Tuesday, April 27, 2010

Lessons from the Freebirth Movement

I just finished reading the dissertation Born Free: Unassisted Childbirth in North America by Rixa Freeze, PhD, of Stand and Deliver. All 300+ pages of it. It was very interesting. I have understood for quite a while that some women give birth unassisted because they feel forced into it because of a lack of acceptable options (such as for a women who is going for a VBAC but the hospitals in her area have "banned" it, and DEMs are illegal in her state, or other situations like that) I used to not understand why some women choose unassisted birth (also called "freebirth") when a midwife-attended homebirth would be an option for them, though I always respected their right to choose it. I am ione who would, in the face of limited options, find the best attendant for a hospital I could and fight for the kind of birth I wanted over choosing to "go it alone" at home. Rixa's dissertation gave me insight into the way unassisted birthers think. Here are a few things I learned:

1) UCers believe, as do others in the NCB community, that intervention in the birth process increases the risk of complications occurring. Unlike the rest of the NCB community, they include things other than medical procedures as interventions. Instruction, support, or even the mere presence of a caregiver is seen by the UC community as disruptive to the birth process.

2) UCers highly value intuition. They believe that the parents of the child should be responsible to make all decisions about the birth. They trust that as they birth alone and as focused as possible on their bodies, intuition will guide them to seek out medical help if a need arises for it, which prevents anyone but them from deciding that an intervention is necessary.

3) They believe midwifery is misguided--midwives are trained to "do" too much at births. They also take issue with midwifery being a paid profession. They believe that ideally, birth knowledge would be freely shared among women so every woman can be her own midwife. There would be a few trusted experts who would sometimes provide assistance, but as a service and not a job.

There is a lot more in the dissertation, and I recommend reading it to anyone who is curious about it. I'm still not planning on having any of my own babies unassisted, but I do feel like I understand better where women who do it are coming from. Reading it also got me to think about some things I'd never thought about--questions about what role I would want a midwife to fill at a homebirth. Would I want her to coach me or stand back and watch? Be in the other room? Do I want cervical checks, occasional fetal heart monitoring monitoring, suctioning, etc? I always figured, if I had a homebirth, I'd avoid "unnecessary intervention" by being away from the hospital, but Rixa's dissertation helped me see that there is more to it than that.

So, Rixa, if you ever read this, thanks for sharing your dissertation and all of the insights in it.

Friday, April 23, 2010

My Son's Birth

I did the homestudy program from Hypnobabies to prepare for this birth. I really enjoyed Hypnobabies during my pregnancy. It includes daily relaxation practice, which I often used to help me relax and fall asleep. It helped me bond with my baby and look forward to his birth. It also had tools for helping me get rid of my fears and helped me have more confidence in myself.

For those reading this who are unfamiliar with Hypnobabies, one of the concepts taught in it is that words have power. Many words commonly used in pregnancy and birth have negative associations in many people’s minds. Hypnobababies replaces these words with other words, in an effort to help you be more positive. I will be using these words during my story. Instead of “contraction,” I use “pressure waves.” I also avoid using the words “labor” and “delivery,” calling it “birthing” instead, and I try to avoid using the word “pain” when talking about birth.

For those reading who are studying Hypnobabies, you may or may not need to use your bubble of peace. I would label my birth “mostly comfortable.” Hypnobabies definitely worked for me, but there were times when I got off track and had discomfort, and I really struggled a lot during the pushing phase. Honestly, there were times during my birthing when if someone asked at the time if I was having “pain,” I probably would have said yes, but most of the time I was comfortable and felt very calm and relaxed.

On Friday, March 5, 2010, I woke up around 4:00 a.m. having pressure waves. I tried listening to my Hypnobabies tracks to see if I could fall back asleep, but after about an hour, I decided to get up because if the baby was going to come today, I was going to need to get a few last minute things together for my hospital bag. I found the charger for my digital camera battery, and I sat on my birth ball at the computer, printed out some extra copies of my birth preferences, and plugged in my ipod so it could charge. I got on the internet and did some stuff and tried to time the pressure waves with the “contraction master” website, but they seemed to weaken while I was on the ball and were sort of hard to time.

A couple hours later, my husband Tiatia got up to go to work, and then my 2 year old daughter got up. My pressure waves had pretty much stopped by this point. My daughter and I had breakfast. I think we ate some of the blueberry muffins we had made as a project the day before. I put on a few shows for her on the DVR and I did some cleaning. I loaded the dishwasher and cleaned the kitchen, including mopping the floor. Then I felt tired, so I sat down and folded a load of laundry that I’d washed the day before. My daughter and I had some chicken noodle soup for lunch.

Around 1:00 p.m., after starting a load of laundry, I read my daughter some books and then I put a Hypnobabies track on out loud and I laid down with her and we both had a nap. I woke once during the nap to a pressure wave but went back to sleep and then had another one when I woke up around 2:30 and I think one or two more while I was lying down. My pre-birth waves mostly came at night or early in the morning, so having waves during the day was unusual for me. They were also strong enough that I was wondering if hypnosis was going to work. I used my lightswitch and peace cue and it really helped me feel more comfortable during them. I suspected that it would soon be time to meet my baby. I got up and put on my headphones and listened to Birthing Day affirmations while I did some more cleaning and preparing. I moved the load of laundry to the dryer, straightened up the living room, and got together My daughter’s clothes and things she would need for staying with friends while we were at the hospital.

My daughter woke up and I think she played with toys for a little while. I hadn’t had any cervical checks from my doctor, but I had tried to feel my cervix myself. It had felt soft and slightly open about a week before. I decided to check it again and it felt softer and more open now, if I had to guess, I’d say about 3 cm, and I could feel how The baby’s head was now against it. I had noticed that he felt lower on Thursday morning, and at my appointment that day, Dr. I. felt my belly and said that his head was engaged. A piece of brown-tinged mucus plug came out on my fingers when I checked myself. I started to finish packing my hospital bag, but all the stuff I needed would not fit in the bag I had already started to pack. I tried transferring it to another bag, but it wouldn’t all fit in that one either.

