Third Time's a Charm!

So, after a few detours, let's get back to the story of Lily's birth. Although this was my third birth, this was the first birth that I felt like I was prepared and was in total control of. I knew I wanted a natural birth, with a supportive care-giver. After much searching, I found Marcia. Marcia is a wonderful CNM who is helping women in our area get the birth they desire despite the hospital setting. She was wonderful throughout the whole pregnancy!

On Lily's due date, December 23, there was no action. No signs of labor. Nothing. We had Christmas as usual, but I was feeling very poorly. I thought that surely labor must be just around the corner, but no such luck! I tried everything recommended by Marcia, but nothing seemed to be helping. Finally, at 1 week past my due date Marcia said that we had to schedule an induction. I really wanted a completely natural birth, and an induction was not part of the plan. I let them schedule the induction and went home. I got to thinking about it and decided that I wanted to cancel the appointment. I wanted to give Lily the full two weeks that the OB over Marcia would allow her to wait.

The next week came and went with no action, so I was induced on January 7 - a full 15 days after my due date. When I got to the hospital that morning, the nurses started their regular rituals. The first was an HIV test despite the fact that I had already been tested and was in a monogamous relationship. I tried to decline because I knew that I would want my hands to be pain free when positioning myself in different ways to try to get through labor naturally. The nurses told me that if I declined the test they would take my newborn away from me after birth to test her for HIV. Of course I didn't want that, so I consented. Well, the nurse put the needle in wrong somehow and my hand started swelling to a huge, painful size. She removed the needle and tried again a few times before getting enough blood for the test. Finally that was over, and Marcia arrived to try to rupture the membranes as a first attempt to start labor. She was unable to break my water, so the IV was started with pitocin and Marcia left to attend to her patients until I needed her.

The contractions started to pick up fairly quickly. I had warned the nurses that my previous labor with Karlie had only been 4 1/2 hours, so they were keeping a close eye on me. About an hour after they started pitocin I was already at 7 cm. They called Marcia to head back over, and she arrived soon after that. At the time, I was managing contractions by sitting next to the bed on a birthing ball. I wasn't able to move around much because of the IV, monitoring strips, and blood pressure cuff, so I was staying close to the bed. Thankfully, Marcia instructed the nurses to set me free from all of the devices and helped me walk into the bathroom. She shut the door and I was able to move around however I wished without interference.

Finally, I was ready to push. Marcia requested that I move back to the bed because she didn't want to deliver in the bathroom. I pushed a few times and then told Marcia that I couldn't do it anymore. I then told her that it hurt. I was losing control at that point. I felt dizzy and out of it. The nurses gave me oxygen while Marcia talked to me. She was so calm and sweet about it when she said, "It's going to hurt, just push the pain away." Her calmness helped me so much, and with the next push I felt the "ring of fire". If you have never felt this, it's hard to explain. It is SO very painful, but a relief at the same time. After that, the pushing felt more like a strong pressure and not so painful. Lily was born about 4 pushes later.

One of the nurses was excited, and I laughed when she said, "It's just like I've seen on TV!" I guess she hadn't been around for many natural births. I had so much energy right after the birth - it was a birthing high! Although I had had to be induced, I was still thrilled with the way the birth had gone.

Breastfeeding Misconceptions

Well, yesterday Julia wasn't feeling very well. Children always seem to do this on the weekends. She wasn't eating food, had a fever, and even nursing wouldn't calm her crying. Since we live next door to an urgent care, I decided to run over just to rule out an ear infection. It could be teething, or it could be a virus. I just wanted to make sure they couldn't see something that I at home might have missed.

The visit to urgent care started out great. The front desk ladies were really nice - talking to Julia and asking about the Mei Tai I was wearing her in. The wait wasn't even five minutes! We got into an exam room and talked to a really nice nurse who weighed Julia and took her temperature, pulse, and blood oxygen levels.

Now, I should throw in here that Julia has been a really small baby and slow to gain weight. I realize this, and I have been consistently seeing a lactation consultant and having her weight monitored. It is slow going, but she has been consistently gaining at her own pace.

