Flipping channels, I came across a show about some famous socialite named Kendra. I have no idea who this person is, and I really don't care - then, before I clicked to the next channel, I notice that this woman, Kendra, is in the hospital, and obviously pregnant. Like a train wreck, I couldn't look away as I watched the program's presentation of her labor, watched her lie in bed for 24 hours with Pitocin and an epidural, only to end up with a c-section.
Smiling doctor telling her the day before she was induced, "We've given her something to help her get some rest, since she'll have a big day tomorrow..." Every time marker in the footage, she's still lying in bed, in the same position... Smiling doctor reappearing at the 23 hour mark, saying "You've been a trooper, and baby looks fine on the monitors, but it's time to go have a baby..." Wheeling her to the OR five hours after that... Kendra saying, "9 pounds, 5 ounces, no wonder I needed a c-section!..."
I get so angry, sometimes, the way the medical system can manipulate parents into doing things their way. The calm, rational part of me reminds me that this is an example of parents who's birth experience was peripheral to the fact that a baby was born. I understand, and I respect that. But... I feels a deep sadness for the lost and beautiful experience they missed out on.
To bring myself back to a happy place, I came across news that Gisele Bundchen had her baby at home in the water. (-:
Sunday, January 31, 2010
Tuesday, January 26, 2010
Some More Perspective
Recently, I wrote about Samantha Burton being forced to submit to bed rest and a c-section, and I basically said that both parties probably made some poor decisions, and maybe it would have been better if both mom and OB had quit their working relationship and mom had found another care provider.
Then, Mom's Tinfoil Hat made a comment-turned-post in her blog, and had a point I found interesting: just because a woman is smoking doesn't necessarily mean she doesn't care about herself or her baby, or even that she's headed for disastrous consequences. I particularly like when she said,
"We all have our priorities. Exercise has also been associated with pregnancy loss. I wonder what you think of women who are selfish enough to take epilepsy meds."
Whether Samantha was making the right decisions or not isn't the focus of the court; the point to her case is that she was barred from exercising her right to choose her own course of action. The writer of another article about Samantha's situation (which I can't put my fingers on right now) said something to the effect of, "At what point do women's decisions render them incubators and wards of the state?"
I've been thinking a lot about smoking in pregnancy, and a client of mine recently let me know that she was smoking through probably about her 20th week of pregnancy, tapering back slowly until she had quit altogether. My personal decision to not serve women who are pregnant and still smoking seemed to dissipate suddenly when she told me this - I had been offering her support through her pregnancy already, and her smoking status didn't change the fact that I've helped her thus far by providing research, information and resources to her. Maybe she needed my support in these ways while she worked through her decision to quit smoking, and maybe without my support she wouldn't have made it to the point of quitting. And even if she didn't quit, she still needs me at her birth, I'm her primary point of support (after her medical care provider).
This is all very thought provoking. I think I'll go ruminate upon it all some more.
Then, Mom's Tinfoil Hat made a comment-turned-post in her blog, and had a point I found interesting: just because a woman is smoking doesn't necessarily mean she doesn't care about herself or her baby, or even that she's headed for disastrous consequences. I particularly like when she said,
"We all have our priorities. Exercise has also been associated with pregnancy loss. I wonder what you think of women who are selfish enough to take epilepsy meds."
Whether Samantha was making the right decisions or not isn't the focus of the court; the point to her case is that she was barred from exercising her right to choose her own course of action. The writer of another article about Samantha's situation (which I can't put my fingers on right now) said something to the effect of, "At what point do women's decisions render them incubators and wards of the state?"
I've been thinking a lot about smoking in pregnancy, and a client of mine recently let me know that she was smoking through probably about her 20th week of pregnancy, tapering back slowly until she had quit altogether. My personal decision to not serve women who are pregnant and still smoking seemed to dissipate suddenly when she told me this - I had been offering her support through her pregnancy already, and her smoking status didn't change the fact that I've helped her thus far by providing research, information and resources to her. Maybe she needed my support in these ways while she worked through her decision to quit smoking, and maybe without my support she wouldn't have made it to the point of quitting. And even if she didn't quit, she still needs me at her birth, I'm her primary point of support (after her medical care provider).
