Fourth childbirth class.
Jan. 29th, 2005 01:55 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
rivkaNot quite the same high as the third class, but I still feel very, very lucky to be taking this course.
The fourth class was divided into two parts: pain medication, and pushing.
As might be expected from a bunch of midwifery clients, most of us started out pretty much anti-pain medication. The instructor's goal seemed to be to get us to adopt a more nuanced view, yet without whitewashing the undesirable side effects of drugs. Her mantra was "the right drug, in the right dosage, at the right time, for the right reason." The chart of drug risks and benefits in our textbook was kind of sobering, but, as was brought out in discussion, having uncontrolled and unbearable pain isn't exactly risk-free either - it can have a negative impact on the mother, the baby, and the progress of labor, just as if it were a drug. So it's all about tradeoffs.
We split into pairs to research the uses, timing, administration, risks, and benefits of one of five potential classes of medications: sedatives, narcotics, general anesthesia, epidural anesthesia, and spinal anesthesia. Then each pair presented their research to the class, for discussion. I was a little bit dismayed to learn that narcotics involve a lot of the same behavioral restrictions as epidurals, in terms of being required to stay in bed and have continuous electronic fetal monitoring. Those restrictions are a major part of why I wouldn't want an epidural even if my spinal fusion did permit. So that's good to know. On the other hand, our instructor pointed out that it's possible to ask for a half dose of narcotics, if you're worried about being too groggy - which hadn't ever occurred to me. (The half dose, I mean, not the grogginess.)
I now have a much clearer understanding of the difference between spinal anesthesia and epidural anesthesia, and am encouraged that it might be possible to have a spinal for a C-section even if my fusion prevents me from getting an epidural. My biggest fear about childbirth is that I will need to have a C-section under general anesthesia, and won't be able to see and hold my baby right away.
We talked about what to do during labor if you have previously agreed that you don't want to use pain medications, but then the mother changes her mind in mid-labor. Suggestions: ask to have your progress checked, try going another 5 contractions without medication, and - I thought this was interesting - have a code word that means, "I don't care what we agreed on earlier, get an anesthesiologist in here STAT." She did a nice job of explaining the rationale behind having a safeword, during which Michael and I avoided catching each other's eye.
Then we talked about pushing the baby out.
Apparently, at the beginning of the second stage of labor, many women get a 10-20 minute break which childbirth educators call the "rest and be thankful" phase, in which they are fully dilated but not yet feeling the need to push. Mood generally also improves at the beginning of the second stage, even if you don't get a rest. Good to know.
You know how, when a woman gives birth on TV, the doctors are always yelling at her to push? Apparently, that's not such a bright idea. Now the recommendation is for "spontaneous bearing down," which involves not pushing unless you feel an irresistable urge to do so. That apparently works out to about three pushes per contraction, less breath-holding, more efficiency, and less exhaustion. (On the other hand, if you've had an epidural, you still need someone to tell you when to push. The epidural tends to block the urge to bear down, as well as the pain.)
We talked some about positions for pushing, but in general Michele said that our midwives would give us plenty of position advice and we didn't need to figure it out ahead of time. I had read that it's a bad idea to push flat on your back or in a semi-sitting position, because it compresses the coccyx and narrows the birth canal. Michele says that only applies late in the second stage, closer to delivery. Good to know. No squat bars are available at our hospital. "Why?" "Because this is a very, very conservative area to give birth in."
Crowning: the episiotomy rate in our midwife practice is pretty darn low. They use massage and sometimes cold packs - warm compresses used to be the recommended thing, but apparently that increases blood flow to the perineum and thus increases the risk of a tear. If you do have an episiotomy, it generally doesn't hurt because the pressure on the perineum is so intense - although stitching it up afterward might be a different matter.
After birth, the baby goes right onto the mother's belly and is dried and covered up with a blanket or towel to stay warm. If you have a water birth, the baby stays submerged except for the mouth. Delivering the placenta doesn't particularly hurt.
Next week, we discuss waterbirth and probably more postpartum issues. The final week will be all about infant care.