When the Dr. came in she examined Julia's ears right away while asking me some questions. She started off asking about Julia's weight. I had expected that there would be questions, but figured when she heard that everyone else was okay with it she would move on to helping diagnose the cause of the fever. Well, her next question was, "Now, you do feed her powdered milk also, right?". "Umm, no." I say. "I feed her solids at breakfast and lunch and breast milk the rest of the time." At this point it was like I had flipped a switch. She went from examining Julia's ears to checking her for dehydration. She then left the room, coming back minutes later with instructions for me to immediately take her to the children's ER uptown. They would give her fluids by IV. While we were there, they would catheterize her to check for a UTI and do blood work.

At this point I think I'm just staring at the Dr. There have been no signs of dehydration. She is having plenty of wet diapers, clear urine, plenty of tears when she cries, and she is drooling all over the place. Still, when a Dr. suggests something, I of course want to consider her advice.

I left Urgent Care saying goodbye to the nice desk ladies and promising to go straight to the children's ER. Once in the car I called a few trusted friends to ask for advice. My mommy instincts are saying that since this is not an ear infection, it is most likely teething or something viral. At this point, neither of these scenarios would require IVs for my 6 month old. My phone calls validate my feelings on the matter and I head home where my mom is watching the other kids. She also agrees that it is way to early in the game for IV's and catheters. The symptoms do not warrant that kind of treatment.

Last night I made sure she got plenty of liquids through bottles and nursing. I kept a close eye on her temperature and kept her close through the night. She did have a large amount of gas and had a very full poopy diaper. After this, she started to sleep more peacefully. Her fever went down early this morning, and today she seems to be feeling a lot better!

I can't help but think of all the pain I could have put Julia in last night. Catheters and IV's along with possible blood work? I wish that health care providers were more educated about breastfeeding. If my child is sick why in the world would "powdered milk" help her more than a milk that has natural immune factors and the perfect balance of everything she needs. Why does the fact that I am breastfeeding immediately prompt her to check for dehydration and abandon the rest of the exam?

If this situation had occurred with my first child, or even my second, I think I would have followed the advice of the Dr. needlessly putting my child through pain and testing. It angers me that the Dr. would be giving this kind of advice to young mothers, and it saddens me that a lot of mothers have not yet learned to think for themselves. I am grateful for the friends and resources I have that have helped me learn to work along with medical professionals to keep my children healthy and not blindly follow every suggestion.