This is all very thought provoking. I think I'll go ruminate upon it all some more.
Movers and Shakers
There are two hospitals in my city, and the larger one has a birth unit called the Women's Pavilion. This weekend, that hospital put on a baby and family fair. When we doulas initially found out about it, we discussed it at our monthly meeting and were all like, How do we get in on this action!?
We had a few challenges to overcome... Not only were we trying to figure out how to pony-up $250 for a table at the last minutes, but also, in the past, this hospital has denied a table to the local ICAN group (the leader of which is a doula), and we were concerned that we'd be barred, too.
Then, a light bulb went off over the heads of one of the doulas at the table. She works with a government program and managed to secure a table (on the last day of registration - we got lucky, and got one of the last two tables available). So while the major theme of our booth was the services offered by that program, we were also able to slip-in information about other local resources (such as the doulas!) and stuff about informed consent, avoiding a c-section, nutrition, breastfeeding, and more. A whole booth-ful of doulas, dispensing lots of great info, laughing and talking with moms - it was awesome!
We doulas got together at the end of last year and applied for a Lamaze mini-grant to start a birth network - and they awarded one to us. Again, a last minute effort, but it paid off. At this point, I'm thinking, the sky's the limit - imagine what we could do if we weren't operating on the last-minute protocol...
It'll get better, as we figure things out and get a structure going. It's always a little bumpy in the beginning of any endeavor, but with so much talent and skill among us, we're slated for success. It's very exciting.
We had a few challenges to overcome... Not only were we trying to figure out how to pony-up $250 for a table at the last minutes, but also, in the past, this hospital has denied a table to the local ICAN group (the leader of which is a doula), and we were concerned that we'd be barred, too.
Then, a light bulb went off over the heads of one of the doulas at the table. She works with a government program and managed to secure a table (on the last day of registration - we got lucky, and got one of the last two tables available). So while the major theme of our booth was the services offered by that program, we were also able to slip-in information about other local resources (such as the doulas!) and stuff about informed consent, avoiding a c-section, nutrition, breastfeeding, and more. A whole booth-ful of doulas, dispensing lots of great info, laughing and talking with moms - it was awesome!
We doulas got together at the end of last year and applied for a Lamaze mini-grant to start a birth network - and they awarded one to us. Again, a last minute effort, but it paid off. At this point, I'm thinking, the sky's the limit - imagine what we could do if we weren't operating on the last-minute protocol...
It'll get better, as we figure things out and get a structure going. It's always a little bumpy in the beginning of any endeavor, but with so much talent and skill among us, we're slated for success. It's very exciting.
Monday, January 25, 2010
Perspective
Everyone's shaking a finger, either at Samantha Burton or her OB.
Ms. Burton experienced something many of us would consider a worst case scenario: she lost her baby at 25 weeks gestation. And as if that isn't terrible enough, she was held against her will at the hospital when a court ordered her to comply with her OB's recommendation of bed rest. Finally, her OB performed a cesarean in hopes that her baby could be saved - only to discover that fetal demise had already occurred.
A big question echoing in many conversations about this situation is, at what point does a pregnant mom become incapable of deciding what is best for herself and her baby? Ms. Burton was smoking during pregnancy, which is acknowledged by pretty much every care provider out there to be a bad thing. But even if she was making a bad decision, isn't it still her decision to make? That's the crux of the arguements against her OB's decision to initiate a process to hold this mom against her will: freedom to choose.
Last year, I interviewed with a potential client who had two older children, both born premature and with physical and mental abnormalities, who was also a smoker. I didn't contract with this client, simply because I knew, after our interview, that I was not the right person to help her. There were a few reasons why, but the second most important one was because I'm so utterly opposed to smoking, whether one is pregnant or not. Cigarettes are laden with chemicals that are not supposed to be in the body in any amount.
This became a deal breaker for me; my personal feelings about smoking aren't something which can be negotiated around, I can't support someone who wants to continue to smoke when I believe it's a bad decision which puts the lives of both mother and child in danger. I wonder why Ms. Burton's OB decided to go through all of the effort to keep her in the hospital and eventually perform surgery - was it not an option to refer her care to another doctor?
