or comprimise balance
Unfortunately, this approach may lead to a number of serious consequences including, toxemia, eclampsia, heart failure, depression, and thyroid disease.
Pregnant women should exercise a minimum of 30 minutes daily. Two fifteen minute walks daily may provide the following benefits:
Elevated Mood
Improved Circulation
Enhanced Digestive Funtion
Greater Endurance
Increased Muscle Tone
Stable Metabolism
Deeper States of REM Sleep
Higher levels of Energy
Women who did not exercise prior to pregnancy should begin exercising as soon as they possibly can. Start with a short and easy workout gradually building your musle and cardiovascular capacity. Some basic rules to follow about exercise in pregnancy are as follows:
Be Consistent
Begin exercise with a warm-up
Never do anything that hurts
Keep core body temperature under 100.4 degrees
Keep intensity level in the moderate range
Stop exercising before reaching point of fatique or exhaustion
Stop immediately if you experience, bleeding, cramping, or faintness
Reduce intensity with presence of high blood pressure
Practice abdominal breathing to oxygenate the body properly
Avoid activities that stress joints or comprimise balance
Tuesday, June 21, 2011
Treating Constipation in Pregnancy
Even during the earliest stages of pregnancy when the fetus isn’t quite a fetus yet and still measures smaller than a grain of rice you may feel bloated and begin experiencing constipation. Constipation in pregnancy affects half of all pregnant women.
Why is the pregnant body more prone to constipation?
During pregnancy women produce a hormone called progesterone which relaxes movement in the intestines. In turn the bowels move more slowly and less effectively, as a result you see constipation during pregnancy.
High quality minerals and nutrients are necessary for a healthy fetus to grow and develop. As the body attempts to extract as much nutrients as possible from the pregnant woman’s food consumption higher levels of progesterone may be produced. The extra time that the body takes to absorb these nutrients slows the flow of digestion.
Pregnant women also need extra water for the extra blood volume needed during pregnancy. The pregnant body absorbs more water from the bowel than she would if she were not pregnant. This naturally causes a harder and dryer stool.
The longer food remains in the intestines the more water is absorbed from the bowel into your body to help with the extra blood required during pregnancy.
Most if not all prenatal vitamins contain iron which is also known to bring about constipation in pregnancy.
Treating Constipation in Pregnancy
-It is recommended that pregnant women drink a minimum of 72 ounces of water per day.
-Pregnant women should also increase the amount of fiber in their diet with fresh fruits, vegetables, legumes, and whole grains. For a more complete index of foods containing fiber see the fiber chart located at the top of this page.
-Eating two prunes a day is a natural and safe way to increase bowel regularity
-Peppermint tea can be used to help with bloating pains. I would also recommend trying to
reduce your stress levels as much as passable. Stress is also a known cause of constipation.
-Walking for 15 minutes following each meal significantly aids the digestive process and increases circulation to the intestines and bowels.
Why is the pregnant body more prone to constipation?
During pregnancy women produce a hormone called progesterone which relaxes movement in the intestines. In turn the bowels move more slowly and less effectively, as a result you see constipation during pregnancy.
High quality minerals and nutrients are necessary for a healthy fetus to grow and develop. As the body attempts to extract as much nutrients as possible from the pregnant woman’s food consumption higher levels of progesterone may be produced. The extra time that the body takes to absorb these nutrients slows the flow of digestion.
Pregnant women also need extra water for the extra blood volume needed during pregnancy. The pregnant body absorbs more water from the bowel than she would if she were not pregnant. This naturally causes a harder and dryer stool.
The longer food remains in the intestines the more water is absorbed from the bowel into your body to help with the extra blood required during pregnancy.
Most if not all prenatal vitamins contain iron which is also known to bring about constipation in pregnancy.
Treating Constipation in Pregnancy
-It is recommended that pregnant women drink a minimum of 72 ounces of water per day.
-Pregnant women should also increase the amount of fiber in their diet with fresh fruits, vegetables, legumes, and whole grains. For a more complete index of foods containing fiber see the fiber chart located at the top of this page.
-Eating two prunes a day is a natural and safe way to increase bowel regularity
-Peppermint tea can be used to help with bloating pains. I would also recommend trying to
reduce your stress levels as much as passable. Stress is also a known cause of constipation.
-Walking for 15 minutes following each meal significantly aids the digestive process and increases circulation to the intestines and bowels.
Wednesday, June 15, 2011
Pregnancy #3 Isaac's Birth Story
The third time is a charm. My weight gain by the end of pregnancy number three totaled 19 pounds. I walked 5-10 miles a day and nourished my body with plenty of fresh fruits, vegetables, folic acid, and whole grains. I ate meat in moderation and limited my sugar and fat intake.
I felt great. My energy levels were terrific and even though my body started producing relaxin a bit early and experiencing the same pains in my ligaments and joints I promised myself I wouldn’t whine. But just in case, I switched to the doctors within the same clinic. I knew they’d be a little more inclined to strip my membranes if I wanted a little pre-labor boost.
I approached labor and delivery with a better idea of what to expect from my body, the hospital staff, and my husband. This time around I wanted a doula.
This upset Neil. He resented my decision to bring a third party to the birth of number three. He felt like I was saying, “You’re not good enough.”
That wasn’t the message I intended. I simply wanted to create an environment that allowed him to fill his role as companion, not birth coach.
At one point he sarcastically said, “I’m not coming. What do you need me for? You have Tina.”
I explained that Tina was not meant as a replacement for him. She planned to support him, give him tips, encourage me, and ward off any medical staff that intended to alter our birth plan unnecessarily. I tried to convey that her purpose was to make his job easier.
Eventually, Neil accepted Tina’s presence as a possible advantage. As we patiently awaited a spontaneous labor or naturally occurring labor I experienced a few false alarms. You’d think that by baby number three you’d recognize labor when it hit. But I learned something new about the uterus in the pregnant anatomy.
Your uterus will never return to its pre-pregnancy condition. Each time your uterus, the hollow organ known as the womb, houses a new fetus it stretches and weakens. It loses muscle tone in the fibrous tissue. In order for the uterus to continue functioning effectively it must get back in shape and prepare and practice for labor. This warm up period manifests itself with Braxtion-Hicks contractions. You experience Braxton-Hicks contractions by the third trimester of your first pregnancy. However, many woman never notice these little abdominal tightening or quickening. Regardless of whether you recognize them or not, they occur regularly.
These Braxton-Hicks or toning contractions begin sooner and become stronger in subsequent pregnancies. The more your uterus is stretched the more work your uterus must do to get back in shape.
Six weeks prior to the delivery of baby number three I experienced my first FALSE LABOR.
My contractions initiated on their own while my Neil and I sat in a movie theatre. I couldn’t help but feel a little excited. I sat content to watch the movie as labor progressed.
When I we returned home I went walking. My uterus tightened while I walked, but not in regular contraction patterns. I couldn’t really tell if it was a contraction or not. Eventually, my uterus relaxed and I resigned that it must not be labor.
I walked the rest of the way home and retired to bed. Laying in my bed my contractions returned strong. At first they only lasted 30 seconds. I timed the contractions. The clocked at 7 minutes from the start of one contraction to the start of the next.
Realizing that 30 seconds isn’t a very serious contraction I ignored the pain as best I could. The contractions continued to progress. Over the next couple hours the length of each contraction increased to 60 and even 90 seconds. The contractions came regularly and steady in the strength. I continued to time the distance between contractions. By this time my contractions were a little more than 4 minutes apart from the start of one contraction to the beginning of the next contraction. My level of discomfort continued to rise.
I wanted Neil to sleep as long as possible so that he would be well rested for the hard part of labor. I quietly left the bedroom and drew a warm bath.
The buoyancy of the water provided welcome relief. When laboring in water the force of gravity is weakened on your muscle groups. I laid back and relaxed. The contractions continued for over an hour, but they eventually became shorter and farther apart. I took catnaps between contractions until I could finally sleep right through the contractions. When I awoke in the tub realizing that my body wasn’t laboring any longer. I climbed out of the tub and went back to bed.
Contractions came and went through the night, but by 6:00a.m. my body didn’t seem very serious about the prospect of labor.
The physical consequence of false labor is pretty harmless. The biggest challenge presented by false labor is the emotional impact on the expectant mother.
Following my first false labor I felt like my life was touch and go. I didn’t want to commit to workshops or projects that might be disrupted by labor. I spent the last four weeks thinking, Today’s the day!
At my routine office visit four days prior to my due date I asked Dr. Saunders to stip my membranes. He agreed. Upon further assessment he learned that my cervix was only a little more than a centimeter dilated. He performed a little sweeping. The effect proved enough stimulation to get me contracting, but not enough to maintain for more than a few hours. My body just wasn’t ready.
My due date came and went. It’s a distressful thing to reach your due date without a baby. There are such negative associations with due dates. When you fail to return a library book on your due date, you’re fined. When you fail to pay a ticket by the due date, you’re held in contempt of court. When you fail to turn in your homework by the due date, you’re academic grade is penalized. My baby was overdue and there wasn’t anyone to punish. Who was responsible for this unjustice? I got whiny. I probably drove my friends and husband crazy. In a particularly weepy moment I cried, “What if I’m pregnant forever? What if my body never goes into labor?”
In case you’re wondering, that won’t happen. Three days later I visited my the obstetric clinic for my weekly exam. Dr. Parker evaluated me and determined that my cervix still meausured once centimeter. My effacement remained the same as well. He refused to strip my membranes advising that my body wasn’t yet ripe and needed a little more time to prepare for a spontaneous labor. Furthermore, he happened to be the doctor on call that night and didn’t particularly care to start a latent labor that would inevitably keep him up all night. He explained that he didn’t mind assisting a laboring mom in the middle of the night when her body chose that time, but if he had a choice he was going to opt out.
I burst into tears asking what I should do. Dr. Parker was the oldest doctor in the partnership and by far the most seasoned in the trade of obstetrics. After delivering more than 14,000 babies hearing the same sob story probably sounded like a high pitched record.
Dr. Parker let me know that one of the other doctors, Dr. Jones was scheduled as the on call doctor for the following day. He explained that Dr. Jones was offering late night exams at a remote clinic in a more rural clinic. With a look of skepticism he checked his watch and said, “It’s 9:00a.m. now. If you can persuade Dr. Jones to see you after 7:00p.m. you could probably labor latently through the night and transition into real labor by midday. Let me see what I can find out. I’ll be right back.”
Hope soared. Valerie, the nurse in attendance winked at me and gave me the thumbs up. When the door closed behind Dr. Parker she said, “You lucked out, darling. Dr. Jones strips membranes aggressively. He’ll get your labor going for sure. But be warned, it’s going to smart!”
Within a few minutes Dr. Parker returned shaking his head as he couldn’t believe he was assisting in such whimsical treatments. Dr. Jones says he’ll see you at 7:30p.m.
I tried not to smile too big. Although I should have been thanking Dr. Parker profusely, I thought he was a mean callous old man for not doing the deed himself.
At 7:30p.m. I met with Dr. Jones at the other clinic. He looked at me with his bright blue eyes and said, “Are you ready for this. If I’m going to do the job, I’m going to do it right. Have you had your membranes stripped before?”
“Yes, with my two previous babies and once last week.”
“Well, I suspect tt this time it’s going to be a little more uncomfortable. But I need you to relax as best as you can.”
Dr. Jones swept his finger along the uterine wall lifting the amniotic sac. He spread his fingers prying my cervical opening.
He smiled, “There we go. Now you’re dilated somewhere between 2 and 3 centimeters. That should send you on your way. Now go home and mow the lawn and see what you can do to encourage some steady uterine activity.”
My uterus cramped in protest. My entire abdomen tightened acknowledging the procedure. Dr. Jones helped me sit upright and bid me farewell.
Just as Dr. Parker predicted I labored latently or unproductively all night. All though I did manage to get some good rest for a few hours. In the morning I walked five miles and piniced at the park with my children. By 4:00p.m. it required concentration to relax during contractions. Between contractions I felt great. We took our children to my sister-in-law’s house and I labored in the tub. Neil called Tina to let her know that I was in early first stage labor and would let her know when active first stage labor began so that she could meet us in the hospital.
We took a walk around the block and my contractions intensified immensely. In fact, I wasn’t sure I could make it home. I hugged Neil hanging my weight on his shoulders.
Neil whispered words of praise into my ears. I felt comforted by the smell of his neck and the familiar sound of his voice.
Once we were home we climbed into the car with our previously packed hospital bag, CD player, and new infant car seat.
As soon as we arrived at the labor and delivery unit I handed the nurse my Birth Plan and said and said this will be an un-medicated childbirth. The nurse smiled and said, “I’m glad you brought that to my attention. We’ll put you down at the end of the hall in Labor & Delivery Room #13. It’s quieter down there out of the way of the bustle. We’ll want to make sure your nurse is Peggy, she’s terrific with natural childbirth. Some of the other nurses just don’t like to deal with it, but Peggy will treat you great and will be a great help.”
This was sounding pretty good.
The nurse showed me to Triage where I changed into my gown and sat on the bed awaiting the fastening of my External Fetal Monitors.
She performed a cervical exam and determined I measured 4.5 centimeters.
Wow! That was my best admittance dilation yet.
The monitors swooshed and whirred with the baby’s heart rate and reporting the peak of a contraction.
“Looks good. Let’s get your Antibiotic IV going so you can get a good block through you and get a heplock. That way you won’t have to be hooked up to the I.V. for the rest of your labor.”
The nurse walked out of Triage. While passing the nurses’ station one of the other nurse’s announced, “Dr. Lawrence says she’ll be on her way in a little while She wants to know how urgent labor feels. She just started nine holes of golf with her son and she’d like to finish if she can. Will you be okay if it takes her an hour to get here?”
I shrugged. “That fine. We’ll just be doing our thing.”
The nurse continued to lead us down the far end of the hallway and showed us to our room. It was a corner room on the third story with natural light creating a warm cozy feeling on two of the four walls. While we set down our belongings the nurse began drawing warm water in the private bathroom.
Our labor and delivery nurse explained, “The temperature of your water is really nice and warm. The tubs are cast iron so they should retain the heat for along time. But if you start getting cold feel free to let some water out and add more warm water. I’ll show your husband around the nurse’s station so you can help yourself to juice, ice, snacks, or anything else you might like. Is there anything I can get you before I go?”
“I’d like a birthing ball if that’s okay.”
She smiled. “Not a problem. I’ll bring that right away.”
I undressed and stepped into the warm tub. The white cast iron tubs at the hospital were not jetted and they weren’t longer or wider than the standard sized bath tub, but they were deeper. This allowed more of my body to relax in the weightlessness of the water.
Neil sat over the toilet seat and made small talk. Enya played in the background. Neil was in a good mood being better rested this time around. He playfully bantered with his dry sense of humor. We laughed between contractions and I closed my eyes and breathed deep abdominal breaths. I concentrated on slow focused exhalations. I imagined myself blowing on an invisible candle flame just enough to make it flicker, but not enough to extinguish the flame.
