#1 Interview different birth
attendants/practices before or during early pregnancy and CHOOSE a birth
attendant that practices in a way that aligns with your personal
childbirth/postpartum philosophy, is appropriate for your health status, and
(optimally) who practices a midwifery model of care!
I
wish I could scream this from the roof tops! Sometimes I feel like a
broken record I say this so often but I say it so often because it is SO
important!! The bottom line here ladies is that if you think you can pick
any care provider you want and then just write a birth plan that clearly states
your philosophy and preferences and just get what you want…..THINK AGAIN!
Birth attendants are creatures of HABIT more than anything else. If
they cut an episiotomy on the majority of their patients then what makes you
think that if you ask, they won’t cut one on you? In fact, not only will
they cut one on you but they will come up with some bogus reason why it was
necessary. Likewise, if your birth attendant induces most of their
patients, what makes you think that he won’t start pressuring you to set up an
induction date once you hit 37 weeks!
Think
of it this way, if the birth attendant has a high elective induction rate, they
probably feel more comfortable managing pitocin induced or augmented labors as
opposed to spontaneous labors and hence, they will probably try to do
everything in their power [including persuasion (e.g. the “convenience” card
and the “aren’t you sick of being pregnant” card) as well as scare tactics
(e.g. the “big baby” card, the “I might not be there to deliver you if you
don’t” card, or my favorite the “if you don’t your baby might be stillborn/dead
baby” card)] to convince you that your labor needs to be induced or augmented
with pitocin. Why? It probably is a mix between how they were
taught (i.e. medical model of maternity care), what they are used to (a self
fulfilling prophecy), and a desire to be the one in “control.”
Writer
Lela Davidson quotes professional childbirth educator and doula, Kim Palena
James in her article Create a Better Birth Plan: How to Write One and What It
Can and Cannot Do For You:
“Too many parents create birth plans with the
expectation that it will be the actual script of their baby’s birth. There is
no way! Nature scripts how your child is born into this world: short, long,
hard, easy, early, late, etc… The health care providers you choose, and the
facility they practice in, will script how you and your labor are treated. The
variations are vast. I wish every expectant parent spent less time writing
birth plans and more time selectively choosing health care providers that align
with their philosophy on health care, match their health status and their needs
for bedside manner.” (Emphasis mine)
So
PLEASE for the LOVE of all mothers and babies, PLEASE do your homework!
Of
course there is always the chance that you do interview a particular birth
attendant and they act one way in the office with you and then, WHAM!, are a
completely different person when you step foot on L&D. I see it
happen ALL THE TIME where I work. Just because a doctor gives you his
home phone number and is sweeter than sugar in the office, doesn’t mean he
won’t section you just to get to the company Christmas party! (This
actually happened to a patient I took care of! NO lie!) So what can
you do about that!
Jill
from Keyboard Revolutionary recently blogged about this:
“Ya know, sometimes I feel bad for the good
physicians out there. I know they exist. We all do. We’ve all shaken our fists
in righteous indignation at the rants of Marsden Wagner. We’ve listened
intently to the poetic, thickly accented declarations of Michel Odent. We’ve
swooned over the tender ministrations of “Dr. Wonderful,” a.k.a Dr. Robert M.
Biter. God bless those diamonds in the rough, particularly in the obstetrical
field. It must be twice as hard to shine when the lumps of coal around you are
so horrifically ugly.
I was pondering just now in the shower how so
many of us think we’ve got a real gem of an OB (or any other doctor, really)
until show time, and suddenly we’re hit with the ol’ bait-and-switch. Sometimes
there are warning flags along the way, sometimes not. Sometimes the flags don’t
pop up until it’s too late. It sucks that for many women, we don’t realize what
a crock we’ve been fed until we’ve already digested it. How do you know whether
you’ve got a bad egg or your own Dr. Wonderful?”
#2 Ask the RIGHT QUESTIONS and the RIGHT
PEOPLE when researching potential birth attendants.
Two
of my favorite posts from Nicole at It’s Your Birth Right! are her posts about choosing the right birth attendant entitled Choose Wisely I and Choose Wisely II. She writes:
“The decision about WHO
is going to be your birth attendant should NOT be left to chance. Where
you deliver, how you choose to labor, what you chose to do while pregnant and
in labor, while these things are definitely important, without the proper WHO,
the plan will have difficulty coming together.