I realized the waves were coming pretty frequently, so I decided to time them. I got on the computer on the birth ball. Pressure waves were about every 6 minutes apart. I knew it was the real thing now. My phone rang during a pressure wave and I wasn’t able to answer it. I was Tiatia. He was probably calling to tell me he was getting off work and would be home soon. I called him back, but he didn’t answer. I sent him a text saying I thought we’d be going to the hospital tonight, but I don’t think he got it. The idea of getting in the bath sounded really good to me. I put on a DVD for My daughter (I normally try to limit her TV viewing, but I made an exception that day) and I filled the tub and put in a few drops of lavender oil, which I had been putting in my scent diffuser during my Hypnobabies practice to help with relaxation. I put my laptop in the bathroom so I could play my Hypnobabies tracks while I was in the tub. I put on “Painless Childbirth” (which I think is called “Comfortable Childbirth” in the 6th edition) and lied down in the tub and relaxed.

I’d brought my phone in the bathroom and Tiatia called again. He could tell I sounded different and I told him I was having pressure waves that were pretty intense. He asked when I thought the baby was coming, and I told him either late that night or early the next morning. I told him I was in the tub. It turns out he had stopped at the Redbox on his way home and picked up a movie for us to watch that night. Yeah, that didn’t end up happening. He got home a few minutes later and came in the bathroom to check on me and I told him I was coping fine. He watched Our daughter for a while and I guess he fed her macaroni and cheese and he also got together a bag with clothes and toiletries for himself and packed phone chargers, the video camera, the laptop, and the digital camera with it’s now fully charged battery.

I listened to “Deepening” next, and continued to handle the pressure waves very well. I really wouldn’t describe what I was experiencing as painful, and I felt really in-control. Doing the deep slow breathing and using the “peace” cue while imagining anesthesia going to my lower belly (where I felt the majority of the sensation of the waves) really helped. I got into some different positions in the tub. I sat cross-legged and I also kneeled . After “Deepening” I listened to “Special Place” and I felt my baby move around during it, just like he did the first time I listened to it when I felt so connected to him that I got tears in my eyes.

Towards the end of the track, I lost my focus during a few waves and they started feeling really uncomfortable. I called out that I needed help and Tiatia came in. I told him it was really intense and I didn’t know if I could do it. I almost started crying. I was scared. He asked if I wanted to go to the hospital, and I said I did. He started making phone calls to get our daughter taken care of. I got out of the tub and got dressed. I divided the stuff I needed to take to the hospital between my two bags and put my lavender oil and my phone in one of them. Then I got my ipod and my headphones, and realizing that I needed something more than the regular tracks, I put on the Birth Guide. I regained my focus and was once again able to handle the waves. I sat on the birth ball in the living room and leaned forward on the arm of the couch. I told Tiatia I needed a drink, so he gave me a little bottle of apple juice and I took sips of it between waves.

A friend came to get our daughter who and really did not want to leave. I went over to her and gave her a hug and told her it would be okay, but she didn’t believe me. The friend asked if my water had broken and I told her it hadn’t yet, then a pressure wave started, while I was still kneeling on the kitchen floor, and I had to close my eyes and do my deep breathing. She asked, “How far apart are they?” and I couldn’t answer her, both because I was still having the wave and because I didn’t know, I hadn’t been timing them. Somehow Tiatia got into our friend’s car. He came back and asked me how I was doing and I said I was feeling more in-control now. I told him I wanted him to help me time the waves. We went in the bedroom and I turned on a lamp instead of the light so that it wouldn’t be too bright. I sat on the birth ball and put pillows on the bed and leaned forward on the pillows. Tiatia timed the waves with the stopwatch on his phone. I told him I also wanted him to use the “relax” cue on my shoulder. I once again lost focus during a few of the waves and made some noise, but the “relax” helped me relax and focus and I got back to feeling like the waves were only pressure and my anesthesia was working. We discovered that the waves were between 2 and 3 minutes apart and were all lasting over a minute. I was still able to talk calmly between the waves. We decided it was probably a good time to head to the hospital. I said we needed to call Dr. I. and told Tiatia where her number was. At first, he wanted me to call her, but I told him to do it. He called and told her we were going in and how close together the waves were. She said she’d meet us there.

Tiatia loaded everything into the car, and I made sure we got the extra pillows and the birth ball. I also brought my apple juice. I got in the back seat of our mini SUV and we took the headrest off the front seat put a pillow on top of it and leaned forward. I continued listening to the “Easy First Stage” track. I was actually quite comfortable during the 25 minute car ride, which was amazing because I remembered being very uncomfortable in the car last time. When we left the house it was around 9:00 pm.

We parked and Tiatia carried a bunch of our stuff in. We walked in and Tiatia told the receptionist at the ER admitting desk who we were. She called the maternity center and told us they’d be coming to get us. She asked if I wanted to walk or ride in the wheelchair, and I said I thought I’d be fine walking. She put a hospital bracelet on me, during a wave, of course. While we waited for them to come get us, I was standing there, drinking sips of juice between waves, and during them I’d lean on Tiatia and he’d say “relax” to me. It felt wonderful to feel so relaxed and in control. I remember telling Tiatia that they felt like they were coming right on top of each other now, since they were so close together and lasting so long, but I didn’t say it like I was afraid, it was just an observation. It seemed like it was taking a long time for them to come and we started to wonder what the hold up was. The receptionist called them again.

When they finally came for us, they asked again if I wanted the wheelchair and I decided to get it because I remembered from when we came to preregister that it was a pretty long way and the waves were so close together I’d have to stop a lot. Riding in the chair, I was able to keep doing what I had been doing. We got to the LDRP room (not a triage room like I went to first at the hospital where I had my daughter, which I was glad of), and they already had the lights dimmed for us and Dr. I. was there. Once the pressure wave I was having was over, I got out of the chair and our nurse, Dianne, gave me instructions on giving a urine sample and how to wear the hospital gown. I had another pressure wave and leaned forward on the cabinet that contained the fetal monitor machine. Then I said I brought my own nightgown to wear, and she said that said was fine. I told Tiatia which bag it was in, and he gave the bag to me. I took the cup and my bag and gave the sample and got changed.

