It's pretty important to be comfortable during labor. Especially as the contractions get stronger...you want to be in a position that is not only comfortable for you but also aides your labor. Being comfortable in it of itself is an aid in labor progression. Having the option to get up and walk around is also a great thing. What isn't helpful is to be forced into a position and unable to move or walk around at will. Many hospitals will hook you up to a continuous external electronic fetal monitor (EFM) as you come into labor and deliver. It's 2 straps wrapped around your belly: one tracking babies heart and the other tracking your contractions (a tocodynamometer). It then prints out a sheet of paper so nurses and doctors can keep track of your 'progress.' Needless to say, these straps are connected to wires which are connected to the computer, meaning...lack of movement. Once connected, you are pretty much forced to lay in the bed. Hopefully you can still at least move from one side to the other and not have to stay on your back. If your lucky, maybe you can at least stand next to your bed.
There is also an internal electronic fetal monitoring. This is even less comfortable. A thin, spiral wire electrode is placed in the skin of the baby's scalp to detect the heart and a tube (catheter like) is placed with in your uterus to measure contractions. Internal is more accurate but clearly more evasive than the external. This monitoring requires breaking your water and the skin of the baby's scalp. Breaking your water prematurely may cause complications itself and in most hospitals start the clock to push that baby out.
So what is the purpose of this monitoring? For the nurse or doctor to keep track without having to be near. They can check from their office or station all the women in labor as once and not have to get up and walk around to each individual room. Or they can simply enter your room and go to the print out and not have to bother you. However, that might make you feel unimportant in the process since they aren't really paying attention to you. Trust me, you know when you're having a contraction and how the intensity is progressing. You don't need a monitor to tell you that. You're partner may also start to focus on the machine instead of listening and waiting for you. This monitoring is also helpful to hear the babies heart. This is a good thing! The issue is that reading the results is very complex and even experts disagree what different heart rate patterns mean and when intervention is truly neccesary. Fetal distress is a shortage of oxygen, not simply a change in heart pattern but if there is a change your doctor may very likely jump to the conclusion that the baby is in distress and call for a c-section only to pull out a perfectly healthy baby that had no problems. This is becoming more of a problem because doctors infrequently truly know what a natural, normal labor and delivery look like and what the heart patterns mean. Since they are taught how to handle and deal with a crisis, they might jump to an intervention because that's all they know without truly understanding what is going on.
As I said, hearing the babies heart is a good thing and something that does need to be monitored. There are ways other than continuous monitoring. Ask to be intermittently monitored. Instead of being constantly hooked up, you'll only be hooked up about 10-15 min every hour. So the greater part of the hour you can be moving around or lay in whatever position you find comfortable. See if they have a portable radio-transmission (telemetry) unit. There are 2 types. One is where you wear a radio transmitter around your neck and those wires are connected to the belt. The other (and newer version) is wireless. These are waterproof and gives you a broader area to move/walk about. If you must be continuously monitored see if they have one of these...it's the best option for you to be comfortable and allow labor to progress.
The least evasive is a fetal stethoscope. This requires a nurse or doctor to be with you frequently and studies have shown this method allows the birth of healthy babies with fewer c-sections. Unfortunately since you need to be check often, many hospitals don't staff enough people for this option. There is also a hand-help waterpoof telemetry unit so you can be in the bath which being monitored.
Find out what your hospital requires. Some will force you into one option...be sure it's an option you feel comfortable with. As always, read up on the issue!
Tuesday, October 30, 2012
Tuesday, October 23, 2012
You want to cut me where?!
More women should ask this question when an episiotomy is suggested! What is an episiotomy? It's a cut in the perineum (the flat area between the vagina and anus). Why would anyone get cut down there?! Where did the idea to cut in such a sensitive area come from? Interestingly enough from doctors way back when, in the 1920's era of twilight sleep births. Women were completely knocked out and had no consciousness or awareness of what was going on. When it came time to push, obviously they were incapable. So the doctor had to go inside and pull the baby out...usually via forceps. With the addition of forceps the doctor needed more room, enter episiotomies. Women are conscious and aware during labor these days...that's arguable if you have an epidural. But clearly women are not knocked out like they were, so why still use an episiotomy? Good question!