A little more food for thought on epidurals

http://www.childbirth.org/articles/labor/epiepidemic.html

	Epidurals: Why the Epidemic? by Holly Richardson, CD(DONA) If birth is a normal, natural physiologic part of being a woman, why are we seeing more than 90% of women having epidurals? Nationwide, the overall rate runs consistently over 85%, with, of course, pockets of much lower rates. (Birth centers, most midwifery practices, and home birth) Ask a group of women who are or have been pregnant and mostly likely you'll hear the epidural touted as the miracle of modern science, a way to labor and give birth painlessly. Why wouldn't you want one? Common remarks include: "You don't get a medal for going without drugs, you know." "Don't be a martyr." "Of course the used to do it that way in the "olden days," but lots of moms died then too." Sound familiar? Why do so many women find themselves drawn to "pain-free" labors? One big reason is fear. Fear of what? Fear of not surviving the pain, fear of "losing it," fear of making the doctor mad, or fear of not having adequate support for non-epidural labor. Where does this fear come from? A lot of it comes from our highly technological society. There is a society-wide view that technology equals superiority, even considering a natural process like birth. The "technocratic" view of birth is one that considers pregnancy a medical event to be managed - something that can be broken down into parts - a uterus, a fetus, a cervix, a blood pressure reading, etc. Most women in our society have unquestioningly accepted this view of birth. If birth is not micro-managed by a surgeon, dire results are waiting in the wings. As an example, a local doula recently hung fliers in a laundromat on the value and benefit of using a doula. Someone wrote across the top: "Please care enough about your baby to use a certified professional in a hospital - this means a doctor!" We all have fears and no one should ever be belittled or patronized for fearing childbirth, as the fears are real, even if unfounded. Suzanne Arms in "Immaculate Deception II" writes that "in a healthy woman there is little fear and much trust in birth... Most women's fears center around the mistaken belief that they cannot successfully give birth to a healthy baby without outside intervention and the aid of a hospital and a physician-surgeon. Most doctors fears have to do with the birth process somehow being faulty and with women not being capable of responsibility for their pregnancy and labor." In the summer 1996 issue of "Birth," two physicians reviewed epidural anesthesia and "revealed" that it is difficult for women to get accurate information. This is because "objective analysis is thwarted by at least two biases. First, health care providers and consumers have steadfast opinions based on their personal opinions that have not been objectively analyzed. Second, fiduciary conflicts of interest exist among some healthcare providers who hold staunch opinions on this subject, some of whom set local and national policies and serve as reviewers for medical journals" Or in other words, they like epidurals and they make money. The first point addressed issues of consent. Are the vast majority of women choosing epidural anesthesia really making informed decisions? Do they really have the information they need to make the choice that is best for them, not most convenient for their doctor, or the nurses on staff at the hospital? I think we all know the answer to that one and that answer, of course, is no. In fact, natural childbirth is now being made out to be a bad thing. One mother was even told by her obstetrician that wanting a natural childbirth was selfish and not caring about what is best for baby. Have you ever helped mothers who asked their care provider what the risks of an epidural are to her baby and were told there is no risk? Or that they have never heard of such a thing as epidurals being linked to fevers, or that there is no increase in cesarean rates? I have. How about the anesthesiologist who, when asked to inform the parents about risks says sarcastically, "Death, permanent paralysis; need I go on or can I just get you comfortable?" By definition, informed consent is a process that "promotes autonomy, personal dignity, active participation, and responsibility," that allows the client "time to think over information given, weigh the risks and benefits, consider alternative treatments, evaluate further outcomes and decide how to proceed." The following are not reasons to not fully inform a client: That the patient might prefer not to be told the unpleasant possibilities regarding the treatment That full disclosure might suggest infinite dangers to a client ... causing her to refuse treatment That the client, upon learning the risks, may rationally decline treatment The information must be given in a manner that the client can fully understand. Copyright © 1998 by Childbirth.org All rights reserved.

Epidurals

I'd like to take a break from childbirth stories and talk about epidurals. I figure now is a good place to slide this in since I did have epidurals with my first two births, but not with my last two.

My opinion on epidurals (for me) is that they took away from my childbirth experience. The medical pros and cons will be weighed in the following article, but in my experiences, the emotional cons far outweighed the pros. Feeling your body do something that God created it to do is truly an amazing experience. Once the endorphins kick in and your body takes over doing what it already knows how to do, you feel labor progressing and realize that you have the power within you to birth your baby. It's an exciting challenge that you can meet with a beautiful ending.

It can be difficult to find unbiased information on epidurals. There are many articles out there. Some are in full support of only natural child birth, others lean more towards pointing out only the benefits and convenience of epidurals.

I have found and article that was written by Penny Simkin, the author of Pregnancy, Childbirth, and the Newborn: A Complete Guide for Expectant Parents. I enjoyed her book, and I think the pros and cons she gives regarding epidurals are very fair and middle of the road.
http://www.childbirthsolutions.com/articles/birth/epidural/index.php

Here is her article:
Weighing the Pros and Cons of the Epidural
By Penny Simkin

The epidural block has been used increasingly over the past 50 years. Childbirth educators across the country are finding that more and more women plan--even demand--an epidural in order to avoid labor pain.

Why the popularity? Are there any significant disadvantages to epidurals? Are they safe enough for routine use?

Risk Versus Benefit

There is almost always a trade-off when medications and interventions are used during labor. Each woman must know and consider the potential benefits and risks and apply them to her own circumstances.

When the mother is managing her pain well and progress is normal, the risks of an epidural outweigh the benefits. If, however, she is exhausted, in extreme pain or requires painful interventions, the benefits may outweigh the risks.