I get questions, all the time from friends,
friends of friends and even strangers. They want my thoughts about
pregnancy, labor and childbirth. I have spent HOURS talking with women
providing answers and information they should be able to get from their
prenatal provider/birth attendant. I think to myself at the end of those
conversations, “Why isn’t she able to get this information from her?
If he doesn’t make her feel special, does not answer her questions, and
doesn’t agree with her philosophy on childbirth and labor, why on earth is she
allowing him to be her birth attendant?!”
When I pose this question to the women
themselves, the answers unfortunately never include “Because I did my research
and I found him to be the best match for me and my desired childbirth
experience.” Most of the answers I receive fall into [one of] four
categories, none of which are good enough reasons alone to choose a prenatal
care provider/birth attendant. They are: “She delivered my sister/girlfriend”, “She is my
gynecologist,” “He is the best/most popular person in area,” and “Her office is
so close and convenient to my office/house.””
Now
I am not trying to say that you shouldn’t trust your sister, sister-in-law, or
best friend’s opinion about her personal birth attendant but if you are going
to ask such a person for advice please remember that she probably has only had
limited experience with that birth attendant as compared to, say, an L&D
nurse or doula, and it is important to ask her exactly why she loves her birth attendant so much.
Does she love him because he trusts in birth and strived to facilitate a positive
and empowering birth experience for her or does she love him because he was the
only OB in the area that would agree to induce her at 38 weeks because she was
sick of being pregnant? There is a difference!!
If
you have done some research and found a birth attendant that you think you
really like, I would recommend tapping into some community resources to get the
“inside scoop” about your birth attendant. Here are some ideas:
1)
Contact your local grassroots birth advocacy group like International
Cesarean Awareness Network (ICAN) or BirthNetwork National and try to attend a meeting. The women that attend these
meetings are often in tune with the birth culture in their community and can be
GREAT resources for which birth attendants are true and which are really wolves
in sheep’s clothing! Also, don’t count out ICAN as a resource even if you
have never had a cesarean. We have a quite a few moms currently in my
local ICAN group that are first timers and decided to start attending because
they said they were learning so much about birth in general from our meetings!
2)
Sign up for a childbirth preparation class that is NOT funded/run by a hospital and ask the instructor for
her opinion on different birth attendants. It is the only way to
guarantee that your instructor is not held back from speaking her true feelings
since hospital based childbirth instructors are working for the interest and
promotion of their hospital by the very nature of their job. Independent
childbirth instructors like Lamaze, Hypnobabies, Birthing From Within, Bradley etc. etc. can be GREAT resources as to which birth attendants
follow which philosophies because often times their clients come back and tell
them about their experiences.
2)
Consider consulting or hiring a doula. A doula is a great resource as to the true nature of a
birth attendant because she is someone who is actually in the labor and
delivery room with her clients and has as close to an “insider’s view” as you
can get without actually working for the hospital. If you hire a doula to
be with you during your labor, they will also advocate for you, your needs, and
your birth plan as well as provide essential labor support that (unfortunately)
even the most well intentioned nurse might not have the time to do.
#3 Do NOT agree to an induction of labor
unless there is a legitimate obstetrical, maternal, or fetal reason for
delivering the baby before natural spontaneous labor begins!! PLEASE Do
NOT agree to an unnecessary elective induction of labor.
This
might seem like a no brainier ladies but so many get sucked in! They
don’t call it “the seduction of induction” for nothing!
Bottom
line is if you want to protect yourself from such an asinine, unnecessary, and
dangerous intervention as “Pit to Distress” then DON’T agree to be induced
unless there is a very important medical reason!
BABIES
AND MOTHERS HAVE THE BEST OUTCOMES WHEN THEY ARE ALLOWED TO BEGIN LABOR
SPONTANEOUSLY AS WELL AS LABOR AND DELIVER WITH MINIMAL INTERVENTIONS!
In
the Lamaze Institute for Normal Birth’s MUST READ patient education bulletin
entitled Care Practice #1: Labor Begins on Its Own, author Debby Amis, RN, BSN,CD(DONA), LCCE,
FACCE, and editor Amy M. Romano, MSN, CNM write:
“There is growing evidence that induction of
labor is not risk-free. In 2007, Goer, Leslie, and Romano reviewed the entire
body of literature on the risks of induction in healthy women with normal
pregnancies and found that when labor was induced, the following problems may
be more common:
·
vacuum or forceps-assisted vaginal birth;
·
cesarean surgery;
·
problems during labor such as fever, fetal heart rate changes, and
shoulder dystocia;
·
babies born with low birth weight;
·
admission to the NICU;
·
jaundice;
·
increased length of hospital stay.”
