May 04 2010

(More) thoughts on natural childbirth

If you’ve been reading this blog awhile, then you may remember these two posts where I mention some of my thoughts on unmedicated childbirth.

I’m going to go for it again.

This time, I sort of know what to expect. I know what birthing a human feels like. I know what the adrenaline and endorphins during my recovery will feel like.

I know that Johnny was ready (and able) to nurse in his first few minutes of life. He was alert and checking out the world.

I know that the pain of labor did hurt like nothing I’ve ever gone through — but it was not a constant pain. It went away after each contraction to give me a break. When I tell you I was in active labor for oh, 9 hours or so, it was not 9 hours of agony. Not even close.

It was hard work for the first half of it. And then there was maybe two hours of contractions that were super hard and frequent — probably intensified by the Cervadil and me being unable to move around to get to a more comfy position.

And then transition — I can’t remember how long that was. It wasn’t fun. I was talking epidurals at that point, but I wasn’t really serious — I just wanted to know that it was an option if I wanted it.

Pushing was 45 minutes but it felt like 10. The contractions spaced out a great deal and I had a ton of rest between each one. It was extremely intense but I did not consider it painful. Some women do have pain for the pushing part. I think it depends on how the baby is positioned.

Anyway, once Johnny was born, I was good to go. I actually said “I could do that again” while I was still on the delivery bed. And I meant it.

Getting stitched up was really unpleasant, and I didn’t like the feeling of delivering the placenta, but at least it didn’t hurt.

What did hurt was my poor, swollen, achy bottom. That hurt in the hours and days ahead, and it was because I had an unusual tear.

I have a theory.

I think I tore for two reasons. First, I ended up pushing on my back. I was partially sitting up, but I was nowhere near the squatting position. Pushing on your back means your pelvis isn’t opened up as much as it could be. (Pushing while on hands & knees or in a full squat can open the pelvis by 20% or more!) It puts pressure on your tailbone. It’s a convenient position to catch a baby in, but not always the best for the mama.

I think being in that position contributed to my tearing.

The next factor: The midwife directed me to push out Johnny’s body the moment after his head was out. Normally, you can birth the head and then push out the body with the next contraction — way easier because your body is helping you push.

Instead, she told me to keep pushing to get him out.

Now, I do know that the cord was around his neck at least one time, which is fairly common. Perhaps it was too tight for her to slip over his head. Perhaps that was a factor in why she needed Johnny out right then, since the cord was exposed and possibly there was pressure on it, restricting his oxygen supply. Or who knows.

I have a midwife appointment tomorrow and if there’s time, I will ask for some clarification for what might have happened.

If Johnny did indeed need to be born at that moment then I am a-ok with the tear and the subsequent surgery I needed to repair the botched tear repair.

But if it *wasn’t* necessary that I pushed him out right then, then that’s annoying.

I do think that being able to feel my pushing effort since I didn’t have an epidural, it made my pushing really effective.

She told me to push the rest of him out, and I could summon all my strength and give it a good effort. Maybe I would have needed assistance if I had an epidural. Hard to say.

So for baby #2, here are my reasons for wanting to go med-free:

No drugs have been proven totally safe for an unborn baby. The epidural meds (narcotics!) do indeed reach the baby. They can have an effect on the baby. We can’t be completely certain of long-term effects. Many babies appear totally fine after a medicated delivery. But there are some babies who are not fine, and who go into distress just minutes after the epidural is placed, and a c-section is needed to potentially save their life.

The long-term effects of Pitocin isn’t certain. One study found differences in three-year-olds whose moms had been given Pit. Some people have speculated that the rise in Pit use in labor matches up with the rise in Autism rates, but that link hasn’t been nailed down.

I am scared of epidurals. I just don’t trust them to work. Sure, plenty of moms have great experiences with them. But I do not trust that I’ll be able to hold perfectly still during its placement. I don’t trust that the needle will stop at the correct point. I don’t trust that I won’t have long-term pain because of it. I don’t like the idea of not feeling parts of my body. And I don’t want to shut down the natural birthing hormones that are sending good things to my body and baby. I don’t want to have a catheter. I want to be able to move around and pee if I have to pee.

I don’t want an IV while in labor. It hurts, it’s annoying, and it really restricted my movement. I had a heplock placed almost as soon as I showed up to the birth room. I didn’t need anything in the IV until 1 a.m. when my pre-e was diagnosed.

Now, I’m not going to refuse an IV if there’s a legitimate medical reason for giving me some sort of IV drug. But placed ‘just in case’? Not if I have a say in it, thanks.

Do they think I’m getting dehydrated? Give me some water or juice then, please. By mouth. It’s safe, seriously.

If I accept an epidural or any sort of labor augmentation, I’ll need an IV. So that’s one more reason for me to just do it without those things.

I’m not afraid of the pain. As I said before, most of my labor was just plain hard work, but it was manageable. Moving around, using the shower sprayer on my belly, and having Shane help me through it was extremely effective for me. Yes, there was a good portion of it that hurt in ways that still sorta blow my mind. But the most painful parts, I was confined to the bed. I don’t know how it would have felt if I could have flipped into a different position or moved in some way.

And really, I got through it. It wasn’t that bad. I mean, if it was, I wouldn’t be planning to do it again, right?

The pain is temporary. It’s humbling. And it’s not a pain that causes injury. I can handle it.

I don’t want a c-section. With every bit of pain med or labor augmentation/induction that I accept, I put the baby at increased risk for distress. Not all babies tolerate narcotics (or any drugs) well. Plus, drugs can stall labor if it isn’t already scooting along at a steady clip. That means that more Pitocin is needed or whatnot, and that can just add extra stress to the mom and baby.