Dr. I. had me get in the bed so they could put the monitors on me and she could check me. She said that if I needed to move during waves, I could. It turned out I was able to use my hypnosis to stay comfortable in the bed (with the head of it raised) during pressure waves, which is something I couldn’t do during the unmedicated part of my first birthing. Dr. I. checked me and, drum roll, please…I was 8 centimeters! I looked at Tiatia and said how happy I was to be so far along. He had a big smile on his face. Dr. I. showed me how big that was on the dilation chart. She asked Dianne to get a birth ball (we’d left mine in the car—one man can only carry so much) so I could sit on it, which sounded great to me. I sat on the ball and leaned forward on the bed.

Dr. I. asked what the results of my GBS culture had been and I said she’d never told me, so I’d assumed negative. Someone came to take my blood, and I barely felt it. Then Dr. I. said they were going to need to give me an IV for antibiotics because it turns out I tested positive for GBS . At first I said “okay,” but then I said I wasn’t sure if I wanted the antibiotics because I’d done reading on it and there are risks to the antibiotic use, too. Dr. I. said that the antibiotic they use is mild and that it would be to protect the baby. I agreed to get it, and now I do think that was the right decision because had I known I was positive beforehand, I would have done natural remedies to make it less likely for the baby to be infected. Dr. I. said that it was good that my water hadn't broken yet, since the membranes being intact for longer reduces the risk of infection, and she said it would be best to (as I'd requested) wait until it broke on its own.

It took at least 4 tries and 3 different people to get an IV in me. Apparently the veins in my hands are deceptive—they look great, but when you try to put the needle in, it doesn’t work. They ended up putting it on my left forearm. Getting stuck multiple times was really uncomfortable and quite frustrating, so I was relieved when they got it in.

After that, the memories are not completely clear. I remember Dr. I. suggested some different positions. I know I stood leaning forward for a few waves. Someone was behind me with their hands on my hips, but I have no idea who it was. I think after that she wanted me to try kneeling, so she adjusted the bed so that I could kneel on the foot of it and rest my head and arms on the middle part. I think that when I went to get into that position is when I vomited all over the floor, but I knew that was a good sign, a sign that I was nearing full dilation, and I also had read that the act of throwing up can help your body open up faster. I remember saying that I felt better after throwing up. I also remember saying I felt shaky, and Dianne said that meant I might be in transition. The kneeling position was comfortable, and I was still very focused and relaxed, using my hypnosis, restarting the “Easy First Stage” track on my ipod whenever it ended. I think Dr. I. checked me in this position and I was 9 cm.

Soon I started to say “Ah” at the peaks of the pressure waves, and Dr. I. asked if I was feeling rectal pressure and I wasn’t yet. Then a few waves later I said I was starting to feel it. Sometime around this time, “Easy First Stage” ended again and I let “Pushing Baby Out” start playing. Dr. I. had me get back in the semi-seated position and checked me again, and she said there was a lip on my cervix and the baby’s head needed to rotate a little more. I continued to “Ah” all through the waves, and that felt good. I think Dr. I. had me get on my side. She told me that if I really felt I needed to push at the peaks of the waves, I could.

After a while, she checked again, and the lip was still there, so she tried having me push while she held back the lip. That was very uncomfortable and it didn’t work. It was during this that my water finally broke. She told me to try not to push for a while. Now that I had pushed, I felt like I needed to keep pushing. From this point on, I was never able to really get back in the peaceful place I had been before. It also didn’t help that I had never actually listened to “Pushing Baby Out” all the way through to make sure it was okay and it turns out the track on my iPod was incomplete, so it would just stop in the middle of something. I felt panicked and very out of control and was not comfortable at all. As the waves would peak, I’d yell “I CAN’T NOT PUSH!” and would try to push only as much as I absolutely had to. Dianne had to tell me to slow down my breathing so I wouldn’t hyperventilate. At one point, Tiatia kissed me (if you’re unfamiliar with why this is helpful, read Ina May’s Guide to Childbirth by Ina May Gaskin), and that did help me relax some. I was touched that he thought to do that, that he actually had paid attention to some of the stuff I’d shared with him from my reading. I also switched from “Pushing Baby Out” to “Deepening” because I wasn’t supposed to push yet, and then I never went back to “Pushing Baby Out.”

Somehow I got past the really intense part of not being able to push and moved on to the really intense part of trying to push. Dr. I. said I could change positions if I wanted (I was now back to semi-seated), but I didn’t want to move. Dianne pulled some handles up from underneath the bed and told me I could hold on to them while I pushed. I started pushing, but the way I was pushing wasn’t working. Dr. I. noticed I was tightening my pelvic floor, so she and Dianne had to tell me to relax that area and focus on pushing with my abdominal muscles. Dianne got right in my face and Dr. I. told me to look at her. She told me to hold my breath and push. She did count to 10 during some of the pushes, but for most of them she didn’t count and I only pushed as long as I felt I could, and for some of them I did breathe out instead of holding my breath. Dianne also told me not to start pushing when the wave started, but to wait until it built. I was not able to relax the rest of my body while pushing, and as a result, I was very sore the next day. I also burst a blood vessel in my eye.

At some point during the pushing phase, Dr. I. said something about wanting to put in an internal fetal monitor because the external one wasn’t doing a good job of tracking his heart rate. At first I said “okay,” but then my inner advocate kicked in and I said I didn’t want the monitor screwed on my baby’s head. Dr. I. told Dianne to adjust the external monitor and it picked his heart rate up better. I was glad I stood up for my baby.

Once I got pushing figured out, it wasn’t too long before I felt him in the birth canal. The feeling when he crowned was very, very intense. It didn’t feel like burning to me, though, it felt like the perineal massage (a gentle version) I had done a few times, only about 10 times more intense. Looking back on it, the feeling was kind of cool, but at the moment I really wanted it to be over. I wanted to keep pushing, but Dr. I. told me that my perineum would stretch better if I waited for the next pressure wave. His head was out with the next wave and I had to keep pushing his body. I remember Tiatia reminding me to breathe in, because I just wanted to keep pushing.