We enjoyed a beautifully serene quality time together. Eventually, Tina arrived, but didn’t want to interrupt the moment. She stayed in the delivery room while Neil and I laughed and spoke in hushed tones in the bathroom. At one point a contraction began in mid laughter. The physical activity of laughter strained my abdominal muscles. I abruptly stopped laughing, but couldn’t containe my smile. Neil’s ego boosted gaining confidence in his ability to provide adequate support and companionship through labor.
The nurse came came to check my progress. She brought external fetal monitors using telemetry device or battery operated monitors that could be used in the bath tub. She seemed pleased wth the readings and performed a cervical exam while I lounged in the tub.
“You’re progressing. I estimate you’re measuring 7 + centimeters. I’ll call Dr. Lawrence and find out how long it will be before she arrives.”
I closed my eyes and offered a silent prayer, “Dear Farther in Heaven, Thank you for getting me this far. Thank you for sending me Neil. Please stay with me and let my body accept the work its work. Please help me to stay relaxed as the pain intensifies.”
A spirit of gratitude and confidence provided peace. Within minutes my body shifted gears and I felt immense pressure down low. My back pain grew deeper and lower with each contraction.
Relaxation required increased focus. I closed my eyes and concentrated on the notes playing, “Sail away, Sail away.” The music aided my visual imagery as I mentally envisioned myself floating on the shallow shores of Waikiki. I mentally created my personal paradise. The sun shone, the waves lapped, the water sparkled. I felt warm. I focused on the circular warmth emanating from the sun above.
The warmth comforted me. I imagined myself floating closer and closer to the sun basking in its warmth. As the sun came closer, I pictured my cervix opening and expanding its circumference. I let the contractions wrap around me. The enveloped me. I surrendered completely somewhere inside. At times the contractions became powerful enough, I shrank back from the sun in fear that it might burn me.
I continued in this way until the urge to use the bathroom interrupted my concentration. The urgency to get to the toilet overpowered me. I asked Neil to leave the bathroom. I stepped out of the tub and sat on the toilet. The painful sensations down low subsided. The toilet provided welcome counter pressure on my coccyx bone and allowed my perineum tissue to relax completely.
Although I felt better over the toilet, I couldn’t seen to move my bowels. Nothing came. I waited and pushed.
Neil knocked regularly and asked, “Are you okay in there? Are you ready to come out.”
Although I felt okay, I was not willing to get off the toilet. I felt security as I rocked my upper body back and forth while sitting upon the toilet. I couldn’t shake the feeling that I needed to expel something soon.
The nurse returned to the room. I overheard the conversation on the other side of the door.
“Is she still in the tub?”
“No. She said she needed to have a bowel movement. I think she’s still sitting on the toilet.”
“How long has she been sitting on the toilet?”
“Maybe 20 minutes. I checked on her just a couple of minutes ago and she said she was fine but that she didn’t want to leave the toilet.”
The nurse came knocked on the door and said, “Hon, I’m coming into check on you.” She entered exposing my naked pregnant body hunched over the toilet.
“I think you’ve been on the toilet a little too long. You’ve got me concerned. Let’s move you into the room and you can sit on the birth ball. It will give you the same relief without the risk of having a baby in the toilet.”
I stood in my nakedness hoping somebody would hand me a towel or a gown, but too focused on deep abdominal breaths to interrupt my relaxation to ask. I walked across the room where the nurse opened a gown for me to slip my arms through.
She set a clean towel on a birthing ball. “There you go.” I looked at the ball with a contraction vibrating through by core. It seemed that my short walk across the room stepped up the intensity of my contractions significantly.
I stood still afraid to move. No position seemed capable of alleviating the surreal deep pressure.
I felt shifts and movements as though a baby might be rubbing its head against my cervix.
I waited for the contraction to end, but it never really did. Although there was a point where it let up slightly. I bent my knees to sit on the ball but the pressure against my bottom felt alarming. I sat up, exclaiming, “Hot.”
Everyone in the room looked at me startled. That was the first word I’d spoken in quite some time. I felt too much pain to explain the sensation. But there was a hot burning sensation that protested the idea of my sitting on it.
The nurse asked me to sit on the bed and allow her to check my cervix. Feeling like a helpless little girl, afraid to lay on that uncomfortable bed, I said, “I don’t want to.”
The nurse reassured me, “We’ll make it really quick. As soon as you’re done, I promise you can get in any position you want.”
I conceded and sat up on the bed. The pain heightened forcing more pressure in my lower back.
The nurse didn’t seem to require much entrance. “Yep. Just as I thought. You’re done. You’ve got a complete cervix here with a baby ready to come out. I can see lots of hair.”
“Really?” I half laughed with excitement and amazement I’d really done it.
The nurse nodded her head with a smile. “Dr. Lawrence isn’t hear yet, she’s about five minutes away, but Dr. Parker’s here waiting to deliver a baby for a family friend. I’ll walk down the hall and grab him.”
“No. I’d rather wait for Dr. Lawrence.” The nurse looked at me as though I were alien.
“Are you sure? I’m going to go grab him just in case.” She exited the room at a brisk pace.
I carefully scooted off the bed and leaned over the birth ball. The weight of my belly hanging hurt my abdomen, but relieved my back. With my face laying against the towel I saw Dr. Parker rushing into the room followed by our nurse.
“All right, Dr. Parker’s here. Do you want to push?”
“No, thank you.” I shook my head slowly.
“Dr. Parker seemed surprised by my answer.”
“Are you sure?” The nurse queried. “You could be done before Dr. Lawrence arrives.”
“I’ll wait.” I confirmed my decision. What I failed to communicate was that I was still mad at
Dr. Parker for not “helping” me the day before. When I’m angry, with someone I typically withdraw and avoid them. In truth, with as many patients under Dr. Parker’s care, he probably didn’t even remember me. According to the paperwork Dr. Lawrence was my primary caregiver anyway.
Dr. Parker stood in silence for a minute observing the scene. He must have determined that there would be no harm waiting for Dr. Lawrence to arrive.
While I waited for Dr. Lawrence I scanned the room seeking some place or something to provide comfort. I hiccupped incessantly. I felt confused and indecisive. I licked my lips realizing they were dry and chapped. I looked at Tina. “Do you have any chapstick?” She smiled and whipped open a cosmetic bag exposing three types of lip balm, “Would you like mint, pina colada, or cherry ice?”
Under normal circumstances I would have reached for the pina colada. I marched in place delicately as though I were kneading bread with my feet. It felt better to keep moving. If I stopped my instincts told me to lift my feet again like one stepping on hot coals only my feet weren’t the part of my body experiencing discomfort.
I involuntarily released an unusually long burp. I covered my mouth and raised my eyebrows with surprise.
Minutes later Dr. Lawrence entered the room in hospital scrubs. As she dressed in the hospital protective robe and gloves, the nurse advised me to climb on the delivery bed. My feet were cold and I continued hiccupping.
Standing at the foot of the bed Dr. Lawrence assessed the birth canal. “You’ve got a really bulgy bag of waters cushioning the baby’s head. I’m going to slit the membranes and drain the water to minimize the fluid release when you push.”
Dr. Lawrence inserted a tool resembling a crochet hook. The underside of the hook contained a sharp razor like edge designed to penetrate and create a small opening in the bag of waters.
I felt a small amount of pressure release as the membranes ruptured. Water trickled in a steady yet manageable flow. Dr. Lawrence strategically placed towels to absorb the moisture.
“Okay. Relax” Dr. Lawrence instructed.
“Relax?” I looked at her incredulously. I’d been holding a baby inside for the last several minutes and couldn’t conceive of how to reverse my focus.
I took a deep breath through my nostrils filling my lungs all the way into my lower back. I stretched my arms upward and fanned them downward slowly. As I exhaled and slowly and calmly repeated, “I can relax, I can relax, I can relax.”
Dr. Lawrence looked at me like I might be on crack and then turned her attention to my cervix.
“Good. Very good.”
“Now push.” She ordered.
Suddenly I realized this was the scary part. The blood curdling pull your lip over your head part of labor. You’ve heard the terrorizing descriptions of people comparing birth to fitting something the size of a watermelon through an opening the size of a lemon. There was so much pressure along my pelvic floor I didn’t even know where to concentrate my efforts.
I asked, “How?”
Dr. Lawrence tapped her fingers on the tissue crowning over the baby’s head. “Can you feel that?”
“Yes.” I could feel her fingers in sort of a numbed area of my body.
“Focus on that spot right there where my fingers are. Push with all of your strength right there in that spot.”
I pulled my legs back all on my own in a perfect symmetry. The back of the bed angled upward supporting my back. I closed my eyes and heaved with full force. Low grunts emitted from my mouth as I exhaled.
“Wo, wo. Slow it down just a little.” Dr. Lawrence lifted her hand in the stop sign.
I stopped pushing.
“Good. Hold it there for just a second.” I could feel Dr. Lawrence stretching and easing the tissue evenly over my baby’s head.
“Okay, Give me another push in the same place. This time push a little slower.”
I pushed hard, but not my hardest.
“Good. Hold it, hold it, just a little longer. I continued exhaling. My perineum stung, but it didn’t feel nearly as bad as my contractions felt 30 minutes earlier. The tissue stung with a mild irritation or burning as it stretched. As I continued to push I felt a release.
“See the head, dad?” Dr. Lawrence pointed below.
Neil stepped toward the foot of the bed and announced, “You’re almost done, Beck. The head is out.”
“The head is out?” I couldn’t believe it. Pushing wasn’t nearly as bad as I’d expected.
I pushed a third time. The shoulders crept forward forcing the final stretch of the birth canal. I held the push and exhaled low and slow.
Suddenly the rest of the baby’s body exited with a slippery wiggle.
Adrenaline shot through me. I sat up grinning. I scooted back on my bed and set my legs down.
I smiled at Neil, “We did it!”
Neil returned the smile, “No you did. You were amazing!”
My little baby screamed showing off his vocal cords and exercising his new lungs. He continued to scream in complaint of his new surroundings. His shouts continued for nearly twenty minutes. I tried to nurse him, He attempted to latch many times but couldn’t complete a full suction before he opened his mouth to voice complaint about his terrestrial experience.
His little voice cracked. He sounded hoarse. His body shook with angry screams. I nestled him closely and kissed his new little head. I spoke softly to him and welcomed him to the family. His shouts gradually quieted and he took comfort in his first nursing.
During that first hour I walked to the bathroom without assistance. I felt energetic, alive, and on top of the world. Endorphins rushed through my entire body elevating my mood.
After an hour the excitement subsided and I grew sleepy. I fell asleep in a blissful content replaying the experience over and over in my mind.
Analysis
-Presenting the birth plan upon arrival is like placing your order at a restaurant. It allows everyone to better serve you.
-A helpful labor and delivery nurse or doula greatly enhances the birth environment.
-A well rested husband fully on board with the birth goals is a much better labor support than the alternative.
-If you think you need to poop in labor or if you want to sit on the toilet, it’s probably time to push.
-A woman in transition may not be able or willing to communicate her preferences. Discuss modesty and other possibilities in advance.
-Hiccups and Burping are key indicators of transition.
-Transition not Pushing is the most painful part of labor.
-Pushing feels good. It provides relief and releases the building pressure in the perineum floor.
-No amount of discussion in a prenatal class will prepare you for pushing. Ask for a tutorial if you need one. The medical professional can guide you with their experienced vantage point.
-Pushing un-medicated accelerates the pushing stage of labor. The muscles maintain full control and power.
-Pressure in the perineum acts as a natural anesthetic that numbs the perineum tissue.
-After the shoulders are delivered the birth descent is rapid and involuntary over the rest of the body.
-Delivering a baby un-medicated produces a natural state of euphoria that carries you into motherhood with excitement and optimism.
-There are few things in life that produce the pure satisfaction of accomplishing a challenging goal.
I felt great. My energy levels were terrific and even though my body started producing relaxin a bit early and experiencing the same pains in my ligaments and joints I promised myself I wouldn’t whine. But just in case, I switched to the doctors within the same clinic. I knew they’d be a little more inclined to strip my membranes if I wanted a little pre-labor boost.
I approached labor and delivery with a better idea of what to expect from my body, the hospital staff, and my husband. This time around I wanted a doula.
This upset Neil. He resented my decision to bring a third party to the birth of number three. He felt like I was saying, “You’re not good enough.”
That wasn’t the message I intended. I simply wanted to create an environment that allowed him to fill his role as companion, not birth coach.
At one point he sarcastically said, “I’m not coming. What do you need me for? You have Tina.”
I explained that Tina was not meant as a replacement for him. She planned to support him, give him tips, encourage me, and ward off any medical staff that intended to alter our birth plan unnecessarily. I tried to convey that her purpose was to make his job easier.
Eventually, Neil accepted Tina’s presence as a possible advantage. As we patiently awaited a spontaneous labor or naturally occurring labor I experienced a few false alarms. You’d think that by baby number three you’d recognize labor when it hit. But I learned something new about the uterus in the pregnant anatomy.
Your uterus will never return to its pre-pregnancy condition. Each time your uterus, the hollow organ known as the womb, houses a new fetus it stretches and weakens. It loses muscle tone in the fibrous tissue. In order for the uterus to continue functioning effectively it must get back in shape and prepare and practice for labor. This warm up period manifests itself with Braxtion-Hicks contractions. You experience Braxton-Hicks contractions by the third trimester of your first pregnancy. However, many woman never notice these little abdominal tightening or quickening. Regardless of whether you recognize them or not, they occur regularly.
These Braxton-Hicks or toning contractions begin sooner and become stronger in subsequent pregnancies. The more your uterus is stretched the more work your uterus must do to get back in shape.
Six weeks prior to the delivery of baby number three I experienced my first FALSE LABOR.
My contractions initiated on their own while my Neil and I sat in a movie theatre. I couldn’t help but feel a little excited. I sat content to watch the movie as labor progressed.
When I we returned home I went walking. My uterus tightened while I walked, but not in regular contraction patterns. I couldn’t really tell if it was a contraction or not. Eventually, my uterus relaxed and I resigned that it must not be labor.
I walked the rest of the way home and retired to bed. Laying in my bed my contractions returned strong. At first they only lasted 30 seconds. I timed the contractions. The clocked at 7 minutes from the start of one contraction to the start of the next.
Realizing that 30 seconds isn’t a very serious contraction I ignored the pain as best I could. The contractions continued to progress. Over the next couple hours the length of each contraction increased to 60 and even 90 seconds. The contractions came regularly and steady in the strength. I continued to time the distance between contractions. By this time my contractions were a little more than 4 minutes apart from the start of one contraction to the beginning of the next contraction. My level of discomfort continued to rise.
I wanted Neil to sleep as long as possible so that he would be well rested for the hard part of labor. I quietly left the bedroom and drew a warm bath.
