I have a doula who once shared that she had been supporting a mom in labor for a couple of days who eventually ended up having a cesarean. Another doula- not in my company- asked her, “Don’t you wish she had just gotten the epidural much earlier and they had called for the cesarean hours earlier? When I heard that I was aghast! NO! This mom had a journey she was choosing to play out to the very end until there were no other options. And my guess is she is glad she did. And this doula, the one in my company- was happy to have been there supporting her the whole time.

MY BODY

I had a mom recently tell me the story of having her first baby by cesarean due to the suspected large baby. She had been so disappointed that the baby was found to be of only average size. She said that no one supported her through the consideration of having the baby select her own due date and for the mom to labor. Her husband who was a larger man, her mom, her mother in law and her friends all agree with the doctor.  And now she was struggling with finding the right care provider to truly honor her desire for a vaginal birth after a cesarean with her next. And guess what, her friends and family are not supportive of her having a VBAC this time either. I think folks forget it is her journey not theirs!

A mom to be sat in my class recently and shared how she was not going to be fully forthright with information about her birth location with her mom. She felt it would upset her and bring harm in doing so. So instead of being able to share in the joy of their decision to have a home birth, she was going to keep it to herself. It made me sad that her mom’s response would not be one of support. Sure there may need to be some educating for the mom to understand the choice, but in the end I was sad that this young mother did not feel her mom would be able to “hear” it. I am glad this woman does not feel compelled to change her mind to please her mom- but it makes me sad that she has to keep it private as to avoid the conflict.

In that same class was a mom who really wanted to make decisions for her birth that would not make her partner feel good. I don’t mean decisions that would bring harm- I mean personal decision that are right for her. Whether that is for one woman, hiring a doula. Or for another choosing a different birth location. She should be able to decide who to have with her in labor. (I suspect some moms are angry when I am included, and not them for instance.) Or something as simple as what she will wear in labor. These are her decisions to make- it is her birth- the baby is coming out of her body.

I had a mom who made a decision to fight to have a natural- organic birth. She selected midwives who she felt would support her and had lots of conversations with them about what she wanted. She did not want to be induced. She did not want to have augmentation to her labor. She did not want to have any pain medication. She labored prodromally for three days- with little or no sleep. She consented to getting low dose Pitocin when her contractions proved to need assistance in the last hours of her labor. She consented to getting an epidural in a last ditch effort to see if a bit of relaxation to her body and specifically her pelvic floor would make a difference. In the end it did not. She had an ounce short of a 10 pound baby that had been trying to come through her body decline to be able to do so. She has to be proud of her journey. She worked for so hard. She was at the hospital for over 26 hours before the birth. Her two midwives had been so patient- beyond what is the norm at this hospital.

But guess what, her mom was angry. Angry she had a midwife instead of a doctor. Angry that her daughter had somehow bought into this whole “journey” idea. Angry that her daughter had been trusted to labor with this huge baby inside of her. Angry that I had been supporting her daughter in this foolish suffering. Angry that folks had been cavalier with her grandson’s health- he was born by the way perfectly healthy. I sat there while she was indignant with me wondering whose journey this had been. She certainly did not trust the child she had brought into the world to be able to make the right decisions for her.

We may not understand or approve of someone’s choices. But in the end, it is their journey to choose. If they are not being cavalier with harming others- it is time we remember that. Birth is a personal journey. It is not up to the partner, the doctor, her friends or her mother to make these decisions. I support women making personal decisions that are right for them, especially when it comes to their birth choices. It after all is her journey, not theirs.

formula gift

I went to a blessingway last night. The pregnant mother being honored mentioned that although she has every intention to breastfeed, she thought it odd that she received two large containers of powered infant formula in the mail. I asked if she had registered at BabiesRUs and of course she had. What she did not realize is they sell her name to the formula companies to get free samples!

Today on facebook a fellow doula and friend of mine posted this picture. A gift the mom received at the hospital. These hospitals get free formula for their hospital by giving away free gifts to each mom who has had a baby. The bottle feeding moms get a huge supply while the breastfeeding moms get a smaller sampler.

It is no wonder that in the metro area of Atlanta we still don’t have a Mother- Baby Friendly hospital.  Our local hospitals may have IBCLCs on staff- others only have limited access to these trained women, but they also hand out nipple shields, pacifiers and formula with great regularity.  There are ten steps to becoming classified as Mother Baby Friendly.