#4 If you have to be induced or augmented
with pitocin for a true medical or obstetrical reason, be honest with
your nurse about how you are feeling and have one of your labor companions keep
track of how often your contractions are coming.
And
this does NOT mean for your labor companion to “monitor watch”!! It’s not
a TV for goodness’ sake!
Research
has shown that due to the risks of pitocin, continuous electronic fetal monitoring (CEFM) is a safety requirement for anyone being
induced or augmented with it. However, remember CEFM is a machine and
machines have limitations. The tocodynamometer or “toco” is “pressure transducer that is applied to the fundus
of the uterus by means of a belt, which is connected to a machine that records
the duration of the contractions and the interval between them on graph
paper.” However, depending on your body type, how “fluffy” your abdomen
is, your position, and your gestational age, the toco might not be recording
your contractions appropriately. You might be having contractions every
minute but the machine is not registering them. This is why I always
remind women that they have to tell me how they are feeling.
If
you are being augmented or induced with pitocin your nurse SHOULD:
1)
Be
palpating (feeling) your fundus (top of your uterus above the belly button) before, during, and
after contractions periodically throughout your labor to judge how strong they
are (mild, moderate, or strong). Palpation before and after contractions
also assures the nurse that your uterus is actually coming to rest (is soft)
between contractions, which assures that the baby (and mom!) are getting a
break! Remember, unless you have an IUPC (intrauterine pressure catheter) in, the toco can only tell the nurse how far
apart and how long the contractions are NOT how strong they are! That’s
right! Unless you have an IUPC in, the height of the contractions on the
monitors is ABSOLUTELY MEANINGLESS! So therefore the only way for the
nurse to know how strong the contractions are is to TOUCH your belly and ASK
you!
2)
Ask
you about your pain level
(for example to “rate” your pain on a scale of 0 to 5 or 0 to 10) regularly
during your labor unless you have specifically asked her not to ask you about
your pain.
3)
Give
you periodic updates on your progress and the
progress of the pitocin.
[Note:
I can only speak for myself here but what I do when I have a patient on pitocin
is first and foremost to explain the process of titrating the pitocin and what
the desired outcome is (and according to our hospital’s policy the desired
outcome is moderate to strong contractions that are coming every 2-3 minutes,
or 3-5 in a 10 minute period), as well as keep her informed throughout the
process when I am increasing or decreasing the pitocin and for what reason.
For example, I might say “It looks to me like you are contracting every 4 minutes.
What is your pain level? Do you feel like you are getting an adequate
break? Would you like to change position? I would like to increase
to pitocin to achieve a more regular pattern. What do you think?” or “It looks like the baby continues to have
variable deceleration in his heart rate despite all of the position changes we
have tried. I am going to give you a small IV fluid bolus and turn the
pitocin down some to see if it helps to resolve the decels. The baby’s
variability is still very reassuring and she is still having accelerations so
she is doing well. I just would like to keep her that way!” Your nurse should be keeping you “in the
loop” so to speak and if she is not, it is your right to ask questions!]
It
is also important to remember that that running pitocin is much more of an art
than a science. Therefore you might think she is being “mean” if she is
increasing your pitocin since you are only contracting every 6 minutes but
remember, running the pitocin lower than is needed to cause cervical change
isn’t going to help you either. No nurse wants her patient to end up in
the OR for “failure to progress” because she didn’t turn the pitocin up enough. There is a happy medium somewhere that
most nurses are trying to find. So please, know that sometimes, even if
you really feel like those “every 6 minute” contractions are strong enough
already, it is important for the nurse to titrate the medication to achieve an
effective labor pattern that promotes a vaginal delivery with a healthy
baby.
If
your nurse is NOT doing these things then it is your right to ask
questions!!! However, please remember for your own sake that when asking
questions, one attracts more flies with honey than vinegar. Don’t start
yelling at her or demanding a new nurse. Give her a chance and ask
questions first! She might just be so busy that day that she is in the
zone. Most nurses are happy to teach when asked!
#5 Learn about and practice
non-pharmacological methods of pain relief as part of your childbirth
preparation and consider not getting or postponing an epidural until all other
methods of non-pharmacological pain relief have been exhausted.