Potential Benefits of Epidurals

Epidural anesthesia or analgesia provides relief or reduction of labor pain without affecting the mother's mental state. It enables an exhausted mother to relax or sleep during labor and calms the woman who is anxious and tense because of pain. Once an epidural catheter is in place, additional medication can easily be administered as needed, providing prolonged and consistent pain relief.

Some prolonged labors, probably those slowed by anxiety, speed up with an epidural. Anxiety can cause excessive production of the mother's stress hormones such as epinephrine and norepinephrine, which slow contractions. By allowing the mother to rest without pain, the epidural removes her anxiety and her labor progress may improve.2 If not, Pitocin may be administered painlessly. Since epidurals often lower blood pressure, this may benefit some women with pregnancy induced hypertension.3

Epidurals are also useful for cesarean births, making it possible for the mother to remain alert and involved while free from pain. They enable her to avoid general anesthesia, which is considered to carry greater risks.

Epidural narcotics reduce pain without reducing other sensations or muscle function. Women can change positions more easily than with anesthetics. They remain aware of their contractions and often continue to participate; using breathing patterns and other comfort measures. For those women who wish to remain aware of their labors, epidural narcotics are often quite acceptable.

Potential Risks

Epidural blocks carry some risks to the mother, fetus and newborn. Undesired effects tend to be greater with larger doses of medication, a longer interval during which the medication is in effect and immaturity or distress in the fetus.

Undesired effects on the mother:

• Inadequate pain relief (up to 10%)4
  
  
• Rise of the mother's oral and vaginal temperature 5, beginning within one hour after administration of the epidural, which may lead to treatment of the mother and baby for non-existent infection. This effect may be dose-related. This recent finding from England is being investigated in the United States.6
  
  
• Drop in the mother's blood pressure treated with position changes, oxygen and possible vasopressors (less likely if a bolus of IV fluids is given before the epidural).
  
  
• Short or long-term postpartum backache from bruising caused by the injection or from ligament strain caused by prolonged time spent in a damaging position or inappropriate movement (for example, extreme passive flexion of the mother's trunk, hips and knees during the second stage, or sudden vigorous movements of the mother) while her muscles are relaxed and her back is numb (up to 19%). Long-term backache is almost twice as likely to occur with an epidural than without.7
  
  
• Possible unintentional spinal block and resulting spinal headache requiring days of bed rest and a blood patch.
  
  
• Shivering may be reduced with lower doses, by warming of the anesthetic before administration, or by adding narcotics to the anesthetic.8
  
  
• Mild to severe itching of the skin (with narcotics)
  
  
• Retention of urine, requiring a bladder catheter1
  
  
• Mother feels detached from the process and becomes an observer; others may reduce emotional support. The nurse can no longer assess labor progress by observing the mother and must rely more on the monitor and vaginal exams.9
  
  
• Problems caused by human error or maternal structural anomaly, such as inability to place catheter properly; inadvertent injection of anesthetic into a blood vessel; or too much anesthesia, affecting respiration and swallowing (rates vary with skill of the practitioner and anatomy of the mother).
  
  
• Rare complications, such as residual numbness or weakness from needle injury to nerves (almost 1 in 10,000)10, delayed respiratory depression with epidural narcotics (up to 12 hours later)8, and brain damage and death (extremely rare)11.

Undesired effects on the labor:

• May slow labor, requiring Pitocin; and has been found to increase the chances of a cesarean delivery in primigravidas by two or three times.12
  
  
• Often slows second stage by reducing or eliminating the normal surge of oxytocin; and by reducing pelvic floor muscle tone, which may lead to more deep transverse arrests or persistent occiput posteriors. In addition, forceps or vacuum extractor are required more often (20-75%). Delaying pushing until the fetal head is on the perineum reduces the need for forceps. Even though this approach lengthens the second stage, it does not increase the incidence of fetal distress.13

Undesired effects on the fetus:

• Abnormal heart rate patterns, requiring oxygen to the mother, position changes and possible cesarean delivery.
  