Our son was born at 1:47 am. I reached down and pulled him up onto my own belly, which is something I had wanted to do ever since I’d seen it on a video. They put a towel on him and I talked to him and rubbed is back. He was a little purple and not crying. The other nurse, whose name I didn’t get, told me she was going to have to take him. Dr. I. clamped the cord and Tiatia cut it. Tiatia later told me that the nurse had suctioned The baby and given him oxygen. He took a video and some pictures. Dr. I. had me push out the placenta. Then, she and Dianne started doing uterine massage, and my uterus wasn’t firming up and I was bleeding too much. The baby wasn’t ready to breastfeed yet, so they put pitocin in my IV. Dr. I asked if I wanted it in a shot instead, but since the IV was already running, I said it was fine to do it that way. A little while later, I was still bleeding more than they like to see, so Dianne gave me a shot of methergine in my thigh.

When the baby was ready, the nurse brought him back to me before dressing him so I could hold him skin-to-skin. He latched right on and has done a great job nursing ever since. After we had some time to nurse and bond, the nurse weighed him and he was 7 lbs 10 oz—7 oz bigger than his sister was. She diapered, dressed, and swaddled him. Dr. I. showed me the placenta, which was really cool. She showed the maternal side and the membranes that held my baby as he grew. This was really interesting to me.

I felt amazing after the birth. The hormone rush was really awesome feeling. I was so proud of myself for doing it unmedicated and for feeling so in control for much of the time. I really believe I couldn’t have done it without Hynobabies. Dr. I. told me that she thought I should get certified to teach the program like I had told her I was considering doing if I found it helpful during my birth. I was up taking a shower soon after. It felt really good to be able to shower. It was a little difficult still having the IV attached because I wasn’t wearing a hospital gown, so I had to leave one strap of my nightgown around the IV line, and when I tried to put the nightgown back on, it got all tangled around the line and Dianne had to help me fix it.

Because of my positive GBS status and only getting one dose of antibiotics (you’re supposed to get 2 doses, 4 hours apart, but I wasn’t at the hospital long enough), they wanted to keep The baby in the hospital for 48 hours to watch him for signs of infection, since about 80 percent of newborn GBS infections show up during that time period. I loved that I didn’t have to switch rooms at all during my hospital stay and that, because the same nurses who help with the births also do postpartum care, on our last night we got to see Dianne again.

Dianne said she had read my birth preferences and I could tell she really made an effort to follow them. She told us that the reason she left us in the ER waiting room so long was because my birth preferences said I didn’t want it loud and she wanted to do all the noisy room set up before they brought me in. She also said how surprised she was when Dr. I. said I was 8 centimeters, because I wasn’t acting like it. We talked about how difficult my pushing phase was, and Dianne said that it looked like I was actually pushing right, and The baby just wasn’t coming down. She said normally women don’t need to push with their abdominal muscles. She said she was actually thinking they were going to need to use the vacuum extractor, but she hadn’t suggested it because she knew I wanted minimal intervention. Tiatia mentioned that he’d actually yelled “relax” at me when I was panicking, and Dianne said that caused me to suddenly focus. I don’t even remember that, but I guess my subconscious recognized the cue, so my hypnosis training did help more than I thought it did during pushing.

Our son is a very cute and so far is a good baby. His birth was an amazing experience that taught me so much about the capabilities of my mind and body.

Thursday, April 22, 2010

My Daughter's Birth

My first birth story, written soon after her birth (I removed her name from it, though):

Thursday, January 31, 2008

When I woke up I felt like some liquid was trickling out of me and thought that I might have been leaking amniotic fluid. I knew I had a midwife appointment that day, so I wasn't too worried about it. I was also having some contractions--they were about 10-15 minutes apart for a while, but then I didn't feel any for a while, and then I feel back asleep. I went to my appointment and the midwife Mindy did some tests to determine if amniotic fluid was present and they came back negative, but she said that the tests could just not be picking it up, and if I still felt like I was leaking later, I should call the midwife on call and probably go to the hospital to have them check it. She checked my cervix and said that I was 1.5 cm dilated and 80% effaced with the baby at -2 station, which is a big change from the previous week were my cervix was high and closed. I knew it didn’t really tell me anything, but was is nice to know I was making progress.

Friday, February 1, 2008

I woke up at 2:00 am and once again I felt liquid come out and my underwear was wet. I started having contractions that were definitely different from Braxton-Hicks contractions. I called Abby, the midwife on call, and she was with another patient at the other hospital where the midwives also attend births, but she told me to go to the hospital and get checked. I went in and got hooked up to the monitors and they checked to see if my membranes were ruptured. The test with the litmus paper said it still wasn't amniotic fluid. Some of my contractions didn't register on the monitor, but the nurse told me that happens a lot. I was dilated to 2 cm now and still about 80% effaced--so that was some progress. My blood pressure readings were a little high, but I think it was all the nerves and excitement. They called Abby, and she said just to give me a paper with warning signs of pre-eclampsia (none of which I had) and send me home until my labor was more advanced. The nurse used that thing that startles the baby to get a few more good accelerations on the strip, and then sent me home.

We stopped at the grocery store on our way home. We got some gatorade, candy, and a few other random things. I got a lot of contractions while we were walking and I delt with them just fine, but they did hurt. I came home and sat on my birth ball at the computer for a little while, and sitting like that was nice, bouncing seemed to help, too. At 6:00 am, I called work and let them know I wouldn’t be coming in because I was in labor (I knew I couldn’t take care of a room full of three year olds while having these contractions) Then I listened to my relaxation CD that came with the copy of the Hypnobirthing book I bought and went to sleep for a little while.

When I woke up a few hours later, I let Tiatia continue to sleep for a while and I ate breakfast, watched two episodes of Gilmore Girls on DVD and took a bath. I wasn’t having many contractions now. I ate lunch and Tiatia woke up. I decided I needed to do something, so I did a load of dishes, cleaned the counters in our little kitchen and swept the floor. Then I cleaned the mirror, counters, and sink in the bathroom. I guess my nesting instinct had finally showed up. My contractions seemed to pick up quite a bit with all of that moving around. I found it really helpful to breathe deeply and to bounce on my ball during them. Tiatia’s sister Heiporo invited us over for pizza, so we went and brought my ball with us. I felt like I needed to urinate after every contraction I had, and when I went to the bathroom there was bloody show every time. At one point, I lay down on Tiatia’s lap on the couch and fell asleep. I don’t know how long I slept, but I definitely needed it.

