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.