The fourth class was divided into two parts: pain medication, and pushing.
As might be expected from a bunch of midwifery clients, most of us started out pretty much anti-pain medication. The instructor's goal seemed to be to get us to adopt a more nuanced view, yet without whitewashing the undesirable side effects of drugs. Her mantra was "the right drug, in the right dosage, at the right time, for the right reason." The chart of drug risks and benefits in our textbook was kind of sobering, but, as was brought out in discussion, having uncontrolled and unbearable pain isn't exactly risk-free either - it can have a negative impact on the mother, the baby, and the progress of labor, just as if it were a drug. So it's all about tradeoffs.
We split into pairs to research the uses, timing, administration, risks, and benefits of one of five potential classes of medications: sedatives, narcotics, general anesthesia, epidural anesthesia, and spinal anesthesia. Then each pair presented their research to the class, for discussion. I was a little bit dismayed to learn that narcotics involve a lot of the same behavioral restrictions as epidurals, in terms of being required to stay in bed and have continuous electronic fetal monitoring. Those restrictions are a major part of why I wouldn't want an epidural even if my spinal fusion did permit. So that's good to know. On the other hand, our instructor pointed out that it's possible to ask for a half dose of narcotics, if you're worried about being too groggy - which hadn't ever occurred to me. (The half dose, I mean, not the grogginess.)
I now have a much clearer understanding of the difference between spinal anesthesia and epidural anesthesia, and am encouraged that it might be possible to have a spinal for a C-section even if my fusion prevents me from getting an epidural. My biggest fear about childbirth is that I will need to have a C-section under general anesthesia, and won't be able to see and hold my baby right away.
We talked about what to do during labor if you have previously agreed that you don't want to use pain medications, but then the mother changes her mind in mid-labor. Suggestions: ask to have your progress checked, try going another 5 contractions without medication, and - I thought this was interesting - have a code word that means, "I don't care what we agreed on earlier, get an anesthesiologist in here STAT." She did a nice job of explaining the rationale behind having a safeword, during which Michael and I avoided catching each other's eye.
Then we talked about pushing the baby out.
Apparently, at the beginning of the second stage of labor, many women get a 10-20 minute break which childbirth educators call the "rest and be thankful" phase, in which they are fully dilated but not yet feeling the need to push. Mood generally also improves at the beginning of the second stage, even if you don't get a rest. Good to know.
You know how, when a woman gives birth on TV, the doctors are always yelling at her to push? Apparently, that's not such a bright idea. Now the recommendation is for "spontaneous bearing down," which involves not pushing unless you feel an irresistable urge to do so. That apparently works out to about three pushes per contraction, less breath-holding, more efficiency, and less exhaustion. (On the other hand, if you've had an epidural, you still need someone to tell you when to push. The epidural tends to block the urge to bear down, as well as the pain.)
We talked some about positions for pushing, but in general Michele said that our midwives would give us plenty of position advice and we didn't need to figure it out ahead of time. I had read that it's a bad idea to push flat on your back or in a semi-sitting position, because it compresses the coccyx and narrows the birth canal. Michele says that only applies late in the second stage, closer to delivery. Good to know. No squat bars are available at our hospital. "Why?" "Because this is a very, very conservative area to give birth in."
Crowning: the episiotomy rate in our midwife practice is pretty darn low. They use massage and sometimes cold packs - warm compresses used to be the recommended thing, but apparently that increases blood flow to the perineum and thus increases the risk of a tear. If you do have an episiotomy, it generally doesn't hurt because the pressure on the perineum is so intense - although stitching it up afterward might be a different matter.
After birth, the baby goes right onto the mother's belly and is dried and covered up with a blanket or towel to stay warm. If you have a water birth, the baby stays submerged except for the mouth. Delivering the placenta doesn't particularly hurt.
Next week, we discuss waterbirth and probably more postpartum issues. The final week will be all about infant care.
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no subject
Date: 2005-01-29 07:15 pm (UTC)no subject
Date: 2005-01-29 08:56 pm (UTC)Hard (transitional) labor is really, really scary if you're not expecting it. It's sort of like the worst charley horse you've ever had.
