Saturday, September 25, 2010

You all have to go see this post...

This is better than anything I could put together. Seriously, go and read. Notice the looks of joy on those mother's faces!
The Midwife Next Door

All of these things are implementable at any hospital- even the super busy county hospital that I work at. Patients need to be informed (first off), they need to advocate for themselves, and providers need to be willing to change how we deliver obstetric care. Unfortunately now, the only way to get these things in my state is to deliver at a birth center or at home. That makes me very sad.

Tuesday, September 14, 2010

A small joy...

I had to go to the medical library of my hospital and was happy to see a couple of books that surprised me. Penny Simpkin's The Birth Partner and The Womanly Art of Breastfeeding. The info is there!

Sunday, September 12, 2010

Their eyes are open, but they do not see...

How can you tell someone that they are missing something? That they may know so much about a subject (birth in this instance), they may well be an expert, but they are missing something. They are missing the magic, the utter joy, the orgasmic (yea, I said it) quality of birth. Over and over again I have women in my life (nurses and others) make what to my mind are radical terrible decisions. Elective primary c-sections, inductions, bottle-feeding, et. To them, my decision to have out-of-hospital birth is radical, but which is further from normal? Which takes the biggest risk? Which one has the least amount of trust in one's own body?

I just looked through an online album of a friend (someone who is very knowledgeable about birth) who had a primary elective c-section. Too posh to push. Too posh to breastfeed too as evidenced by all of the bottle-feeding pictures. I became overwhelmed with sadness. Sadness for her, she would never understand. Sadness for her baby, once again she would never understand. Why am I struck with so much pity for someone who choose this? Someone who is perfectly content with her birth experience and with her mothering choices?

I don't believe that homebirthing, breastfeeding, cosleeping, or any of the many other gentle parenting choices that I made make me a better mother. But, I do think that it make me a stronger person with a richer life. I do think that it gives my children an edge of happiness in this world that can be so difficult. I do think that it gave me an opportunity to connect to the womanly energy of the universe and of my ancestors in a way that is otherwise impossible.

What I wish is that one by one I could take the birth doubters in my life and have them sit with me through a labor. Have them rub backs, moan with a laboring woman, feel the energy of a labor that is left to progress on it's own. What would they do if they saw a baby caught by her own mother, or father? A baby born with siblings present? A baby who is left alone to transition in her mother's arms? See a mother whose face is filled with utter joy and the immense wonder at what she just did? Would the tears come then? Would they know the beauty that birth could be? Would they know what they missed?

Friday, August 20, 2010

I'm that friend...

My best friend is pregnant- yeah! She is due on my birthday- double yeah! But, I totally suck. Like seriously I'm not even sure that I should talk to her until she delivers. On the phone she asked an innocent question about how I handle working at Big County Hospital and I start to bitch and moan. I'm supposed to be the rah rah birth cheerleader and I start talking about vacuum deliveries and c/sections! What the heck is wrong with me!? She isn't even a nurse- so no terrible stories of her own! I realized what I did, but it was too late. She beat a hasty retreat and I sent her a long apologetic text promising only positive birth stories from now on... I suck. Seriously. Maybe I can blame Big County Hospital for making me jaded? I think I need some beautiful births to get my rah rah spirit back.

Thursday, August 19, 2010

The beauty of laboring down using the California Roll....

This post is specific for a mother with an epidural. Laboring down is nearly impossible for an unmedicated mom. It requires denying the urge to push and that is like trying to stop a speeding train with a feather.

Look at this animation showing the different stages of presentation....

Note all of the movement of the baby. A baby descending through the pelvis is like a key having to fit in a lock. The baby is as much of a participant in the birth as the mother, s/he is not just conked out in the uterus. The baby needs to turn her head one way, her shoulders another, and then rotate back. This doesn't necessarily happen because the mom is pushing, it happens because it is how we are made. It happens because it must.

One mistake that I think a lot of nurses may make is that they start to push a patient as soon as she is completely dilated. I feel that as long as the mom is not uncomfortable/ feeling tons of pressure than waiting for the baby to start to descend in the birth canal is very helpful. It keeps the mom off of that "pushing clock" for a little longer and it shortens the total amount of time and effort needed for her to push the baby out.

I also have theory. When a mother is nearing complete dilation and the baby descends, there is a usually a slowing down and spacing out of the contractions (in natural labor). I believe that this happens because the fundus of the uterus is empty (as the baby's bottom is now lower). I think that waiting and giving time to labor down allows the muscles in that uterus to contract back down around the baby's bottom to allow the uterus to be more of a helper during pushing. A Boggy Uterus doesn't want to contract, but a nice tight uterus contracts much more efficiently. If you wait you will see contractions that have spaced out start coming closer together. This break is God's way of giving an unmedicated mom a rest before she has to push. 