The buoyancy of the water provided welcome relief. When laboring in water the force of gravity is weakened on your muscle groups. I laid back and relaxed. The contractions continued for over an hour, but they eventually became shorter and farther apart. I took catnaps between contractions until I could finally sleep right through the contractions. When I awoke in the tub realizing that my body wasn’t laboring any longer. I climbed out of the tub and went back to bed.
Contractions came and went through the night, but by 6:00a.m. my body didn’t seem very serious about the prospect of labor.
The physical consequence of false labor is pretty harmless. The biggest challenge presented by false labor is the emotional impact on the expectant mother.
Following my first false labor I felt like my life was touch and go. I didn’t want to commit to workshops or projects that might be disrupted by labor. I spent the last four weeks thinking, Today’s the day!
At my routine office visit four days prior to my due date I asked Dr. Saunders to stip my membranes. He agreed. Upon further assessment he learned that my cervix was only a little more than a centimeter dilated. He performed a little sweeping. The effect proved enough stimulation to get me contracting, but not enough to maintain for more than a few hours. My body just wasn’t ready.
My due date came and went. It’s a distressful thing to reach your due date without a baby. There are such negative associations with due dates. When you fail to return a library book on your due date, you’re fined. When you fail to pay a ticket by the due date, you’re held in contempt of court. When you fail to turn in your homework by the due date, you’re academic grade is penalized. My baby was overdue and there wasn’t anyone to punish. Who was responsible for this unjustice? I got whiny. I probably drove my friends and husband crazy. In a particularly weepy moment I cried, “What if I’m pregnant forever? What if my body never goes into labor?”
In case you’re wondering, that won’t happen. Three days later I visited my the obstetric clinic for my weekly exam. Dr. Parker evaluated me and determined that my cervix still meausured once centimeter. My effacement remained the same as well. He refused to strip my membranes advising that my body wasn’t yet ripe and needed a little more time to prepare for a spontaneous labor. Furthermore, he happened to be the doctor on call that night and didn’t particularly care to start a latent labor that would inevitably keep him up all night. He explained that he didn’t mind assisting a laboring mom in the middle of the night when her body chose that time, but if he had a choice he was going to opt out.
I burst into tears asking what I should do. Dr. Parker was the oldest doctor in the partnership and by far the most seasoned in the trade of obstetrics. After delivering more than 14,000 babies hearing the same sob story probably sounded like a high pitched record.
Dr. Parker let me know that one of the other doctors, Dr. Jones was scheduled as the on call doctor for the following day. He explained that Dr. Jones was offering late night exams at a remote clinic in a more rural clinic. With a look of skepticism he checked his watch and said, “It’s 9:00a.m. now. If you can persuade Dr. Jones to see you after 7:00p.m. you could probably labor latently through the night and transition into real labor by midday. Let me see what I can find out. I’ll be right back.”
Hope soared. Valerie, the nurse in attendance winked at me and gave me the thumbs up. When the door closed behind Dr. Parker she said, “You lucked out, darling. Dr. Jones strips membranes aggressively. He’ll get your labor going for sure. But be warned, it’s going to smart!”
Within a few minutes Dr. Parker returned shaking his head as he couldn’t believe he was assisting in such whimsical treatments. Dr. Jones says he’ll see you at 7:30p.m.
I tried not to smile too big. Although I should have been thanking Dr. Parker profusely, I thought he was a mean callous old man for not doing the deed himself.
At 7:30p.m. I met with Dr. Jones at the other clinic. He looked at me with his bright blue eyes and said, “Are you ready for this. If I’m going to do the job, I’m going to do it right. Have you had your membranes stripped before?”
“Yes, with my two previous babies and once last week.”
“Well, I suspect tt this time it’s going to be a little more uncomfortable. But I need you to relax as best as you can.”
Dr. Jones swept his finger along the uterine wall lifting the amniotic sac. He spread his fingers prying my cervical opening.
He smiled, “There we go. Now you’re dilated somewhere between 2 and 3 centimeters. That should send you on your way. Now go home and mow the lawn and see what you can do to encourage some steady uterine activity.”
My uterus cramped in protest. My entire abdomen tightened acknowledging the procedure. Dr. Jones helped me sit upright and bid me farewell.
Just as Dr. Parker predicted I labored latently or unproductively all night. All though I did manage to get some good rest for a few hours. In the morning I walked five miles and piniced at the park with my children. By 4:00p.m. it required concentration to relax during contractions. Between contractions I felt great. We took our children to my sister-in-law’s house and I labored in the tub. Neil called Tina to let her know that I was in early first stage labor and would let her know when active first stage labor began so that she could meet us in the hospital.
We took a walk around the block and my contractions intensified immensely. In fact, I wasn’t sure I could make it home. I hugged Neil hanging my weight on his shoulders.
Neil whispered words of praise into my ears. I felt comforted by the smell of his neck and the familiar sound of his voice.
Once we were home we climbed into the car with our previously packed hospital bag, CD player, and new infant car seat.
As soon as we arrived at the labor and delivery unit I handed the nurse my Birth Plan and said and said this will be an un-medicated childbirth. The nurse smiled and said, “I’m glad you brought that to my attention. We’ll put you down at the end of the hall in Labor & Delivery Room #13. It’s quieter down there out of the way of the bustle. We’ll want to make sure your nurse is Peggy, she’s terrific with natural childbirth. Some of the other nurses just don’t like to deal with it, but Peggy will treat you great and will be a great help.”
This was sounding pretty good.
The nurse showed me to Triage where I changed into my gown and sat on the bed awaiting the fastening of my External Fetal Monitors.
She performed a cervical exam and determined I measured 4.5 centimeters.
Wow! That was my best admittance dilation yet.
The monitors swooshed and whirred with the baby’s heart rate and reporting the peak of a contraction.
“Looks good. Let’s get your Antibiotic IV going so you can get a good block through you and get a heplock. That way you won’t have to be hooked up to the I.V. for the rest of your labor.”
The nurse walked out of Triage. While passing the nurses’ station one of the other nurse’s announced, “Dr. Lawrence says she’ll be on her way in a little while She wants to know how urgent labor feels. She just started nine holes of golf with her son and she’d like to finish if she can. Will you be okay if it takes her an hour to get here?”
I shrugged. “That fine. We’ll just be doing our thing.”
The nurse continued to lead us down the far end of the hallway and showed us to our room. It was a corner room on the third story with natural light creating a warm cozy feeling on two of the four walls. While we set down our belongings the nurse began drawing warm water in the private bathroom.
Our labor and delivery nurse explained, “The temperature of your water is really nice and warm. The tubs are cast iron so they should retain the heat for along time. But if you start getting cold feel free to let some water out and add more warm water. I’ll show your husband around the nurse’s station so you can help yourself to juice, ice, snacks, or anything else you might like. Is there anything I can get you before I go?”
“I’d like a birthing ball if that’s okay.”
She smiled. “Not a problem. I’ll bring that right away.”
I undressed and stepped into the warm tub. The white cast iron tubs at the hospital were not jetted and they weren’t longer or wider than the standard sized bath tub, but they were deeper. This allowed more of my body to relax in the weightlessness of the water.
Neil sat over the toilet seat and made small talk. Enya played in the background. Neil was in a good mood being better rested this time around. He playfully bantered with his dry sense of humor. We laughed between contractions and I closed my eyes and breathed deep abdominal breaths. I concentrated on slow focused exhalations. I imagined myself blowing on an invisible candle flame just enough to make it flicker, but not enough to extinguish the flame.
We enjoyed a beautifully serene quality time together. Eventually, Tina arrived, but didn’t want to interrupt the moment. She stayed in the delivery room while Neil and I laughed and spoke in hushed tones in the bathroom. At one point a contraction began in mid laughter. The physical activity of laughter strained my abdominal muscles. I abruptly stopped laughing, but couldn’t containe my smile. Neil’s ego boosted gaining confidence in his ability to provide adequate support and companionship through labor.
The nurse came came to check my progress. She brought external fetal monitors using telemetry device or battery operated monitors that could be used in the bath tub. She seemed pleased wth the readings and performed a cervical exam while I lounged in the tub.
“You’re progressing. I estimate you’re measuring 7 + centimeters. I’ll call Dr. Lawrence and find out how long it will be before she arrives.”
I closed my eyes and offered a silent prayer, “Dear Farther in Heaven, Thank you for getting me this far. Thank you for sending me Neil. Please stay with me and let my body accept the work its work. Please help me to stay relaxed as the pain intensifies.”
A spirit of gratitude and confidence provided peace. Within minutes my body shifted gears and I felt immense pressure down low. My back pain grew deeper and lower with each contraction.
Relaxation required increased focus. I closed my eyes and concentrated on the notes playing, “Sail away, Sail away.” The music aided my visual imagery as I mentally envisioned myself floating on the shallow shores of Waikiki. I mentally created my personal paradise. The sun shone, the waves lapped, the water sparkled. I felt warm. I focused on the circular warmth emanating from the sun above.
The warmth comforted me. I imagined myself floating closer and closer to the sun basking in its warmth. As the sun came closer, I pictured my cervix opening and expanding its circumference. I let the contractions wrap around me. The enveloped me. I surrendered completely somewhere inside. At times the contractions became powerful enough, I shrank back from the sun in fear that it might burn me.
I continued in this way until the urge to use the bathroom interrupted my concentration. The urgency to get to the toilet overpowered me. I asked Neil to leave the bathroom. I stepped out of the tub and sat on the toilet. The painful sensations down low subsided. The toilet provided welcome counter pressure on my coccyx bone and allowed my perineum tissue to relax completely.
Although I felt better over the toilet, I couldn’t seen to move my bowels. Nothing came. I waited and pushed.
Neil knocked regularly and asked, “Are you okay in there? Are you ready to come out.”
Although I felt okay, I was not willing to get off the toilet. I felt security as I rocked my upper body back and forth while sitting upon the toilet. I couldn’t shake the feeling that I needed to expel something soon.
The nurse returned to the room. I overheard the conversation on the other side of the door.
“Is she still in the tub?”
“No. She said she needed to have a bowel movement. I think she’s still sitting on the toilet.”
“How long has she been sitting on the toilet?”
“Maybe 20 minutes. I checked on her just a couple of minutes ago and she said she was fine but that she didn’t want to leave the toilet.”
The nurse came knocked on the door and said, “Hon, I’m coming into check on you.” She entered exposing my naked pregnant body hunched over the toilet.
“I think you’ve been on the toilet a little too long. You’ve got me concerned. Let’s move you into the room and you can sit on the birth ball. It will give you the same relief without the risk of having a baby in the toilet.”
I stood in my nakedness hoping somebody would hand me a towel or a gown, but too focused on deep abdominal breaths to interrupt my relaxation to ask. I walked across the room where the nurse opened a gown for me to slip my arms through.
She set a clean towel on a birthing ball. “There you go.” I looked at the ball with a contraction vibrating through by core. It seemed that my short walk across the room stepped up the intensity of my contractions significantly.
I stood still afraid to move. No position seemed capable of alleviating the surreal deep pressure.
I felt shifts and movements as though a baby might be rubbing its head against my cervix.
I waited for the contraction to end, but it never really did. Although there was a point where it let up slightly. I bent my knees to sit on the ball but the pressure against my bottom felt alarming. I sat up, exclaiming, “Hot.”
Everyone in the room looked at me startled. That was the first word I’d spoken in quite some time. I felt too much pain to explain the sensation. But there was a hot burning sensation that protested the idea of my sitting on it.
The nurse asked me to sit on the bed and allow her to check my cervix. Feeling like a helpless little girl, afraid to lay on that uncomfortable bed, I said, “I don’t want to.”
The nurse reassured me, “We’ll make it really quick. As soon as you’re done, I promise you can get in any position you want.”
I conceded and sat up on the bed. The pain heightened forcing more pressure in my lower back.
The nurse didn’t seem to require much entrance. “Yep. Just as I thought. You’re done. You’ve got a complete cervix here with a baby ready to come out. I can see lots of hair.”
“Really?” I half laughed with excitement and amazement I’d really done it.
The nurse nodded her head with a smile. “Dr. Lawrence isn’t hear yet, she’s about five minutes away, but Dr. Parker’s here waiting to deliver a baby for a family friend. I’ll walk down the hall and grab him.”
“No. I’d rather wait for Dr. Lawrence.” The nurse looked at me as though I were alien.
“Are you sure? I’m going to go grab him just in case.” She exited the room at a brisk pace.
I carefully scooted off the bed and leaned over the birth ball. The weight of my belly hanging hurt my abdomen, but relieved my back. With my face laying against the towel I saw Dr. Parker rushing into the room followed by our nurse.
“All right, Dr. Parker’s here. Do you want to push?”
“No, thank you.” I shook my head slowly.
“Dr. Parker seemed surprised by my answer.”
“Are you sure?” The nurse queried. “You could be done before Dr. Lawrence arrives.”
“I’ll wait.” I confirmed my decision. What I failed to communicate was that I was still mad at
Dr. Parker for not “helping” me the day before. When I’m angry, with someone I typically withdraw and avoid them. In truth, with as many patients under Dr. Parker’s care, he probably didn’t even remember me. According to the paperwork Dr. Lawrence was my primary caregiver anyway.
Dr. Parker stood in silence for a minute observing the scene. He must have determined that there would be no harm waiting for Dr. Lawrence to arrive.
While I waited for Dr. Lawrence I scanned the room seeking some place or something to provide comfort. I hiccupped incessantly. I felt confused and indecisive. I licked my lips realizing they were dry and chapped. I looked at Tina. “Do you have any chapstick?” She smiled and whipped open a cosmetic bag exposing three types of lip balm, “Would you like mint, pina colada, or cherry ice?”
Under normal circumstances I would have reached for the pina colada. I marched in place delicately as though I were kneading bread with my feet. It felt better to keep moving. If I stopped my instincts told me to lift my feet again like one stepping on hot coals only my feet weren’t the part of my body experiencing discomfort.
I involuntarily released an unusually long burp. I covered my mouth and raised my eyebrows with surprise.
Minutes later Dr. Lawrence entered the room in hospital scrubs. As she dressed in the hospital protective robe and gloves, the nurse advised me to climb on the delivery bed. My feet were cold and I continued hiccupping.
Standing at the foot of the bed Dr. Lawrence assessed the birth canal. “You’ve got a really bulgy bag of waters cushioning the baby’s head. I’m going to slit the membranes and drain the water to minimize the fluid release when you push.”
Dr. Lawrence inserted a tool resembling a crochet hook. The underside of the hook contained a sharp razor like edge designed to penetrate and create a small opening in the bag of waters.
I felt a small amount of pressure release as the membranes ruptured. Water trickled in a steady yet manageable flow. Dr. Lawrence strategically placed towels to absorb the moisture.
“Okay. Relax” Dr. Lawrence instructed.
“Relax?” I looked at her incredulously. I’d been holding a baby inside for the last several minutes and couldn’t conceive of how to reverse my focus.