One reason given is to help prevent a tear down there. There are 3 different cuts used however, the most common is called a midline. It's a cut from the vagina straight down. This is the worst kind yet easiest to perform and stitch up, so of course it's used most often. Why is this the worst? Think of a piece of cloth. If you grab it and try to tear it apart, it's very difficult perhaps impossible. Now if you start with a little cut already in place, you can tear right through it. That is your perineum. With no cut in place, tearing should be minimal or not happen at all. But with a cut, you may rip right through to your anus. OWWW!!! Because this was such an issue 2 other options came about. The mediolateral: instead of going straight down from the vagina it's a diagonal to the side. The 3rd kind combines the two and looks like a hockey stick: straight down from the vagina and then to the side.
These cuts are done during crowing where the pressure of the babies head is pushing against the perineum and creates a natural anesthetic. After the birth, you can feel it and you need a local anesthetic to stitch it up. If you were to tear naturally, it would be a much smaller tear and most likely will not need stitches. There are ways to avoid an episiotomy and most likely a tear. During pregnancy: do squats. Instead of bending over, squat. This helps stretch the perineum and prepare you for labor. During labor: only push when you feel the urge. Pushing at any other time creates pressure on your perineum when it's not ready to stretch. Take your time pushing the babies head out. Allow your perineum to stretch naturally and don't force it to open before it's ready. Your body prepares for this by pushing baby down during a contraction and then receding a bit. It doesn't mean your baby doesn't fit or doesn't want to come out...this is the natural process your body is going through in order to protect itself from injury. Work with your body, not against it...it really does know what it's doing. This coming down and receding of baby is especially important if you have a large baby. Your baby is built to fit through your body...but again, we must let our bodies do the work it knows it needs to do. Kegels also help strengthen your perineum. They are important both before and after baby! Warm compress, perineum oil or olive oil, and perineum massage during crowning help relax and stretch the perineum so that it will not tear.
Other reasons given:
-it helps speed up your labor. It does but a few minutes cut from labor doesn't replace weeks and months and perhaps a lifetime of pain and discomfort.
-protects against incontinence. The episiotomy may actually cause incontinence. Kegels will strengthen you down there to protect you against this.
-protects baby from shoulder dystocia. There are actually different laboring positions that can help a baby who is stuck.
The fact is every reason given has been given without any proven medical research. Most women do not need it. Medical science knows that routine episiotomies are not beneficial and carry many disadvantages. For example: pain and discomfort for weeks and months perhaps a lifetime, sexual dysfunction due to the pain, increase blood loss, create a larger tear than necessary, cause incontinence, cause you not to be able to breastfeed because of the pain. If medical science knows there are no benefits why do some doctors continue to do it routinely? It's how it's always been done...they learned this in their training and continue to do it. Regardless of true need and lack of medical evidence.
Be sure to ask your doctor their view on episiotomies. Some think most first time moms need it. Other think all women need it. Others think it should only be saved for absolute need. A good response is NOT: we'll see what happens during labor. That generally means you will end up with one.
This little cut is a very big deal! Please read up on it and know where your doctor stands.
One reason given is to help prevent a tear down there. There are 3 different cuts used however, the most common is called a midline. It's a cut from the vagina straight down. This is the worst kind yet easiest to perform and stitch up, so of course it's used most often. Why is this the worst? Think of a piece of cloth. If you grab it and try to tear it apart, it's very difficult perhaps impossible. Now if you start with a little cut already in place, you can tear right through it. That is your perineum. With no cut in place, tearing should be minimal or not happen at all. But with a cut, you may rip right through to your anus. OWWW!!! Because this was such an issue 2 other options came about. The mediolateral: instead of going straight down from the vagina it's a diagonal to the side. The 3rd kind combines the two and looks like a hockey stick: straight down from the vagina and then to the side.
These cuts are done during crowing where the pressure of the babies head is pushing against the perineum and creates a natural anesthetic. After the birth, you can feel it and you need a local anesthetic to stitch it up. If you were to tear naturally, it would be a much smaller tear and most likely will not need stitches. There are ways to avoid an episiotomy and most likely a tear. During pregnancy: do squats. Instead of bending over, squat. This helps stretch the perineum and prepare you for labor. During labor: only push when you feel the urge. Pushing at any other time creates pressure on your perineum when it's not ready to stretch. Take your time pushing the babies head out. Allow your perineum to stretch naturally and don't force it to open before it's ready. Your body prepares for this by pushing baby down during a contraction and then receding a bit. It doesn't mean your baby doesn't fit or doesn't want to come out...this is the natural process your body is going through in order to protect itself from injury. Work with your body, not against it...it really does know what it's doing. This coming down and receding of baby is especially important if you have a large baby. Your baby is built to fit through your body...but again, we must let our bodies do the work it knows it needs to do. Kegels also help strengthen your perineum. They are important both before and after baby! Warm compress, perineum oil or olive oil, and perineum massage during crowning help relax and stretch the perineum so that it will not tear.