Maybe it's not that simple, I don't know.... The Hippocratic Oath does basically say you can't refuse to help someone when you become a doctor. I know there's probably many more details about Ms. Burton's situation which caused her OB to steer her care in the direction it went. It was a bad situation for both mother and care provider, and maybe both of them could have made better decisions along the way. I find it difficult to take sides with either the mother or the care provider (providers, really, both the OB and the hospital) when both acted in ways with which I don't agree.
I think it's worth noting that this sort of thing is rare, and as frightening as it can be to have something like this happen practically in my own back yard, it's important to keep things in perspective. A pregnant mom in preterm labor is a challenge to any care provider; and a care provider who doesn't agree with a mother's choices during pregnancy is a challenge for that mother. It seems a little paradoxical, but rising to the challenge sometimes means walking away.
Ms. Burton experienced something many of us would consider a worst case scenario: she lost her baby at 25 weeks gestation. And as if that isn't terrible enough, she was held against her will at the hospital when a court ordered her to comply with her OB's recommendation of bed rest. Finally, her OB performed a cesarean in hopes that her baby could be saved - only to discover that fetal demise had already occurred.
A big question echoing in many conversations about this situation is, at what point does a pregnant mom become incapable of deciding what is best for herself and her baby? Ms. Burton was smoking during pregnancy, which is acknowledged by pretty much every care provider out there to be a bad thing. But even if she was making a bad decision, isn't it still her decision to make? That's the crux of the arguements against her OB's decision to initiate a process to hold this mom against her will: freedom to choose.
Last year, I interviewed with a potential client who had two older children, both born premature and with physical and mental abnormalities, who was also a smoker. I didn't contract with this client, simply because I knew, after our interview, that I was not the right person to help her. There were a few reasons why, but the second most important one was because I'm so utterly opposed to smoking, whether one is pregnant or not. Cigarettes are laden with chemicals that are not supposed to be in the body in any amount.
This became a deal breaker for me; my personal feelings about smoking aren't something which can be negotiated around, I can't support someone who wants to continue to smoke when I believe it's a bad decision which puts the lives of both mother and child in danger. I wonder why Ms. Burton's OB decided to go through all of the effort to keep her in the hospital and eventually perform surgery - was it not an option to refer her care to another doctor?
Maybe it's not that simple, I don't know.... The Hippocratic Oath does basically say you can't refuse to help someone when you become a doctor. I know there's probably many more details about Ms. Burton's situation which caused her OB to steer her care in the direction it went. It was a bad situation for both mother and care provider, and maybe both of them could have made better decisions along the way. I find it difficult to take sides with either the mother or the care provider (providers, really, both the OB and the hospital) when both acted in ways with which I don't agree.
I think it's worth noting that this sort of thing is rare, and as frightening as it can be to have something like this happen practically in my own back yard, it's important to keep things in perspective. A pregnant mom in preterm labor is a challenge to any care provider; and a care provider who doesn't agree with a mother's choices during pregnancy is a challenge for that mother. It seems a little paradoxical, but rising to the challenge sometimes means walking away.
Tuesday, January 12, 2010
Making the Best Decisions Possible
I recently posted about being called to a birth-in-progress on New Year's Eve, and mentioned that mom was admitted for low amniotic fluid based on an AFI of 4.5 (0.5 of a point below the 'low' assessment rankings).
It's sort of been bugging me, and I wanted to see what research was out there about this kind of testing. So, I pulled out my handy A Guide to Effective Care in Pregnancy and Childbirth and did a little reading.
Effective Care mentions the AFI somewhat obliquely in chapter 12, section 5.5:
Basically, what I took from that was, researchers believe the biophysical profiling approach is an effective means by which to see how mom and baby are faring, but the research may be flawed or incomplete when one reviews it, and so Effective Care authors believe it's difficult to say whether it's an effective method or not.
I think this is another instance where care providers try to lump all women into categories, like making an IF/THEN/ELSE statement. (Well-Rounded Mama is dealing with a similar situation with her health care, so it's not unfair to say that this sort of thing happens all the time in other instances of health care.) It makes me wonder what my last client's experience would have been like if she had made different decisions, and decided to place her trust more in her (very healthy) body than in (uncertain) risk assessment testing.