What should you do while waiting? Well, I believe that the epidural does not prevent a mother from being an active participant in the birth. Just because you have an epidural does not mean that you get to sleep throughout labor. I use a technique known as the "California Roll"- Google it and you just come up with sushi. It is sometimes called "Chicken Wing" (but that leaves an important step out). I am sure that other hospitals have different names for this, I am hoping that other nurses are already doing this. This is a great doula technique for you doulas who are attending a hospital birth.

I DO NOT like using high fowlers to labor a patient down. You do that and the baby's head is just slamming against that coccyx the whole time. You end up with a patient with terribly swollen labia, an increased risk for tearing, and a potentially swollen cervix.

1) I put the mom in a far left lateral position first- she is nearly laying on her stomach. The right leg is held up by the left stirrup, but the knee needs to be really flexed up as far as it can towards her stomach. I flip over the bottom left pad on my labor bed to support her left leg, but you can use a pillow here. This position allows her coccyx to be mobile. In a standard semi-fowlers, high-fowlers, or lithotomy position the coccyx is completely immobilized by her sitting on it! If you put a mom in this position, I want you to see how open her pelvis is, how much more room this gives the baby to descend. I leave her in this position for about 20-30 minutes.

2) I then sit her upright in a throne position in the bed. Essentially high-fowlers, but with a big twist. The bed essentially looks like a chair and I sit the father of the baby or another family member on the bottom of the bed in between mom's feet. She is leaning forward leaning on their shoulders with her belly falling between her knees. I then tell the Dad/family member to rock left to right and front to back. I leave them there for 20-30 minutes. This also works with her leaning over a birth ball, but with an epidural I prefer to have a person there to help stabilize mom.

3) I lay her back down in a far right lateral position. The exact opposite of step one. She is there for another 20-30 minutes.

Over and over I have had tremendous results with this. I have turned OP babies, I have fixed swollen cervixes, I have gotten a cervix to dilate that hasn't dilated in 5+ hours, I have caused a very tight pelvis to open and allow baby to descend from "sky high", I have fixed asynclitic babies, and I have saved moms many an hour pushing. I even had a brow presentation once with a G1 using this technique to help baby to descend. It gives both time and and the room for a baby to move down.

The goal here is to try and mimic what an unmedicated mom would do if possible. An unmedicated mom would NEVER choose to lay in bed in a semi-fowlers position if she wasn't hooked up to a monitor. She would be up rocking her pelvis and letting her belly fall forward.

An epidural labor will never be a "normal" birth, but a good nurse/doula can try to minimize a mother's chance of ending up with a surgical (vaginal or otherwise) delivery.

Wednesday, August 18, 2010

A woman had her baby taken away for three years for refusing a c/section...

I was incredulous to read this article on a woman at a New Jersey hospital who refused to sign a pre-consent for a c/section. Here is another article on the same situation. She wanted the chance to have informed consent at the time of the surgery instead of signing her rights away before it was medically indicated. I understand completely where she is coming from. There is always time for a signature- even in the most pressing of moments there can be someone getting a signature. As long as she was informed of the risks ahead of time, she could of waited to sign until she was rolling into the OR if needed.

This hospital has a 50% c/section rate. If I was delivering there, I would probably not want to sign the c/section consent as well! It seems that your odds are just as good for an operative delivery as they are for a vaginal one! Ridonkulous!

What really pisses me off about this is that she is made out to be a "bad mother" because she didn't want her baby to be delivered via c/section. C/S really suck for moms, but they are hard on babies too. Gunky lungs, difficulty breastfeeding, spinal anesthesia, and the list goes on and on.

What this really comes down to is whether or not it is possible for someone to have "informed consent" when they sign the c/s consent in early labor. The decision for an operative delivery is taken away from the parents and given to the doctors. The doctors decide if a c/s is necessary based on their own views. Their views are based on a lot of medical training, but also on a fear of litigation. If something goes bad and the doc did a c/s it nearly will always clear him because "s/he did everything possible". How can a parent make an informed consent for a situation that hasn't even happened yet? Does it really take so long to go over the risks of surgery in early labor (but not get a patient signature) and get the signature when the need arises? Is it really that big of a deal to tell a patient the reason that we want to section them? At least then they will feel like somewhat of a participant in their birth. During a stat there are nearly always lots of hands to get the work done, is it really that hard to make getting a signature part of the work? We can get a baby out in 6 minutes at my hospital. I don't see that number being affected by the need for a signature as long as the patient was informed of the risks of a c/s in early labor.

Does refusing to sign a consent make a woman a bad mother- bad enough that her baby is taken away for 3 years? I don't think so. Heck, does having a home birth without even an OR around make a woman a bad mother? Hell no. This thinking is just part of the medicalized childbirth model that really needs to be changed.