Other reasons given:
-it helps speed up your labor. It does but a few minutes cut from labor doesn't replace weeks and months and perhaps a lifetime of pain and discomfort.
-protects against incontinence. The episiotomy may actually cause incontinence. Kegels will strengthen you down there to protect you against this.
-protects baby from shoulder dystocia. There are actually different laboring positions that can help a baby who is stuck.
The fact is every reason given has been given without any proven medical research. Most women do not need it. Medical science knows that routine episiotomies are not beneficial and carry many disadvantages. For example: pain and discomfort for weeks and months perhaps a lifetime, sexual dysfunction due to the pain, increase blood loss, create a larger tear than necessary, cause incontinence, cause you not to be able to breastfeed because of the pain. If medical science knows there are no benefits why do some doctors continue to do it routinely? It's how it's always been done...they learned this in their training and continue to do it. Regardless of true need and lack of medical evidence.
Be sure to ask your doctor their view on episiotomies. Some think most first time moms need it. Other think all women need it. Others think it should only be saved for absolute need. A good response is NOT: we'll see what happens during labor. That generally means you will end up with one.
This little cut is a very big deal! Please read up on it and know where your doctor stands.
Monday, October 15, 2012
I can't eat, now what?!
So, you can't eat. Of course the hospital isn't going to allow you and your baby to simply dehydrate! They came up with an idea to 'solve' the no eating issue, Intravenous fluid aka IV. Who doesn't need a routine IV? Any women who is not ill. I would venture to say that would be most of us yet women are put into a box...they are pregnant so they must need an IV. But why? Oh my, this is a BIG subject and I hope to cover as much as I can.
First let's start with what exactly is a routine IV. It's called routine because at many hospitals if you come in for labor, regardless or anything, one of the first things they will do is stick you with an IV. What are they giving you through the IV? Generally, saline but they may pump in some glucose. Nothing substantial enough to energize you for the difficult job ahead of you. However, this should keep you hydrated or contribute to water intoxication due to over hydration. Glucose can be dangerous because it can cause hyperglycemia in the infant.
Where does the routine IV go? In your vein, could be your hand, wrist, arm...it depends on what your veins look like. Once the IV is inserted your mobility has decreased. Any movement requires wires to be moved or if you wish to walk around, you have to take the pole with you and push as you walk. If you've been in labor you know, you don't want to have to think about anything else other than the work you are doing. It is a cumbersome task to now think not only about your contractions but also how to maneuver with an IV pole.
Other than to hydrate you, which could be easily taken care of by drinking water during your labor what other benefits does the IV have? You will be told, that in case of an emergency you are already hooked up. That worries me on one level because if a hospital can not accommodate my need in an emergency with a quick injection of an IV, then I don't want them working on me at all!! Also, the true risk of an emergency in a low risk pregnancy is very rare. Somewhere around 2-4%. Not to mention, it is rarer still that an emergency would suddenly appear out of nowhere. If you are being well taken care of during your labor, any emergency would be spotted early on and watched carefully. Now, let's say you are worried and would feel better with an IV in place, just in case you are one of those rare moments. Ask for a heparin lock. It's basically the IV needle injected but not connected to anything. So, there is easy access just in case but without the pole, wires or being pumped with any fluids.
Ok, so you've been given a routine IV...what's the big deal really? Doesn't the hospital have our best interest in mind? Hmmmmm, let's talk about what happens now. You've been given your IV and you'll be told, the contractions you've been working through so beautifully will probably slow down. What do you do when your contractions slow down? Eat, move around, try different positions, shower, etc. Can't do all of those, at least not easily. So now you're contractions have slowed or stopped and the hospital doesn't like that. Since you're already hooked up, let's try some pitocin to speed up those contractions. (or as the nurses so loving say 'let's pit her.') Luckily I've never had pitocin so I can't speak from personal experience but what I hear and read, the contractions with pitocin are stronger and longer than natural contractions and you now have pitocin contractions along with your natural contractions along side them. INTENSE! With that intensity, you can't handle it and decide that an epidural is needed. Well why not?! You're already hooked up to the IV why not add more wires and medicine? Now it's time to push! Yay, the moment we've all been waiting for!! However, you are having difficulty pushing because you can't feel anything, Or the baby is having a difficult time due to the constant contracting or the epidural drug affecting them and now there is worry or concern that the baby is in distress. Options? Episiotomy, forceps, vacuum, C-section. All because you weren't allowed to eat or drink during your labor.