Humanity is on the search for "true indicators", but life isn't always consistent in its outcomes and occurrences. So, here's the approach I'll have when I'm a pregnant mom: I'll make the best decisions possible with ALL of the information available and won't forget to listen to intuition and feelings as well as intellect.
It's sort of been bugging me, and I wanted to see what research was out there about this kind of testing. So, I pulled out my handy A Guide to Effective Care in Pregnancy and Childbirth and did a little reading.
Effective Care mentions the AFI somewhat obliquely in chapter 12, section 5.5:
- 5.5 Fetal biophysical profile
The ‘biophysical profile’ was derived from a study of serial ultrasound examinations and antenatal cardiotocography (non-stress test) in high-risk pregnancies. Combining five biophysical ‘variables’ considered to be of prognostic significance (fetal movement, tone, reactivity, breathing, and amniotic fluid volume) into a score, reduced the frequency of false-positive and false-negative results compared to the non-stress test alone. An additional advantage of the biophysical profile over the nonstress test is that it permits assessment of the possibility of major congenital anomalies. This may be important, as detection of a serious anomaly may on occasion help to avoid a cesarean section when the baby is clearly abnormal.
Only two controlled trials of biophysical-profile testing have been performed. Both were conducted in women referred to units specializing in fetal biophysical assessment. They compared care based on biophysical score results with that based on non-stress test results, following a management protocol. In both studies, the biophysical profile score was a better predictor of low 5-min Apgar scores than the non-stress test. The biophysical profile was both more sensitive and more specific in predicting overall abnormal outcome than the nonstress test.
Despite the better predictive value of the biophysical score than the non-stress test, its use did not result in any improvements in outcome for the baby. Outcomes measured included perinatal death, fetal distress in labor, low Apgar score, and low birth weight-for-gestational age. Compared with cardioiocography alone, biophysical-profile testing showed no obvious effect (either beneficial or deleterious) on these outcome measures. The available evidence provides no support at all for the use of biophysical profile as a test of fetal well-being in high risk pregnancies. However, the number of women included in these studies is so small that any estimates of effect are extremely imprecise.
Basically, what I took from that was, researchers believe the biophysical profiling approach is an effective means by which to see how mom and baby are faring, but the research may be flawed or incomplete when one reviews it, and so Effective Care authors believe it's difficult to say whether it's an effective method or not.
I think this is another instance where care providers try to lump all women into categories, like making an IF/THEN/ELSE statement. (Well-Rounded Mama is dealing with a similar situation with her health care, so it's not unfair to say that this sort of thing happens all the time in other instances of health care.) It makes me wonder what my last client's experience would have been like if she had made different decisions, and decided to place her trust more in her (very healthy) body than in (uncertain) risk assessment testing.
Humanity is on the search for "true indicators", but life isn't always consistent in its outcomes and occurrences. So, here's the approach I'll have when I'm a pregnant mom: I'll make the best decisions possible with ALL of the information available and won't forget to listen to intuition and feelings as well as intellect.
Friday, January 8, 2010
More Catch-Up: Links in Review
The Case Against Reasoning, by Morgan Gallagher
Morgan sums-up something I've been struggling to explain to others: formula is suboptimal. She says,
There is less in formula milk, than there is in human milk. There is less physiological growth in bottle feeding, than there is in breastfeeding. Combine the two, and add in that modified cow's milk destroys the natural flora in the new born gut.. and you have an activity that increases health risks in homo sapiens: formula feeding.
She also expresses aptly the way business drives culture, and how advertisers manipulate us so effectively into believing that something that is suboptimal is normal, and something normal is achievable only if you're Superwoman. It's a cleverly devious bit of psychology: breastmilk is "best" so formula is "okay" claim the formula companies - but it's not true!
Yoga for Hip Discomfort: Eka Pada Rajakapotasana (One-Legged King Pigeon Pose)
BirthActivist recommends this pose for hip pain during pregnancy. Those loosening joints are sometimes uncomfortable, so this may help.
I interviewed a client several months ago who was experiencing hip pain, and I wish I'd known about this back then!