I took a deep breath through my nostrils filling my lungs all the way into my lower back. I stretched my arms upward and fanned them downward slowly. As I exhaled and slowly and calmly repeated, “I can relax, I can relax, I can relax.”
Dr. Lawrence looked at me like I might be on crack and then turned her attention to my cervix.
“Good. Very good.”
“Now push.” She ordered.
Suddenly I realized this was the scary part. The blood curdling pull your lip over your head part of labor. You’ve heard the terrorizing descriptions of people comparing birth to fitting something the size of a watermelon through an opening the size of a lemon. There was so much pressure along my pelvic floor I didn’t even know where to concentrate my efforts.
I asked, “How?”
Dr. Lawrence tapped her fingers on the tissue crowning over the baby’s head. “Can you feel that?”
“Yes.” I could feel her fingers in sort of a numbed area of my body.
“Focus on that spot right there where my fingers are. Push with all of your strength right there in that spot.”
I pulled my legs back all on my own in a perfect symmetry. The back of the bed angled upward supporting my back. I closed my eyes and heaved with full force. Low grunts emitted from my mouth as I exhaled.
“Wo, wo. Slow it down just a little.” Dr. Lawrence lifted her hand in the stop sign.
I stopped pushing.
“Good. Hold it there for just a second.” I could feel Dr. Lawrence stretching and easing the tissue evenly over my baby’s head.
“Okay, Give me another push in the same place. This time push a little slower.”
I pushed hard, but not my hardest.
“Good. Hold it, hold it, just a little longer. I continued exhaling. My perineum stung, but it didn’t feel nearly as bad as my contractions felt 30 minutes earlier. The tissue stung with a mild irritation or burning as it stretched. As I continued to push I felt a release.
“See the head, dad?” Dr. Lawrence pointed below.
Neil stepped toward the foot of the bed and announced, “You’re almost done, Beck. The head is out.”
“The head is out?” I couldn’t believe it. Pushing wasn’t nearly as bad as I’d expected.
I pushed a third time. The shoulders crept forward forcing the final stretch of the birth canal. I held the push and exhaled low and slow.
Suddenly the rest of the baby’s body exited with a slippery wiggle.
Adrenaline shot through me. I sat up grinning. I scooted back on my bed and set my legs down.
I smiled at Neil, “We did it!”
Neil returned the smile, “No you did. You were amazing!”
My little baby screamed showing off his vocal cords and exercising his new lungs. He continued to scream in complaint of his new surroundings. His shouts continued for nearly twenty minutes. I tried to nurse him, He attempted to latch many times but couldn’t complete a full suction before he opened his mouth to voice complaint about his terrestrial experience.
His little voice cracked. He sounded hoarse. His body shook with angry screams. I nestled him closely and kissed his new little head. I spoke softly to him and welcomed him to the family. His shouts gradually quieted and he took comfort in his first nursing.
During that first hour I walked to the bathroom without assistance. I felt energetic, alive, and on top of the world. Endorphins rushed through my entire body elevating my mood.
After an hour the excitement subsided and I grew sleepy. I fell asleep in a blissful content replaying the experience over and over in my mind.
Analysis
-Presenting the birth plan upon arrival is like placing your order at a restaurant. It allows everyone to better serve you.
-A helpful labor and delivery nurse or doula greatly enhances the birth environment.
-A well rested husband fully on board with the birth goals is a much better labor support than the alternative.
-If you think you need to poop in labor or if you want to sit on the toilet, it’s probably time to push.
-A woman in transition may not be able or willing to communicate her preferences. Discuss modesty and other possibilities in advance.
-Hiccups and Burping are key indicators of transition.
-Transition not Pushing is the most painful part of labor.
-Pushing feels good. It provides relief and releases the building pressure in the perineum floor.
-No amount of discussion in a prenatal class will prepare you for pushing. Ask for a tutorial if you need one. The medical professional can guide you with their experienced vantage point.
-Pushing un-medicated accelerates the pushing stage of labor. The muscles maintain full control and power.
-Pressure in the perineum acts as a natural anesthetic that numbs the perineum tissue.
-After the shoulders are delivered the birth descent is rapid and involuntary over the rest of the body.
-Delivering a baby un-medicated produces a natural state of euphoria that carries you into motherhood with excitement and optimism.
-There are few things in life that produce the pure satisfaction of accomplishing a challenging goal.
Tuesday, June 14, 2011
Pregnancy #2 Alia's Birth Story
I looked forward to labor with confidence. I felt like I knew what to expect. What small desire I possessed to labor un-medicated with baby one grew into a real vocalized and written goal.
I bought relaxation music and a miniature CD player to bring to the hospital. I invested in a few essential oils such as lavender and chamomile to aid in aromatherapy. Late at night while my husband worked his graveyard shift I practiced abdominal breathing and mental labor simulations. I continued to make prenatal toning exercises part of regular routine.
As my due date approached the certified nurse midwives confirmed that baby number two was in the anterior occiput position, the most favorable position for birthing. My confidence waxed strong.
Early on the morning of November 30th I could tell I was getting closer but these contractions were nowhere near as intense as the contractions I recalled from labor number one.
We walked around the block hoping to speed up the timing a little bit I was sleepless and tired and wanted to get this show on the road.
Walking seemed to be the trusty trick to accelerating labor contractions. Most of the time I could continue walking through the contractions which is a definite indicator that I have some work to do. A few times I stopped and hung my body weight upon my husband in a bear hug. It felt good to have him support my back.
When we got home I desperately wanted to sleep but my body engaged in a serious work. I soaked in my tub with the jets on my back once more.
We called Julie, the certified nurse midwife on duty and informed her that we were on our way to the hospital. Contractions were four minutes apart, but there it wasn’t urgent. We loaded the car with our previously packed hospital bag, CD player, throw-up bowl, birth plan, and infant car seat. This time the drive seemed much more tolerable than with baby number one.
As soon as we arrived at the nurse’s station in the Labor and Delivery unit I wondered if I were really in labor at all anymore. I felt good. In fact, I couldn’t recall a contraction in the last ten minutes. What I didn’t realize is that sometimes the excitement of going to the hospital can release endorphins that temporarily stop the labor process.
The nurse showed us to triage where they handed me a hospital gown and instructed me to lay on the observation bed. A nurse strapped the external fetal monitors to my abdomen and began measuring contractions.
The labor and delivery nurse performed a cervical exam and announced two and a half centimeters dilated and 75% effaced. I looked to see if her hands were big. Nope. They were average.
A little after 7:00a.m. the nurse assigned us to our own room. We set up our CD player, dimmed the lights and I pulled out my essential oils. The nurse looked at me and said, “You aren’t planning to go natural are you?”
I nodded and handed her my birth plan.
“Great!” she sighed with irritation. It would have been helpful if you’d shown us this when you checked into the hospital. We could have assigned you to a room with a tub. Now it’s too late. All of our inductions have arrived. Let me see if I can find someone willing to swap you rooms.”
I felt burdensome and didn’t want to cause problems. I looked to my husband for input.
Neil shrugged his shoulders with indifference.
I hated the thought of forcing someone out of their room. Not to mention walking through the hallway in a hospital gown with an open back and lugging all of our belongings around.
“Do I need a room with a tub?” I queried.
The nurse seemed impatient. “Nobody goes natural without the tub. If you want a room with a tub you need to make up your mind now so that I can arrange for someone to switch rooms with you.”
I looked back at Neil. “Do you think we should switch rooms?”
Neil shook his head. “Let’s just stay here.”
The nurse asked, “Last chance, are you sure?”
“Yes.” I nodded my head but doubted our decision.
I labored for another hour un-medicated. Neil fell asleep in a rocking chair while I stayed on my hands and knees rocking to alleviate the pressure of the baby’s head on my back.
The nurse came in and asked, “How are we doing in here. Are you ready for the epidural yet?”
I shook my head. “I think I’m okay.”
The nurse looked surprised. “Maybe labor stopped.” She suggested. “Let’s put the monitors back on you and see what’s happening. Come climb back on the bed.”
I would prefer to be anywhere in labor but on a hospital bed; especially if it meant lying on my back. Lying on my back in the supine position increased the pressure on my lower back significantly. Contractions seemed manageable when I moved around and shifted positions.
The monitors beeped and the indicator on the graph climbed and spiked representing the intensity of my contraction. The pressure of the bands felt restrictive and aggravating.
The nurse watched the graph and nodded. “You’re still contracting.” Let’s take a look at your dilation.”
Now the rough part. I needed to scoot down low toward the foot of the bed for a cervical exam.
The nurse waited for the contraction to end but by this point in labor my contractions were much closer together and upon having her fingers perform the exam, I immediately started contracting again.
The nurse removed her hand from the birth canal and pulled the latex glove from the wrist until it was inside out.
The labor and delivery nurse looked at me sternly. “You’re 7 centimeters. You don’t have a tub. You’re going to need the epidural. The anesthesiologist is in the room next door. When he finishes there he’s leaving and you’ll miss your chance if you don’t get it now. Do want me to go grab him.”
My first thought, Really? Seven centimeters, this isn’t as bad as I thought it was going to be. But with her words came a mist of doubt. She must know something I didn’t.
In a less than confident voice I managed, “That’s okay, I think we’ll be fine.”
The nurse didn’t back down, “Listen, I’ve never seen anyone make it through transition without the tub. I’ll send him in as soon as he’s done next door.”
The nurse exited. I knelt down and leaned forward on a birthing ball preparing for my next contraction. I looked over at Neil still slumbering in the chair. I placed my hand on his knee and wiggled it a little to wake him gently.
“Neil, what do you think we should do?”
He grunted, “About what?”
“About the epidural.”
He looked annoyed. “I don’t care. Get if you want. She said you can’t do it without the tub, do you want to risk it?”
I felt betrayed. I stared at him in silence. Why didn’t anyone think I could labor un-medicated. I made it this far without any complaint. Did everyone think I was being difficult? I felt completely alone and vulnerable.
“Well let’s try some of these oils, their supposed to really assist with relaxation. Will you rub this one on my feet?”
Neil opened his eyes again, “I don’t know how to apply essential oils. I’m trying to sleep.” His tone expressed fatigue and irritation.
My eyes stung as I fought back the urge to cry. I stood up and walked over to the bed with my back to him. I leaned on the bed for support.
Neil sighed heavily and raised from the chair for the first time since we arrived. “Where is it?”
I handed him the oil. He let a few drops drip into his palm and then massaged them into my foot while I lay on my side on the bed. He dropped my foot in frustration.
“This is disgusting. You have dust all over your feet from walking barefoot on the hospital foor. Now the oil is turning it into sludge on the soles of your feet.”
“I’m sorry.” Embarrassment and hurt surfaced. In retrospect I’m not sure which emotion dominated. But it was clear that I was annoying the nurse and now I was annoying my husband.
Neil walked back to the rocker and plopped down trying to get comfortable when the nurse re-entered with the anesthesiologist. I don’t recall his name so I’ll refer to him as Dr. Smooth hereafter.
“Dr. Smooth this is Mr. and Mrs. Rasmussen. Mrs. Rasmussen hasn’t decided if she’d like an epidural or not. She’s afraid that she won’t achieve her birth plan goals if she gets an epidural. What advice do you have for Mrs. Rasmussen?”
Dr. Smooth smiled at me with kind eyes. “It’s good to meet you Mrs. Rasmussen. My you have big beautiful brown eyes. Do you mind me asking the origin of your ethnic background?”
“My mother’s family immigrated from Italy in 1938.” Maybe women are just suckers for praise, but this man felt like my new best friend.
“Well that explains it.” He nodded jovially. “Mrs. Rasmussen what’s your first name?”
“Becky” I replied.
“Becky? I once had a girl friend named Becky. She didn’t have beautiful brown eyes like you, if I remember correctly they were green. But she was pretty all the same. I’ve liked the name ever since.”
“Becky, why don’t you lay down on your side for just a moment ,here. I’m going to hand you this clip board with a few forms and we’re going to talk about your concerns okay?”
What could it hurt to talk? Labor pains were surging deeper into my core and this Dr. Smooth provided the best company and the best distraction thus far.
“Becky, I want you to imagine for a minute that your tooth is aching. The throb is deep. Pain is searing up into your sinus cavity. Your head is aching. Your jaw is sensitive to touch. You schedule a dentist appointment and discover that a large molar is cracked and rotting all the way around the nerve. The only way to save the tooth is to proceed with a root canal. Would you do it?”
I imagined myself in the dental chair feeling the throbbing tooth with pain emanating from my uterus. “Of course!”
Dr. Smooth continued, “You’re a smart girl, Becky.”
Now let’s imagine that the dentist suggests the administration of local anesthetic to numb that area of the mouth. He’s concerned for your oral health and wants to ensure you hold perfectly still during the procedure. Would you do that for him?”
“Yes.”
Dr. Smooth walked around to my back side. “You would? That would be a silly thing to feel guilty for, wouldn’t it?” He placed his hand on my back and said, “This will feel just a little bit cold. We’re just washing you with some antiseptic. So you think you could live with yourself if you accepted a little bit of anesthesia?”
“Yes.” His line of thinking made sense, but it didn’t ring true somewhere inside me.
“That’s right, Becky. You’re a good girl, there’s nothing to feel guilty about. You deserve to be comfortable. Just write your name on that line right there giving us consent to help you.”
I felt trapped in a strange sort of way. My heart wanted to resist his instructions but my conscience told me it would be improper to waste this polite man’s time by refusing his services.
I signed the document.
“There you go, sweetheart. That’s all there is to it. Now curl up nice and tight for me. Hold perfectly still. You’re going to feel the tiniest prick.”
Dr. Smooth inserted the local anesthetic between the two vertebrae following it by the larger needle.
He inserted the epidural catheter forming a loop and taping it to my back. “Wallaah!” He pronounced. “You’re among. That wasn’t so bad was it.”
Dr. Smooth winked at me and shook my husband’s hand. “You take good care of her, you hear?”
My husband cleared his throat, “Will do.”
Doctor Smooth left and the nurse looked satisfied. Neil looked satisfied. Why didn’t I feel satisfied?
A few minutes later, my C.N.M. Julie O’Neil arrived. “How are we doing in here? It sounds like you’re getting closer?” Julie smiled brightly. “It looks like you just got an epidural. How are you feeling?”
Julie pulled a chair by my bedside. Do you want to watch some T.V.?
“Sure.”
Julie and I laughed and talked while Neil snoozed in rocker. Every few minutes Julie looked at the external fetal monitor screen. She recommended we place bets on the height and weight of the baby. Julie really brightened my spirits. I felt so thankful to enjoy her company.
When an hour passed, she recommended we find out what was happening inside.
By now it was 9:30a.m. and I could hardly keep my eyes open.
Julie performed a cervical exam and said, “Good news. It’s time to push. I’ll be right back with some assistance.”
I sat up a bit and called to Neil, “Hey, babe. It’s time to push.”