When we got home from Heiporo’s, my contractions seemed more frequent and they were intense. Tiatia suggested I get in the tub, so I did. The water was nice and relaxing. I found sitting sideways in the tub with my legs crossed to be comfortable, and during contractions I would lean forward against the side of the tub and breathe deeply. Tiatia got a cup and poured water over the parts of me that were out of the water. He got me a glass of water to drink, too. He had to work on some homework, and I was doing fine, so I sat in the tub by myself for a while. I wanted to listen to the playlist of relaxation music I had on the iPod, so Tiatia set up our iHome in the bathroom and I just sat there listening to the music and breathing, and by this time it was after midnight.

Saturday, February 2, 2008

I tried to keep track of how close together my contractions were with the clock on the iHome, but it got to a point were the contractions were too distracting to remember the times. I was also feeling a little nauseated at this point. When Tiatia came to check on me, I had him sit with me and write down the start and stop times for the contractions. They were averaging four minutes apart and lasting about a minute each, so after timing them for about an hour, I got out of the tub and called Claudia, who was now the midwife on call. She said it was up to me if I wanted to go to the hospital or not and that I’d probably be okay to stay home for a little while. She could tell from how composed I sounded that I was handling things fine. It was about 3:00 am by now.

Tiatia decided to put on a movie, so I tried to rest and watch the movie. I couldn’t lie down during strong contractions, though, so when I felt them, I got up and bounced on my birth ball. We watched the movie for about two hours (it was a long movie) and then I just felt like I wasn’t handling the contractions that well anymore. I think it was the lack of sleep that caused me to get the shakes. I think the contractions had spaced out a little now, but I was just feeling out of control, so we decided to go ahead and go to the hospital. Heiporo had volunteered to come with us to the hospital and help out, so we went and picked her up and headed to the hospital. It was almost 6:00 am when we got there and I got in to triage. They hooked me up to the monitors and took my vitals and all of that.

The time I was in triage is a bit of a blur. I remember the nurses checked me and found that I was still only about 2 cm, but was now fully effaced. They let me rest for a while because Mindy’s on call shift would be starting at 8:00 am so they said they were going to let her sleep a little longer. I listened to my relaxation CD and it helped a lot. Tiatia and Heiporo said that there were contractions measuring on the monitor, but I don’t think I really felt them. I don’t remember what the nurse was doing when she noticed a little puddle of fluid under me, and said “I think your water broke.” This time, the test was positive for amniotic fluid, so they had to keep me. While I waited for Mindy to get to the hospital, I rested again, listening to my music. This time the contractions spaced out.

When Mindy got there, she tested me again and I was, in fact, leaking amniotic fluid. I’m pretty sure I had been leaking since Thursday, but Mindy could count time of rupture of membranes as when the hospital had found it, 7:15 am. She told me that it looked like my contractions had slowed down, and said she may need to give me pitocin. I cried and told her that I really did not want pitocin, that I wanted to get up and walk around and see if activity could get my contractions going like it had on Friday and she said I could do that.

They got us checked in to a room. I think I was the only one there at the time, so they gave us the one with the view of the Mt. Timpanogos temple because Heiporo had said we wanted that one. The nurse was really nice and got me a birth ball (we had left mine in the car) and told me that she would do intermittent monitoring of the baby, which she did by holding the monitor on my belly with her hand (or letting me hold it there). She also said that if I did end up getting pitocin, I still wouldn’t have to stay in bed, even though I’d have to have continuous monitoring, because she could get me a telemetery monitor.

Tiatia and I walked laps around the labor and delivery floor for the next couple of hours. During contractions he would hold me and I would lean against him and try to relax. Sometimes I would take a break by sitting on the birth ball. When we were walking, Mindy stopped us and told us that she had a different doctor backing her up than she usually has, and this guy was more intervention-minded and not as familiar with the way she does things. He wanted her to start me on pitocin right away, and she knew he would want that, and that’s why she had taken a while to get to the hospital that morning, so she could give me as much time as she could to progress on my own. After my reaction to the idea of pitocin, she had told him that waiting six hours is just the way she does it. She said that with her usual doctors, she can get twelve hours, but she wasn’t going to push it with this guy. That meant I had until 1:15 to make progress, and then we had to do the pitocin.

At 1:15, I had still not progressed, despite all the walking I was doing. I was desperate to avoid the pitocin, and wearing myself out even more because of it. We also tried some natural oxytocin stimulation, but it didn’t seem to do much. Mindy told me that because the break in my membranes was high up, there was still a bag of waters between the baby’s head and my cervix, so she was going to rupture it. I agreed, since my water was already broken. I wish she would have offered to do that earlier, or that she had given me more time after that to progress on my own, but they hooked me up to the IV and got the pitocin started right after that. Mindy had explained that she uses pitocin very gently, starting with the lowest dose and gradually increasing if necessary, and that if my cervix starts to change, she could turn it off and see how I would continue on my own.

Well, they gave me the lowest dose, and I immediately threw up and started feeling very intense contractions, much closer together. I was still in the bed, and the nurse pushed on my knees during the contraction, which helped. She taught Tiatia how to do it, so he pushed on my knees for the next few contractions. Then somebody suggested I get on the birth ball, which I did. I found I could get through the contractions by bouncing and breathing deeply to the rhythm of the bouncing (in-bounce-bounce-bounce, out-bounce-bounce bounce). Tiatia sat behind me and bounced me with his hands so I didn’t have to use my legs to bounce. Between the contractions, they wanted me to lean back against him so they could get good readings on the baby’s heartbeat. I was fine leaning back, but then when the contractions started, I had to pull myself upright, which was a bit annoying. I think Tiatia may have asked me if I wanted my music, but I said no because I was very focused on what I was doing and music seemed like it would be a distraction, but I wish now that I had listened to it. I think it would have helped me relax and take my mind off the pain.