The thing to remember, though, once hard labor starts, is you know how when you have a charley horse, you can either let your leg double up like it wants to and roll around being in pain until it feels like letting go or you can focus your mind on keeping your leg straight and pulling against the cramp until it stops?
This is an extraordinarily useful technique during labor.
(Bradley, ten pound baby with a head the size of a bowling ball)
no subject
Date: 2005-01-29 10:52 pm (UTC)My experience was so atypical that I can't really comment, except to say that I found it very very easy to distinguish between pressure on my cervix and an urge to defecate, and they didn't believe me until afterwards when it became obvious I was right. Pander to your digestion first; my mother bore me in spite of constipation and it was the only birth that really hurt, apparently, and I - well, I had issues, but they were compounded by that typical and unromantic pregnancy side-effect.
no subject
Date: 2005-01-30 02:54 pm (UTC)My godmother has three children, all grown up now, and the longest she was ever in labour was half an hour. One of them was literally born in the ambulance on the way to hospital. None of the births hurt at all, though the ambulance bit was embarrassing. So it's possible that all this worry will be for nothing.
no subject
Date: 2005-01-30 03:09 pm (UTC)It doesn't seem that way. Because narcotics can depress the maternal and fetal heart rates, they want to monitor the baby while you're under the influence.
Now, if I don't get meds, the standard will be 10-20 minutes of fetal monitoring when I first get there, followed by a brief check every hour. Very reasonable.
So it's possible that all this worry will be for nothing.
My mother and sister both had short, easy labors. I am choosing to believe that it runs in families - there's no reason to expect that mine will be any different. I would like the labor to last longer than half an hour, though, because I'd like enough time to figure out what's going on and get to the hospital.
I'm actually not that worried about labor pain, although it might look like that from all the musing and the detailed posts about childbirth class. Preparing as much as possible is a coping mechanism for me.
no subject
Date: 2005-01-30 07:36 pm (UTC)I also cope by preparing for the worst case; that way, whatever happens, I feel fine, because the worst case is prepared for. That's why my birth plan said "would prefer not to X unless I change my mind while in labour." And I did. And I had my mother over for two weeks before and after the birth, scheduled, on the grounds that if it went well, that would be fun, and if it went badly, it would be useful. It was both.
no subject
Date: 2005-01-31 12:46 am (UTC)I asked my midwife at the last visit if labors ran in families, and told her about my mom and sister. She told me, essentially, that I'll have the greatest likelihood of an easy birth like theirs if I believe that I'm going to have one. So I'm believing with all my might. :-)
(I certainly don't think she meant "you can will yourself any kind of labor you want," I think she just meant, "if you have positive expectations, fear and tension will be less likely to interfere with your labor." Obviously there was no way that positive thinking was going to get you out of your situation.)
no subject
Date: 2005-01-31 05:33 am (UTC)I was born, tiny but in robust good health, at just about seven months of gestation. Long labor, but no complications whatsoever, and was turning myself over in the long-rows-of-color-coded-babies crib the same night I came out. I was exactly the same length as a Cabbage Patch Preemie doll (as my mom told me when, many years later, I got one, and she held it babystyle the way she used to hold me).
I *do* believe in fairies, I do, I *do*!
episiotomies aren't so bad
Date: 2005-01-30 10:42 pm (UTC)Glad to know everything is going so well, so far. Having had two natural labours, drug-free, that ended with episotomies, I just wanted to say that they aren't so bad. (I won't talk about the two caesarian sections.) If you need one, like I did, because of a crowning baby that just wasn't getting any further for quite a few minutes, you may be yelling for them to do it fast! It doesn't hurt at all when they do it (what did you say about sensory overload in an earlier post?) and here (Sydney, Australia) they give you a local for the stitch up (and you have a baby in your arms). Sure, it would be better not to need one, but don't resist for the sake of it. Same nuances as the drugs, really. Babies can get distressed at the last minute too. Best of luck. Emma