Clean Eating Magazine: Recipes and Meal Plans
I am quickly becoming a BIG fan of this magazine. Wholesome food recommendations, awesome recipes, informative nutrition articles... The meal plans alone are worth the price of the magazine - each day's meal plan has a sum of total calories, fats, fibers, sodium and proteins consumed.
There's a link between eating well in pregnancy and avoidance of eclampsia and HELLP syndrome. Most pregnancy nutritionists recommend eating between 80 and 100 grams of protein daily, among other guidelines - and these meal plans could be a big help to the mom who doesn't regularly track her food intake.
Calm Birth, by Dr. Robert Bruce Newman
I ordered both the Calm Birth book and CD recently. The book is more or less a review of stuff I already knew, but I found the history and research-backed information about the effects of meditation very interesting and potentially helpful for my clients. I've been recommending the Hypnobabies "Relax Me" scripts to my clients, but for those who think hypnosis is hooey, I think Calm Birth may be more approachable.
Two new blogs on my blog feed: Kayce's Doula Journey and Doula Momma
Doula Momma is a DONA doula and Lamaze childbirth educator; Kayce is a self-described birth junkie and future midwife. Both offer lots of stories and data worth looking at.
Morgan sums-up something I've been struggling to explain to others: formula is suboptimal. She says,
There is less in formula milk, than there is in human milk. There is less physiological growth in bottle feeding, than there is in breastfeeding. Combine the two, and add in that modified cow's milk destroys the natural flora in the new born gut.. and you have an activity that increases health risks in homo sapiens: formula feeding.
She also expresses aptly the way business drives culture, and how advertisers manipulate us so effectively into believing that something that is suboptimal is normal, and something normal is achievable only if you're Superwoman. It's a cleverly devious bit of psychology: breastmilk is "best" so formula is "okay" claim the formula companies - but it's not true!
Yoga for Hip Discomfort: Eka Pada Rajakapotasana (One-Legged King Pigeon Pose)
BirthActivist recommends this pose for hip pain during pregnancy. Those loosening joints are sometimes uncomfortable, so this may help.
I interviewed a client several months ago who was experiencing hip pain, and I wish I'd known about this back then!
Clean Eating Magazine: Recipes and Meal Plans
I am quickly becoming a BIG fan of this magazine. Wholesome food recommendations, awesome recipes, informative nutrition articles... The meal plans alone are worth the price of the magazine - each day's meal plan has a sum of total calories, fats, fibers, sodium and proteins consumed.
There's a link between eating well in pregnancy and avoidance of eclampsia and HELLP syndrome. Most pregnancy nutritionists recommend eating between 80 and 100 grams of protein daily, among other guidelines - and these meal plans could be a big help to the mom who doesn't regularly track her food intake.
Calm Birth, by Dr. Robert Bruce Newman
I ordered both the Calm Birth book and CD recently. The book is more or less a review of stuff I already knew, but I found the history and research-backed information about the effects of meditation very interesting and potentially helpful for my clients. I've been recommending the Hypnobabies "Relax Me" scripts to my clients, but for those who think hypnosis is hooey, I think Calm Birth may be more approachable.
Two new blogs on my blog feed: Kayce's Doula Journey and Doula Momma
Doula Momma is a DONA doula and Lamaze childbirth educator; Kayce is a self-described birth junkie and future midwife. Both offer lots of stories and data worth looking at.
Playing Catch-Up
Ach, I've been so out of touch lately. It's been a whirlwind since the beginning of the holiday season, and I've been struggling to keep up.
New Year's Eve, I found myself hanging out at my buddy Kim's house. It was around 1:00 PM, and she was telling me how one of the couples in her last class (which I attended) was in labor, and called her very early that morning to talk through some stuff. In the middle of our gossip session, my phone rang - to my surprise, it was the daddy of the couple we were discussing! Our conversation went something like this:
Dad: Well, we're in labor, and have been for a long time...
Me: How are things going?
Dad: Honestly, I'm not sure... I mean, we've been here since Wednesday, and [Mom] is having a hard time managing her pain."
Me: How are YOU holding up?
Dad: I'm exhausted. All of us are.