Tiatia suggested the tub at one point, and that I agreed to. Mindy was sitting with us most of this time, helping me breathe. She checked me and found I was still not progressing and said we needed to up the dose of pitocin. I freaked out and said I did not want her to that it hurt and I couldn’t do it. She said she could give me an IV med to take the edge off, and I said that if I got in the water and it didn’t help, I wanted something. They went ahead and increased the pitocin, and I got in the tub. The water helped a little, but not enough. I think that, psychologically, knowing I was getting more pitocin made everything worse.

Mindy called Tiatia out of the bathroom to talk to him. He came in and told me that I was doing so well, but we still had a long way to go and I was so exhausted from the lack of sleep and dealing with contractions for so long. He said that the back up doctor wanted to do a c-section for failure to progress if I didn’t show change by 6:00 pm. I think it was almost 4:00 by this point. He said that if I got an epidural, I’d be able to rest up for the pushing, which rest Mindy felt I really needed. With an epidural, they could also increase the pitocin as much as they needed to get labor really going. I agreed to the epidrual because I didn’t want to deal with the pitocin contractions anymore, I really did not want a c-section, and I just wanted my baby to be here.

It was tough to deal with the contractions until the anesthesiologist got there. I had given up the idea of doing it unmedicated, so I wanted the pain to be over. My mother-in-law got there after they sent for the anesthesiologist. She coached me on relaxing, and was so sweet, but I had given up. She had wanted to be there earlier, but she had to translate in Tahitian for the funeral of President Hinckley. I got out of the tub and got back on the birth ball for a while. I asked Mindy to check me before I got the epidural to see how far I got on my own. She said it was about 3 cm. Then the anesthesiologist got there. While he was setting up, I sat on the bed and Tiatia looked into my eyes and told me I was doing great.

I was happy with the epidural because it did not make me completely numb, but I couldn’t feel the pain from the contractions. The epidural was on my left side, so I had to lay on my right side to get it to spread to the right. They told me about the button that would give me more if I needed it, but said that if I suddenly started feeling something, to tell them before I pushed it so they could check me, because starting to feel something usually means you’ve made progress. They also put in a catheter and an internal contraction monitor, so they could know how strong the contractions were to better judge how much pitocin to use.

About an hour later, Mindy checked me and I was 4 cm, which was a change, but Mindy later told me it wasn’t as big of a change as she expected. I switched over to my left side. I think there was a reason (besides that it was comfortable for me) but I don’t remember. Tiatia got me the iPod and I listened to my music and dosed. Then I started feeling the contractions on the right side of my belly again, so I called the nurses and told them. Mindy came and checked me again, and now I can’t remember how many cm she said I was, but it was a big change—7 cm, I think. She had me change back over to my right side and said I should push the epidural button.

I rested some more, and then I started feeling pressure. I also noticed that my heart was racing. The nurse came in to check on me and I told her all of this. We figured the racing heart was just excitement. She told Mindy about the pressure, and she came and checked me again and I was 9 and a half cm. The next time she checked, there was still a little lip of cervix on my right side. My mother-in-law came in and had me concentrate on opening my birth canal during the contractions. Once the lip was gone, it was time to push. It was about 9:00 pm when I started pushing. Because of the epidural, I had to be in a semi-seated position for pushing, putting my chin to my chest and grabbing my thighs. They coached me to hold my breath and push to a count of 10, three pushes for each contraction. Tiatia supported one leg and the nurse held the other. I watched the progress of her head in the mirror. Mindy massaged and supported my perineum and had me switch to pushing to a count of 5 as Tehani’s head emerged. Then she had me stop pushing and we had a baby at 9:54 pm.

Mindy put our daughter on my stomach. She was having a bit of a hard time breathing, so Mindy clamped the cord (it had slowed, but not stopped) and Tiatia cut it, and they took her to the warmer so they could suction her and drain her lungs. Then they did all the procedures, weighed her and all of that, and wrapped her up and gave her to Tiatia. He and his mom took pictures of her. The placenta was delivered, and Mindy was stitched me up. I tore in three places, but they were all not very bad tears. My left labium was a tough stitch job because it was torn on both sides, but Mindy did great with it. She said I stretched great and that next time I give birth, I probably won’t tear at all. Tiatia brought me the baby and I got to nurse her soon after.

I am disappointed that I didn’t get the birth I hoped for, that I “gave in” and got the epidural. When Mindy came to see me the next day, she told me it is okay to morn the loss of the birth I wanted and was very understanding about it. She hated that she had felt it was necessary to suggest pain medication. I told her I was sad about it, but I really felt like I had made the best decision I could under the circumstances. I was exhausted and couldn’t do the pitocin anymore at that point. I also said I would choose a vaginal birth with an epidural over a c-section. She said she didn’t want it to seem like she was threatening me with a c-section to scare me into getting the epidural, but the possibility of a c-section was something we had to deal with considering the doctor who was backing her up that day. Mindy told me she was impressed at how prepared I was, and said that sometimes being prepared can work against you, as it did for me and the pitocin.

Our little girl is a beautiful baby and we love her very much. I didn’t get my perfect birth, but I got my perfect baby.

Wednesday, April 21, 2010

Views of Birth Reflected in Mirrors

Beauty is eternity gazing at itself in a mirror. -Kahlil Gibran

I watched my first baby being born with a mirror. I felt like it helped me to see that my pushing was making progress, and I think felt a a little more connected with what was going on, despite my body being half-numb. I like watching babies emerge because I think it's amazing to see the divine design of the female body at work. I was not offered a mirror during my son's birth, but it didn't really matter because, being able to really feel it, him descending and crowning was very real--an intensity I couldn't possibly escape, even though I sort of wanted to at the time. But looking back on it, it was actually kind of cool. For me, birthing as connected as possible to the experience helped me appreciate my body and gave me confidence in my strength.

Recently I was telling a group of women about how my doctor had waited for spontaneous rupture of membranes at my son's birth (my water broke when I had only a lip of cervix left) and I mentioned how sometimes babies are born "in the caul" (with membranes intact), and I said I'd seen a video of it and it was really cool. One woman, who chose epidurals for the births of all the children she's had so far, said that she had never seen a birth video showing a baby emerging before and she doesn't want to see what it looks like, at least not until she is done having children herself. She said that declines to use a mirror when it is offered during the second stage. My friend explained that she deliberately distances herself from what is happening to her body--she doesn't want to know. She even said that it is because she has the epidural and can't feel what is happening that she disconnects herself from it, and that if she were to have an unmediated birth, she might not feel the same way about it. She also admitted that she may be making what happens worse in her mind than it actually is.