Recovering from a c-section doesn’t sound pleasant. How would I be able to take good care of myself, plus a newborn, plus a toddler? That sounds just plain yucky.

I want breastfeeding to start well. Some babies born with drugs in their system go on to be perfectly strong nursers without any troubles. And some babies born to med-free moms have trouble with nursing at the beginning. But generally speaking, it seems that breastfeeding does come easiest to a med-free duo.

I want a good recovery. I don’t have time to feel really lousy while all those drugs are being flushed out of my system. I don’t want anything to stand in the way of those happy hormones.

I want to keep some sort of control over what’s happening. Yes, I totally get that things don’t go as planned. I had weird things happen in my labor that I certainly didn’t prepare for. I get it.

I get that even the best intentions for a med-free birth can end up in a c-section, or an epidural or the sort. And I like to think that I will be fine with that outcome, if that’s how it plays out.

But I don’t like laying in a bed, unable to really get up and move around, with wires hooked up to me and being told how and when to push and all that. That sounds like a passive delivery more than an active birth and I don’t like it.

I want to be left alone. My body knows how to do this. I know how to do this.

—-

So why not a homebirth or delivery at a free-standing birth center? Money. My insurance doesn’t cover the birth center. I can’t justify paying out of pocket for it.

And the homebirth, I just don’t feel like that’s something I want.

I like being at a hospital in case something random really does go wrong (especially since I’m due in winter–an ambulance transport might be scary because of icy roads or heavy snow, or something like last winter).

So since I will be in a hospital, and one with a pretty high epidural rate (I will need to find out the midwife practice’s rate, but they use the regular hospital labor nurses)…I will hire a doula.

The doula will be my talking birth plan, able to communicate my wishes to the nursing staff and to help me figure out what to do when random things come up and the ‘plan’ goes flying out the window.

I’m hiring my former Bradley childbirth educator who is also a doula, and I think she will be a huge asset.

Before I let this post sound like I am anti-hospital, I should clarify that I’m not. I am thankful for the medical advances that are able to save babies and moms. I do believe that labor nurses are compassionate people who genuinely do care about the moms and babies in their care.

It was just my experience that the nursing staff I encountered had extremely limited experience with med-free moms and they didn’t quite know how to handle me.

So in the most non-confrontational way that I can muster, I’m going to give birth my way. I hope that between my doula, Shane and I, we can communicate to the staff that I’m not trying to go against every bit of hospital protocol they have just to make them mad.

I’m just trying to give birth. Ya know?

And I will let it be known that if there are any medical students or residents or nurses or OBs hanging out in the labor ward, that they are welcome to observe me in labor and while delivering if they don’t have anything else to do and are interested. Some OBs seriously have never seen an unmedicated birth.

I am looking forward to labor and I am not afraid.

One final note: Please do not take this post as judgement about you or your choices. Selfish as this is going to sound, it was about me and my choices. If you know and understand the risks of a medicated delivery and still think that is the best option for you and your baby, then that is your choice. You’ve gotta do what you’ve gotta do.

And heck, I’m not saying that I won’t end up with an epidural or a c-section. God only knows. I’m just saying I’m going to do all that I can to avoid those things.



7 Responses to “(More) thoughts on natural childbirth”

  1. Yup, the hours and days after my daughters birth were worse then the birth, since I also tore. I recently got together with a few other ladies who had also had unmedicated births and we swapped birth stories. One of the ladies talked about how she tore pretty bad for the first but did not tear at all of the second. Her doula advised her to deliver on her hands and knees for the second to prevent tearing. That interested me since I know i will want to do everything I can to not tear for the next baby. You might want to talk to your doula and she if she has hear of some positions being better then others the second times around to help prevent tearing. Hopefully things will go well this time around for you…

  2. It really does make sense to me that being in another position could help prevent tearing.

    I think I will possibly try using a squat bar and just squatting (but I can still do this on the adjustable hospital bed) or possibly hands & knees. We’ll see!

  3. Does your hospital have a water birth option? Birthing in the water makes squatting really effortless for the mother and the supple-ness of the skin from the water makes it all stretch much easier to help minimize tearing. (I had one teeny tear, which I think was from Hans’ hand being up to his face when he came out.)

    And I am with you about being scared of an epidural! It’s so true. I hate needles and I especially would hate a needle while trying to be still during a contraction. But gosh, during transition I admit I did start rethinking my fear of needles. Hehe. But that’s the feeling that tells me it’s almost over anyway :-).

  4. The hospital has tubs to make laboring easier, but I don’t think they actually allow the birth to occur in the water. I think. I will ask!

    At the very least, maybe I can be in the water until I’m pushing.

  5. You’re totally capable, Kacie! Reading your post made me cheer inside for you. Praying that everything goes smoothly to allow for an unmedicated birth.

  6. Thank You! Thank You! Thank You!

    I appreciate your honesty and your approach. I stumbled upon your blog and as I read it, you describe exactly my thoughts and my feelings.

    I had 3rd degree tearing with my daughter 2 years ago. I’m certain it was from delivering on my back. My labor stalled, I was pressured into taking pain medication, and before I knew it I was hooked to an IV that severely restricted my movement.

    When I found out I was pregnant again I was totally bummed out and couldn’t figure out why… after a long time of soul searching I realized that I was totally unsatisfied with my first labor!!

    I’m looking for the balance of not being confrontational and yet assertive and it’s hard. I want a unmedicated all natural birth!! So… thank you!! I know that it’s possible and that I’m not the only one who’s struggled with this!!

  7. Thanks so much for sharing this! I am opting for a natural birth when I have my first baby in March. It’s a little scary but it’s encouraging to read your post! :)

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