I started to cry. I think it was the fatigue. “I’m too tired. I can’t do this. I just want to sleep.”
Julie re-entered the room. “I heard that. I promise you we’ll let you sleep as soon as you’re done. This won’t take long at all.”
The nurse and Neil helped me pull my legs back into the assisted squat position. I started to protest. “I don’t want to. I’m too…”
My uterus contracted and the urge to push overcame me. I held on to my legs that were being supported by Neil and the nurse and heaved, “I need to push.”
Julie laughed, “I guess you had it in you after all.” Her shoulder length blond hair fell in her face as she tried to get a better view of my perineum.
“Shoot, I forgot a scrunchy.”
When the contraction ended I lowered my legs and rested. I pulled the pony tail out of my hair and said, “Here you can use mine.”
Julie smiled, “Are you sure?” She removed her gloves and accepted the scrunchy. She pulled her hair into a tight pony tail and put new gloves on her hands.
The resting period lasted longer than I anticipated. The pushing stage is also known as the second stage of labor. In this stage contractions are usually further apart allowing the laboring mother to regroup.
Another contraction began. I inhaled deeply pulled back my legs and began exhaling ever so slowly through three long breaths as I bore down.
Twenty minutes (two contractions) later baby number two arrived. She looked beautiful with a mass of thick black wet hair.
Julie said, “You wanted this baby wiped down and wrapped in a blanket, right?”
I nodded appreciative of her recollection of my birth plan.
It took approximately one minute before they handed me my new baby girl and it was love at first sight.
I didn’t communicate my feelings very openly to Neil about his role as coach. I let the feeling of abandonment and disappointment fester inside. I silently held it against him for over a year.
Analysis
-Minor forms of induction can cause latent or long unproductive labors
-Your healthcare professional knows more than you do; even if you don’t like what they have to say.
-The consequence of home induction methods may be more than you bargained for.
In my case it wasn’t worth it.
-It’s best to present your birth plan at admittance and request a room that accommodates your goals.
-Just because your partner loves you the most, it doesn’t mean he’ll be your best coach. Your coach should care about your goals as much as you do. Consider your mom, friend, sister, or a doula.
-The power of suggestion is REAL
-Normal vaginal delivery is less painful than back labor
-The urge to push can be recognized with an epidural anesthetic.
Delving Deeper
Was the birth of baby number two a failure? I didn’t meet my goal. I knew I could deliver baby number two without an episiotomy so on the second birth I focused on my desire to labor un-medicated.
This is a difficult question to answer. At the time I felt like I failed. I lamented a missed opportunity. I felt jipped out of the full experience. I thought my coach failed me.
Over a year later I realized this wasn’t about the failure of a birth plan. It ran much deeper. We as a team we failed to communicate and create a cohesive game plan. The birth itself was a success story with a happy mom, healthy baby, and a much better beginning.
I bought relaxation music and a miniature CD player to bring to the hospital. I invested in a few essential oils such as lavender and chamomile to aid in aromatherapy. Late at night while my husband worked his graveyard shift I practiced abdominal breathing and mental labor simulations. I continued to make prenatal toning exercises part of regular routine.
As my due date approached the certified nurse midwives confirmed that baby number two was in the anterior occiput position, the most favorable position for birthing. My confidence waxed strong.
Early on the morning of November 30th I could tell I was getting closer but these contractions were nowhere near as intense as the contractions I recalled from labor number one.
We walked around the block hoping to speed up the timing a little bit I was sleepless and tired and wanted to get this show on the road.
Walking seemed to be the trusty trick to accelerating labor contractions. Most of the time I could continue walking through the contractions which is a definite indicator that I have some work to do. A few times I stopped and hung my body weight upon my husband in a bear hug. It felt good to have him support my back.
When we got home I desperately wanted to sleep but my body engaged in a serious work. I soaked in my tub with the jets on my back once more.
We called Julie, the certified nurse midwife on duty and informed her that we were on our way to the hospital. Contractions were four minutes apart, but there it wasn’t urgent. We loaded the car with our previously packed hospital bag, CD player, throw-up bowl, birth plan, and infant car seat. This time the drive seemed much more tolerable than with baby number one.
As soon as we arrived at the nurse’s station in the Labor and Delivery unit I wondered if I were really in labor at all anymore. I felt good. In fact, I couldn’t recall a contraction in the last ten minutes. What I didn’t realize is that sometimes the excitement of going to the hospital can release endorphins that temporarily stop the labor process.
The nurse showed us to triage where they handed me a hospital gown and instructed me to lay on the observation bed. A nurse strapped the external fetal monitors to my abdomen and began measuring contractions.
The labor and delivery nurse performed a cervical exam and announced two and a half centimeters dilated and 75% effaced. I looked to see if her hands were big. Nope. They were average.
A little after 7:00a.m. the nurse assigned us to our own room. We set up our CD player, dimmed the lights and I pulled out my essential oils. The nurse looked at me and said, “You aren’t planning to go natural are you?”
I nodded and handed her my birth plan.
“Great!” she sighed with irritation. It would have been helpful if you’d shown us this when you checked into the hospital. We could have assigned you to a room with a tub. Now it’s too late. All of our inductions have arrived. Let me see if I can find someone willing to swap you rooms.”
I felt burdensome and didn’t want to cause problems. I looked to my husband for input.
Neil shrugged his shoulders with indifference.
I hated the thought of forcing someone out of their room. Not to mention walking through the hallway in a hospital gown with an open back and lugging all of our belongings around.
“Do I need a room with a tub?” I queried.
The nurse seemed impatient. “Nobody goes natural without the tub. If you want a room with a tub you need to make up your mind now so that I can arrange for someone to switch rooms with you.”
I looked back at Neil. “Do you think we should switch rooms?”
Neil shook his head. “Let’s just stay here.”
The nurse asked, “Last chance, are you sure?”
“Yes.” I nodded my head but doubted our decision.
I labored for another hour un-medicated. Neil fell asleep in a rocking chair while I stayed on my hands and knees rocking to alleviate the pressure of the baby’s head on my back.
The nurse came in and asked, “How are we doing in here. Are you ready for the epidural yet?”
I shook my head. “I think I’m okay.”
The nurse looked surprised. “Maybe labor stopped.” She suggested. “Let’s put the monitors back on you and see what’s happening. Come climb back on the bed.”
I would prefer to be anywhere in labor but on a hospital bed; especially if it meant lying on my back. Lying on my back in the supine position increased the pressure on my lower back significantly. Contractions seemed manageable when I moved around and shifted positions.
The monitors beeped and the indicator on the graph climbed and spiked representing the intensity of my contraction. The pressure of the bands felt restrictive and aggravating.
The nurse watched the graph and nodded. “You’re still contracting.” Let’s take a look at your dilation.”
Now the rough part. I needed to scoot down low toward the foot of the bed for a cervical exam.
The nurse waited for the contraction to end but by this point in labor my contractions were much closer together and upon having her fingers perform the exam, I immediately started contracting again.
The nurse removed her hand from the birth canal and pulled the latex glove from the wrist until it was inside out.
The labor and delivery nurse looked at me sternly. “You’re 7 centimeters. You don’t have a tub. You’re going to need the epidural. The anesthesiologist is in the room next door. When he finishes there he’s leaving and you’ll miss your chance if you don’t get it now. Do want me to go grab him.”
My first thought, Really? Seven centimeters, this isn’t as bad as I thought it was going to be. But with her words came a mist of doubt. She must know something I didn’t.
In a less than confident voice I managed, “That’s okay, I think we’ll be fine.”
The nurse didn’t back down, “Listen, I’ve never seen anyone make it through transition without the tub. I’ll send him in as soon as he’s done next door.”
The nurse exited. I knelt down and leaned forward on a birthing ball preparing for my next contraction. I looked over at Neil still slumbering in the chair. I placed my hand on his knee and wiggled it a little to wake him gently.
“Neil, what do you think we should do?”
He grunted, “About what?”
“About the epidural.”
He looked annoyed. “I don’t care. Get if you want. She said you can’t do it without the tub, do you want to risk it?”
I felt betrayed. I stared at him in silence. Why didn’t anyone think I could labor un-medicated. I made it this far without any complaint. Did everyone think I was being difficult? I felt completely alone and vulnerable.
“Well let’s try some of these oils, their supposed to really assist with relaxation. Will you rub this one on my feet?”
Neil opened his eyes again, “I don’t know how to apply essential oils. I’m trying to sleep.” His tone expressed fatigue and irritation.
My eyes stung as I fought back the urge to cry. I stood up and walked over to the bed with my back to him. I leaned on the bed for support.
Neil sighed heavily and raised from the chair for the first time since we arrived. “Where is it?”
I handed him the oil. He let a few drops drip into his palm and then massaged them into my foot while I lay on my side on the bed. He dropped my foot in frustration.
“This is disgusting. You have dust all over your feet from walking barefoot on the hospital foor. Now the oil is turning it into sludge on the soles of your feet.”
“I’m sorry.” Embarrassment and hurt surfaced. In retrospect I’m not sure which emotion dominated. But it was clear that I was annoying the nurse and now I was annoying my husband.
Neil walked back to the rocker and plopped down trying to get comfortable when the nurse re-entered with the anesthesiologist. I don’t recall his name so I’ll refer to him as Dr. Smooth hereafter.
“Dr. Smooth this is Mr. and Mrs. Rasmussen. Mrs. Rasmussen hasn’t decided if she’d like an epidural or not. She’s afraid that she won’t achieve her birth plan goals if she gets an epidural. What advice do you have for Mrs. Rasmussen?”
Dr. Smooth smiled at me with kind eyes. “It’s good to meet you Mrs. Rasmussen. My you have big beautiful brown eyes. Do you mind me asking the origin of your ethnic background?”
“My mother’s family immigrated from Italy in 1938.” Maybe women are just suckers for praise, but this man felt like my new best friend.
“Well that explains it.” He nodded jovially. “Mrs. Rasmussen what’s your first name?”
“Becky” I replied.
“Becky? I once had a girl friend named Becky. She didn’t have beautiful brown eyes like you, if I remember correctly they were green. But she was pretty all the same. I’ve liked the name ever since.”
“Becky, why don’t you lay down on your side for just a moment ,here. I’m going to hand you this clip board with a few forms and we’re going to talk about your concerns okay?”
What could it hurt to talk? Labor pains were surging deeper into my core and this Dr. Smooth provided the best company and the best distraction thus far.
“Becky, I want you to imagine for a minute that your tooth is aching. The throb is deep. Pain is searing up into your sinus cavity. Your head is aching. Your jaw is sensitive to touch. You schedule a dentist appointment and discover that a large molar is cracked and rotting all the way around the nerve. The only way to save the tooth is to proceed with a root canal. Would you do it?”
I imagined myself in the dental chair feeling the throbbing tooth with pain emanating from my uterus. “Of course!”
Dr. Smooth continued, “You’re a smart girl, Becky.”
Now let’s imagine that the dentist suggests the administration of local anesthetic to numb that area of the mouth. He’s concerned for your oral health and wants to ensure you hold perfectly still during the procedure. Would you do that for him?”
“Yes.”
Dr. Smooth walked around to my back side. “You would? That would be a silly thing to feel guilty for, wouldn’t it?” He placed his hand on my back and said, “This will feel just a little bit cold. We’re just washing you with some antiseptic. So you think you could live with yourself if you accepted a little bit of anesthesia?”
“Yes.” His line of thinking made sense, but it didn’t ring true somewhere inside me.
“That’s right, Becky. You’re a good girl, there’s nothing to feel guilty about. You deserve to be comfortable. Just write your name on that line right there giving us consent to help you.”
I felt trapped in a strange sort of way. My heart wanted to resist his instructions but my conscience told me it would be improper to waste this polite man’s time by refusing his services.
I signed the document.
“There you go, sweetheart. That’s all there is to it. Now curl up nice and tight for me. Hold perfectly still. You’re going to feel the tiniest prick.”
Dr. Smooth inserted the local anesthetic between the two vertebrae following it by the larger needle.
He inserted the epidural catheter forming a loop and taping it to my back. “Wallaah!” He pronounced. “You’re among. That wasn’t so bad was it.”
Dr. Smooth winked at me and shook my husband’s hand. “You take good care of her, you hear?”
My husband cleared his throat, “Will do.”
Doctor Smooth left and the nurse looked satisfied. Neil looked satisfied. Why didn’t I feel satisfied?
A few minutes later, my C.N.M. Julie O’Neil arrived. “How are we doing in here? It sounds like you’re getting closer?” Julie smiled brightly. “It looks like you just got an epidural. How are you feeling?”
Julie pulled a chair by my bedside. Do you want to watch some T.V.?
“Sure.”
Julie and I laughed and talked while Neil snoozed in rocker. Every few minutes Julie looked at the external fetal monitor screen. She recommended we place bets on the height and weight of the baby. Julie really brightened my spirits. I felt so thankful to enjoy her company.
When an hour passed, she recommended we find out what was happening inside.
By now it was 9:30a.m. and I could hardly keep my eyes open.
Julie performed a cervical exam and said, “Good news. It’s time to push. I’ll be right back with some assistance.”
I sat up a bit and called to Neil, “Hey, babe. It’s time to push.”
I started to cry. I think it was the fatigue. “I’m too tired. I can’t do this. I just want to sleep.”
Julie re-entered the room. “I heard that. I promise you we’ll let you sleep as soon as you’re done. This won’t take long at all.”
The nurse and Neil helped me pull my legs back into the assisted squat position. I started to protest. “I don’t want to. I’m too…”
My uterus contracted and the urge to push overcame me. I held on to my legs that were being supported by Neil and the nurse and heaved, “I need to push.”
Julie laughed, “I guess you had it in you after all.” Her shoulder length blond hair fell in her face as she tried to get a better view of my perineum.
“Shoot, I forgot a scrunchy.”
When the contraction ended I lowered my legs and rested. I pulled the pony tail out of my hair and said, “Here you can use mine.”
Julie smiled, “Are you sure?” She removed her gloves and accepted the scrunchy. She pulled her hair into a tight pony tail and put new gloves on her hands.
The resting period lasted longer than I anticipated. The pushing stage is also known as the second stage of labor. In this stage contractions are usually further apart allowing the laboring mother to regroup.
Another contraction began. I inhaled deeply pulled back my legs and began exhaling ever so slowly through three long breaths as I bore down.
Twenty minutes (two contractions) later baby number two arrived. She looked beautiful with a mass of thick black wet hair.
Julie said, “You wanted this baby wiped down and wrapped in a blanket, right?”
I nodded appreciative of her recollection of my birth plan.
It took approximately one minute before they handed me my new baby girl and it was love at first sight.
I didn’t communicate my feelings very openly to Neil about his role as coach. I let the feeling of abandonment and disappointment fester inside. I silently held it against him for over a year.
Analysis
-Minor forms of induction can cause latent or long unproductive labors
-Your healthcare professional knows more than you do; even if you don’t like what they have to say.