Me: Do you need some help?
Dad: [big sigh of relief] I would be grateful for anything you could offer us.
Me: I've gotta run home and get my bag, but give me 20 minutes and I'll be there. What's your room number?
(Mom told me later after the birth, "That was the shortest phone conversation I'd ever heard.")
When I got there everyone looked deflated, and the room was in chaos, stuff was everywhere. How could anyone be comfortable laboring in this environment? I thought to myself. While I helped clean up, I explained that we had a plane to catch to go to my cousin's wedding in another state, and I would stay as long as I could, but I might not be able to be there for the birth. They said it was okay, and any help was better than none!
I immediately started the work of assessing the situation; mom, dad and baby's grandmother filled me in on what I'd missed. At 41 weeks and 2 days, mom went to an appointment with her OB and never got to go home. She was admitted for oligohydramnios (based on an AFI of 4.5), induced with Cervidil (which was removed after she reached 4 cm), membranes released (SROM) at around 5:30 AM that day, and she'd been laboring for around 24 hours without any other medical interventions. The Cervidil induction was painful and frightening, and mom was happy to have it removed - but since that time, her contraction patterns were sketchy, and her tone and demeanor were like that of a woman condemned to Sisyphus' fate. "I feel like it's never going to end," she confessed.
I got mom out of the bed; dad fell into it and immediately went to sleep. Baby's grandmother went out, brought back food for the family, and went home to get some rest.
After some dinner, mom seemed to be getting her energy back, so I started to pep talk her, during which we changed positions, tracked contractions together, and focused on approaching labor one rush at a time. I knew she was still in early labor because she was able to talk easily between her contractions. Every time a contraction was nearing or had ended, she would affirm, "Contractions are good..." And I would reply, "Contractions make a baby come out," or, "Contractions go away and then we can rest." As we talked, it became clear that the intensity of her pain was due to her fear of that pain, and her feelings of inadequacy about herself as a laboring mother.
When dad woke, he was amazed by the change that had come over his wife. "You're a new woman," he said, and hugged and kissed her.
The hospital experience was a mixed bag; while the majority of the attending staff was supportive of their decisions (to varying degrees of approval and disapproving forbearance, though mostly the former), interruptions easily knocked mom out of her labor, and slowed her contractions. At one point, during a heavy discussion with the attending OB, her solid 1:00-1:30-minute / every 3 minutes contractions stopped altogether for 20 minutes. An encouraging nurse recommended that we try nipple stimulation, which helped get her back into the groove of labor, but mom would stop doing stimulation cycles (2 minutes on, 2 minutes rest with a contraction in between) and labor would slow again. Dad mustered himself long enough to convince the attending OB to get her off of continuous EFM, which he felt was interfering with her ability to relax and wasn't proving helpful (baby had a textbook perfect heart rate for the entire labor). After his confrontation with the doctor, his physical exhaustion and emotional stress got the better of him, and he was a little shaky. But the pay off was time in the tub, free from monitoring.
16 hours later, it was time for me to go. I felt terrible about it, but they were very understanding. Before I left, mom decided to try a small dose pain medication, but it was largely ineffective, so she asked to be prepped for an epidural. (For the second time, I missed a potential opportunity to witness an epidural being placed! Drat.) Even though this family was seeking an unmedicated birth, after 32 hours of labor, mom was just too tired to manage labor sensations anymore.
Baby's grandmother arrived a little while after I had to go, and 12 hours later, mom birthed her baby - vaginally!! Interestingly, they set her up with an push button epidural; she was able to chose when to have the next dose of the medicine, and she hit the button only once after the initial dose. She later told me that the rest she got during the first dose helped a lot, and then after that just having the option of pain relief was comforting.
New Year's Eve, I found myself hanging out at my buddy Kim's house. It was around 1:00 PM, and she was telling me how one of the couples in her last class (which I attended) was in labor, and called her very early that morning to talk through some stuff. In the middle of our gossip session, my phone rang - to my surprise, it was the daddy of the couple we were discussing! Our conversation went something like this:
Dad: Well, we're in labor, and have been for a long time...
Me: How are things going?