Okay,
I know that this one is a bit controversial but please here me out first.
It
is the truth that pitocin contractions, especially when the pitocin is being
abused, are typically stronger and longer than spontaneous labor contractions.
Also, being that you have to be on continuous monitoring can also limit
your movement and hence, one of your most effective and instinctual coping
methods for the pain. For this reason, many people feel that it is crazy
for a woman to go though a pitocin labor without an epidural. And when
“Pit to Distress” is in play, it is truly unbearable to both experience and to
witness. However, if pitocin is administered compassionately and
appropriately it is important to know that an epidural is NOT an absolute
necessity. I have seen many women do it without an epidural and many who
have done it with an epidural. So if you have to be induced with pitocin
and you desire an “unmedicated” birth, your hands aren’t completely tied.
You CAN do it. However, I have said time and time again, I would rather a
woman have a vaginal delivery with an epidural than a cesarean section
without. That being said, the pitocin and epidural partnership
has a dark side too.
While
an epidural can help the woman relax and allow the pitocin to work more
effectively, most birth attendants that practice “Pit to Distress” persuade and
even bully their patients into getting an epidural specifically so the nurse
can “crank the pit” without the woman objecting. But I would like to
remind you that even if you can’t feel those contractions, your baby IS feeling
them. Also, epidurals themselves CAN and DO cause fetal distress and
anyone who tells you that epidurals pose no risk to the baby is being
dishonest! At my work, we nickname this the “ten by ten”. That is,
almost without fail, many women who get an epidural are is likely to experience
a whopping fetal heart rate deceleration lasting approximately ten minutes about ten minutes after she is put back to bed, which of
course throws everyone into a tizzy.
All
of a sudden mom finds herself with her face planted into the bed, her ass in
the air, a mask of oxygen on her face, an anesthesiologist pushing adrenaline
into her IV to increase her blood pressure and a doctor with his hands up her
vagina screwing a monitor onto the baby’s head. Most babies do recover
from said decel and go on to deliver vaginally. But it is NOT rare for
the baby to NOT recover which lands mom…you know where….in the OR. And
guess what! Since she already has that epidural in place, why they can
just cut her open even faster!
Please
know that I am not condemning any woman who requests an epidural in labor,
especially if she is on pitocin. I just want all you women out there to
know that sometimes that epidural that they keep waving in your face is just a
way for them to shut you up so they can CRANK the pit.
#6 If you feel like you are contracting
strongly at least every 2-3 minutes (3-5 in a 10 minute period) and the nurse
or birth attendant desires to increase your pitocin, you might want to consider
requesting a vaginal exam.
Now,
I know limiting vaginal exams is very important to many women as they are
invasive and uncomfortable/painful. I completely understand!
However, if your care provider wants to increase the pitocin and you feel it is
unnecessary, asking for a vaginal exam is a way to reveal if you are making any
cervical change. If you ARE making cervical change then there is no real
need to continue to go up on the pitocin! Remember the TRUE goal of
pitocin administration is to stimulate an effective labor pattern that causes
cervical change. It is NOT (despite how many birth attendants practice)
just about getting a patient to “max pit.” Every woman is
different!
#7 You could always try writing something
about pitocin administration in your birth plan.
For
example: “If deemed necessary, I would like to try non-pharmacological
methods of labor augmentation and induction including (blank) first before
resorting to pharmacological methods. However, if my birth attendant and
I agree that pitocin will be administered to me, I request that the pitocin be
administered following the “low dose” protocol and is increased in intervals no
closer than every 30 minutes, allowing my body an appropriate amount of time to
adjust and react to each dose increase.
I
will be very honest with you. If your birth attendant or hospital does
not practice in this way, it is doubtful that this request will be
granted. However, I suppose it can’t hurt and is worth a shot! At
least it can provide a sympathetic nurse with another platform on which to
argue with the birth attendant if necessary (like, “But Doctor X, your
patient has specifically requested a low dose pit protocol!”)
This
should be a last resort! Remember, writing something in your birth plan
does not guarantee you it is going to happen if your birth attendant doesn’t
practice that way! Please refer back to point #1 about choosing the RIGHT
birth attendant for you!!!
The proceeding information was from nursingbirth.com
Sweet Pea in the Pod
www.sweetpeainthepod.com
(928)963-1808
Sedona, Arizona
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