  
• Increased likelihood of newborn septic workup, IV antibiotics and isolation in the nursery if the mother develops an "epidural fever" that causes fetal tachycardia or newborn fever.
  
  
• If the fetus is already stressed greater amounts of the medication are "trapped" in the fetal circulation, leading to more pronounced newborn effects (see below).

Undesired effects on the newborn:

• Short-term (six weeks or less) subtle neurobehavioral effects, such as irritability and inconsolability and decreased ability to track an object visually or to shut out noise, bright light.4 There are no data on potential long-term effects.
  
  
• Possible less efficient or less organized initial rooting and suckling behavior. Nurses have reported more difficulties in feeding babies whose mothers had an epidural when compared to unmedicated babies.6
  
  
• Decreased infant responsiveness may lead to long-term consequences for the parent-infant relationship.14 Parents should be counseled to give their babies time to recover from the birth and medication and should avoid a label of "difficult child" or "incompetent mother."

Conclusion

The childbirth educator's duty is to inform, not to talk women into or out of using an epidural. Many women will choose an epidural, when well informed of benefits, risks and alternatives; others will choose to avoid it if their labor allows.

When women are well informed, they will consider the information, along with other factors - such as their fears, self-perceptions, their goals for their birth experiences, their support system - and make the most suitable decision.

Take Two

Let me tell you, a LOT of things happened between birth one and pregnancy two, but here we are pregnant again!

This time is going to be so much better! I have been through childbirth once already, I know more of what I am doing, and I know I don't want an epidural. I am also very afraid of having a large baby again (Franklin was 9lb 1oz). I will stick with the same OB that I used last time. They're really nice and surely they will be behind my choices 100%!

So here we go! The pregnancy is going great and I don't really need any gear. In fact, I have found that I didn't need half of the gear I got for Franklin. The 18 week ultrasound looks great even though they couldn't tell whether the baby is a boy or girl. The only thing they are concerned about is size. The second baby is usually bigger than the first, they say.

We are nearing the end of the pregnancy, two weeks to go! The OB says that the baby feels big. She would feel more comfortable inducing at 39 weeks. I am also very concerned about having a big baby, so I don't protest much.

Week 39 and the morning of the induction arrives. I know the drill...IV, fluids, monitors, bed. I have informed the nurse that I want to try to labor without an epidural. As the contractions start to pick up, the nurse makes it her personal goal to remind me at each peak that an epidural is available for me if I should want it. Eventually, she gives up and leaves me with Frank to labor in peace. I am not allowed out of the bed, and I can't move much or the monitors will not be able to pick up the heart rate and contractions like they need to. Still, I have elevated the bed until I am in a semi-decent position.

The contractions are really intense now. So intense that I am just barely grasping at the edge of feeling in control. I am definitely starting to lose it fast. If I had done my homework, I would have realized that this was transition. Just that little glimmer of encouraging information would have been enough to help me through to the end. All of a sudden the nurse comes scurrying into the room. "The anesthesiologist is leaving the hospital for the day. This is your last chance for an epidural! I would really suggest you reconsider!" I agree to let her check me to see how far I am progressing. Being on my back is torturous, and the check shows that I have progressed only to 4, maybe 5 cm. I think to myself that there is no way that I can make it another 5 cm in this much pain and worry that I have several hours to go this way like I did with Franklin's birth. I finally consent to the epidural. I can barely hold still for the process, but soon it is over and I am now laying back in the bed. The nurse leaves saying to call if we need anything.

My pain level has not really been lessened by the epidural, and now I can not use my legs at all to change positions. Frank asks if he should call the nurse. I say, "And tell her what? Childbirth hurts?" A few moments later though, I feel like pushing. I tell Frank to quickly call the nurse. She is sure that I must just need my bladder emptied, but she checks me anyway. At that point her eyes widen and she yells, "DON'T push!". She runs out of the room to call my OB. Luckily, my OB happened to be nearby. She ran into the room just in time to help the baby out onto the bed. She didn't even have time to put on her scrubs.