You may be thinking, come on...that's a pretty unrealistic picture you're painting. Think about it. Look at women around you or perhaps your own birth experience. Did it really go the way you wanted it or was it more the way your OB/GYN and hospital wanted it to go? What was the need for the routine IV again?
Study after study has shown that eating and drinking during a normal labor are safe and there is no evidence that restricting food and fluids in normal labor is beneficial.
As always, please research and educate yourself before agreeing to anything! Don't wait until it's too late...choose a doctor or midwife that is truly open to working for and with you.
First let's start with what exactly is a routine IV. It's called routine because at many hospitals if you come in for labor, regardless or anything, one of the first things they will do is stick you with an IV. What are they giving you through the IV? Generally, saline but they may pump in some glucose. Nothing substantial enough to energize you for the difficult job ahead of you. However, this should keep you hydrated or contribute to water intoxication due to over hydration. Glucose can be dangerous because it can cause hyperglycemia in the infant.
Where does the routine IV go? In your vein, could be your hand, wrist, arm...it depends on what your veins look like. Once the IV is inserted your mobility has decreased. Any movement requires wires to be moved or if you wish to walk around, you have to take the pole with you and push as you walk. If you've been in labor you know, you don't want to have to think about anything else other than the work you are doing. It is a cumbersome task to now think not only about your contractions but also how to maneuver with an IV pole.
Other than to hydrate you, which could be easily taken care of by drinking water during your labor what other benefits does the IV have? You will be told, that in case of an emergency you are already hooked up. That worries me on one level because if a hospital can not accommodate my need in an emergency with a quick injection of an IV, then I don't want them working on me at all!! Also, the true risk of an emergency in a low risk pregnancy is very rare. Somewhere around 2-4%. Not to mention, it is rarer still that an emergency would suddenly appear out of nowhere. If you are being well taken care of during your labor, any emergency would be spotted early on and watched carefully. Now, let's say you are worried and would feel better with an IV in place, just in case you are one of those rare moments. Ask for a heparin lock. It's basically the IV needle injected but not connected to anything. So, there is easy access just in case but without the pole, wires or being pumped with any fluids.
Ok, so you've been given a routine IV...what's the big deal really? Doesn't the hospital have our best interest in mind? Hmmmmm, let's talk about what happens now. You've been given your IV and you'll be told, the contractions you've been working through so beautifully will probably slow down. What do you do when your contractions slow down? Eat, move around, try different positions, shower, etc. Can't do all of those, at least not easily. So now you're contractions have slowed or stopped and the hospital doesn't like that. Since you're already hooked up, let's try some pitocin to speed up those contractions. (or as the nurses so loving say 'let's pit her.') Luckily I've never had pitocin so I can't speak from personal experience but what I hear and read, the contractions with pitocin are stronger and longer than natural contractions and you now have pitocin contractions along with your natural contractions along side them. INTENSE! With that intensity, you can't handle it and decide that an epidural is needed. Well why not?! You're already hooked up to the IV why not add more wires and medicine? Now it's time to push! Yay, the moment we've all been waiting for!! However, you are having difficulty pushing because you can't feel anything, Or the baby is having a difficult time due to the constant contracting or the epidural drug affecting them and now there is worry or concern that the baby is in distress. Options? Episiotomy, forceps, vacuum, C-section. All because you weren't allowed to eat or drink during your labor.
You may be thinking, come on...that's a pretty unrealistic picture you're painting. Think about it. Look at women around you or perhaps your own birth experience. Did it really go the way you wanted it or was it more the way your OB/GYN and hospital wanted it to go? What was the need for the routine IV again?
Study after study has shown that eating and drinking during a normal labor are safe and there is no evidence that restricting food and fluids in normal labor is beneficial.
As always, please research and educate yourself before agreeing to anything! Don't wait until it's too late...choose a doctor or midwife that is truly open to working for and with you.
Monday, October 8, 2012
Can I eat???
