Thursday, August 29, 2013

Labor Choices

There are only a few lessons I can clearly remember from elementary school. Of course, I can attribute elementary school to my ability to do basic math, (mostly) write in cursive, make a tiny volcano, and find a library book among many other important skills. But I’m talking about life lessons.

One that has stuck with me was about choices. One day the principal came over the intercom and discussed this topic saying something like: We make around 610 choices every day. Some of these are minute, like which shirt to wear or to brush our teeth, and we spend little time thinking about them. Others are very important and it may take a lot of consideration before we decide on something. Some decisions we make are impulsive like pushing someone back who has pushed us and some choices are even involuntary. From the very smallest to the biggest choices; every choice has some consequence, some kind of reaction.  And, he explained, that sometimes a small choice (like not brushing our teeth) can lead to a bigger consequence. So it's important to consider what choices we make each day.

From the moment we find out we’re pregnant (or even start trying) we begin to make choices. To continue to drink caffeine or not (I chose to drink it and enjoyed it every day), to eat or not eat lunch meat (I opted against this one). And what about alfalfa sprouts and soft cheese and on and on. And that’s just the VERY beginning. 

One of the things that I find the most frustrating about the birthing process, though, is that it often seems women really aren’t given a lot of choices. They are told about policy and protocol and asked a few questions about preferences. But often it seems like the doctors or hospitals are making most of the choices. So what happened to the lesson I learned in elementary school? What happened to us getting to make choices? We can decide what we want to do with our body and baby for 9 months but when it comes down to the day of their births - seems like choice isn't always in the discussion.

There are 3 things that I have decided to detail regarding my experiences with what I feel are limited birth choices (although there are many more examples). And this isn’t about a natural, medication-free birth. I completely realize the thought of that alone would make many women not want to read this. This is just about options about natural choices.

1. The Checks: In no other medical setting is a test performed just to “check” - there has to be some purpose, some indication that the finding will result in a change of care. The checks before labor even begins can tell an anxious and anticipating soon-to-be mother absolutely nothing about when her baby will come and often just induces more anxiety! However, this is a standard practice around 36 weeks of pregnancy. The important thing to know is if you are 3cm dilated you might not go into labor for 5 more weeks or you can be zero centimeters and go into labor tomorrow. The “check” can not guide or predict anything about your baby's birth day. There’s even some risk associated with them. So, why do it?

My story:  

Baby #1 - My very first check was when I was 41 weeks and 3 days and was on the day of my induction. The check was done to determine what type of induction I would need. And throughout the induction, my checks were only performed to determine the next intervention in the induction. I fully understand the purpose of checks in this setting. But we made it clear that no other hospital staff were to perform these checks – only the midwife I had agreed to provide my care.  After about 17 or so hours of active labor, I was checked for the fourth time during my labor. I was told I was 5cm dilated (only a 1cm increase) from the check 4 hours earlier. I felt defeated and began to cry. How was that possible? I had been walking in circles for hours and each lap around the nurses’ station I was having to stop more often and for longer to get through the contractions. I was certain I had progressed further. My family was watching me and they were certain. The damn check indicated otherwise. Defeated. To my core. I went back into the shower where I got the most pain relief.  A very quick hour after that check, I was fully dilated and pushing. Case in point – the check was not a predictor of time for my baby’s birth -even in the middle of labor!

Baby #2 – I labored for 11.5 hours out of the hospital. After being in the hospital for 22 minutes I gave birth to my perfectly healthy baby with NO CHECKS!!!

2. Timing: I hear it over and over again. The doctor or a practice will not “let” a woman be pregnant for longer than 41 weeks. The length of pregnancy is different for all women. A recent study reports that pregnancy length doesn't just vary due to inaccuracies of dating conception, but that it naturally varies up to 5 weeks for different women. So, in effect, many offices don’t allow women to be pregnant for their entire term and induce on an arbitrary timeline (meaning for no medical purposes). Now, that being said, I do understand there are potential risks to mom and baby that often need to be evaluated. That’s why open communication with providers is so important. So the question here is, why are there policies on the length of a pregnancy in the absence of any medical concern?

My story:

Baby #1 – During the 41st week of my pregnancy, my amniotic fluid levels had continued to decrease after 2 separate ultrasound checks that week. My husband and I discussed options with my midwife and weighed the risks and benefits and made the decision to proceed with an induction at that time. My induction ultimately went very smoothly and I gave birth at 41 weeks 4 days to a perfectly healthy baby girl. My induction wasn’t arbitrary; there was a medical reason, but it was still a choice. We had no way of knowing what would have happened otherwise and had to make the best choice we could with the information we had. But part of me, even today, still wonders if I should have waited for the next day.

Baby #2 - I had anticipated my second pregnancy to be as long as my first so I was pleasantly surprised when my baby decided to enter this world at 40 weeks and 5 days!!