The Ten Steps to Successful Breastfeeding are:

  1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
  2. Train all health care staff in the skills necessary to implement this policy.
  3. Inform all pregnant women about the benefits and management of breastfeeding.
  4. Help mothers initiate breastfeeding within one hour of birth.
  5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
  6. Give infants no food or drink other than breast-milk, unless medically indicated.
  7. Practice rooming in – allow mothers and infants to remain together 24 hours a day.
  8. Encourage breastfeeding on demand.
  9. Give no pacifiers or artificial nipples to breastfeeding infants.
  10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.

How do you think offering pacifiers, throwing nipple shields at moms who have latch issues and handing out free formula fits into this initiative?

I recently had a birth at a satellite hospital in North Forsyth. It was my first birth here. I had hoped it would be a great facility that supported natural birth since some of the doulas with my company have had good births here. The mom had vacillated about moving to a different facility but due to insurance reasons, made the decision to stay the course. She took a childbirth class with friends of mine and felt really prepared.  We had discussed being prepared to have to stand firm in some areas if she wanted the birth she desired.

She started out with on again off again type contractions that had started Sunday and continued into Monday. She had had an exam in the office on Friday. (Vaginal exam 3- she had had two prior to this appointment) Often times labor gets a kick start by having an exam. But sometimes the exam causes a start that is not quite ready to get going and thus leads to an on again off again irritated uterus. The mom had knowledge of the risks.

I was in touch with them on and off.  I met them at the hospital early on Tuesday morning. She was concerned that she was not yet in active labor. And then we met our nurse, Tammy. She came in and announced we were lucky since she was not only a nurse but a previous midwife. She then told my client that if she was wondering if she was in active labor, she most certainly was not. BOMB!

bomb

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Npr has been having a plethora of articles on labor and birth. The Baby Project. They are packed full of information and power for a pregnant woman. Here is one that a client sent to me to help understand her fears of her upcoming labor. The article seemed to resonate with her concerns. I am going to address some of the things and how they could be handled differently. This is the second half of a birth story that was begun in a previous article. The Broken Epidural.

“However, due to HIPAA regulations, I was separated from Frank while a nursing assistant asked me 100,000 admission questions. Didn’t we pre-register to avoid this? I constantly repeated to anyone who would listen: “My husband has a copy of my medical records.””

Recently a mom came in in active labor to the hospital with me along side of her- her doula. The mom’s husband was moving the car and she wanted me to stay with her. But due to the privacy act of HIPPA, I was asked to leave the room. She was about to be alone with a nurse she had yet to learn the name of and answer questions of a personal and private matter. I had been hired to help her with pain coping techniques and this nurse was dismissing me. I asked later what we could have done to avoid that as this had left my client feeling abandoned.

You can waive your privacy rights and tell the staff that you want your doula or partner to stay with you. It is your right to waive them. This could have been offered to her but it was not. But knowing this now- I think it is important to understand it may be hospital protocol to have your support people leave, but you can refuse it.

“Yet the hospital’s system required that I give fresh answers to inane questions such as, “Do you remember when you had your last period?” while I was having intense contractions. There were also incredibly vague questions like, “Do you have any medical issues?” Later, a resident came in to ask me the same questions yet again and when I mentioned a tonsillectomy a few years back, the nurse’s aide admonished me, “You didn’t tell me that!”” (more…)

When in labor you will probably be asked this question: On a scalre of 1 to 10, with  10 being the worse pain you have ever felt and 1 being no pain, where are you on your pain scale?

http://denverhealth.org/LinkClick.aspx?fileticket=TFyVg2WioCI%3D&tabid=3623

http://www.pain.com/go/default/practitioner/medical-library/expert-interviews/the-need-for-new-jcaho-pain-standards/

This scale was determined to be used by hospitals for pain control and management. If you had surgery and had postoperative pain this is useful. It is not useful when someone is having labor pain to focus on levels that are not anything she has ever felt before.

PAIN : purposeful, anticipated, intermittent and normal

Purposeful pain alerts us to action. In labor early pain tells us to alert support, go to where you are going to be birthing, hydrate, call the midwife, etc.

Anticipated pain readies us for being prepared by taking classes, learning pain coping skills, understanding our options. To go into labor not anticipating pain means you are going to be shocked when your body goes into labor. Anticipate it- welcome it- as it brings your baby closer to being in your arms. The fear- tension- pain cycle that Dr. Grantley Dick-Read wrote about tells us that if we fear it- we tense more and the pain is more difficult.  So know it may be painful- not so painful you can’t do it- just painful- so prepare!