-The consequence of home induction methods may be more than you bargained for.
In my case it wasn’t worth it.
-It’s best to present your birth plan at admittance and request a room that accommodates your goals.
-Just because your partner loves you the most, it doesn’t mean he’ll be your best coach. Your coach should care about your goals as much as you do. Consider your mom, friend, sister, or a doula.
-The power of suggestion is REAL
-Normal vaginal delivery is less painful than back labor
-The urge to push can be recognized with an epidural anesthetic.
Delving Deeper
Was the birth of baby number two a failure? I didn’t meet my goal. I knew I could deliver baby number two without an episiotomy so on the second birth I focused on my desire to labor un-medicated.
This is a difficult question to answer. At the time I felt like I failed. I lamented a missed opportunity. I felt jipped out of the full experience. I thought my coach failed me.
Over a year later I realized this wasn’t about the failure of a birth plan. It ran much deeper. We as a team we failed to communicate and create a cohesive game plan. The birth itself was a success story with a happy mom, healthy baby, and a much better beginning.
Thursday, June 9, 2011
Pregnancy #1 Giana's Birth
At a routine office visit at 38.5 weeks gestation Karen, a Certified Nurse Midwives in my obstetric clinic, announced that the protein traces in my urine sample were alarmingly high. She feared that my pre-eclampsia state might worsen and develop into eclampsia which is potentially fatal. Eclampsia is characterized by blurred vision, and blood pressures high enough to induce seizures.
Karen sent me to the hospital for non-stress testing with the on call midwife. In the Labor and Delivery unit, Claudia decided to induce labor using Prepidil Prostaglandin E2 Gel; which is a prescription prostaglandin ointment that is applied directly on the Cervix. The presence of prostaglandins in the gel soften and thin the cervix, otherwise known as ripening.
At the end of the ripening period contractions occur. Sometimes they are not strong enough to induce labor on their own and require a follow up of Pitocin IV Administration. At the time I knew that Pitocin could cause strong, erratic contractions resulting in hyperstimulation of the uterus, but I did not know that Prepidil Gel could do likewise. Pitocin IV Administration is the most common form of induction, it may also be referred to as Oxytocin or Pit.
In addition to applying the Prepidil Gel, Claudia stripped my membranes. The stripping or sweeping of membranes involves the provider inserting a finger into the cervix and lifting the amniotic sac of the cervix with a stirring motion. This process irritates or triggers the local release of additional prostaglandins. Additional prostaglandins intensify the ripening of the cervix. The stripping of membranes can be moderately to extremely uncomfortable. It requires that you be at least 2 centimeters dilated and usually results in bloody show or the presence of blood on the caregivers’ fingers.
In my case the contractions began immediately with abdominal cramping similar to menstrual cramps. Claudia instructed me to report back to the hospital for a second dose or application if labor hadn’t initiated within four hours.
I left the hospital optimistic about my body’s ability to perform its proper functions. My husband, Neil, and I went walking, hiking, riding over bumpy roads, etc. Labor was not imminent.
Four hours later we reported back to Claudia in the Labor & Delivery unit. I wasn’t feeling very hopeful that a second dose would prove much more effective.
Claudia applied a second dose and once again stripped my membranes. At this point I should mention that it’s very important to avoid using the bathroom for at least 15 minutes after applying the Prepidil Gel as it is very expensive and needs time to sit on the cervix for maximum efficacy.
Two minutes later. My bowels cramped and I announced, “Claudia, I have to use the bathroom.”
“Is there any possibility you can wait?” she asked.
Cringing, I shook my head.
Claudia sighed, “Okay, do what you have to do.”
I barely made it to the bathroom in time for my bowels to empty what seemed like their entire contents. I sat on that toilet for at least 30 minutes before I dared to stand again.
I changed out of my gown preparing to go home. Claudia informed us that if labor didn’t initiate by seven o’ clock the following morning I needed to return to the Labor and Delivery unit for a Pitocin IV induction.
As Neil drove me home my back ached, my stomach cramped and my swollen appendages throbbed. I headed for the bath tub where I soaked for an hour. My back pain intensified so much that I could no longer stand the pressure of the hard tub against my spine.
Neil lounged on the couch watching an NBA game and I retired to bed.
I curled up in a ball lying on my left side. I felt completely exhausted but I couldn’t sleep. My back hurt so badly and no matter what position I tried I couldn’t seem to relieve it. I tossed and turned for a couple of hours.
Eventually Neil entered the dark room and joined me in bed. We both lay there in silence for what seemed like an eternity. Labor tends to distort our perception of time, which is why I highly recommend keeping a watch on you.
Sometime after midnight I queried, “Neil are you awake?”
“Yeah.” He mumbled as though he were really in a deep sleep.
“I need help. My back hurts so badly. I don’t know what’s wrong with me. Will you please call Claudia?”
Neil climbed out of bed and punched the previously programmed number on the phone. I carefully crawled out of my side of the bed and rocked myself back and forth on hands and knees. I leaned all the way forward resting my head between my elbows desperately working toward some sort of relief.
Then it came…relief. Sweet relief! I experienced a full 45 seconds of relief.
Suddenly the pain gripped me again growing stronger until I thought I couldn’t bare it any longer. I felt nausea sweep over me. “I’m going to throw-up, Neil. I need a bowl.”
This pain was NOT natural! It felt like something was very wrong. In retrospect it seems I experienced a bit of uterine hyper stimulation. I never again in any subsequent pregnancy experienced any sensations as severe as those endured in this labor.
Neil ran to the kitchen and grabbed a plastic bowl in the midst of describing my behavior to Claudia. He handed me the bowl and asked, “Claudia wants to know if the back pain is wrapping around toward the front of your uterus?”
We’d been taught in our prenatal class that you should go to the hospital when your contractions were 3-5 minutes apart. But they also described uterine contractions as a tightening or cramping of the muscles surrounding the abdominal area. This certainly did not fit that description.
I shook my head, “I don’t know. My back pain is so intense it’s overpowering all my other senses. I noticed that it stops hurting for a little bit so I started timing it. If this back pain is labor than the timing from the beginning of one contraction to the start of the next is about 2 minutes apart.”
Neil relayed the message into the phone. Then he nodded his head and said, “Yeah, she normally demonstrates a high pain tolerance. Okay, okay, yeah, okay. See you in a little bit.”
He turned off the phone and directed me, “She wants us to meet her at the hospital right away.”
I released a dull groan as I tried to raise myself to a kneeling position. When I moved one leg forward to get upright my water instantly burst. Nothing could have prepared me for the volume of the gush.
Our childbirth instructor taught us that when the water breaks or membranes rupture it’s like peeing your pants. A steady stream of clear fluid flows from the vagina, only you can’t stop it. What I didn’t know at the time that her description only applied to a high amniotic rupture. A low rupture produces a much more forceful splash. It was like having 10” water balloon pop between my legs. Along with the clear fluid a blood clot the size of a Kiwi dropped and that’s when I lost my calm.
“Neil what just happened? That’s not supposed to happen.” I looked to Neil for clarification. His eyes gave way to his own panic. Everything seemed out of my control. My body went rigid with fear. I stopped breathing deep, calm, oxygenating breaths and resorted to shallow fearful pants.
We hurried to the car with our previously packed hospital bag but forgot the plastic bowl. During our fifteen minute drive to the hospital I felt every acceleration in my uterus and back. I felt every tiny crack in the asphalt as well as the not so tiny ones. My body lurched forward when Neil applied the brakes and intensified my pain severely.
Neil apologized profusely and tried to find the balance between quick and cautious. I thought the fates were against me when we saw orange cones, excavators, and a construction crew providing after hours improvements on the road in front of the hospital.
We waited in the car for the pain to subside and then made a mad dash for the door. I quickly remembered that walking speeds up labor and intensifies contractions. The pain returned halfway across the parking lot. I stopped, wincing at the pain. We waited for my body to give me clearance to begin walking again.
Typically the labor and delivery nurse admits you to Triage, an observation room where they monitor your contractions, effacement, and dilation prior to officially admitting you. Luckily, Claudia called ahead and advised them to admit me upon arrival.
I vomited all over the hospital bed. The nurse gave me a hospital gown to change into and a little pink basin to capture any further projections. I vomited three more times. The basin wasn’t deep enough. In each of the three incidents the vomit ricocheted out of the bowl, all over my gown and back in my face.
As the labor and delivery nurse continually changed my gown she strapped on my external fetal monitors. The external fetal monitor is a monitoring device that uses two belts. One uses ultrasound to measure your baby’s heart rate and the other is a pressure transducer used to measure your contractions. The feedback is printed on a graphical machine to illustrate the baby response to your contractions. The elastic belts are strapped across your abdomen snugly. The extra pressure on my laboring abdomen was more than a subtle discomfort.
As soon as the monitor picked up the whoosh, whoosh, whoosh of my baby’s heart beat, the labor and delivery nurse began prepping me for the administration of an intravenous antibiotic treatment for my positive testing as a Group B Strep carrier.
Claudia arrived 10 minutes later. I don’t think I’ve ever been so happy to see anyone. It must have been the longest 10 minutes of my life. As soon as she entered the room she recognized my back pain for what it was: Back Labor! She quickly gave Neil a tutorial on how to apply Counter Pressure and relieve the pain. She performed a cervical exam and announced that I hadn’t dilated at all since earlier in the day, I was still measuring 2 centimeters! All that pain and no progress, are you serious?
She positioned me upright on the hospital bed with my knees raised and my feet flat. She pressed my knees toward me and downward forcing my tail bone against the back of the bed. I couldn’t believe the difference it made. The pressure was truly a natural anesthetic.
I looked at the clock 12:45a.m.
Our prenatal instructor taught that most first time moms average 12 hours in labor. If this was the beginning I couldn’t imagine how much worse it was going to get not to mention how much longer. The thought terrified me beyond all reason. Little did I know, I’d been laboring all day. I heard the woman in the labor and delivery room across the hall screaming, “Help! Dear, God it hurts, it hurts, it hurts!” The wails coming from her room echoed through the hallway.
I remember thinking if I’m only two centimeters into dilation how long will it take before I start screaming like that lady? “I want an epidural!” I announced.
The anesthesiologist arrived 20 minutes later. He instructed me to lie on my side curled into the fetal position forming an arc in my back. I thought I might cry. He was asking me to give up the counter pressure with the required position change.
I quickly complied. He washed my back with an antiseptic and provided a sterile drape. He then inserted a needle to numb the local site of the injection. He followed the local needle with a large needle intended for insertion between two vertebrae a little above the belly button.
He instructed me to hold perfectly still regardless of whether or not a contraction started. I lay still as the anesthesiologist slowly and carefully guided the needle toward the dural membrane and injected the anesthetic. He informed me that it would take 10-15 minutes before the numbing would take effect. The anesthesiologist then threaded a tiny catheter through the needle and taped it to my back.
Electing an epidural meant I must also receive a bladder catheter. Why hadn’t anybody ever mentioned this part of the procedure? I wasn't emotionally prepared for a physical invasion of my urethra.
Several minutes later I lay partially upright on my back. I could still feel every nerve in my lower body. But something wasn’t right. Breathing required so much effort. My fingers felt heavy and cold. My tongue was tingling. I couldn’t form words and I felt like my head was spinning. I silently thought I’m dying. I’m losing my ability to grip Neil’s hand. He’ll know I’m dead when I can’t hold it anymore. I wonder if I’ll hear the monitors beep in my last moments.
I concentrated with every fiber of my being, “Is the top of my body supposed to be numb?” I managed the question with a leaden tongue.
“What?” Both Claudia and the anesthesiologist expressed alarm.
Apparently the anesthesiologist accidentally inserted the needle with too much of an upward angle shifting the direction of the anesthetic flow upward rather than downward. They quickly flattened the bed and arched me back into the fetal position. The anesthesiologist removed the epidural catheter and began the process anew.
The anesthesiologist connected the syringe to a catheter and placed the syringe in a pump. The pump slowly depressed a plunger that provided a continuous dose of anesthetic. Fifteen minutes later I felt completely comfortable for the first time in several hours.
By this time it was 2:00a.m. I tried to sleep but it was difficult. My body shook convulsively. The shaking came so violently that my body tipped sideways. My husband propped me back up. My legs shook toward the edge of the bed. My vision was blurred. My blood pressure was 199/120. I appeared headed for eclampsia.
Claudia called for a Magnesium Sulfate IV Administration. This chemical stabilizes blood pressures and reduces the risk of cardiac arrest as well as minimizes the risk kidney or liver failure. I could feel the cool liquid trickling through the intravenous entrance of my hand. I fell asleep to this sensation.
Forty-five minutes later I awoke startled by a painful a new sensation. I thought my pubic bone was breaking. I pressed the call button for the nurse. Apparently the epidural numbs muscular nerves such as uterine contractions and cervical dilation, but the anesthesia cannot numb bone nerves. To make matters worse, I couldn’t move or adjust my position to alleviate the pain.
Claudia and the nurse returned.
“My epidural isn’t working.” I mistakenly thought the pain was attributed to an ineffective epidural. Claudia performed another cervical exam at which point she determined I was complete or a full 10 centimeters dilated. I also measured a +3 station which meant my body had been involuntarily working on fetal descent and the baby was beginning to crown. That’s when the pushing began.
My limp noodle legs continued to shake with random convulsions. Powerless and incapable of pulling my legs back into the classic birth position, I awaited assistance. Neil stood on one side and held back my left leg. The labor and delivery nurse, held back my right leg. Neil was stronger and better able to hold my left leg back in a true imitation of the classic squat, but the nurse seemed to master the angle with more comfortable placement. The lack of congruency annoyed me. I wanted to hold my legs back myself. I knew I could manage the symmetry better if I could evenly distribute resistance to both legs, but I didn’t have the arm strength and my legs were under temporary paralysis. They continued to shake, I felt frustrated with the lack of control I held over my body.
I delivered my baby sunny side up. This means she was facing up or occiput posterior. In this position the occiput or back of the baby’s head is toward the mother’s back. In a normal vaginal delivery the baby is born facing downward or occiput anterior. When the baby’s head applies pressure against the cervix with the crown in the anterior position it aids in opening the cervix.
Usually, there is not enough room for the baby’s head to pass through the pelvic chamber without rotating into the anterior position. This explains the extreme back labor pain as well as the feeling that my pubic bone was breaking. It was in essence being stretched to the max.
My birth plan expressed my desire to hold my new infant immediately after delivery and begin breastfeeding. What I didn’t anticipate was the presentation. I thought the nurse or C.N.M would provide a preliminary wipe down before handing me the infant. Not so.
Claudia instantly handed me my new infant dripping in fluids and showing a small amount of residue from the vernix caseosa or white filmy substance primarily comprised of sebum, fatty lipids, cholesterol and ceramide. Prior to birth I read that the function of the vernix is to moisturize the infant’s skin, provide a slippery passage through the birth canal, as well as offer antibacterial benefits.