3. Nourishment: Labor is called labor because it is one of the most physically demanding things your body will EVER go through. So hydrating and nourishing it through hours and hours of intense work is just simply logical. However, once a woman enters a hospital setting she is most often made NPO (medical lingo for “nothing by mouth”) or limited to ice chips, popsicles and little more. I would like to use the example of a marathon runner here. Lets take away her water, her Gatorade, her Goo. How well do you think she would perform? Would she win? Would she even finish the race? Doubtful. So why would we do this to women during labor? The reason is because the medical world is overly cautious. There is a (very small) risk that you may have to have anesthesia during an emergency caesarian and you may vomit  into your lungs. Yup, that’s the reason. You also risk having the unpleasant experience of vomiting during regular if thirst and starvation aren't also unpleasant! I definitely think it's worth asking the question of your providers if you may have something to sustain you through this time. 

My story:

Baby #1 -  Was born at 9:57 PM and I ate lunch that day. I didn’t eat dinner because I was in transition and didn’t want to eat. In fact, I vomited on my nurse's shoes. Although it was probably not all that pleasant for her, it didn't really bother me much. (I was a little busy). I also drank my labor beverage of choice (Peach Snapple) until I no longer wanted to drink it. 

Baby #2 - Was born at 6:57 PM and I ate lunch that day. I also drank a latte from Starbucks around 3:00. I had sips of water up until about an hour before the birth.

I ate and drank a considerable amount during labor for both of my children. Even with this, I don’t think I can explain to you the hunger I experienced after giving birth. I have never, ever been hungrier in my entire life. I asked for food immediately and was given peanut butter crackers and juice in the delivery room. Once I got to the post postpartum room, I had a white bread turkey sandwich (one of my least favorite sandwiches, and I found it delicious), some fruit, and more juice. My husband scrounged more food for me from the patient area. I rested on and off through the night and counted down the hours until breakfast. I had a near panic attack when I found out it didn’t come until 8:00 (it’s served at 7:00 at my hospital).  The kind nurse brought me a pre-breakfast bagel and fruit and then I ate the hot breakfast an hour later. I ate and ate and ate. And the thirst is the same or worse!! Every time I think back on the experience of my post-labor hunger and thirst I can't help but feel for the moms that are cut off from this basic necessity for hours while putting their bodies through the demand of labor.
Now in closing: I’m not suggesting that all women go out and refuse cervical checks, refuse inductions, or demand to eat and drink whatever they want during labor. Only that I have noticed that we are often told what will happen, rather than being given options on these things. We just get instructions on the way it shall be done based on the obstetrician’s office policy or the hospital policy. I didn't accept many of the "norms" as part of my pregnancy and labor and asked questions to find out if there were alternative options. I did lots of research, attended 10 weeks of birthing classes and read my hypno-birthing book. I'm certainly glad that I did these things and I just hope that more women can be empowered to ask more questions and make more choices - whatever the right choices may be for them. 

You can't make positive choices for the rest of your life without an environment that makes those choices easy, natural, and enjoyable. - Deepak Chopra


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  1. I love your post. I was fortunate enough to also participate in a practice that held many of the same values as your own. I was able to avoid checks and also eat throughout labor. I remember one day when I was around 38 weeks: I went into the OB office and the same medical assistants check in both the midwife patients (me) and the standard OB patients. She weighed me, took my BP then told me to take off my clothes. My response was something like "I'm not getting undressed today, I am not having an exam." The medical assistant became furious with me basically demanding that I get undressed and that if I didn't my doctor would be furious when they had to come in and waste there time waiting for me. I tried to stay calm, but you can imagine being faced with this at >30 weeks, it is hard to keep your cool. When the midwife came in she verified that I of course didn't have to be checked and she apologized for the MA's behavior. It gave me a perspective though: this MA goes through every day telling women to take off their clothes for basically pointless "checks", and I was apparently the first person who had every said "no" to her. Wow.

    1. This really stands out to me what a violation this is to our bodies but it's really not viewed that way. If it's something you want - that's fine! but women should be given the choice and told about risk/benefit just as they are for all other medical procedures! Thank you for sharing!!

  2. Found you through the mommy link up and glad I did!!! Loving reading around your blog :)

    1. Thanks, Anne! Just read your post on hospital versus home birth. So good to hear more open-minded discussions surrounding labor and options! Home births and birthing centers aren't legal in my state so I had to deliver in a hospital and was lucky to have supportive midwives. I still had to do a lot of research and self educating to get the best hospital births possible though!

  3. Great post! It's so important for women to educate themselves and I just adore everything you had to say.

  4. One of my biggest motivators for blogging is an attempt to help women become more educated with labor and breastfeeding because, as you said, it is so important! Thank you so much for the lovely comment, Jane!


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