Intermittent pain means it is not ongoing- in fact if you have contractions 3 minutes apart- that is twenty an hour- and if the peak is the part that is the most difficult, you are looking at less than 7 minutes of difficult pain per hour. It is not like having constant pain- it is intermittent. So, try to go with the intermittent time between contractions- use it to rest- to recoop. Then ride the wave during those seven minutes and think about surrendering to it, not fighting it.

Normal pain means what you will be feeling is normal. 300,000 women will birth with you on the day you give birth.  Birth is not so painful that we should not want to do it again. Our species relies on it. Birth in normal.

So, keep the pain scale for the pain that is not purposeful, not anticipated to have to be present, not intermittent and not normal. And keep this skill out of the labor room!

If you are asked about this pain measurement, know that you can tell the staff you decline being asked further.

 

Yesterday when I went to get an additional tattoo.  I sat in the chair and thought I was ready. When David put the needle to my back, I had second thoughts. It hurt! I told him that he needed to be prepared for some whine! I had to remember to take a deep breath and release my shoulders. I also realized how much I rely on music when needing a distraction for pain. David had forgotten to turn on the music. He stopped when I mentioned it and turned on his music for me.

The full tattoo took an hour. He worked mostly straight through with a few breaks to take care of other business and give me a chance to check it out at the mirror. But what I realized was that after about fifteen minutes of David putting the needles to my skin, the sharp pain that was at the beginning was gone. I am sure the music helped distract me. I am sure that the great conversation I have with David each time also helps.  But it also dawned on me that the pain receptors in our bodies had sent more endorphins to me to help me with the pain. I did not even consider the last 45 minutes of being tattooed as painful at all- instead a sensation that was uncomfortable but not grimacing in any way.

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I had a client in 2008 who desired a natural birth but after several hours without any change in dilation, interventions were begun and she ended up with a cesarean birth. She was my only doula client who ended up with a primary cesarean last year. She had stayed at 8 cm for several hours and then received an epidural. The effects of the epidural dropped her blood pressure causing the baby to go into distress and her cesarean was immediate. I hate that it happened. I am not sure we could have done any more than we did. Perhaps if she had been able to relax more- given more time before getting the epidural… I don’t know. But the thing that caused me the real problem with this birth was not the outcome per se.

This hospital, Emory Crawford Long, does not allow a laboring woman to have anyone stay with her if she chooses to get an epidural. NO ONE- as in not her husband or her doula or her friend or her mom… only medical staff. Why?

Let’s hear from the nurses…on allnurses.com the forum had these comments: (more…)

Epidurals have become so common place that I think many folks feel they must have no risks at all. So, I thought I would write about some of the risks you need to consider. First let me give you a definition of an epidural from an anesthesiology website “Epidural anesthesia is most commonly placed in the low back (lumbar region). Unlike Spinal this technique may also be accomplished in the mid-back (thoracic region) for surgery in the area of the chest. After a sterile prep and draping, local anesthetic is placed in the skin numb the area where the Epidural need will be placed. The needle for Epidural passes between the vertebrae of the Spinal column to the Epidural space. Once the position is verified, a very small catheter(tube) is placed via the needle. The needle is then removed and the catheter remains in the Epidural space. The catheter is then taped to the patients back. Local anesthetics and narcotics given epidurally via this catheter. The procedure usually takes 10 – 25 minutes.”

One great website with a fabulous article is http://www.healing-arts.org/mehl-madrona/mmepidural.htm

The doctor writing the article posts these concerns. (more…)

The Two Big Factors in Labor and Birth

 

As a labor doula there are two factors that I think make the most difference in labors. The first one is fear. Pam England says that the work of pregnancy is worry. We need to get all our fears out on the table and address them one by one. That way when labor begins, we have gotten the fear factor out of the way and we can labor. When a woman is holding onto some hidden fears she does not allow her body to unfold and birth. This truly inhibits the mind-body connection that is so essential for birth to flow more easily.

Some of the greatest fears are not unique to most women. There is a fear of loosing control. The concern about pooping when they are pushing out their baby. There is concern that their behavior will be such that they will be embarrassed by it later. There is the issue of trust for their provider and the location where they will birth. Will their partner be supportive enough? Will this experience enhance their relationship or hurt it? Will their body “fail” them- not opening properly or not being able to withstand the pain? Will they have to fight for what they want? Will they allow something to happen that they will later regret? These are just a few of the concerns most women share with me. The answers or solutions are as varied and individual as the concerns. I do know that these concerns need to be addressed long before labor begins so that these same concerns won’t inhibit the natural process of labor. (more…)