This woman's words taught me that although epidurals don't usually result in a "drugged" feeling like that reported by some women who take narcotics during birthing, the drugs don't actually have to affect your mind to cause a state of mental numbness. Being numb and disconnected from the experience must drain birth of some of the best parts of it. Numbness is all on one level, while the process of natural birthing has highs and lows.

When reflecting upon this conversation, I remembered another conversation I had with different group of women, about 4 years ago, before my first pregnancy when my husband and I were newlyweds. I had done no personal research into the subject of birth outside of maybe watching TLCs "A Baby Story." I realize that this conversation may actually have shaped a lot of my original perceptions about childbirth, which I discussed in my previous post, My Journey to Natural Childbirth. I remembered a woman in this group also saying she declined to use a mirror during her child's birth, that she did not want to see it happening. She had an epidural and trusted that the episiotomy her doctor performed was necessary. I also remember her saying that she was afraid of giving birth at first, but she explained that by the end of her pregnancy she was so miserable the idea of giving birth "didn't seem so bad."

These two conversations, which both mentioned not using mirrors during pushing, about 4 years apart and with women in 2 different states, reflected very similar views of birth--the view that birth is a "necessary evil"--something no one really wants to experience, but must because the baby has to come out somehow. This idea that the act of giving birth is undesirable would support withdrawing from it as much as possible, physically and emotionally. The view of birth as a medical procedure fits with this idea--it is justified to be squeamish about a medical procedure like surgery--I know I wouldn't want to know what was happening to me during surgery, and I avoid watching surgery on TV. I think our medical establishment has actually influenced us to think of birth, even if it is vaginal, as something like surgery. This may explain where the very small population of women opt for true maternal request cesareans are coming from, whether they give birth vaginally or surgically doesn't matter, because there really isn't much difference between a cesarean and a birth-by-machine. Medicalization of birth makes it scary, removes it from the realm of things women are expected to know about, and makes it something it is okay to be removed from.

If, however, we think of birth as a normal, natural process, then it makes sense that women might want to see it. Midwife Ina May Gaskin has suggested that we need to see images of other women birthing before doing it ourselves in order to know what our bodies are capable of and not be afraid. The woman who shared her experience 4 years ago has no idea what her body is capable of--she neither felt nor saw her baby come out of her and the doctor who performed her episiotmy sent her the message that her body is not capable of naturally stretching to allow a baby to pass through. These numb and mirror-less births, were the baby comes out of the mother's body without her really experiencing it, perpetuate the fear of birth because it remains an "unknown" to women, even those who have done it, and it is normal to fear the unknown.

Perhaps women's attitudes about mirrors in birth reflect back to us the truth about what the birth experience means to them?

Sunday, April 18, 2010

Maslow's Hierarchy of (Birth) Needs

At a church meeting I attended recently, a speaker brought up psychologist Abraham Maslow's Hierarchy of Needs to make a point about serving others. It had been years since I thought about Maslow's Heirarchy, but I was familiar with it from the AP Psychology class I took in high school and I think it was also covered in the Child Development course I took as a requirement for my Bachelor degree in Early Childhood Education. This course was actually where, as a college freshman, I first learned that placentas come out. I don't know what I thought happened to it before--guess I figured it was just a permanent part of the mother's anatomy or something. Perhaps public high school curricula are a little lacking on the subject of childbirth?

In my high school psychology class, we discussed the different theories of psychology--Freud's psychoanalytic theory, behaviorism, etc. We divided into groups, each representing a theory. I chose to join the Humanist group. Basically, the theory of Humanism is that people are like seeds with the potential to grow into something great if all of their needs are met. For plants, the needs are soil, water, sunlight, etc. Maslow attempted to explain what human beings need with his Hierarchy of Needs, usually depicted as a pyramid like this:
Maslow arranged the needs this way because he believed that certain types of needs must be met before other needs manifest. In other words, if more pressing needs like needs for food, sleep, and safety are unmet, then the person can't be very concerned with higher needs, like belonging and confidence.

Here is an explanation of each level of needs, quoted from this site.

Physiological Needs
These are biological needs. They consist of needs for oxygen, food, water, and a relatively constant body temperature. They are the strongest needs because if a person were deprived of all needs, the physiological ones would come first in the person's search for satisfaction.

Safety Needs
When all physiological needs are satisfied and are no longer controlling thoughts and behaviors, the needs for security can become active. Adults have little awareness of their security needs except in times of emergency or periods of disorganization in the social structure (such as widespread rioting). Children often display the signs of insecurity and the need to be safe.

Needs of Love, Affection and Belongingness
When the needs for safety and for physiological well-being are satisfied, the next class of needs for love, affection and belongingness can emerge. Maslow states that people seek to overcome feelings of loneliness and alienation. This involves both giving and receiving love, affection and the sense of belonging.

Needs for Esteem
When the first three classes of needs are satisfied, the needs for esteem can become dominant. These involve needs for both self-esteem and for the esteem a person gets from others. Humans have a need for a stable, firmly based, high level of self-respect, and respect from others. When these needs are satisfied, the person feels self-confident and valuable as a person in the world. When these needs are frustrated, the person feels inferior, weak, helpless and worthless.

Needs for Self-Actualization
When all of the foregoing needs are satisfied, then and only then are the needs for self-actualization activated. Maslow describes self-actualization as a person's need to be and do that which the person was "born to do." "A musician must make music, an artist must paint, and a poet must write." These needs make themselves felt in signs of restlessness. The person feels on edge, tense, lacking something, in short, restless. If a person is hungry, unsafe, not loved or accepted, or lacking self-esteem, it is very easy to know what the person is restless about. It is not always clear what a person wants when there is a need for self-actualization.