Some women actually massaged the vernix or “baby cold cream” in to the newborn infant’s skin. On this my first pregnancy, I still felt a little squeamish. Neither my husband nor I were interested in reaping in this particular aspect of mother nature’s rewards. I sheepishly asked Claudia if she could wipe the baby down a little and place her in a blanket. Thus began our first swaddling.
Shortly after the swaddling began, Claudia noticed a contraction on the electronic fetal monitor and urged me to give a good push for the delivery of the placenta. The placenta exited the birth canal with little effort. The slippery and flexible amniotic sac molded much more comfortably through the already stretched vagina than a head and shoulders.
The labor and delivery nurse began rigorously massaging my abdomen in an attempt to expel any remaining placental tissue or blood clots. The aggressive massage initiated post delivery uterine contractions also known as after birth pains. These pains were hardly noticeable as the epidural still rendered full effect. I continued to swaddle and nurse my baby throughout the uterine massage.
Swaddling lasted for approximately 20 minutes while my baby’s umbilical cord slowly stopped pulsating. Our prenatal instruction explained that the cord pulsates much like a heartbeat as it transmits oxygen and nutrients from the placenta to the baby. I looked at the umbilical cord with wonder. The length didn’t surprise me. It measured approximately 20 inches or 50 centimeters long. It was the diameter or thickness of the cord that caught me by surprise. The thickness of the cord measured approximately ¾ of an inch thick or 2 centimeters. The cord initially appeared dark red with firm sinewy and fibrous walls in the places where it hadn’t calcified. As time passed and the cord slowly stopped pulsating, the color eventually faded. The volume of blood slowly filtered into my baby’s body providing her with her normal blood volume levels.
My reading suggested that early cord clamping, tying, or cutting can leave a baby low on red blood cells and act as a catalyst for an early onset of anemia. Other studies indicated that milking or allowing the cord to pulsate for longer periods of time allowed the cord to “milk” stem cells from the placental site. In class we discussed the option of saving your infant’s placenta and umbilical cord in a blood bank. The cord typically stops pulsating between 7 minutes for un-medicated births and 20 minutes for medicated births.
Claudia inspected the placenta to find that both the placenta and umbilical cord experienced extensive calcification. Calcification is a process by which the placenta begins to shut down. It appeared that the calcification had constricted the flow of nutrients to my baby. Claudia suspected that my baby had lost quite a bit of weight in the womb based on the excessive wrinkled skin.
I marveled at all of my baby’s fine, dark hair also known as lanugo. The hair covered the surface of her back, buttocks, and ears. The black hairs culminated at a point at the top of her ear reminding me of Spock from Star Trek. It appeared black while it was still wet with amniotic fluid, but later took on a dark brown appearance. Within a few weeks most of the lanugo fell out.
Following the delivery I felt ravenously hungry and hammered. I couldn’t tell what I wanted most: food or sleep. The only problem was that my husband was asleep in the chair and the R.N. kept forgetting to bring me food. Oh, what I would have done for some fresh fruit or a granola bar!
A couple of hours later the epidural catheter was removed from my back. The process felt somewhat uncomfortable, but not awful. I remained on a bladder catheter for the first 24 hours as they kept me on a Magnesium Sulfate IV for the next 48 hours and monitored my eclampsia. The Magnesium Sulfate most likely saved my life, but it left me feeling groggy and lethargic. It also limited my mobility. I couldn’t shower or use the bathroom. Even if I weren’t connected to a bladder catheter and a Magnesium Sulfate IV pump, I don’t know that I would have possessed the strength and energy to carry out the task anyway.
So what can we take from this experience?
- Labor is not predictable
- All contractions are not equal
- Ruptured membranes can manifest in the form of a trickle or a gush
- Cervical dilation is not an accurate indicator of labor progression
- Counter pressure is an effective natural anesthetic
- Epidural’s do not guarantee universal pain relief
- A laboring woman receiving an anesthetic epidural may not recognize the urge to push
- Most woman do not practice kegel contractions faithfully
- Healthy babies are derived from even the most unpredictable births
- You’re likely to exhibit the same behavior in labor that you exhibit in an argument (we’ll talk about this more in subsequent chapters)
Analysis
Who is responsible for my dissatisfying birth experience? The anesthesiologist? My husband? Our childbirth educator? The hospital? Me? The Midwife?
The Anesthesiologist- The anesthesiologist did not ask me to get an epidural. He just happened to be the on-call doctor when the nurses woke him from a peaceful slumber and told him that the patient in L&D Room #11 wanted an epidural.
It is true that the anesthesiologist made a mistake in the first administration of the epidural anesthetic, but one incident was not the cause nor was it the worst consequence of my birth experience. We all make mistakes, even in our professional careers. We place high expectations on healthcare professionals to meet certain standards of performance, because we trust them with our very lives. Reason and mature emotional intelligence suggests we must accept that it is unrealistic to expect medical professionals to perform every procedure with perfect precision every time.
My husband- Neil was the only person who attended me from the first labor contraction to the last. He also had the least experience of all the other birth attendants. If he’d been a better labor support companion would the outcome have been different?
Expectant moms must remember they are not the only one entering unfamiliar territory. Their husbands are equally as frightened. Many men express their feelings of helplessness while their wife is in labor. One new father said, “I would have done anything to remove my wife from her misery. Even if it meant enduring the pain myself.” The problem is that there isn’t a magic transfer button.
The Child Birth Educator-. The childbirth educator spent a great deal of time emphasizing issues of consumerism or options at birth and terms and definitions related to the birth process. We dedicated many hours to learning how to stop medical staff doctors, nurses, and other hospital staff from botching up our birth experience.
She helped us choose a good provider and learn abdominal breathing techniques. We didn’t learn very many relaxation techniques, but we learned many birth positions to help alleviate pain. We learned much about the text book definitions of the anatomy, pregnancy, and birth, but we didn’t fully understand the role they would play in real life labor and delivery.
The hospital- The hospital did not solicit my patronism. I could have opted for a home birth or free standing birth center. The hospital room was clean and comfortable. The staff was courteous. My quarters were private. The hospital equipment detected and provided treatment for all of my risk factors. Although I must admit the bands of the electronic fetal monitors were terribly uncomfortable.
The Midwife- Claudia was wonderful. I wanted to send her flowers.
Me- I took the initiative to attend a birth class. I opened my mind to new options. I followed my caregivers instructions. I did all of my prenatal toning exercises on a regular basis. It couldn’t be my fault. The reality was that I botched up my own birth experience by not maintaining optimum health.
Many birth classes provide a good service in preparing and educating pregnant couples with techniques prior to the birth of their baby. If we want to look at the larger picture it is important to consider that the number one factor influencing the outcome of the baby is a healthy mother.
Karen sent me to the hospital for non-stress testing with the on call midwife. In the Labor and Delivery unit, Claudia decided to induce labor using Prepidil Prostaglandin E2 Gel; which is a prescription prostaglandin ointment that is applied directly on the Cervix. The presence of prostaglandins in the gel soften and thin the cervix, otherwise known as ripening.
At the end of the ripening period contractions occur. Sometimes they are not strong enough to induce labor on their own and require a follow up of Pitocin IV Administration. At the time I knew that Pitocin could cause strong, erratic contractions resulting in hyperstimulation of the uterus, but I did not know that Prepidil Gel could do likewise. Pitocin IV Administration is the most common form of induction, it may also be referred to as Oxytocin or Pit.
In addition to applying the Prepidil Gel, Claudia stripped my membranes. The stripping or sweeping of membranes involves the provider inserting a finger into the cervix and lifting the amniotic sac of the cervix with a stirring motion. This process irritates or triggers the local release of additional prostaglandins. Additional prostaglandins intensify the ripening of the cervix. The stripping of membranes can be moderately to extremely uncomfortable. It requires that you be at least 2 centimeters dilated and usually results in bloody show or the presence of blood on the caregivers’ fingers.
In my case the contractions began immediately with abdominal cramping similar to menstrual cramps. Claudia instructed me to report back to the hospital for a second dose or application if labor hadn’t initiated within four hours.
I left the hospital optimistic about my body’s ability to perform its proper functions. My husband, Neil, and I went walking, hiking, riding over bumpy roads, etc. Labor was not imminent.
Four hours later we reported back to Claudia in the Labor & Delivery unit. I wasn’t feeling very hopeful that a second dose would prove much more effective.
Claudia applied a second dose and once again stripped my membranes. At this point I should mention that it’s very important to avoid using the bathroom for at least 15 minutes after applying the Prepidil Gel as it is very expensive and needs time to sit on the cervix for maximum efficacy.
Two minutes later. My bowels cramped and I announced, “Claudia, I have to use the bathroom.”
“Is there any possibility you can wait?” she asked.
Cringing, I shook my head.
Claudia sighed, “Okay, do what you have to do.”
I barely made it to the bathroom in time for my bowels to empty what seemed like their entire contents. I sat on that toilet for at least 30 minutes before I dared to stand again.
I changed out of my gown preparing to go home. Claudia informed us that if labor didn’t initiate by seven o’ clock the following morning I needed to return to the Labor and Delivery unit for a Pitocin IV induction.
As Neil drove me home my back ached, my stomach cramped and my swollen appendages throbbed. I headed for the bath tub where I soaked for an hour. My back pain intensified so much that I could no longer stand the pressure of the hard tub against my spine.
Neil lounged on the couch watching an NBA game and I retired to bed.
I curled up in a ball lying on my left side. I felt completely exhausted but I couldn’t sleep. My back hurt so badly and no matter what position I tried I couldn’t seem to relieve it. I tossed and turned for a couple of hours.
Eventually Neil entered the dark room and joined me in bed. We both lay there in silence for what seemed like an eternity. Labor tends to distort our perception of time, which is why I highly recommend keeping a watch on you.
Sometime after midnight I queried, “Neil are you awake?”
“Yeah.” He mumbled as though he were really in a deep sleep.
“I need help. My back hurts so badly. I don’t know what’s wrong with me. Will you please call Claudia?”
Neil climbed out of bed and punched the previously programmed number on the phone. I carefully crawled out of my side of the bed and rocked myself back and forth on hands and knees. I leaned all the way forward resting my head between my elbows desperately working toward some sort of relief.
Then it came…relief. Sweet relief! I experienced a full 45 seconds of relief.
Suddenly the pain gripped me again growing stronger until I thought I couldn’t bare it any longer. I felt nausea sweep over me. “I’m going to throw-up, Neil. I need a bowl.”
This pain was NOT natural! It felt like something was very wrong. In retrospect it seems I experienced a bit of uterine hyper stimulation. I never again in any subsequent pregnancy experienced any sensations as severe as those endured in this labor.
Neil ran to the kitchen and grabbed a plastic bowl in the midst of describing my behavior to Claudia. He handed me the bowl and asked, “Claudia wants to know if the back pain is wrapping around toward the front of your uterus?”
We’d been taught in our prenatal class that you should go to the hospital when your contractions were 3-5 minutes apart. But they also described uterine contractions as a tightening or cramping of the muscles surrounding the abdominal area. This certainly did not fit that description.
I shook my head, “I don’t know. My back pain is so intense it’s overpowering all my other senses. I noticed that it stops hurting for a little bit so I started timing it. If this back pain is labor than the timing from the beginning of one contraction to the start of the next is about 2 minutes apart.”
Neil relayed the message into the phone. Then he nodded his head and said, “Yeah, she normally demonstrates a high pain tolerance. Okay, okay, yeah, okay. See you in a little bit.”
He turned off the phone and directed me, “She wants us to meet her at the hospital right away.”
I released a dull groan as I tried to raise myself to a kneeling position. When I moved one leg forward to get upright my water instantly burst. Nothing could have prepared me for the volume of the gush.
Our childbirth instructor taught us that when the water breaks or membranes rupture it’s like peeing your pants. A steady stream of clear fluid flows from the vagina, only you can’t stop it. What I didn’t know at the time that her description only applied to a high amniotic rupture. A low rupture produces a much more forceful splash. It was like having 10” water balloon pop between my legs. Along with the clear fluid a blood clot the size of a Kiwi dropped and that’s when I lost my calm.
“Neil what just happened? That’s not supposed to happen.” I looked to Neil for clarification. His eyes gave way to his own panic. Everything seemed out of my control. My body went rigid with fear. I stopped breathing deep, calm, oxygenating breaths and resorted to shallow fearful pants.
We hurried to the car with our previously packed hospital bag but forgot the plastic bowl. During our fifteen minute drive to the hospital I felt every acceleration in my uterus and back. I felt every tiny crack in the asphalt as well as the not so tiny ones. My body lurched forward when Neil applied the brakes and intensified my pain severely.
Neil apologized profusely and tried to find the balance between quick and cautious. I thought the fates were against me when we saw orange cones, excavators, and a construction crew providing after hours improvements on the road in front of the hospital.
We waited in the car for the pain to subside and then made a mad dash for the door. I quickly remembered that walking speeds up labor and intensifies contractions. The pain returned halfway across the parking lot. I stopped, wincing at the pain. We waited for my body to give me clearance to begin walking again.
Typically the labor and delivery nurse admits you to Triage, an observation room where they monitor your contractions, effacement, and dilation prior to officially admitting you. Luckily, Claudia called ahead and advised them to admit me upon arrival.
I vomited all over the hospital bed. The nurse gave me a hospital gown to change into and a little pink basin to capture any further projections. I vomited three more times. The basin wasn’t deep enough. In each of the three incidents the vomit ricocheted out of the bowl, all over my gown and back in my face.
As the labor and delivery nurse continually changed my gown she strapped on my external fetal monitors. The external fetal monitor is a monitoring device that uses two belts. One uses ultrasound to measure your baby’s heart rate and the other is a pressure transducer used to measure your contractions. The feedback is printed on a graphical machine to illustrate the baby response to your contractions. The elastic belts are strapped across your abdomen snugly. The extra pressure on my laboring abdomen was more than a subtle discomfort.
As soon as the monitor picked up the whoosh, whoosh, whoosh of my baby’s heart beat, the labor and delivery nurse began prepping me for the administration of an intravenous antibiotic treatment for my positive testing as a Group B Strep carrier.
Claudia arrived 10 minutes later. I don’t think I’ve ever been so happy to see anyone. It must have been the longest 10 minutes of my life. As soon as she entered the room she recognized my back pain for what it was: Back Labor! She quickly gave Neil a tutorial on how to apply Counter Pressure and relieve the pain. She performed a cervical exam and announced that I hadn’t dilated at all since earlier in the day, I was still measuring 2 centimeters! All that pain and no progress, are you serious?
She positioned me upright on the hospital bed with my knees raised and my feet flat. She pressed my knees toward me and downward forcing my tail bone against the back of the bed. I couldn’t believe the difference it made. The pressure was truly a natural anesthetic.
I looked at the clock 12:45a.m.
