Tuesday, January 15, 2008

Comfort measures for labor and birth

I've had a lot of people ask me about this topic lately, so I thought I'd put it in a blog post. I think that when preparing for the birth of a child, it's really important to learn about comfort measures, regardless of the kind of birth you're planning. While there are many ways to support a woman physically, emotional support is important, as well. I'm going to try to address both topics.

Emotional: Emotional well being is very important. Attitude towards birth can pave the way for the type of experience a woman is going to have. Are you scared? Do you view birth as a necessary evil to be endured on the way to motherhood? Do you view it as a bodily process you'd rather avoid if you could? Or are you excited? Do you look forward to birthing a new little human being? Are you looking forward to getting the whole experience? Do you view birth as a positive event? It's very important to figure out what your feelings are towards birth. It's also important to really look inside of you, and figure out if you have any fears associated with birth. The more these negative feelings can be resolved before the birth, the more positive the birth experience is going to be. Welcoming contractions, working with your body instead of fighting it, and feeling excited about birth all help a woman stay relaxed, and the more relaxed you are, the more comfortable you are going to feel. Don't be afraid of what's going to happen, don't feel embarrassed by this process that can, admittedly, leave you rather exposed. Find someone you can trust to be your birth partner. Having someone there who fully supports you emotionally is going to be a great assett. Some husbands will fill this role wonderfully, but more often than not, they feel insecure and overwhelmed witnessing the miracle of birth. If your husband/partner falls into the second category, seriously consider getting a doula. Doulas are great cheerleaders, and they can actually help the father understand what's happening, and can find ways for him to be more involved and feel less helpless. Lastly, choosing a care provider who shares your philosophy of birth is crucial. You will get all the support you need if you have a birth attendant who's "on the same page". So when planning for the birth of your child, don't neglect the emotional aspect. :o)