Dad: Honestly, I'm not sure... I mean, we've been here since Wednesday, and [Mom] is having a hard time managing her pain."
Me: How are YOU holding up?
Dad: I'm exhausted. All of us are.
Me: Do you need some help?
Dad: [big sigh of relief] I would be grateful for anything you could offer us.
Me: I've gotta run home and get my bag, but give me 20 minutes and I'll be there. What's your room number?
(Mom told me later after the birth, "That was the shortest phone conversation I'd ever heard.")
When I got there everyone looked deflated, and the room was in chaos, stuff was everywhere. How could anyone be comfortable laboring in this environment? I thought to myself. While I helped clean up, I explained that we had a plane to catch to go to my cousin's wedding in another state, and I would stay as long as I could, but I might not be able to be there for the birth. They said it was okay, and any help was better than none!
I immediately started the work of assessing the situation; mom, dad and baby's grandmother filled me in on what I'd missed. At 41 weeks and 2 days, mom went to an appointment with her OB and never got to go home. She was admitted for oligohydramnios (based on an AFI of 4.5), induced with Cervidil (which was removed after she reached 4 cm), membranes released (SROM) at around 5:30 AM that day, and she'd been laboring for around 24 hours without any other medical interventions. The Cervidil induction was painful and frightening, and mom was happy to have it removed - but since that time, her contraction patterns were sketchy, and her tone and demeanor were like that of a woman condemned to Sisyphus' fate. "I feel like it's never going to end," she confessed.
I got mom out of the bed; dad fell into it and immediately went to sleep. Baby's grandmother went out, brought back food for the family, and went home to get some rest.
After some dinner, mom seemed to be getting her energy back, so I started to pep talk her, during which we changed positions, tracked contractions together, and focused on approaching labor one rush at a time. I knew she was still in early labor because she was able to talk easily between her contractions. Every time a contraction was nearing or had ended, she would affirm, "Contractions are good..." And I would reply, "Contractions make a baby come out," or, "Contractions go away and then we can rest." As we talked, it became clear that the intensity of her pain was due to her fear of that pain, and her feelings of inadequacy about herself as a laboring mother.
When dad woke, he was amazed by the change that had come over his wife. "You're a new woman," he said, and hugged and kissed her.
The hospital experience was a mixed bag; while the majority of the attending staff was supportive of their decisions (to varying degrees of approval and disapproving forbearance, though mostly the former), interruptions easily knocked mom out of her labor, and slowed her contractions. At one point, during a heavy discussion with the attending OB, her solid 1:00-1:30-minute / every 3 minutes contractions stopped altogether for 20 minutes. An encouraging nurse recommended that we try nipple stimulation, which helped get her back into the groove of labor, but mom would stop doing stimulation cycles (2 minutes on, 2 minutes rest with a contraction in between) and labor would slow again. Dad mustered himself long enough to convince the attending OB to get her off of continuous EFM, which he felt was interfering with her ability to relax and wasn't proving helpful (baby had a textbook perfect heart rate for the entire labor). After his confrontation with the doctor, his physical exhaustion and emotional stress got the better of him, and he was a little shaky. But the pay off was time in the tub, free from monitoring.
16 hours later, it was time for me to go. I felt terrible about it, but they were very understanding. Before I left, mom decided to try a small dose pain medication, but it was largely ineffective, so she asked to be prepped for an epidural. (For the second time, I missed a potential opportunity to witness an epidural being placed! Drat.) Even though this family was seeking an unmedicated birth, after 32 hours of labor, mom was just too tired to manage labor sensations anymore.
Baby's grandmother arrived a little while after I had to go, and 12 hours later, mom birthed her baby - vaginally!! Interestingly, they set her up with an push button epidural; she was able to chose when to have the next dose of the medicine, and she hit the button only once after the initial dose. She later told me that the rest she got during the first dose helped a lot, and then after that just having the option of pain relief was comforting.
All's well that ends well. Baby had 1/5 minute Apgars of 8/9, mom had minimal tearing (not even a 1st degree), and they're breastfeeding really well. Three days after the baby was born, they moved to another city so dad could start a new job - I wish them all the best on their new adventure, and thank them for letting me share in their happy day. (-:
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