How many women have been told that once they arrive at the hospital they are not allowed anything by mouth (NPO=nil per os latin)? This is the first area I'd like to disuss where women are put into a box during labor and delivery. I had no restrictions on what I could eat or drink during my labor. My husband and I packed a wide variety of fruits, granola, and other easy to eat foods I found yummy during my pregnancy to eat while I was laboring, as well as water and gatorade. When we finally decided it was time to go to the hospital I had not eaten dinner yet so my husband quickly made me a PB&J sandwich and told me to eat it with some fruit. He reminded me I needed some fuel to help with the work that was ahead of me. Though I wasn't really interested in food, I listened because he was right, I needed some fuel and ate my sandwich. Then we packed up the car with all the other eating 'essentials' and left. With an array of options to choose from, there was not one moment after arriving to the hospital where I thought to myself: hmmmmm, I really want to eat something now. After the fact, I was really glad I had eaten before but there was absolutely no interest during. I don't remember this detail exactly, but I think I may have had a little water during the intense contractions but if I did it was only a sip here and a sip there. During the pushing stage, I got real thirsty! I pushed for over 2 hours and my mouth became thoroughly parched. My husband would hold a bottle of gatorade during the breaks with a straw for me to sip. I can remember thinking: wow, that tastes so good and refreshing right now. It was never more than a small sip or two at a time, but it was enough to energize me and help remove the dryness my mouth felt. I really did feel the difference between when I wasn't drinking anything and when I started.
I bring this story up because the reality is that when you really start contractions and intense labor, you're not going to want to eat. However, it is important that you have eaten. Who would tell an athlete to go out full force and play there sport with no food or water in them and accesible to them? Nobody would, so why are laboring women told they shouldn't eat or drink?? They NEED the energy and nutrients food gives them.
Now, I'll be honest with you. Some women vomit during labor (usually transition) and it might be gross to see your previous meal come up. But wouldn't you rather throw something up than have no energy to push out your baby??
NPO was instated many, MANY years ago. Back in the day when women were knocked out (aka twilight sleep) during labor and delivery and the general anesthesia they were given could cause the contents of the stomach to enter the lungs and cause difficulty breathing and perhaps death. This was back in the 30's and 40's. It's now been acknowledged that this fear isn't really there any more but hospitals and drs still follow the same protocol non-the-less because 'that's how it's always been done.'
What happens if you have no food? You have no energy and may no be able to complete the task at hand on your own. What happens if you have no drink? This could lead to both maternal and fetal dehydration. Both very, very serious! How does a hospital fix this issue?? Routine IV. We'll talk about that next time. The lack of food or drink might also be a cause for slowing contractions which often times leads to other interventions.
Luckily, some hospitals have lifted the no food ban and now allow at least water. That is a great start!
I bring this story up because the reality is that when you really start contractions and intense labor, you're not going to want to eat. However, it is important that you have eaten. Who would tell an athlete to go out full force and play there sport with no food or water in them and accesible to them? Nobody would, so why are laboring women told they shouldn't eat or drink?? They NEED the energy and nutrients food gives them.
Now, I'll be honest with you. Some women vomit during labor (usually transition) and it might be gross to see your previous meal come up. But wouldn't you rather throw something up than have no energy to push out your baby??
NPO was instated many, MANY years ago. Back in the day when women were knocked out (aka twilight sleep) during labor and delivery and the general anesthesia they were given could cause the contents of the stomach to enter the lungs and cause difficulty breathing and perhaps death. This was back in the 30's and 40's. It's now been acknowledged that this fear isn't really there any more but hospitals and drs still follow the same protocol non-the-less because 'that's how it's always been done.'
What happens if you have no food? You have no energy and may no be able to complete the task at hand on your own. What happens if you have no drink? This could lead to both maternal and fetal dehydration. Both very, very serious! How does a hospital fix this issue?? Routine IV. We'll talk about that next time. The lack of food or drink might also be a cause for slowing contractions which often times leads to other interventions.
Luckily, some hospitals have lifted the no food ban and now allow at least water. That is a great start!
Wednesday, October 3, 2012
Are all women alike?
As I have said before, I'm pregnant with #2. It's been interesting to see how this pregnancy has differed from the first. In practical terms: I am unable to rest when I want, eat exactly when I want and sometimes have to wait a bit before using the bathroom when I need...all due to a current little one running around. But I don't think those factors play completely into why this pregnancy is different. To begin with, I'm carrying this child differently...it feels much lower and I can often feel the movements at the bottom of my stomach more than other places. This child hasn't been as active as my first. I imagine because the baby is lower, I have to use the bathroom more frequently but have a more difficult time with BM this time around. As I think about labor and delivery I hope for the same experience as I had with my first however, I can only imagine that this labor and delivery will be as different as my pregnancy. I am only one person yet with myself there are differences. Why then are women put in a box when it comes to pregnancy and delivery. Every women will have a unique experience in both. It doesn't seem possible to say that X and Y will happen to every women at a certain time or in a certain way when every women is as different as every pregnancy. Be careful when choosing your dr for your pregnancy and delivery. Be certain they do not put women in a box and expect you to fit perfectly in it because that's when unnecesary interventions occur!
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