Physical: I really believe that it's beneficial for all women to take a good childbirth preparation course. Even when you plan on just getting an epidural, there's always a chance you may not be able to get one, or it won't work properly. If that's the case, being well prepared will make the experience a lot less stressful, and less traumatizing. What makes a good childbirth preparation course? Generally, one that's taught outside the hospital setting. You'll learn a lot more than when to ask for the epidural. :p There are lots of different "methods" to choose from. Some teach specific ways to help you relax, others are more general. Whatever you choose, the more you learn about the birth process and your choices when it comes to birth, the better. Being informed about your choices is very important. After all, it's YOUR birth, YOUR body, and YOUR baby. In a hospital setting, you'll be confronted with lots of "protocol". It's routine practice to make the woman lay in bed, hooked up to continuous monitoring, and an IV "just in case". That's the minimum. Often, if labor doesn't progress quickly enough, pitocin will be added to the IV to speed things up. Once a woman is dilated to a certain degree (generally 3-5 cm), it's routine practice to break the amniotic sac (artificial rupture of membranes, or AROM). Once again, this is done in hopes of speeding up labor. When full dilation is reached, it's not uncommon for the woman to be reclined, and her feet to be put in stirrups (lithotomy). She is then instructed to push, while holding her breath for 10 counts. If the doctor feels the pushing stage is taking too long, or there's a risk for tears, an episiotomy is performed. Reading through all of this, it comes as no surprise that many women find the labor and birth experience to be excruciatingly painful, scary, and they opt for an epidural. You can see where the horror stories are coming from, and you may have one of your own to tell. What women need to realize is that they have a choice. They don't have to consent to any of the above treatment. None of these procedures, which are used routinely, have been shown to improve outcome when used for low-risk women. Meaning, you're no more likely to end up with a healthy baby if you have all of these interventions than if you don't. Mostly, these protocols have been set up for the doctor's convenience, as well as for (perceived) liability protection. Not to mention the money that's involved for manufacturers of fancy machines and drugs, but I won't even get into that. :p Often, the more interventions are used, the more likely problems are going to develop. AROM removes the protective cushion around the baby, pitocin makes contractions stronger and closer together. Both of these make labor more painful for the mom, and make it more stressful for the baby. Lithotomy position for pushing generally prolongs the pushing stage, and is more likely to lead to severe tears or episiotomy (which, in turn, can result in more severe tears extending from the incision). So what is woman to do? For one, be informed. Read as much as you can. I'm going to work on a book list for recommended reading, so check back every so often to see which books I feel are really beneficial. Decide how you want your birth to go. Write up a birth plan. Some doctors are not very welcoming towards parents voicing their birth preferences. In fact, some go as far as to say when you see someone come in with a birth plan, get the OR ready for a c-section. If your care provider isn't willing to work with you, or starts telling you stories of everything that can go wrong, and/or the woman/baby who died, seriously consider switching. A birth plan, of course, is not a binding contract by any means. What it does is help you figure out what kind of a birth you'd like to have. Talking about your preferences with your care provider will help him/her know how to help you, and it's always beneficial to have your care provider back you up in your choices should the nurses at the hospital give you a hard time. So what is it that you can do to have a better, easier birth? For one, labor at home as long as possible. Being in a familiar environment will make you feel more comfortable. You'll be able to move around as you choose, without having machines hooked up to you. You can eat and drink as you wish. Once you get to the hospital and get checked in, get out of that bed! Walk around, or get a birthing ball to sit on. For monitoring, ask to be monitored only intermittendly. I was actually able to stay on the birthing ball while hooked up to the monitor, which was way more comfortable than being on the bed. Some hospitals also have telemetry units, which allow you to move around freely. Ask not to have an IV. There is no evidence that shows routine IV fluids to be beneficial, unless the woman is vomiting severely. Genereally, it's perfectly acceptable to stay hydrated by drinking clear liquids, and you'll be more comfortable not having to drag around an IV pole. Refuse AROM. The only indication for AROM is if the baby is in serious distress, and internal monitoring is indicated. Keeping your membranes intact will make labor much more comfortable, and less stressful for both you and your baby. It'll also help the baby rotate into optimal positioning for birth, again making things more comfortable for you. Change positions. Moving around throughout labor will help you find positions that are most comfortable for you. Keep your bladder empty. A full bladder can slow contractions, which you don't want to happen. Refuse pitocin augmentation to "speed things up". Artificial oxytocin can not only interfere with your body's natural production of oxytocin, but can also lead to hyperstimulation of the uterus, which is bad news for both mom and baby. In general, the rule before consenting to any intervention is asking "Is mom okay? Is baby okay?" If the answer to both of those questions is "YES", refuse the intervention. Throughout your labor, try to stay relaxed. The more relaxed you are, the more comfortable you are going to feel. Take deep, slow breaths. When breathing in, visualize your body relaxing from top to bottom. When breathing out, visualize a wave washing away your discomfort. Or use whatever other visualization may be helpful to you. Don't be afraid to vocalize. Let the sounds come out as they do, but do make sure to keep your voice in a low pitch range. It'll help you stay relaxed. Make sure your birth partner knows to redirect you if you go into high pitch, as a high pitch usually indicates that you're tensing up, which makes you more uncomfortable. Don't be afraid of noise. You know that saying, "I am woman, hear me roar"? Don't be afraid to roar. :p Of course, there's nothing wrong with being quiet. Just do whatever feels natural to you, and don't worry about what others may think. It's YOUR birth, you do what you need to. :o) Try water. If a tub is available, give it a try. Even a shower can do wonders for relaxation. Some call water "nature's epidural", it can really help you relax and ease your discomfort. Once it comes time for you to push, ask not to be flat on your back with legs in stirrups. Being in a more upright positions, hands and knees, or even lying on your side, are all much more conducive to productive pushing. Ask that nobody count to ten, and don't hold your breath. Instead, take a deep breath in, and slowly breathe out as you bear down. You'll keep up a good blood oxygenation that way, which is important for you and your baby. Ask that your birth attendant not give an episiotomy. Yes, there is always a chance of tearing, but with an episiotomy, you'll have a 100% chance of injury. And an episiotomy is much more likely to extend into a 3rd or 4th degree tear, both of which rarely occur naturally. An episiotomy can also result in severe bleeding, much more so than a natural tear. Once you've given birth, try to breastfeed as soon as possible. It'll help your body release more oxytocin, which will help your uterus contract, expel the placenta, and control bleeding. Last, but not least, enjoy your baby! :o)

Now that I've written a novel, I do want to mention one last thing. I firmly believe everyone should think about the type of birth experience they'd like to have. Everyone should be well informed about all of the options available to them. Everyone should communicate with their care provider, to make sure philosophies of birth match up. Regardless of what kind of birth you envision for yourself, be prepared that things may go differently than planned. Someone may plan on a natural birth at home, and end up with a c-section. Someone may plan on having an epidural, and not get one. Someone may even be planning a c-section, and be surprised by a precipitous labor and birth. Birth, even though generally a normal physiological process, does not come with any guarantees. Anyone who'd like to make you believe it does, is wrong. Nobody can promise a healthy baby, or a healthy mom, and we need to realize this. So do your homework. Prepare yourself the best you can, even for the possiblity of deviation from your birth preferences. And don't be afraid to mourn if your experience is not what you envisioned. While it's true that the goal is a healthy mom and baby, it's okay to evaluate your birth experience, and to take time to heal if it's not what you were hoping it would be. Physical health is important, but so is emotional health. And so we come full circle. Hopefully some of the information here is going to be helpful, and I hope those of you who are expecting are going to have a happy Birth Day, whenever that time comes. :o)


miranda said...

Great tips, Doreen! This one's a keeper -- in case I ever have another baby.

Lari said...

Okay... this is weird. We must be drinking the same water or something because I had just finished writing my birth plan when I surfed on to your blog. lol
Anyways, I posted my birth plan in my blog and I would really appreciate any input and suggestions!
This is my first baby and I need all the support and help I can get!