Now, I've heard that birth is psychological. There are many examples of birth stories in Ina May's Guide to Childbirth where the woman couldn't give birth until she solved some issue with her partner or voiced a fear or something like that. I also have read a lot about the mind-body connection and how a woman feels during birthing can affect the physical process of birth (a explanation of this is in Better Birth: The Ultimate Guide to Childbirth from Home Birth to Hospitals by Denise Spatafora). I've also heard explanations from an evolutionary standpoint, that humans, like animals, have to feel comfortable in our surroundings to give birth.

However, I've never heard the psychology of birth explained in terms of unmet needs before. If we assume that meeting the needs on Maslow's Hierarchy is essential to a woman's emotional well-being, and hence, important for both the physical progress and the woman's experience of birth, then it's easy to see why some births go smoother and are better experiences than others. A lot of what is common in birth in America actually denies women of their needs.

In the average hospital birth, women are usually denied food and sometimes denied drink (physiological needs) and given an intravenous drip and ice chips instead. Women can't feel safe (safety needs) in the hospital if they fear strangers, unfamiliar places, needles, or bodily injury from episiotomy or cesarean. Traumatic birth stories sometimes mention the woman feeling alone, deserted, or unloved (social needs) when she was taken away from loved ones to be preped for surgery or left to be "watched" by a fetal monitor. Sometimes women are disrespected (esteem needs) by being ordered around, spoken to demeaningly (you can find a lot of examples of these two at www.myobsaidwhat.com), or not being free to move. With so much frustration of women's needs, no wonder there are so many unsatisfying birth experiences.

If you were to look at my birth plan from my son's birth (unmedicated hospital birth), you would find evidence of my needs to be able to drink, to feel safe, and to be respected. Perhaps social needs explain the results the various doula studies. Wanting a birth environment that allows these needs to be met certainly explains why some women choose out-of-hospital births.

Emjaybee, in a post at the Unnecessarean, recently asked so what does "good" look like? I think that the ideal birth environment would be one that supports the fulfillment of women's needs. This means one with unrestricted access to food and drink, one that is non-threatening in both appearance and practice, where women who want continuous emotional support can have it and there is no restriction on the presence of family members, and where caregivers are religiously respectful of the woman's autonomy, decisions, space, and person--where thy ask permission instead of stating their intentions and they avoid any unnecessary disruptions or interventions.

For women who are able to have all their needs met at birth, it can be a highly satisfying event, maybe even, I suggest, a self-actualizing experience.

Wednesday, April 14, 2010

Birth Trauma and Birth Disappointment

I've been reading the book Birth Crisis by Sheila Kitzinger. This book deals with the subject of birth trauma and PTSD following traumatic births--recognizing it, healing from it, and preventing it. It is a great book for birth professionals to help them know how to support women--either in recovering from birth trauma or giving birth following trauma, including some non-birth trauma. A lot of what is in the book relates to this blog, in that she discusses how over-medicalization and loss of personal control in childbirth can negatively impact women. The image on the cover depicts "birth-by-machine," though here, the "machine" refers to the entire maternity system.

Interestingly, I've also seen a lot of posts on blogs about birth trauma lately. One example is this post from Descent into Motherhood. Also, this recent post from Jill at the Unnecessarean talks about how ludicrous a comment was that was made on one of her posts. I find her Glenn Beck example humerous, though I am actually a fan of Glenn Beck and tend to agree with most of what he says. As someone with an education background, I have a lot of respect for his talent as a teacher, shown in his ability to make boring, political and economic topics interesting to people like me. But Glenn Beck is so not the point. I completely agree with Jill that trying to blame birth trauma on "culture" does not make any sense. Disrespect is disrespect. Violence is violence. Violation is violation. It doesn't matter what you "expect" or "value." When women are mistreated in childbirth and don't recognize it as mistreatment, is it not still mistreatment? In cultures where spouse abuse is culturally acceptable, are the battered women not still being abused?

There is a difference between trauma and disappointment. Birth trauma refers to experiences where the woman feels degraded, disrespected, assaulted and/or very afraid, usually involving some sort of breech of trust on the part of her caregiver, but not always. Birth disappointment occurs when the experience the woman gets is different than the experience she hoped for, even if she recognizes that the change of plans was for the best. During pregnancy, I try to live by the mantra "hope for the best, prepare for the worst," but I find it is not really possible to be fully prepared for every possibility in childbirth. Its also not possible to enter childbirth with absolutely no expectations. We can be flexible, but we can't control how what happens in childbirth affects us any more than we can control what happens in childbirth. We can, however, choose to heal, whatever healing means for us.

Monday, April 12, 2010

My Journey to Natural Childbirth

Before I got pregnant with my first baby, what limited knowledge I had about birth led me to two conclusions: 1) birth is painful, but 2) there are drugs for it. I thought everyone got epidurals. I didn’t understand why anyone wouldn’t. I thought “why would you have pain when you don’t have to?” I certainly try to avoid pain whenever possible. I figured that if epidurals were as common as they seemed to be, they must be pretty safe. I thought an epidural would be the only way to make childbirth not be a completely horrible experience. I believed God must have created epidurals so that women wouldn’t have to suffer.

It's hard to say exactly what opened my mind to the idea of natural childbirth. A lot of it came from my experiences posting on online forums. The internet has a way of exposing people to new ideas. I discovered that people still do natural childbirth. I also went to a seminar at Babies 'R' Us by an instructor of the Mongan Method of HypnoBirthing talking about the theories behind hypnosis for childbirth and recruiting for her class. I decided that I could do natural childbirth.

Then I started reading. And reading and reading. One article that was important in my decision process was The Hidden Risks of Epidurals by Sarah J. Buckley. It showed me that epidurals were not as simple as I once thought. Also on my reading list were The Thinking Woman's Guide to a Better Birth by Henci Goer, Active Birth by Janet Balaskas, and Ina May's Guide to Childbirth by Ina May Gaskin.

All of this reading radically changed my point of view about childbirth. My new conclusions were: 1) God created birth as a beautiful and delicate process, 2) people interfering with that process unnecessarily can easily through it off track, leading to complications and a need for more interventions, and 3) women who plan for and accomplish natural childbirth often have wonderful and empowering experiences.