At that moment I am furious that I had an epidural when the baby was born at the most, 30 minutes later. Then, Frank tells me that it is a girl! I am then so overwhelmed with excitement for this sweet little baby girl that we will name Karlie.

It really was a better birth than the first, but I still can't help but thinking, next time....

The Beginning

I didn't wake up one morning with this extreme passion for pregnancy and birth. I was 2o years old, newly married, and excited about my job and decorating my new house. When we found out we were pregnant with Franklin, I carried my excitement for decorating over into a nursery for the new baby. On our date nights we would browse the aisles of The Baby Depot, and we looked forward to registering for all the many things we would need. We diligently did our research as we picked patterns and strollers, cribs and swings, high chairs and car seats.

No one I knew was pregnant. We were the first of our friends to have a baby. I had gotten glowing recommendations for an OB office in town from a lady at work, so that is where I went. Friendly nurses and caring doctors won me over quickly. Never once did I think to research my birth options. They were doctors trained in this sort of thing, they knew what they were doing!

We went on the tour of the hospital and were shown the beautiful rooms with hardwood floors and pretty upholstery. Many in the tour group were asking questions about visitors and policies. One mother asked when it would be too late for an epidural. She didn't want to arrive so late that she missed her chance. My ears perked up. After all, who would want to go through unnecessary pain? I made a mental note to make sure that I arrived in time!

Finally! 40 weeks was here...but Franklin was not. We tried all kinds of things to encourage him to come out: cod liver oil and orange juice (EEWWWWWW!! btw), eggplant parmesan, walking miles around the mall, and pineapple. Nothing worked! At my OB appointment that week they said it was time to schedule an induction. I remember asking if it was necessary and what the pros and cons were, but I don't remember hearing anything that I was opposed to. Basically, it would be dangerous to let him stay in there much longer. How could I argue with that?

Induction day came and we arrived at the hospital bright and early. Immediately I was hooked up to IVs delivering fluids and strapped to monitors. Labor hadn't even started and I was stuck in the bed. I asked permission to go to the bathroom, but even in that short amount of time the nurses were banging on the door telling me that I needed to get back into the bed and on the monitors. Pitocin was started and then came the contractions along with some pain. "Was I ready for my epidural?" the nurse asked. Of course I was, I surely didn't want to wait until it was too late, did I?

Foolishly, Frank and I kept asking the nurse how much longer it would be. She told us that most inductions were finished by 3:00, so we called our family with that update. Our pastor came to visit, and I passed the time sucking on hard candies, chewing ice, and reading a book. I was relatively comfortable and just waiting for something to happen. By 3:00 we realized that the baby would not be born any time soon. We began to become impatient.

Two full hours after the baby SHOULD have been born already I was told that it was time to push. Great! Frank steadied one leg and the nurse steadied the other. I couldn't feel a thing and had no idea what I was doing. After two pushes the nurse said, "keep it up!" and went to the doorway to continue discussing her recent beach vacation with her boyfriend with the other nurses in the hallway crowded around the door. We called her back a few times to ask what we were supposed to be doing. She was frustrated and told us to just watch the contraction monitor and push during the peaks. We really tried, but nothing seemed to be happening.

Finally, my OB came to check on my progress. She gave me 45 more minutes to push, then it was going to have to be a C-section. She suggested that the nurse help me push in a different position, then she left. They dropped down the bottom of the bed and helped me to sit up on the end. Of course, gravity helped a lot! Franklin was born 30 minutes later at 8:58pm.

While it was still an amazing miracle, and my entrance into motherhood, I still felt like something was missing from my birth experience.

Wonderfully Made

God knit us together in our mother's womb. We are fearfully and wonderfully made. Most people often associate this with newborn babies. They are so perfect and wonderful! Each tiny finger and pudgy little toe, the beautiful curve of their pretty little ears, every part of a baby is so perfectly made!

Did you ever stop to think that women are also wonderfully made. Even while in our mothers wombs we were created to be able to give birth. Our bodies were made to be able to grow and sustain another human being! Not only that, but we were designed to birth these little humans that grew inside of us.