Our prenatal instructor taught that most first time moms average 12 hours in labor. If this was the beginning I couldn’t imagine how much worse it was going to get not to mention how much longer. The thought terrified me beyond all reason. Little did I know, I’d been laboring all day. I heard the woman in the labor and delivery room across the hall screaming, “Help! Dear, God it hurts, it hurts, it hurts!” The wails coming from her room echoed through the hallway.
I remember thinking if I’m only two centimeters into dilation how long will it take before I start screaming like that lady? “I want an epidural!” I announced.
The anesthesiologist arrived 20 minutes later. He instructed me to lie on my side curled into the fetal position forming an arc in my back. I thought I might cry. He was asking me to give up the counter pressure with the required position change.
I quickly complied. He washed my back with an antiseptic and provided a sterile drape. He then inserted a needle to numb the local site of the injection. He followed the local needle with a large needle intended for insertion between two vertebrae a little above the belly button.
He instructed me to hold perfectly still regardless of whether or not a contraction started. I lay still as the anesthesiologist slowly and carefully guided the needle toward the dural membrane and injected the anesthetic. He informed me that it would take 10-15 minutes before the numbing would take effect. The anesthesiologist then threaded a tiny catheter through the needle and taped it to my back.
Electing an epidural meant I must also receive a bladder catheter. Why hadn’t anybody ever mentioned this part of the procedure? I wasn't emotionally prepared for a physical invasion of my urethra.
Several minutes later I lay partially upright on my back. I could still feel every nerve in my lower body. But something wasn’t right. Breathing required so much effort. My fingers felt heavy and cold. My tongue was tingling. I couldn’t form words and I felt like my head was spinning. I silently thought I’m dying. I’m losing my ability to grip Neil’s hand. He’ll know I’m dead when I can’t hold it anymore. I wonder if I’ll hear the monitors beep in my last moments.
I concentrated with every fiber of my being, “Is the top of my body supposed to be numb?” I managed the question with a leaden tongue.
“What?” Both Claudia and the anesthesiologist expressed alarm.
Apparently the anesthesiologist accidentally inserted the needle with too much of an upward angle shifting the direction of the anesthetic flow upward rather than downward. They quickly flattened the bed and arched me back into the fetal position. The anesthesiologist removed the epidural catheter and began the process anew.
The anesthesiologist connected the syringe to a catheter and placed the syringe in a pump. The pump slowly depressed a plunger that provided a continuous dose of anesthetic. Fifteen minutes later I felt completely comfortable for the first time in several hours.
By this time it was 2:00a.m. I tried to sleep but it was difficult. My body shook convulsively. The shaking came so violently that my body tipped sideways. My husband propped me back up. My legs shook toward the edge of the bed. My vision was blurred. My blood pressure was 199/120. I appeared headed for eclampsia.
Claudia called for a Magnesium Sulfate IV Administration. This chemical stabilizes blood pressures and reduces the risk of cardiac arrest as well as minimizes the risk kidney or liver failure. I could feel the cool liquid trickling through the intravenous entrance of my hand. I fell asleep to this sensation.
Forty-five minutes later I awoke startled by a painful a new sensation. I thought my pubic bone was breaking. I pressed the call button for the nurse. Apparently the epidural numbs muscular nerves such as uterine contractions and cervical dilation, but the anesthesia cannot numb bone nerves. To make matters worse, I couldn’t move or adjust my position to alleviate the pain.
Claudia and the nurse returned.
“My epidural isn’t working.” I mistakenly thought the pain was attributed to an ineffective epidural. Claudia performed another cervical exam at which point she determined I was complete or a full 10 centimeters dilated. I also measured a +3 station which meant my body had been involuntarily working on fetal descent and the baby was beginning to crown. That’s when the pushing began.
My limp noodle legs continued to shake with random convulsions. Powerless and incapable of pulling my legs back into the classic birth position, I awaited assistance. Neil stood on one side and held back my left leg. The labor and delivery nurse, held back my right leg. Neil was stronger and better able to hold my left leg back in a true imitation of the classic squat, but the nurse seemed to master the angle with more comfortable placement. The lack of congruency annoyed me. I wanted to hold my legs back myself. I knew I could manage the symmetry better if I could evenly distribute resistance to both legs, but I didn’t have the arm strength and my legs were under temporary paralysis. They continued to shake, I felt frustrated with the lack of control I held over my body.
I delivered my baby sunny side up. This means she was facing up or occiput posterior. In this position the occiput or back of the baby’s head is toward the mother’s back. In a normal vaginal delivery the baby is born facing downward or occiput anterior. When the baby’s head applies pressure against the cervix with the crown in the anterior position it aids in opening the cervix.
Usually, there is not enough room for the baby’s head to pass through the pelvic chamber without rotating into the anterior position. This explains the extreme back labor pain as well as the feeling that my pubic bone was breaking. It was in essence being stretched to the max.
My birth plan expressed my desire to hold my new infant immediately after delivery and begin breastfeeding. What I didn’t anticipate was the presentation. I thought the nurse or C.N.M would provide a preliminary wipe down before handing me the infant. Not so.
Claudia instantly handed me my new infant dripping in fluids and showing a small amount of residue from the vernix caseosa or white filmy substance primarily comprised of sebum, fatty lipids, cholesterol and ceramide. Prior to birth I read that the function of the vernix is to moisturize the infant’s skin, provide a slippery passage through the birth canal, as well as offer antibacterial benefits.
Some women actually massaged the vernix or “baby cold cream” in to the newborn infant’s skin. On this my first pregnancy, I still felt a little squeamish. Neither my husband nor I were interested in reaping in this particular aspect of mother nature’s rewards. I sheepishly asked Claudia if she could wipe the baby down a little and place her in a blanket. Thus began our first swaddling.
Shortly after the swaddling began, Claudia noticed a contraction on the electronic fetal monitor and urged me to give a good push for the delivery of the placenta. The placenta exited the birth canal with little effort. The slippery and flexible amniotic sac molded much more comfortably through the already stretched vagina than a head and shoulders.
The labor and delivery nurse began rigorously massaging my abdomen in an attempt to expel any remaining placental tissue or blood clots. The aggressive massage initiated post delivery uterine contractions also known as after birth pains. These pains were hardly noticeable as the epidural still rendered full effect. I continued to swaddle and nurse my baby throughout the uterine massage.
Swaddling lasted for approximately 20 minutes while my baby’s umbilical cord slowly stopped pulsating. Our prenatal instruction explained that the cord pulsates much like a heartbeat as it transmits oxygen and nutrients from the placenta to the baby. I looked at the umbilical cord with wonder. The length didn’t surprise me. It measured approximately 20 inches or 50 centimeters long. It was the diameter or thickness of the cord that caught me by surprise. The thickness of the cord measured approximately ¾ of an inch thick or 2 centimeters. The cord initially appeared dark red with firm sinewy and fibrous walls in the places where it hadn’t calcified. As time passed and the cord slowly stopped pulsating, the color eventually faded. The volume of blood slowly filtered into my baby’s body providing her with her normal blood volume levels.
My reading suggested that early cord clamping, tying, or cutting can leave a baby low on red blood cells and act as a catalyst for an early onset of anemia. Other studies indicated that milking or allowing the cord to pulsate for longer periods of time allowed the cord to “milk” stem cells from the placental site. In class we discussed the option of saving your infant’s placenta and umbilical cord in a blood bank. The cord typically stops pulsating between 7 minutes for un-medicated births and 20 minutes for medicated births.
Claudia inspected the placenta to find that both the placenta and umbilical cord experienced extensive calcification. Calcification is a process by which the placenta begins to shut down. It appeared that the calcification had constricted the flow of nutrients to my baby. Claudia suspected that my baby had lost quite a bit of weight in the womb based on the excessive wrinkled skin.
I marveled at all of my baby’s fine, dark hair also known as lanugo. The hair covered the surface of her back, buttocks, and ears. The black hairs culminated at a point at the top of her ear reminding me of Spock from Star Trek. It appeared black while it was still wet with amniotic fluid, but later took on a dark brown appearance. Within a few weeks most of the lanugo fell out.
Following the delivery I felt ravenously hungry and hammered. I couldn’t tell what I wanted most: food or sleep. The only problem was that my husband was asleep in the chair and the R.N. kept forgetting to bring me food. Oh, what I would have done for some fresh fruit or a granola bar!
A couple of hours later the epidural catheter was removed from my back. The process felt somewhat uncomfortable, but not awful. I remained on a bladder catheter for the first 24 hours as they kept me on a Magnesium Sulfate IV for the next 48 hours and monitored my eclampsia. The Magnesium Sulfate most likely saved my life, but it left me feeling groggy and lethargic. It also limited my mobility. I couldn’t shower or use the bathroom. Even if I weren’t connected to a bladder catheter and a Magnesium Sulfate IV pump, I don’t know that I would have possessed the strength and energy to carry out the task anyway.
So what can we take from this experience?
- Labor is not predictable
- All contractions are not equal
- Ruptured membranes can manifest in the form of a trickle or a gush
- Cervical dilation is not an accurate indicator of labor progression
- Counter pressure is an effective natural anesthetic
- Epidural’s do not guarantee universal pain relief
- A laboring woman receiving an anesthetic epidural may not recognize the urge to push
- Most woman do not practice kegel contractions faithfully
- Healthy babies are derived from even the most unpredictable births
- You’re likely to exhibit the same behavior in labor that you exhibit in an argument (we’ll talk about this more in subsequent chapters)
Analysis
Who is responsible for my dissatisfying birth experience? The anesthesiologist? My husband? Our childbirth educator? The hospital? Me? The Midwife?
The Anesthesiologist- The anesthesiologist did not ask me to get an epidural. He just happened to be the on-call doctor when the nurses woke him from a peaceful slumber and told him that the patient in L&D Room #11 wanted an epidural.
It is true that the anesthesiologist made a mistake in the first administration of the epidural anesthetic, but one incident was not the cause nor was it the worst consequence of my birth experience. We all make mistakes, even in our professional careers. We place high expectations on healthcare professionals to meet certain standards of performance, because we trust them with our very lives. Reason and mature emotional intelligence suggests we must accept that it is unrealistic to expect medical professionals to perform every procedure with perfect precision every time.
My husband- Neil was the only person who attended me from the first labor contraction to the last. He also had the least experience of all the other birth attendants. If he’d been a better labor support companion would the outcome have been different?
Expectant moms must remember they are not the only one entering unfamiliar territory. Their husbands are equally as frightened. Many men express their feelings of helplessness while their wife is in labor. One new father said, “I would have done anything to remove my wife from her misery. Even if it meant enduring the pain myself.” The problem is that there isn’t a magic transfer button.
The Child Birth Educator-. The childbirth educator spent a great deal of time emphasizing issues of consumerism or options at birth and terms and definitions related to the birth process. We dedicated many hours to learning how to stop medical staff doctors, nurses, and other hospital staff from botching up our birth experience.
She helped us choose a good provider and learn abdominal breathing techniques. We didn’t learn very many relaxation techniques, but we learned many birth positions to help alleviate pain. We learned much about the text book definitions of the anatomy, pregnancy, and birth, but we didn’t fully understand the role they would play in real life labor and delivery.
The hospital- The hospital did not solicit my patronism. I could have opted for a home birth or free standing birth center. The hospital room was clean and comfortable. The staff was courteous. My quarters were private. The hospital equipment detected and provided treatment for all of my risk factors. Although I must admit the bands of the electronic fetal monitors were terribly uncomfortable.
The Midwife- Claudia was wonderful. I wanted to send her flowers.
Me- I took the initiative to attend a birth class. I opened my mind to new options. I followed my caregivers instructions. I did all of my prenatal toning exercises on a regular basis. It couldn’t be my fault. The reality was that I botched up my own birth experience by not maintaining optimum health.
Many birth classes provide a good service in preparing and educating pregnant couples with techniques prior to the birth of their baby. If we want to look at the larger picture it is important to consider that the number one factor influencing the outcome of the baby is a healthy mother.
Monday, June 6, 2011
Depression in Pregnancy
Some studies indicate that up to 70 of women experience symptoms of depression during pregnancy. A general feeling of sadness or discontent may not be associated in any way to your attitude about the baby or being a mother. If you're pregnant and struggling with depression you're not alone.
Depressive symptoms in pregnancy are often smaller than a full diagnosis. Often feelings of dissatisfaction may leave you feeling melancholy. It is likely that mood swings, emotional outbursts and other psychological insecurities are a result of the increase of hormones present in pregnancy.
However, depression may be situational and not physiological. Sometimes the stress of pregnancy brings associated depressive symptoms, even when the pregnancy was planned. Feelings of gloominess may intensify if there are complications related to the pregnancy or preparation for the pregnancy. Some common catalysts for the pregnancy blues may include loss of employment, relationship challenges, weight gain, or lack of energy.
Other causes of stress are simply produced by natural changes that pregnancy potentially brings, such as switching to a new house or apartment that better accomodates your growing family. Sometimes these changes create additional financial pressures, which may induce stress and depression, common in pregnancy.
Feelings of cheerlessness can negatively affect a healthy appetite, sleep habits, and exercise routines, which are all important elements of maintaining good mental health in pregnancy.
Treatment
If you are struggling with feeligns of listlessness try the following:
-Remove any unnecessary stress from your life
-Communicate your feelings with your partner and enlist their support
-Ensure you're eating plenty of Omega 3 Fatty Acids, Folic Acid, and plenty of B Vitamins
-Make time for naps if you need them
-Exercise daily even if it's only walking for 15 minutes twice a day
If symptoms of depression persist speak with your clinician to ensure you receive proper prenatal care.
Depressive symptoms in pregnancy are often smaller than a full diagnosis. Often feelings of dissatisfaction may leave you feeling melancholy. It is likely that mood swings, emotional outbursts and other psychological insecurities are a result of the increase of hormones present in pregnancy.
However, depression may be situational and not physiological. Sometimes the stress of pregnancy brings associated depressive symptoms, even when the pregnancy was planned. Feelings of gloominess may intensify if there are complications related to the pregnancy or preparation for the pregnancy. Some common catalysts for the pregnancy blues may include loss of employment, relationship challenges, weight gain, or lack of energy.
Other causes of stress are simply produced by natural changes that pregnancy potentially brings, such as switching to a new house or apartment that better accomodates your growing family. Sometimes these changes create additional financial pressures, which may induce stress and depression, common in pregnancy.
Feelings of cheerlessness can negatively affect a healthy appetite, sleep habits, and exercise routines, which are all important elements of maintaining good mental health in pregnancy.
Treatment
If you are struggling with feeligns of listlessness try the following:
-Remove any unnecessary stress from your life
-Communicate your feelings with your partner and enlist their support
-Ensure you're eating plenty of Omega 3 Fatty Acids, Folic Acid, and plenty of B Vitamins
-Make time for naps if you need them
-Exercise daily even if it's only walking for 15 minutes twice a day
If symptoms of depression persist speak with your clinician to ensure you receive proper prenatal care.
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